HAM 15 ANNUAL REPORT OF THE Medical Officer of Health OF THE borough of hammersmith For the Year 1914. CONTENTS. A page Aged Persons, Deaths of 16 Anthrax 26 B Births 6 Bakehouses 42 C Chickenpox 21 Continued Fever 25 Cholera 25 Cerebro Spinal Meningitis 26 Customs and Inland Revenue Acts 48 D Deaths 7 Death Rate (London) 18 Diphtheria 23 Diarrhoea 27 Diagnosis, Wrong 35 Disinfection 35 Dairies, Cowsheds, and Milk- shops Order 82 E Enteric Fever 24 Erysipelas 25 F Food Seizures 49 Fish Curer 55 Fried Fish, Vendor of 59 Factories, Inspection of 77 G Glanders 26 H Health Visitor, Report on work of 10 Hydrophobia 26 House to House Inspection 67 Houses Let in Lodgings 67 Housing, Town Planning, etc., Act 69 Home Office Return 77 I Introduction 3 Illegitimate Children, Death Rate 8 Infantile Mortality Rates 8, 15 Influenza 35 Ice Cream Manufacturers 82 m page Marriages 6 Maternity and Child Welfare 12 Measles 21 Military Encampment 69 Mortuary 80 Meteorology 87 N Notification of Births 7 Notices 67 O Outlying Institutions, Deaths at 17 Ophthalmia Neonatorum 26, 50 Olympia 69 P Population 6. Puerperal Fever 25 Plague 26 Poliomyelitis 26 Public Health (Milk and Cream) Regulations 83 Proceedings 86 R Relapsing Fever 25 Rag Flock Act, 1911 85 S Smallpox 21 Scarlet Fever 23 Slaughterhouses 42 Seizure (unsound food) 49 Staff 64 Summonses 85, 86 Smoke Abatement 87 T Tables, Registrar General 9, 16, 19, 31 Typhus Fever 25 Tuberculosis 35 Tuberculosis Dispensary 37 W Whooping Cough 23 White City Camp 69 Z Zymotic Diseases, Deaths from 20 Do. do. Number of Cases 27 annual report OF THE MEDICAL OFFICER OF HEALTH OF THE borough of hammersmith For the Year 1914. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hammersmith. gentlemen—i beg to present to you my Annual Report for 1914. The Report will deal with the vital statistics, and with the work carried out under the direction of your Council during the 52 weeks ending on January 2nd, 1915. The statistical tables prescribed by the Local Government Board are included, as well as the several other tables that directly or indirectly relate to the Public Health of the Borough. The vital statistics of the Borough for the year under review were, with the exception of a decline in the birth rate from 24.6 to 23.5 per 1,000, of a satisfactory nature. The death rate, 13.7, compares favourably with the death rate, I4.2 for the previous year and the corresponding rate of 14.4 for the whole of the Metropolis. The infantile mortality rate (the number of deaths under 1 year of age to every 1,000 births) was 94, being 9 below that of the previous year, while that for the whole of London was 104. It is very gratifying to be able to report this decrease, but it is obvious, however, that our efforts should be continued with increasing vigilance, in order to permanently reduce this loss of infant life. 4 The number of cases of infectious diseases (excluding tuberculosis) were very much higher than in the preceding year, owing to an epidemic of scarlet fever which continued for many months throughout the whole of the Metropolitan area, but the prevalence of the other notifiable infectious diseases compares very favourably with that for the Metropolis. There was a decided decrease in the number of notifications of cases of tuberculosis. With the outbreak of war it was expected that an increased prevalence of disease would follow. Fortunately this has not been the case, and the general health of the population has remained quite good up to the present. During the year a number of Belgian refugees, the majority of whom were destitute, were received in the Borough and thereby involved a danger of the importation of infectious disease into the community, but up to the present nothing of serious importance has resulted. Towards the end of the year the White City was taken over by the Territorial Association and used for the purpose of housing troops. Unfortunately, many cases of infectious disease occurred, measles and scarlet fever being the most prevalent. Olympia was taken over by the Military Authorities and used as an internment camp. The number of alien prisoners varied from 400 to 1,500. No serious outbreak of infectious disease occurred amongst the prisoners In common with many other Medical Officers, I was called upon to assist the Military Authorities and make reports as to the sanitary condition of the camps situated in the Borough. This led to an increased amount of work, but did not seriously interfere with the ordinary work of the Department. I am, Gentleman, Your obedient servant, J. B. HOWELL, Medical Officer of Health. 5 SUMMARY OF STATISTICS, Etc, FOR THE YEAR 1914. Population of Registration area at Census 121,521 Population estimated to the middle of year 124,750 Natural increase, i.e. excess of births over deaths 1,223 Area of Borough 2,282 5 acres. Density of population 54.65 persons per acre over total area. Marriages registered 1,180 Births registered. (Corrected) 2,935 Birth rate 23.5 Deaths registered. (Corrected) 1,712 Death rate 13.7 Infantile mortality 270 deaths under one year, or 94 per 1,000 births. 6 POPULATION. According to the Census of 1901, the population of the Borough was then 112.239. By the Census of 1911 the population for the same area was 121,521, showing an increase during the 10 years to the extent of 9,282. In this Report the rates are calculated on the estimated population up to the middle of the year 1914, viz., 124,750. The corrected number of births registered was 2,935, whilst the corrected number of deaths of residents was 1,712, thus showing a natural increase of population by excess of births over deaths of 1,223. The area of the Borough is 2282.5 acres, there being 54.65 persons to the acre, showing an increase as compared with the Census 1911 of 1.50 per acre. MARRIAGES. The number of marriages during the year was 1,180, the marriage rate being 18.9 per 1,000 of the population. BIRTHS. During last year 2,824 births, 1,416 males, 1,408 females, were registered in this Borough against 2,951 in the previous year. Making due allowance for the increase of the population, the number of births registered last year was 278 below the average number registered during the previous 10 years. Adding 125 births which occurred outside the Borough, transferred by the Registrar-General as belonging to Hammersmith, and deducting 14 births which occurred in this Borough which are transferred to other districts by the RegistrarGeneral, the corrected number of births for last year was 2,935. On the population estimated up to the middle of the year, i.e., 124,750 inhabitants, the corrected number of births registered was equal to an annual rate of 23.5 births per 1,000 persons living. The birth rate in London on the estimated population of London up to the middle of the year, i.e., 4,518,021 inhabitants, 7 was equal to an annual rate of 24.3 births per 1,000 persons living. These figures are calculated upon the corrected number of births registered. NOTIFICATION OF BIRTHS ACT, 1907. Births registered 2,824 Corrected number of births 2,935 Notifications received from Midwives. Doctors. Lying-in Hospitals. Poor LawInstitutions. Parents. 1,281 874 91 57 177 Total notifications received ... 2,480 DEATHS. During last year 1,676 deaths were registered in this Borough, 865 males, 811 females, against 1,704 in 'the previous year. Making due allowance for the increase of the population, the number of deaths registered in the Borough last year was 73 below the average number registered during the previous 10 years. Adding 223 deaths of residents of this Borough, which took place in general hospitals and other public institutions in other Boroughs of London, London County Lunatic Asylums and Metropolitan Imbecile Asylums, also 46 deaths of residents reported to me by the Registrar-General as having occurred in other parts of England, and deducting 233 deaths of non-residents which occurred, 174 at the West London Hospital, 23 at Nazareth House, 15 at the Hammersmith Infirmary, and 21 transferable deaths of non-residents which occurred in this Borough, the corrected number of deaths of residents registered last year was 1,712. On the before-mentioned estimated population, the corrected number of deaths of residents registered last year was equal to an annual rate of 13.7 deaths per 8 1,000 persons living. The death rate in London on the estimated population of London up to the middle of the year was equal to an annual rate of 14.4 deaths per 1,000 persons living. DEATHS OF INFANTS. The corrected number of deaths of residents under one year of age registered last year was 276, against 314 in the previous year. The number of deaths of infants under one year of age registered last year was equal to 161 per 1,000 of the total corrected deaths of residents registered, and to 94 per 1,000 of the total corrected registered births. The number of deaths of infants under one year of age, residents in London last year, was equal to 175 per 1,000 of the total deaths registered, and 104 per 1,000 of the total registered births. The mortality rate of infants under one year of age was, as compared with the total deaths of residents registered, 14 per 1,000 less in this Borough than in London, and as compared with the total births registered 10 per 1,000 less in this Borough than in London. DEATHS OF ILLEGITIMATE CHILDREN. The corrected number of deaths of illegitimate children under 1 year of age was 28, or at the rate of 125 per 1,000 illegitimate births. The following table on infantile mortality has been prepared by me in accordance with the direction of the Local Government Board. 9 LOCAL GOVERNMENT BOARD RETURN.—TABLE IV. Infant Mortality during the year 1914. Nett Deaths from stated Causes at various Ages under 1 Year of Age. METROPOLITAN BOROUGH OF HAMMERSMITH CAUSES OF DEATH. Under 1 Week. 1-2 Weeks 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 year. ALL CAUSES. Certified 55 14 15 6 90 49 62 38 37 276 Uncertified — — — — — — — Small-pox - - - - - - - - - - Chicken-pox — — — — — - - - - - Measles — 1 — — 1 - 1 1 5 8 Scarlet Fever — — — — — - - - - - Whooping Cough — — — 1 1 — 4 2 1 8 Diphtheria and Croup — — — — — — 1 — — 1 Erysipelas — — — — — — — 1 — 1 Tuberculous Meningitis — — - - - - - - 1 1 Abdominal Tuberculosis — — — - — - - 1 1 2 Other Tuberculous Diseases — — — — - — 1 — 1 Meningitis (not Tuberculous) — — — — — - - 1 1 2 Convulsions — 1 1 2 4 2 3 3 — 12 Laryngitis — — — — - - - - Bronchitis — — — - - 3 1 1 - 5 Pneumonia (all forms) 4 — 1 — 2 6 9 5 19 4 Diarrhoea _ - - - - 6 12 9 2 29 Enteritis — — 1 2 3 6 12 5 2 28 Gastritis - - - - - 2 1 1 - 4 Syphilis - - - - - 3 3 - 1 7 Rickets - - - - - - 1 2 - 3 Suffocation, overlying — — 1 — 1 3 2 - - 0 Injury at Birth 3 — — — 3 - - - - 3 Atelectasis 7 — — — 7 - - - - 7 Congenital Mal ormatious 1 4 1 - 6 1 - - - 7 Premature Birth 33 5 4 - 42 5 1 - - 48 Atrophy, Debility, and Marasmus 8 3 6 1 18 8 9 2 2 39 Other causes 2 - - - 2 4 1 4 2 13 55 14 15 6 90 49 62 38 37 276 Nett Births in the Year: Legitimate, 2,791; Illegitimate, 144. Nett Deaths is the Year of : Legitimate Infants, 248; Illegitimate Infants, 28. 10 REPORT ON THE WORK OF THE HEALTH VISITOR. During the year 2,824 births were registered in the Borough. Adding 125 births which were registered outside the Borough and transferred by the Registrar-General as belonging to Hammersmith, and deducting 14 births which were registered in the Borough and transferred by the RegistrarGeneral to other districts, the corrected number of births for the year was 2,935. Two hundred and eighty-three deaths of infants under 1 year of age were registered in the Borough. 44 of which occurred in the West London Hospital, and 34 in the Hammersmith Infirmary. Thirty-two deaths of the non-residents of this Borough occurred, 28 at the West London Hospital, 2 at the Hammersmith Infirmary, and 2 were transferable to other districts. Twenty-five deaths of residents were registered outside the Borough, 22 occurring in Institutions, and 3 being transferred by the Registrar-General. Deducting 32 deaths of infants, being non-residents, and adding 25 deaths of infants of this Borough, the corrected number of deaths of infants was 276. Of the 276 deaths, 48 were prematurely born and 55 died under one week. Of the 55 deaths of infants under 1 week, 3 were newly born infants found dead in various parts of the Borough, parentage being unknown. During the year 2,875 visits were made by the Council's Health Visitor. Of this number 2,184 were first visits, and 512 second and subsequent visits. One hundred and seventynine visits were made when it was found that the parents had removed or were out. Fourteen cases of Ophthalmia Neonatorum were visited bv the Health Visitor. The feeding of the 2,184 infants was found to be as follows:— Breast fed 1,864 Hand and breast 162 Hand only 122 Out or engaged on first visit 36 2,184 11 The following table gives the number of births and deaths and the death rate per 1,000 births, as calculated by the Registrar-General, during the past nine years, commencing 1906, the year of the appointment of the He ilth Visitor. Births. Deaths. Deaths of infants per 1,000 births. 1906 3,112 430 138 1907 3,029 362 117 1908 3,204 383 120 1909 2,995 360 120 1910 2,906 329 99 1911 2,929 434 146 1912 2,880 259 90 1913 2,951 314 103 19I4 2,935 267 94 During the year 70 hospital letters were given for mothers and infants to attend the West London Hospital for medical treatment. The education of the young mothers is an important factor in the preservation of infant life. A healthy child can be made unhealthy by improper feeding, whether the child is fed by the breast or by hand. It is important to impress on the young mothers the necessity of having regular times for feeding, quite as much by breast-feeding as by hand. Feeding Cards provided by the Council have been distributed where necessary, and the mothers take great care of them. On many occasions, the existing card, which has become dirty from hanging up in the living room, has been replaced by a clean one. The Hammersmith School for Mothers has extended its usefulness by opening two new branch centres during the year, one at Becklow Road and one at College Park. The mothers appreciate these branch centres very much, especially the one at College Park, where the Hammersmith mothers were such a long way from the Centre. The Women's League of Service has provided several mothers with free dinners where they were required. There was not so much poverty last winter as in former winter seasons, men out of work joined the Army and so provided for their wives and families. There are a great many young inexperienced mothers who welcome the visits of the Health Visitor. Many of them have no friends in London and are very glad to have advice 12 on the feeding, rearing and clothing of infants. The home talks are very much appreciated by the mothers and in many cases the Health Visitor has been requested to call and see their babies when visiting in the district where they live. REPORT OF MEDICAL OFFICER OF HEALTH ON MATERNITY AND CHILD WELFARE. Gentlemen,—I desire to bring before the Committee the circular letter of the Local Government Board to County Councils and Sanitary Authorities regarding maternity and child welfare, issued in July, and submit observations on the suggestions of the Board for dealing with the subject. The Local Government Board state in their circular that an estimate has been laid before Parliament for a grant to be distributed by the Board in aid of local authorities and voluntary agencies in respect of institutions or other provision for maternity and child welfare. The amount of the estimate is not given, but it is intimated that the grants of local authorities may amount to half or possibly less of the approved expenditure. Institutions for Maternity and Child Welfare. The clinics, dispensaries, etc., shall be primarily concerned with the provision of medical and surgical advice and treatment for expectant and nursing mothers, and children from birth, until they enter a public elementary school, nursery school, creche, day nursery, school for mothers, or other school. Up to the present in their infant welfare work, local authorities have concerned themselves more especially with the child in its first year. The Local Government Board suggest that this work should be extended, and in two directions. During Pregnancy. The expectant mother should receive attention by means of advice and treatment. Histories of previous pregnancies may be obtained, and the possible occurrence of abortions and miscarriages, with the presence of the underlying causes, such as syphilis, lead poisoning, displacement of the womb, etc. Where such conditions are found and require operative interference, the patient will be referred to an appropriate hospital. 13 During Labour and Confinement. Furnishing of skilled and prompt attendance at home. The treating of difficult cases, e.g. mothers with contracted pelvis, diseases of the womb, heart or kidney. The treatment of complications, such as white leg, and puerperal fever. The above work would tend to attain two objects— 1. The safe delivery of the pregnant mother and her subsequent good health. 2. The birth of a healthy child. The other direction in which the extension of the work is desirable is the welfare of the child after its first year, until such time as it enters a school and is taken over by the education authorities. The Local Government Board suggest that the foregoing objects should be attained by the establishment of maternity and child welfare centres or institutions. It is also desirable to have home visitations paid both to expectant and nursing mothers, and to infants and children up to the age of 5, by the staff of the institution. To carry out the scheme it will be necessary to have— (a) Malernity centres to which expectant and nursing mothers may come for advice and treatment, and where children up to the age of 5 years may be brought for the same purpose. (b) A medical officer to be in charge of the centre. (c) An adequate staff of health visitors. (d) Co-operation of midwives and local hospitals having obstetric and gynaecological departments. (e) Records which must be carefully kept. A complete scheme would comprise the following elements, each of which will, in this connection, be organised in its direct bearing on infantile health:— 1. Arrangements for the local supervision of midwives. (This is done at present by the London County Council.) 2. Arrangements for—Ante-natal: (i.) An ante-natal clinic for expectant mothers. (ii.) The home visiting of expectant mothers. (iii.) A maternity hospital, or beds at a hospital, in which complicated cases of pregnancy can receive treatment. 3. Arrangements for—Natal: (i.) Such assistance as may be needed to ensure the mother having skilled and prompt attendance during confinement at home. 14 (ii.) The confinement of sick women, including women having contracted pelvis or suffering from any other condition involving danger to the mother or infant, at a hospital. 4. Arrangements for—Post-natal: (i.) The treatment in a hospital of complications arising after parturition, whether in the mother or in the infant. (ii.) The provision of systematic advice and treatment for infants at a baby clinic or infant dispensary, (iii.) The continuance of these clinics and dispensaries, so as to be available for children up to the age when they are entered on a school register, i.e. the register of a public elementary school, nursery school, creche, day nursery, school for mothers, or other school. (iv.) The systematic home visitation of infants and of children not on a school register as above defined. In the circular it is stated that the Board of Education will administer grants to institutions of the nature of schools for mothers. Schools for Mothers. A school for mothers is primarily an educational institution providing training and instruction for the mother in the care and management of infants and little children. It may include—(a) Systematic classes. (b) Home visiting. (c) Infant consultations. The provision of specific medical and surgical advice (if any) should be only incidental. If provision is adequate and satisfactory, grants may be paid by the Board of Education at the rate of one-half of the approved expenditure. In other cases the Board may pay at a lower rate or withhold the grant. The Board will take into consideration, in fixing the grant, the scope, character, and efficiency of the work of the institution, and will have regard to the provision made for— I. Co-ordinating the work of the institution with— (a) Similar institutions in the same district. (b) Baby clinics and infant dispensaries providing medical and surgical advice and treatment for infants and little children. 15 (c) The school medical service on the one hand, and the sanitary authority on the other. 2. Keeping records of attendance at the institution and of visits paid to the homes. The institution is to be conducted by a responsible body of managers and a person must be appointed as correspondent on behalf of the managers. Table showing the Infantile Mortality Rates of the County of London, the City of London, and the Metropolitan Boroughs during the 52 Weeks of 1914, as calculated by the Registrar-General. Deaths under 1 year to 1,000 Births Registered. County of London 104 Chelsea 67 Lewisham 74 Stoke Newington 78 City of Westminster 80 Hampstead 80 Woolwich 85 Wandsworth 89 Holborn 90 Hackney 92 St. Pancras 92 Battersea 93 City of London 94 Hammersmith 94 Kensington 94 Paddington 95 Greenwich 98 St. Marylebone 98 Camberwell 99 Deptford 99 Lambeth 104 Islington 105 Fulhani 113 Poplar 116 Finsbury 123 Souttiwark 124 Stepney 124 Bermondsey 125 Bethnal Green 137 Shoreditch 141 c 16 DEATHS OF AGED PERSONS. The corrected number of deaths of residents at 65 years of age and upwards that were registered during last year was 525, against 496 in the previous year. These deaths last year were equal to 4.2 per 1,000 of total persons living, and 313 per 1,000 of the total deaths of residents registered. The corrected deaths registered of persons at 65 years of age and upwards belonging to London last year was equal to 4.1 per 1,000 of the total persons living, and 284 per 1,000 of the total deaths of London residents registered. This death rate was, therefore, I greater in this Borough than in London as compared with the total persons living, and 29 per 1,000 greater in this Borough than in London as compared with the total deaths registered. LOCAL GOVERNMENT BOARD RETURN.—TABLE I. Vital Statistics of Whole District during 1914 and Previous Years. METROPOLITAN BOROUGH OF HAMMERSMITH. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett. of Non-residents registered in the District. of Residents not registered in the Disti ict. Number. Rate. Number. Rate. Under i Year of Age. At all Ages. Number Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1909 119917 2887 1778 14.1 220 217 361 1775 14.1 1910 120877 2910 1569 12.3 240 209 304 I538 12.1 1911 121766 2807 2929 24.1 1927 15.8 259 245 434 148 1913 15.'7 1912 122750 2755 2883 23.5 1595 13.0 253 251 261 91 1593 13.0 1913 123745 2951 3042 24.6 1704 13.8 227 275 314 103 1752 14.2 1914 124750 2824 2935 23'5 1676 13.4 233 269 276 94 1712 137 Area of District in acres (land and inland water ) 2282.5 Total population at all ages 121,521 Total families or separate occupiers 28,462 At Census of 1911 (cf. Census, Vol. 5). 17 DEATHS OF RESIDENTS. Belonging to the Borough occurring in Public Institutions, &c., in districts outside, during the year 1914. Fever Hospitals. Western Hospital 13 North Western Hospital 3 Northern Hospital 2 South Western Hospital 1 General Hospitals. St. George's Hospital 10 Middlesex Hospital 7 Guy's Hospital 6 Children's Hospital, Paddington 6 St. Mary's Hospital 5 Cancer Hospital, Chelsea 5 Queen Charlotte's Hospital 4 Infants' Hospital 4 Charing Cross Hospital 4 St. Bartholomew's Hospital 3 Belgrave Hospital 3 Queen Mary's Hospital 3 St. Thomas' Hospital 2 Westminster Hospital 2 London Hospital 2 Park Hospital 2 German Hospital, Hackney 2 Victoria Hospital 2 Mount Vernon Hospital 1 French Hospital 1 Samaritan Free Hospital 1 Consumption Hospital, Kensington 1 London Temperance Hospital 1 Brompton Hospital 1 University College Hospital 1 Italian Hospital 1 Children's Hospital, Great Ormond Street 1 National Hospital for Diseases of Heart, St. Marylebone 1 Chelsea Hospital for Women 1 Hospital of St. John and St. Elizabeth 1 King's College Hospital 1 Seaman's Hospital, Greenwich 1 Women's Hospital for Children, 688, Harrow Road 1 East London Hospital 1 Grove Hospital 1 Grosvenor Hospital 1 Homieopathic Hospital, Great Ormond Street 1 Asylums. Hanwell Asylum 15 Banstead Asylum 14 Long Grove Asylum 6 Colney Hatch Asylum 5 Tooting Bee Asylum 4 Horton Asylum 4 Caterham Asylum 3 Leavesden Asylum 3 Cane Hill Asylum 2 Claybury Asylum 1 Fountain Temporary Asylum 1 Wandsworth Asylum 1 Manor Asylum 1 Other Institutions. Fulham Workhouse 8 Bow Institution 6 Kensington Infirmary 3 Marylebone Infirmary 3 Whitechapel Infirmary 2 Fulham Infirmary 2 Holborn Infirmary 1 British Home and Hospital for Incurables 1 Union Infirmary, St. John's Hill, Battersea 1 Home for Invalids, 1, Highbury Terrace 1 Westminster Infirmary 1 Whitechapel Union Workhouse 1 St. Thomas's Home 1 Clapham Maternity 1 St. Pancras Infirmary, South 1 Holborn Workhouse, Shoreditch 1 St. Luke's House, Kensington 1 Various. Oxford Circus Tube Station 1 37, Plough Court, Lombard Street, E.C. 1 13, Stanbridge Road, Putney 1 "Ingle wood," Grove Park, Cam- berwell 1 In River Thames, off Battersea Bridge 1 Langham Hotel, Portland Place 1 43, Sutherland Street, Pimlico 1 72, Edith Road, Fulham 1 13. St. Edmund's Terrace, St. Marylebone 1 172, Holland Park Avenue, Kensington 1 33, Belsize Square, Hampstead 1 216, Portsdown Road, Paddington 1 26, Holland Park Gardens, Kensington 1 Piccadilly Circus Station 1 30, Porchester Square, Paddington 1 40, College Street, Islington 1 In River Thames, off Empire Wharf, Poplar 1 In River Thames, under Putney Bridge 1 18 Corrected Death-rates of Metropolitan Boroughs after Distribution of Deaths in Public Institutions, Etc., as calculated by the Registrar-General for year 1914. Deatlh rate from all causes. Average County of London 14.4 Hampstead 10.4 Lewisham 10.9 Wandsworth 10.9 City of Westminster I2.6 Paddington 13.0 Kensington 13.1 Stoke Nevvington 13.1 Battersea 13.3 City of London 13.4 Fulham 13.4 Chelsea 13.5 Camberwell 13.7 St. Marylebone 13.8 Woolwich 13.8 Hackney 13.9 Hammersmith 13.9 Deptford 14.4 Lambeth 14.6 Greenwich 14.7 Islington 15.2 St. Pancras 15.6 Bethnal Green 16.0 Holborn 16.1 Stepney 16.5 Poplar 17.1 Berinondsey 17.4 Southwark 17.8 Shoreditch 19.0 Finsbury 19.6 19 LOCAL GOVERNMENT BOARD RETURN.—TABLE III. Causes of, and Ages at, Death during the Year 1914. METROPOLITAN BOROUGH OF HAMMERSMITH. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Total Deaths whether of “Residents" or “Nonresidents" in Institutions in the District. All ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified 1712 276 61 57 62 73 219 438 525 689 Uncertified 0 0 0 0 0 1 0 0 0 0 Enteric Fever 3 0 0 0 0 2 1 0 0 3 Small-pox 0 0 0 0 0 0 0 0 0 0 Measles 41 8 20 10 3 0 0 0 0 13 Scarlet Fever 5 0 0 1 4 0 0 0 0 0 Whooping Cough 20 8 5 6 1 0 0 0 0 3 Diphtheria and Croup 15 1 4 3 6 0 0 1 0 3 Influenza 12 1 0 0 0 0 2 3 6 0 Erysipelas 7 1 0 0 0 0 2 3 1 6 Phthisis (Pulmonary Tuberculosis) 179 0 4 5 11 24 59 64 12 74 Tuberculous Meningitis 21 2 1 6 10 1 0 1 0 19 Other Tuberculous Diseases 12 2 1 2 1 3 3 0 0 7 Cancer, malignant disease 143 0 0 0 0 1 9 70 63 62 Rheumatic Fever 8 0 0 0 1 0 3 3 1 0 Meningitis 8 2 1 4 4 1 1 4 1 8 Organic Heart Disease 185 0 0 0 5 7 25 74 74 42 Bronchitis 112 5 1 2 2 0 1 26 75 33 Pneumonia (all forms) 165 41 16 12 3 5 29 35 24 78 Other Diseases of Respiratory Organs 25 1 0 0 0 3 3 6 12 7 Diarrhœa and Enteritis 74 57 7 3 0 1 3 2 1 32 Appendicitis and Typhlitis 5 0 0 0 1 1 0 2 1 8 Cirrhosis of Liver 22 0 0 0 0 0 4 13 5 11 Alcoholism 6 0 0 0 0 0 0 5 1 1 Nephritis and Blight's Disease 73 0 0 0 1 2 8 29 33 42 Puerperal Fever 3 0 0 0 0 1 2 0 0 3 Other accidents and diseases of Pregnancy and Parturition 10 0 0 0 0 0 10 0 0 0 Congenital Debility and Malformation, including Premature Birth 94 94 0 0 0 0 0 0 0 23 Violent Deaths, excluding Suicide 57 8 0 1 5 8 12 9 14 38 Suicide 10 0 0 0 0 0 3 5 2 4 Other defined Diseases 386 45 1 2 4 14 38 83 199 169 Diseases ill-defined or unknown 1 0 0 0 0 0 1 0 0 0 Total 1712 276 61 57 62 74 219 438 525 689 SubEntries included in above figures. Cerebro-spinal Meningitis 2 0 0 0 2 0 0 0 0 0 Poliomyelitis 0 0 0 0 0 0 0 0 0 0 20 DEATHS FROM THE SEVEN PRINCIPAL ZYMOTIC DISEASES. The total number of deaths of residents that were registered from the seven principal zymotic diseases was 158 against 186 in the previous year. The deaths of residents last year from these diseases were equal to 92 per 1,000 of the total deaths of residents registered, and were at the rate of 1.3 deaths per 1,000 persons living. The deaths from the seven principal zymotic diseases in the whole of London were equal to 100 per 1,000 of the total deaths registered, and were at the rate of 1.4 deaths per 1,000 persons living. These deaths were, therefore, as compared with the total deaths of residents registered, 8 less per 1,000 deaths belonging to this Borough than in London, and, as compared with the population, .1 per 1,000 less in this Borough than in London. The following table shows the deaths of residents registered from the seven principal zymotic diseases which occurred in the 10 years 1905 to 1914:— YEAR. Small-pox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Enteric Fever. Diarrhœa and Cholera. Total. 1905 0 30 11 21 54 5 89 210 1906 0 56 16 27 20 8 144 271 1907 0 52 10 23 31 6 39 161 1908 0 14 11 15 18 5 108 171 1909 0 84 9 26 39 5 42 205 1910 0 67 6 25 26 4 37 165 1911 0 34 5 32 31 7 206 315 1912 0 28 3 14 16 4 38 103 1913 0 49 7 12 41 0 77 186 1914 0 41 5 15 20 3 74 158 Average in last 10 years. 0 46 8 21 30 5 85 195 21 It will be seen from the preceding table that the total number of deaths from these zymotic diseases last year was, making no allowance for the increase in population, 37 below the average number registered in the last 10 years. CASES OF ILLNESS REPORTED AS DUE TO INFECTIOUS DISEASE. There were, omitting tuberculosis, 1,267 cases reported as due to notifiable infectious diseases in this Borough against 818 in the previous year. The number of cases of tuberculosis notified was 443, against 718 in the previous year. There were also reported 958 cases of infectious diseases that were not notifiable, against 1,242 in the previous year; 235 of these were chicken-pox, 491 measles, and 232 whooping cough. SMALL-POX. No case of small-pox was notified in the Borough last year, against no case in the previous year. CHICKEN-POX. Two hundred and thirty-five cases of chicken-pox were reported, against 171 cases in the previous year. Two hundred and thirty-two cases were treated at the homes of the patients, 1 at Hampstead Infirmary, 1 at the West London Hospital, and 1 at the Metropolitan Asylums Board Hospital. No death was registered. MEASLES. Four hundred and ninety-one cases were reported as due to measles, against 700 cases in the previous year. Four hundred and seventy-two cases were treated at the homes of the patients, 9 at the Metropolitan Asylums Board's Hospitals, and 10 at the Hammersmith Infirmary. Forty-one deaths were registered. As this is not a notifiable disease it is of no use giving the mortality rate on the cases reported, as no doubt only a proportion of the cases which occurred were known. 22 Owing to the stringent instructions of the Educational Department of the London County Council most of the cases, as usual, occurring among pupils at the The following chart shows the number of Deaths from Measles per 100,000 inhabitants since 1900. schools of the London County Council were reported to me. A strict system of disinfection was carried out in accordance with the provisions of the Public Health (London) Act, 1891, and very little opposition was met with. The disinfection in the case 23 of measles has continued to entail a large amount of extra work on the Public Health Department, and particularly so on the Disinfectors. From the whole of the notifiable infectious diseases there were only 30 deaths, whereas from measles alone there were 41 deaths. In every case that was reported the premises were at once inspected as to the sanitary condition. SCARLET FEVER. Nine hundred and fifty-four cases were notified as due to scarlet fever, against 533 in the previous year. Eight hundred and seventy-seven cases reported last year were isolated at Isolation Hospitals, and 77 cases were treated at the homes of the patients. Five deaths were registered. The mortality rate on the cases reported was only .5 per cent. DIPHTHERIA AND DIPHTHERITIC MEMBRANOUS CROUP. One hundred and fifty-seven cases were reported as due to diphtheria or diphtheritic membranous croup, against 141 cases in the previous year. One hundred and forty-one cases reported last year were treated at the Isolation Hospitals, and 16 at the homes of the patients. Fifteen deaths were registered. The mortality rate on the cases reported was 9.5 per cent. During the year 30 orders on the Lister Institute of Preventive Medicine, with swabs, were supplied to medical practitioners attending suspected cases of diphtheria. WHOOPING COUGH. Two hundred and thirty-two cases were reported as due to. whooping cough, against 371 cases in the previous year. All the cases were treated at the homes of the patients. Twenty deaths were registered. As this is not a notifiable disease it is of no use giving the mortality rate on the cases reported, as doubtless a very large number of cases occurred which were not known of in the Public Health Department. 24 I have continued to receive as heretofore information as to cases from the Head Teachers of the Schools of the London County Council. The following chart shows the number of Deaths from Whooping Cough per 100,000 inhabitants since 1900. ENTERIC FEVER. Fourteen cases were reported as due to enteric fever, against 14 in the previous year. Four of the cases reported last year were treated at the Isolation Hospitals of the Metropolitan Asylums Board, 2 at the 25 Hammersmith Infirmary, 2 at the West London Hospital, 1 at St. Mary's Hospital, and 5 at the homes of the patients. Three deaths were registered. The mortality rate on the cases reported was 21.4 per cent. During the year one order on the Lister Institute of Preventive Medicine, with voidal outfit, was supplied to a medical practitioner attending a suspected case of enteric fever. TYPHUS FEVER. No case was reported as due to typhus fever, against no case in the previous year. SIMPLE CONTINUED FEVER. No case was reported as due to simple continued fever, against no case in the previous year. RELAPSING FEVER. No case was reported as due to relapsing fever, against no case in the previous year. PUERPERAL FEVER. Seven cases were reported as due to puerperal fever, against 8 cases in the previous year. Four of the cases reported last year were treated at the homes of the patients, and 3 at the Hammersmith Infirmary. Three deaths were registered. The mortality rate on the cases reported was 42.8 per cent. CHOLERA. No case was reported as due to cholera, against no case in the previous year. ERYSIPELAS. One hundred and two cases were reported last year as due to erysipelas, against 98 cases in the previous year. Seventy-three cases were treated at the homes of the patients, 26 at the Hammersmith Infirmary, 1 at the West London Hospital, 1 at Kensington Infirmary, and 1 at a Private Nursing Home. Seven deaths were registered. The mortality rate on the cases reported was 6.8 per cent. 26 PLAGUE. No case was reported as due to plague, against no case in the previous year. CEREBRO-SPINAL FEVER. Two cases were reported as due to cerebro-spinal fever, against one case in the previous year. Two deaths were registered, the mortality rate being 100 per cent. GLANDERS. No case was reported as due to glanders, against no case in the previous year. ANTHRAX. No case was reported as due to anthrax, against no case in the previous year. HYDROPHOBIA. No case was reported as due to hydrophobia last year, against no case in the previous year. OPHTHALMIA NEONATORUM. Thirty cases were reported as due to ophthalmia neonatorum, against 22 cases in the previous year. The cases reported last year were treated: 25 at the homes of the patients, 2 at the Western Ophthalmic Hospital, 2 at the Middlesex Hospital, and 1 at the Hammersmith Infirmary. ACUTE POLIO-MYELITIS. One case was reported as due to polio-myelitis, against 1 case in the previous year. The case reported was treated at St. Mary's Hospital. The patient was a boy, aged 5 years, and was discharged from the hospital with paralysis of the lower extremities. The boy is at present visiting St. Mary's Hospital once a month and is regaining the use of his legs. 27 SUMMER DIARRHŒA. The number of deaths from diarrhœa was 74, being 3 less than in the previous year. Fifty-seven were under 1 year of age. During the year leaflets dealing with precautions which should be taken for the prevention of summer diarrhœa were sent to premises where births had occurred during the previous twelve months. The Lady Health Visitor also delivered leaflets where births had occurred during the year of this Report. DANGER FROM FLIES. During the year, illustrated leaflets were distributed, pointing out the danger from flies, and showing how disease was spread by their carrying filth and germs from ashpits, privies, manure heaps, decaying animal and vegetable refuse, to food, etc. Supplies of leaflets were sent to the Registrars of Births and Deaths, who kindly offered to hand them to parents registering the births of their children. TABULAR STATEMENT—ZYMOTIC DISEASES. The following table shows the number of cases that were reported as due to the undermentioned 20 zymotic diseases during the years 1905 to 1914. Year. Small-pox. Scarlet Fever. Diphtheria of Diphtheritic Croup. Typhus Fever. Enteric Fever. Simple continued Fever. Relapsing Fever. Puerperal Fever. English Cholera. Erysipelas. Plague. Chicken-pox.* Measles * Whooping Cough.* Cerebro-spinal Fever. Anthrax. Glanders. Hydrophobia. Ophthalmia Neonatorum. Acute Polio-myelitis. Total 1905 0 360 237 0 41 0 0 13 0 125 0 219 417 286 0 0 0 0 0 0 1698 1906 0 439 270 0 33 1 0 10 0 125 0 68 627 56 0 0 0 0 0 0 1629 1907 0 577 207 0 40 0 0 7 0 76 0 198 538 337 4 0 0 0 0 0 1984 1908 0 383 199 0 29 0 0 6 0 65 0 113 161 156 1 0 0 0 0 0 1113 1909 0 380 188 0 17 0 0 14 0 75 0 140 847 281 1 0 0 0 0 0 1943 1910 0 340 161 0 31 1 0 9 0 63 0 228 484 200 2 1 1 0 0 0 1521 1911 0 236 195 1 28 1 0 3 0 97 0 304 554 250 1 0 0 0 18 1 1689 1912 0 335 177 0 11 0 0 7 0 99 0 363 487 208 3 0 0 0 17 1 1708 1913 0 533 141 0 14 0 0 8 0 98 0 171 700 371 1 0 0 0 22 1 2060 1914 0 954 157 0 14 0 0 7 0 102 0 235 491 232 2 0 0 0 30 1 2225 Av'rge in last 10 yrs. 0 454 193 0 26 0 0 8 0 93 0 204 531 238 1 0 0 0 9 0 1757 * Not a notifiable disease. 28 The following chart shows the number of Deaths from Diarrhœa per 100,000 inhabitants since 1900. 29 Chart showing the total number of cases of Notifiable Infectious Diseases (excluding Tuberculosis) notified week by week in the Borough during 1914. 30 Chart showing the number cases notified week by week in the Borough, of Scarlet Fever, Diphtheria and Typhoid Fever during 1914. 31 LOCAL GOVERNMENT BOARD RETURN.—TABLE II. Cases of Infectious Disease notified during the year 1914. METROPOLITAN BOROUGH OF HAMMERSMITH. Notifiable Disease. Number of Cases Notified Total Cases Notified in Each Locality. (e.g. Parish or Ward) of the District. Total Cases Removed to Hospital. At all Ages. At Ages—Years. Under 1 1 & under 5 Years. 5 & under 15 Years. 15 & under 25 Years. 25 & under 45 Years. 45 & under 65 Years. 65 and upwards. North Centre South Small-pox 0 0 0 0 0 0 0 0 0 0 0 0 Cholera (C) Plague (P) 0 0 0 0 0 0 0 0 0 0 0 0 Diphtheria (including Membranous Croup) 157 2 39 80 26 8 1 1 81 62 14 141 Erysipelas 102 5 4 4 16 21 42 10 40 46 16 29 Scarlet Fever 954 4 187 608 110 42 2 1 430 322 202 877 Typhus Fever 0 0 0 0 0 0 0 0 0 0 0 0 Enteric Fever 14 0 0 1 7 4 2 0 2 8 4 9 Relapsing Fever (R) Continued Fever (C) 0 0 0 0 0 0 0 0 0 0 0 0 Puerperal Fever 7 0 0 0 2 5 0 0 5 1 1 3 Cerebro-Spinal Meningitis 2 0 0 2 0 0 0 0 2 0 0 1 Polio-myelitis 1 0 0 1 0 0 0 0 1 0 0 0 Ophthalmia Neonatorum 30 30 0 0 0 0 0 0 18 9 3 5 Pulmonary Tuberculosis 381 0 8 65 52 145 100 11 163 152 66 101 Other forms of Tuberculosis 62 5 14 30 8 5 0 0 25 29 8 20 Totals 1710 46 252 791 221 230 147 23 767 629 314 1186 Isolation Hospital or Hospitals. Sanatoria, &c.—Western Fever Hospital, Fulham, and occasionally other Fever Hospitals under the Metropolitan Asylums Board, and exceptionally the London Fever Hospital at Islington, and when necessary the Small-pox Hospitals of the Metropolitan Asylums Board. 32 2. The following table of Deaths from Infectious Diseases is compiled from the Registrar-General's Report. Boroughs. Population estimated to the middle of 1914. Births. Deaths from Deaths under 1 year of Age. All causes. Enteric Fever. Small-pox Measles. Scarlet Fever. Whooping-cough. Diphtheria. Diarrhœa and Enteritis (under 2 years) Pulmonary Tuberculosis COUNTY OF LONDON 4,518,021 109,667 64,994 147 — 1,385 316 918 706 3,031 6,281 11,395 West. Paddington 142,193 2,965 1,846 3 — 4 8 25 20 79 145 281 Kensington 171,234 3,210 2,242 1 — 15 17 7 13 63 187 302 Hammersmith 123,853 2,935 1,717 5 — 41 5 21 16 67 170 275 Fulham 157,303 4,154 2,101 9 — 31 21 42 22 126 205 468 Chelsea 64,511 1,299 870 3 — 3 5 6 8 21 87 87 City of W'stmnstr 154,544 2,155 1,936 9 — 6 10 21 15 35 205 173 North. St. Marylebone 114,355 2,132 1,577 6 — 2 9 20 18 59 146 208 Hampstead 86,388 1,273 893 4 — 2 2 16 10 11 55 102 St. Pancras 214,133 5,223 3,334 4 — 56 18 51 30 121 379 481 Islington 325,496 8,171 4,923 15 — 97 24 84 43 228 470 857 Stoke Newington 50,511 1,045 661 — — 1 3 6 4 16 58 8l Hackney 223,393 5,460 3,099 8 — 106 9 53 39 127 303 502 Central. Holborn 46,832 764 754 6 — 11 2 9 4 13 92 69 Finsbury 84,521 2,541 1,652 2 — 76 6 45 9 88 167 312 City of London 17,831 181 239 1 — 1 1 3 2 1 20 17 East. Shoreditch 109,569 3,511 2,075 2 — 112 5 55 20 148 234 496 Bethnal Green 127,807 3,786 2,034 4 — 68 7 48 28 174 210 518 Stepney 275,081 8,058 4,539 8 — 182 28 72 70 268 465 997 Poplar 160,839 5,073 2,743 6 — 66 10 31 34 195 268 590 South. Southwark 188,321 5,604 3,350 2 — 95 22 59 37 207 330 693 Bermondsey 124,683 3,849 2,165 3 — 81 8 14 18 140 203 482 Lambeth 297,094 7,022 4,319 16 — 58 16 40 50 202 422 728 Battersea 167,451 4,303 2,220 3 — 50 11 26 17 122 210 402 Wandsworth 331,321 6,675 3,617 5 — 26 13 56 41 148 298 591 Camberwell 261,828 6,580 3,589 5 — 65 23 47 39 143 373 653 Deptford 109,269 3,115 1,572 3 — 51 9 9 25 91 150 308 Greenwich 96,018 2,408 1,412 5 — 47 7 6 16 53 132 235 Lewisham 169,211 3,336 1,830 6 — 7 8 19 24 55 126 247 Woolwich 122,431 2,839 1,679 3 — 25 9 27 34 30 171 240 33 The following table of Deaths from Infectious Diseases per 1,000 persons living is compiled from the Registrar-General's Report. Boroughs. Per 1,000 Persons Living. Rate per 1,000 Births. Births. Deaths From All Causes. Enteric Fever. Small-pox. Measles. Scarlet Fever. Whooping-cough. Diphtheria. Pulmonary Tuberculosis. Diarrhœa and Enteritis (under 2 years). Total Deaths under 1 year. Crude. Standar dized. COUNTY OF LONDON 24.3 14.4 14.4 0.03 — 0.31 0.07 0.20 0.16 1.39 27.64 104 West. Paddington 20.9 13.0 12.9 0.02 — 0.03 0.06 0.18 0.14 1.02 26.64 95 Kensington 18.8 13.1 13.1 0.01 — 0.09 0.10 0.04 0.08 1.10 19.63 94 Hammersmith 23.8 13.9 13.7 0.04 — 0.33 0.04 0.17 0.13 1.38 22.83 94 Fulham 26.5 13.4 13.8 0.06 — 0.20 0.13 0.27 0.14 1.31 30.33 113 Chelsea 20.2 I3.5 12.9 0.05 — 0.05 0.08 0.09 0.12 1.35 16.17 67 City of Westminster 14.0 12.6 13.2 0.06 — 0.04 0.06 0.14 0.10 1.33 16.24 80 North. St. Marylebone 18.7 13.8 14.1 0.05 — 0.02 0.08 0.18 0.16 1.28 27.67 98 Hampstead 14.8 10.4 11.0 0.05 — 0.02 0.02 0.19 0.12 0.64 8.64 80 St. Pancras 24.5 15.6 15.6 0.02 — 0.26 0.08 0.24 0.14 1.77 23.17 92 Islington 25.2 15.2 14.8 0.05 — 0.30 0.07 0.26 0.13 1.45 27.90 105 Stoke Newington 20.7 13.1 12.5 — — 0.02 0.06 0.12 0.08 1.15 15.31 78 Hackney 24.5 13.9 14.0 0.04 — 0.48 0.04 0.24 0.18 1.36 23.26 92 Central. Holborn 16.4 16.1 16.2 0.13 — 0.24 0.04 0.19 0.09 1.97 17.02 90 Finsbury 30.1 19.6 19.4 0.02 — 0.90 0.07 0.53 0.11 1.98 34.63 123 City of London 10.2 13.4 14.0 0.05 — 0.06 0.06 0.17 0.11 1.12 5.52 94 East. Shoreditch 32.1 19.0 19.6 0.02 — 1.02 0.05 0.50 0.18 2.14 42.15 141 Bethnal Green 29.7 16.0 16.6 0.03 — 0.53 0.05 0.38 0.22 1.65 45.96 137 Stepney 29.4 16.5 17.3 0.03 — 0.66 0.10 0.26 0.26 1.70 33.26 124 Poplar 31.6 17.1 16.9 0.04 — 0.41 0.06 0.19 0.21 1.67 38.44 116 South. Southwark 29.8 17.8 17.9 0.01 — 0.51 0.12 0.31 0.20 1.76 36.94 124 Bcrmondsey 31.0 17.4 17.4 0.02 — 0.65 0.06 0.11 0.14 1.63 36.37 125 Lambeth 23.7 14.6 14.3 0.05 — 0.20 0.05 0.14 0.17 1.42 28.77 104 Bittersea 25.8 13.3 13.4 0.02 — 0.30 0.07 0.16 0.10 1.26 28.35 93 Wandsworth 20.2 10.9 11.0 0.02 — 0.08 0.04 0.17 0.12 0.90 22.17 89 Camberwell 25.2 13.7 13.6 0.02 — 0.25 0.09 0.18 0.15 1.43 21.73 99 Deptford 28.0 14.4 14.3 0.03 — 0.47 0.08 0.08 0.23 1.38 29.21 99 Greenwich 25.1 14.7 14.5 0.05 — 0.49 0.07 0.06 0.17 1.38 22.01 98 Lewisham 19.8 10.9 10.7 0.04 — 0.04 0.05 0.11 0.14 0.75 16.49 74 Woolwich 23.3 13.8 14.1 0.02 — 0.20 0.07 0.22 0.28 1.40 0.57 85 D 34 LONDON AND THE METROPOLITAN BOROUGHS. (Compiled from Registrar-General's Report.) Number of Cases of Infectious Disease Notified in the several Boroughs of the Administrative County of London during the 52 Weeks ended 2nd January, 1915.0 Boroughs. Estimated Population in the middle of 1914† Total Cases. Enteric Fever. Typhus. Continued Fever. Small-pox. Scarlet Fever. Diphtheria (including Membranous Croup). Cholera. Erysipelas Cerebro-spinal Fever Puerperal Fever. Anthrax Glanders. Ophthalmia Neonatorum Polio-myelitis. West. Paddington 142,193 1,255 10 — 2 — 743 295 — 140 1 10 — — 51 3 Kensington 171,234 1,379 11 — 2 — 962 200 — 165 2 6 — — 31 — Hammersmith 123,853 1,313 14 — — — 977 179 — 102 2 7 — — 31 1 Fulham 157,303 1,580 40 — 1 — 1,043 271 — 152 1 33 — — 39 — Chelsea 64,511 417 23 1 1 — 272 74 — 34 1 8 — — 3 — City of Westminster 154,544 1,223 49 — 2 1 844 186 — 111 1 10 — — 18 1 North. St. Marylebone 114,355 808 37 — — — 434 235 — 67 1 9 — — 25 — Hampstead 86,388 596 17 — — — 281 231 — 45 — 7 — — 12 3 St. Pancras 214,133 1,985 44 — 1 — 1,207 451 — 224 3 18 — — 34 3 Islington 325,496 3,016 75 — — — 1,851 661 — 335 7 25 — — 54 8 Stoke Newington 50,511 429 4 — — — 264 98 — 49 — 3 — — 11 — Hackney 223,393 1,699 28 — 3 — 806 495 — 296 3 17 2 — 44 5 Central. Holborn 46,832 282 15 — — — 171 64 — 22 — 4 — — 6 — Finsbury 84,521 801 19 — — — 449 145 — 157 3 11 — — 16 l City of London 17,831 137 5 — — 1 85 31 — 10 — — — — 5 — East. Shoreditch 109,569 899 19 — 1 — 424 221 — 198 3 13 1 — 18 1 Bethnal Green 127,807 1,402 18 — — — 654 376 — 305 2 9 — — 31 7 Stepney 275,081 3,537 47 — — — 2,089 885 — 403 4 33 — — 49 27 Poplar 160,839 1,384 34 — — — 663 53 — 222 9 23 2 — 71 8 South. Southwark 188,321 2,248 24 — — — 1,447 340 — 325 6 29 4 — 69 4 Bermondsey 124,683 960 8 — — — 581 216 — 123 5 5 1 — 20 1 Lambeth 297,094 2,706 50 — 3 — 1,754 560 — 237 5 23 — — 63 10 Battersea 167,451 1,502 21 — — — 996 267 — 156 1 13 — — 47 1 Wandsworth 331,321 2,319 47 — — — 1,410 537 — 238 3 31 1 — 50 2 Camberwell 261,828 2,371 29 — 1 — 1,541 458 — 270 4 24 — — 39 5 Deptford 109,269 1,370 9 — — — 863 252 — 229 — 5 — — 11 1 Greenwich 96,018 945 10 — 1 — 552 243 — 123 4 3 — — 9 — Lewisham 169,211 1,563 51 — — — 955 406 — 129 — 7 — — 14 1 Woolwich 122,431 1,218 15 — — — 693 387 — 101 1 7 — — 14 — Port of London ? 15 6 — — 1 4 1 — 2 1 — — — — — Administrative County of London 4,518,021 41,382 779 1 18 3§ 25,015 9,118 — 4,970 73 393 11 — 885 93 Ages 0-1 1,509 2 — — — 233 182 — 164 32 — — — 884 12 ,, 1-5 8,982 25 — 2 — 5,882 2,795 — 195 20 — — — — 63 ,, 5- 14,467 77 — 3 — 10,675 3,521 — 165 8 — 1 — 1 16 ,, 10- 6,396 103 — 1 — 4,863 1,265 — 159 5 — — — — — ,, 15- 2,418 110 — 3 — 1,494 479 — 320 3 7 1 — — 1 ,, 20- 1,608 117 — 2 — 810 359 — 239 1 79 1 — — — ,, 25- 2,130 170 1 2 1 807 349 — 579 3 215 2 — — 1 ,, 35- 1,497 112 — 1 2 228 135 — 924 — 92 3 — — — ,, 45- 1,157 55 — 2 — 44 47 — 1,008 1 — — — — — ,,55- 722 14 — 2 — 7 11 — 685 — — 3 — — — ,, 65 and upwards 559 4 — — — 5 5 — 545 — — — — — — Age not stated 138 — — — — — — — — — — — — — — *This table is supplied by the Medical Officer of Health of the Administrative County of London and is compiled from returns which the London County Council receives from the Metropolitan Asylums Board under section 55 (4) of the Public Health (London) Act. 1891. † Based on the results of the Censuses of 1901 and 1911 ‡The figures for enteric fever, diphtheria and erysipelas at "all ages" exclude Naval and Military cases. § Subsequently found not to be cases of small-pox. 35 WRONG DIAGNOSIS. Thirty-five cases of Infectious Disease were removed to the Hospitals of the Metropolitan Asylums Board and subsequently returned home in consequence of the patients being found not to be suffering from the diseases stated on the certificates, or any other notifiable diseases. This number referred to 17 cases of scarlet fever and 18 of diphtheria. DISINFECTION. During the year disinfection was carried out at 1,663 houses where cases of infectious disease, etc., had occurred. All bedding and articles of clothing, etc., were removed to the Council's Disinfecting Station and disinfected. Thirty-nine bundles of clothing and bedding were removed from the White City Camp and disinfected. Four thousand blankets were disinfected for the Military Authorities at the White City Camp and 3,000 at Olympia. It was found necessary to obtain assistance in this work, which I am pleased to report was most readily given by the Kensington Borough Council. INFLUENZA. Twelve deaths were registered as due to influenza, against 13 deaths in the previous year. No official action was taken in reference to this complaint, as no application was made for the disinfection of any of the houses in which death occurred. TUBERCULOSIS. Four hundred and forty-three cases were notified to me against 718 cases in the previous year, 381 of which were cases of pulmonary tuberculosis and 62 cases of other forms of tuberculosis. In all cases notified, or in which death occurrcd, the premises were at once inspected, and after death in all cases occurring in private dwelling-houses an 36 The following table shows the number of Notifications of males and females at various age periods from pulmonary and non-pulmonary tuberculosis, during the year 1914. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from 4th January, 1914, to the end of the week ending on the 2nd January, 1915. Age Periods. Number of Notifications on Form "A." Number of Notifications on Form "B." Number of Notifications on Form "C.' Primary Notifications. Total Notifications (i.e., including cases previously notified by other doctors.) Primary Notifications Total Notifications (i.e., including cases previously notified by other doctors.) Poor Law Institutions. Sanatoria. 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 & upwards. Total. Under 5. 5 to 10 10 to 15 Total Pulmonary, Males — 4 20 11 10 10 37 36 50 12 6 196 292 586 — — — — — 2 90 28 Pulmonary, Females — 4 19 12 12 17 27 31 20 9 4 155 231 — 1 — 1 1 58 17 Non-pulmonary, males 3 6 11 2 1 — 1 — — — — 24 28 — — — — — 10 — Non-pulmonary, Females 1 7 8 3 3 4 3 1 — — — 30 35 — 1 — 1 1 6 1 37 offer was made to disinfect the premises at the expense of your Council. In every case of pulmonary tuberculosis a printed instruction as to the course that should be adopted for the prevention of consumption was left at the premises. In many instances advantage was taken of the offer of the Council to disinfect. Two hundred and twelve deaths were registered against 183 in the previous year. During the year 29 orders on the Lister Institute of Preventive Medicine, with sputum outfits, were supplied to medical practitioners attending suspected cases of tuberculosis. TUBERCULOSIS DISPENSARY. The question of the provision of a Tuberculosis Dispensary in conjunction with the West London Hospital was fully considered and compared as to its advantages and disadvantages, with the following scheme which I submitted to your Public Health Committee:— A complete scheme for dealing with Tuberculosis embraces a number of conditions. To make the scheme a satisfactory one there should be the fullest co-operation between the various bodies engaged in the tuberculosis campaign and co-ordination of all the work done. 1. In the first place the Public Health Department should be the centre of the organisation. It is to the Medical Officer of Health of the district that all cases are officially notified, and he is therefore in the best position to organise this work. He should be able to link up and utilise all the available agencies, voluntary or otherwise, that may be useful. 2. Upon the receipt of a notification an officer of the Local Authority, acting under the instructions of the Medical Officer of Health, shall visit the home, and take such steps as are necessary or desirable for investigating the source of infection and when possible removing the cause and preventing the spread of infection. The preliminary visit and investigation may be done by a nurse, who will fill up a form with full particulars of the 38 patient and the home condition. At this visit, the nurse may discover that the patient or doctor wishes the treatment undertaken by the dispensary, when suitable arrangements can be made. If treatment at the dispensary is not desired, the nurse gives advice on the preventive aspect, supplying a sputum flask and disinfectant. The form filled up by the nurse is returned to the Medical Officer of Health and any insanitary conditions of the home are attended to. Contacts.—The house of each case is to be visited at least once each month, whether the patient is in a sanatorium, attending the dispensary, or a private doctor. The contacts are seen by the nurse who advises them to be examined by his or her own doctor or at the dispensary. If the patient is attended by a private practitioner, the latter will be sent a list of the contacts and asked if he intends to examine them. In this event he will notify any cases he may discover among the contacts. If he has any doubts as to the diagnosis of any, the services of the Tuberculosis Dispensary are at his disposal. If the private practitioner does not intend to examine the contacts, they will be urged to have it done at the dispensary by the Tuberculosis Officer. School cases.—A list of contacts who attend school will be sent to the Divisional Medical Officer who will arrange for their examination by the school doctor. Arrangements will be made to examine doubtful cases at the dispensary. The Divisional Medical Officer can arrange for the periodical weighing of the contacts, and the result entered on records. He can also arrange for the better or more suitable feeding of such children, if they are poor, as well as for their attendance at open air schools if possible. 5. Bacteriological Examination of Sputum.—This can be done where and when necessary at the dispensary. 6. Disinfection.—Premises should be disinfected by the staff of the Public Health Department, after the removal or death of the patient. 7. Advanced cases.—Arrangements can be made for the nursing of advanced cases whose removal to an institution is not practicable, at the patient's own home, by fully trained district nurses of the local district nursing associations. 8. Shelters, for the open air treatment of patients at their own homes, where they have a suitable open space, can be supplied by the Borough Council. 39 10. The home conditions under which the patient lives should be considered and, where possible, the housing accommodation improved. Educating the general public by means of lectures on the prevention of consumption should be encouraged, and printed general instructions as to the prevention of the spread of the disease, etc., should be distributed. 11. Institutional treatment.—This is provided for by the London County Council, and includes:— (а) Beds at sanatoriums and hospitals for suitable cases. (b) Beds at hospitals for surgical cases. We have approximately 1,200 patients on the Register at present. When the scheme is in working order and all contacts examined, the number of tuberculous patients will probably be increased to about 1,500. In order to carry out the above scheme it will be necessary to establish a dispensary in some central part of the Borough, and for this purpose 1 suggest that a suitable house be rented, such alterations as are necessary made, properly furnished and equipped. I estimate the annual expenditure of such a scheme to be approximately as follows:— £ Tuberculosis Officer (commencing salary) 500 Two nurses (£100 each, rising by annual increments of £10 to £130) 200 Dispenser and Secretary 100 Rent, rates and taxes 70 Light, coal, etc. 20 Caretaker, with rooms, light and coal 50 Drugs 100 Telephone 6 Incidentals 20 966 Capital Expenditure. Alterations (estimate) 120 Furniture, including laboratory, equipment and appliances (estimate) 300 With regard to the capital expenditure, the Local Government Board will assist by a grant of not more than £240. As above stated the annual expenditure is estimated at £966. Probably one-third of the patients treated will be insured patients and the Insurance Committee will be expected to pay their share. 40 The Local Government Board will pay 50 per cent. of the remainder, and the London County Council 25 per cent. so that the incidence of the cost will be as follows : £ Insurance Commissioners 322 Local Government Board 322 London County Council 161 Hammersmith Borough Council 161 966 In their memorandum the Local Government Board express the opinion that any scheme should be linked up to a local hospital for assistance in cases of doubtful diagnosis. I have written to the Secretary of the West London Hospital asking whether his authorities are prepared to do this, and if so, what fee will be charged. To this letter I am awaiting a reply. 1 may say that in the boroughs where such arrangements exist, the local hospitals make no charge in some cases, in others, fees of 10s. 6d. are asked for. Your Committee recommended the adoption of the above scheme, which has been submitted to the Local Government Board, the London County Council, and the London Insurance Committee for their approval. The following is a summary of returns received from the Metropolitan Boroughs as to the action taken by them in regard to the provision of dispensaries, and schemes adopted for the treatment of tuberculosis. BOROUGHS WHERE MUNICIPAL DISPENSARIES HAVE BEEN ESTABLISHED. Capital expenditure. Annual expenditure. Remarks. Deptford. 109,182 £300 £900 Dispensary premises presented by the MaYor. Greenwich. 93,067 £2.389 £750 X Ray 10s. 6d. to 21s. Hampslead. 86,731 £156 £685 The annual expenditure has been under-estimated by £30. Lambeth. 296.724 — £I.327 Branch Dispensary established at St. Thomas's Hospital. Wandsworth. 338.998 £181 155. £1.070 Arrangements have been made with St. Thomas's Hospital for diagnostic or surgical purposes. BOROUGHS WHERE MUNICIPAL DISPENSARIES HAVE NOT BEEN ESTABLISHED. Battersea. There is a Voluntary Dispensary temporarily approved by 167,338 the Local Government Board. 41 Bermondsey. Arrangements have been made with Voluntary Dispensary. 124.213 Council contribute £200 per annum. Bethnal Green. The question is at present under consideration. 127,662 Camberwell. Question at present under consideration. 261,348 Chelsea. A scheme with Brompton Hospital has been prepared, but 66,400 negotiations are still going on with the London Insurance Committee. Finsbury. A scheme has been submitted, but not yet provided. 84.000 Fulham. Arrangements made with Voluntary Dispensary, Council 158.849 contributing £750 per annum. Hackney. No arrangements yet made. 223,369 Holborn. Arrangements are practically complete for the use of the 49,357 Tuberculosis Dispensary at University College Hospital. The gross cost payable to the Hospital has been agreed at £300. It is estimated that the actual cost to the Borough will be less than £100 per annum. Islington. A scheme has been prepared for the establishment of two 324,764 Dispensaries, which has been provisionally approved by the Local Government Board and Insurance Committee, but not as yet by the Loudon County Council. Annual cost £2,135. Kensington. A scheme has been prepared, and has been approved by the 172,317 Local Government Board, but has not yet become operative. Lewisham. A scheme prepared at estimated cost of £1,120, but not yet 172,433 in operation. Paddington. Arrangements being made with :— 142,055 (a) St. Mary's Hospital Tuberculosis Dispensary. (b) Paddington Tuberculosis Dispensary (approximately £800 per annum excluding insured per-ons). Poplar. The Council has agreed to pav to the Dispensary Committee 160,913 the sum of £1,200 per annum on condition that such ment shnll in 110 year exceed 50 per cent. of the total expenditure of the Dispensary Committee during that year. Number of patients (1913) 1,899. St. Marylebone. Arrangements made with existing institutions at estimated 112,892 cost of £200 per annum St. Pancras. Scheme not yet complete. 218,387 Shoreditch. Arrangements have been made with the Royal Hospital for 111,390 Diseases of the Chest, City Road. Dispensary managed by Joint Committee (representatives of Borough and Hospital). Number of patients (1913) 413. Estimated cost to the Borough will be £200 per annum. Stepney. Negotiations are still proceeding. 273,265 Southwark. One Dispensary will be in working at Christmas. 191,000 Stoke Newington. In process of establishment. Estimated cost £400. Esti51,000 mated number of tuberculous patients is 350. Westminster. Scheme with Charing Cross and St. George's Hospitals 152,346 under consideration. Capital cost £1,305. Cost to Council £275. Woolwich. Agreement with Central Fund £200. Number of patients 128,230 1,500. Attendance 10,000. 42 LICENSED SLAUGHTER HOUSES. The whole of the licensed slaughter houses in the Borough have been regularly inspected during the year. At the annual inspection of slaughter houses in October, 1914, I had received notices that 7 licences were to be applied for. In all cases they were found to be, as far as your Council's requirements were concerned, in a satisfactory condition and your Council decided to inform the London County Council that you offered no opposition to the renewal of those licences. At the Special Sessions at the London County Council, held in October, the 7 licences were granted. The following is a list of the licensed slaughter houses in the Borough:— NORTH DISTRICT. Wards Nos. 4, 5, 6, and 7. address. name of licensee. 185 Uxhridge Road John Mullet Allwright 40 Golcihawk Road John Trayling 138 ,, Joseph Moore CENTRE DISTRICT. Wards Nos. 2 and J. address. name of licensee. 247 Goldhawk Road Arthur W. Godfrey. 55 Dalling Road Charles Meeks. SOUTH DISTRICT. Ward No. 1. address. name of licensee. 65 King Street Thomas Holton 321 .. Stanley Brooks Midwinter BAKEHOUSES. The 61 bakehouses in the Borough have been regularly inspected. Ninety-four defects were discovered upon the premises during the year. Notices 43 were at once served upon the bakers calling upon them to comply with the regulations of your Council. In every case the notice was complied with. It was not decided to apply for any summonses against bakers whose bakehouses were found not to be in conformity with the Act, as they readily complied with the requirements of your Council when called upon by notice to do so. The following is a list of the bakehouses at present in the Borough:— NORTH DISTRICT. Wards Nos. 4, 5, 6, and 7. address. name. 410 Uxbridge Road Mackintosh & Co. †25 Uxbridge Road H. Hemmings 121 Askew Road Not in use *242 Goldhawk Road G. Lousden †*32 Norland Road J. R. Gobbing †*74 Goldhawk Road R. Steele *128 Askew Road F. Faubel *75 Uxbridge Road J. J. Saner *216 Uxbridge Road F. C. Stiles †74 Askew Road C. Steinmetz †*1 Kenmont Terrace, Harrow Road H..T. Rogers *2 Hunt Street A Burt †*4 St. Helen's Terrace W. Allinson *55 Melina Road W. Tompkins †*167 Askew Road H. F. Paulus *126 Uxbridge Road H. Seaborne 41 Gayford Road Not in use †*39 St. Ann's Road E. Tomlin *106 Goldhawk Road A. J. Wills 104 Latimer Road Not in use 166 Goldhawk Road J. Pendry †*104 Askew Road J. Miller 44 CENTRE DISTRICT. Wards Nos. 2 and 3. address. name. *54 Richmond Road J. Alderton *13 Shepherd's Bush Green Not in use *87 Masboro' Road Not in use 348 King Street W. Landgrebe *75 Blythe Road F. Guthiel *31 Goldhawk Road John Burnett †* 11 Lamington Street Ernest Witt 258 King Street P. Erbach *94 Shepherd's Bush Road Not in use *85 The Grove W. Gerres *102 Dalling Road W. Schlarb †*84 Shepherd's Bush Road F. T. Ries 70 Glenthorne Road M. Durand 24 Bradmore Park Road J. Heide & Son *77 Brackenbury Road G. Gardiner *134 Shepherd's Bush Road C. Jacobs *1 Masboro' Road W. Lorenz *98 Blythe Road P. Puhl *17 Kilmarsh Road L. Lorenz *7 Shepherd's Bush Road A. Royston *192 Dalling Road Not in use †*i Aldensley Road H. Stumm *67 Masboro' Road J. Teague *47 Milson Road W. Warwick *33 Glenthorne Road E. Winstone †* Cadby Hall, Hammer- J. Lyons & Co. smith Road †i The Grove Palmer's Stores, Ltd. 316 King Street W. Lines *6 Beaconsfield Terrace Road Not in use 45 SOUTH DISTRICT. Ward No. I. address. name. 65 Bridge Road W. Bass †88 Queen Street Not in use †1 Eyot Gardens J. R. Chibnall, Limited 2 and 4 Crispe Road Mrs. Gottig 93 Black Lion Lane A. Gurney *82 Great Church Lane G. Acres 16 'Black Lion Lane A. Mulford †213 Hammersmith Road G. Bamford †45 Great Church Lane Fullers, Limited 7 St. Peter's Road J. Miller * Underground Bakehouses. † Factory Bakehouses. 46 Table Showing Number of Families or Separate Occupiers and Number of Persons at Census, 1911. Name of District. Population, Census, 1911. Families or separate occupiers, Census, 1911. Lewisham 160,834 37,013 Wandsworth 311,360 70,155 Woolwich 121,376 26,504 Stoke Newington 50,659 12,163 Greenwich 95,968 20,692 Deptford 109,496 25,040 Camberwell 261,328 58,679 Hackney 222,533 50,622 Battersea 167,743 39,598 Hampstead 85,495 18,625 Lambeth 298,058 70,827 Hammersmith 121,521 28,462 Fulham 153.284 36,432 Poplar 162,442 35,158 Kensington 172,317 38,387 Paddington 142,551 33,925 Bermondsey 125,903 28,032 Chelsea 66,385 15,936 Islington 327,403 79,902 Bethnal Green 128,183 27,755 Shoreditch 111,390 24,801 Stepney 279,804 56,949 St. Marylebone 118,100 28,509 Southwark I91,907 44,453 St. Pancras 218,387 52,994 City of Westminster 160,261 35,984 Finsbury 87,923 21,239 Holborn 49,357 11,030 47 Table Showing extent in Acres, and Number of Persons to the Acre, at Census, 1911. Name of District. Extent in Acres, Census, 1911. Number of Persons to the Acre. Census 1911. Woolwich 8,276.6 14.66 Lewisham 7,01.44 22.92 Greenwich 3,851.7 24.96 Wandsworth 9,107.4 34.19 Hampstead 2,265.0 37.74 Hammersmith 2,282.5 53.15 Camberwell 4,480.0 58.33 Stoke Newington 863.5 58.66 City of Westminster 2,502.7 64.03 Hackney 3.287.8 67.07 Poplar 2,327.7 69.78 Deptford 1,562.7 70.06 Lambeth 4,080.4 73.04 Kensington 2,291.1 75.21 Battersea 2,160.3 77.64 St. Marylebone 1,472.8 80.22 St. Pancras 2,694.4 80.98 Bermondsey 1,499.6 83.95 Fulham 1,703.5 89.98 Chelsea 659.6 100.64 Paddington 1,356.1 105.11 Islington 3,091.5 105.90 Holborn 405.1 121.83 Finsbury 586.6 149.87 Stepney 1,765.6 158.47 Bethnal Green 759.3 168.81 Shoreditch 657.6 169.38 Southwark 1,131.5 169.59 48 CUSTOMS AND INLAND REVENUE ACTS. During the year 16 applications were received for certificates under these Acts. In every case the premises were inspected as to the sanitary conditions, and in no case was the certificate granted until the whole of the sanitary requirements were carried out, so as to place the premises in a proper sanitary condition. The following is a list of applications received during the year under the Inland Revenue Acts:— Name and Situation of Property. No. of Houses and blocks for which applications were received. No of Tenements therein. No. of Tenements for which Certificate was granted. No. of Tenements for which Certificate was refused. No. of Tenements for which Certificate was deferred. 1 to 8, Blue Hall Mansions 1 Block 8 8 - - 1 to 12, Court Mansions, Vencourt Place 2 Blocks 12 11 1 - 27 to 33. King Street 4 Houses 4 4 — - 110 to 112, Sinclair Road 2 Houses 4 — 4 — 16, Leysfield Road 1 House 2 — 2 - 103, Dailing Road 1 House 2 — 2 — 22, 22A, 22B, Goldhawk Road 3 Shops 3 — 3 — 6 to 16, Lanark Mansions 3 Houses 6 - - 6 (not completed) 9 to19 3 Houses 6 - - 6 (not completed) 1to 4, „ „ 2 Houses 4 — 4 — 114, Sinclair Road 1 House 2 — 2 — 21, Sinclair Gardens 1 House 2 — 2 - 1 to 4, Broadway House Mansions 1 Block 4 — 4 — 26 to 30. Addison Court Mansions 1 Block 3 — 3 - 31 to 33, ,, 1 Block 2 2 — 7 to 9, I'he Broadway 2 houses 2 — 2 — Totals 29 66 23 31 12 49 The following is a list of the premises certified by me during the year:— 1 to 8, Blue Hall Mansions. 27 to 33. King Street. 1 to 8, and 10 to 12. Court Mansions, Vencourt Place, King Slreet. No application was received under Section 35 of the Towns Planning Act, 1909. SEIZURE OF UNWHOLESOME FOOD. On March 5th a resident of the Borough brought to the Public Health Department, five veal cutlets which he said he had purchased the same day about 1 o'clock. The cutlets were submitted to a Justice of the Peace, who gave an order for their destruction as being unfit for the food of man. A summons was taken out, but had to be withdrawn owing to the purchaser disappearing from the neighbourhood. On December 3rd, Sanitary Inspector Cromack was on duty at the White City Encampment, when his attention was drawn to some meat which had been deposited by the Contractors, Messrs. J. Lyons & Co., Ltd., in the larder adjoining the Imperial Banqueting Room, and was requested to examine it. He immediately proceeded to the larder and examined the meat. He found the same to be unfit for the food of man, and informed the officer who had called his attention to its condition, that he intended seizing the meat, and requested him to place a guard over the same, until the arrival of the Medical Officer of Health. I proceeded to the White City and inspected the meat in the presence of an officer and some other members of the Sanitary Company, and representatives of the Company. The meat, which consisted of five trays of uncooked and seven trays of cooked, and weighed 12 cwt., was then placed into seventeen trays for the convenience of removal and submitted to W. P. Hunter, Esq., J.P., who condemned the same and gave an order for its E 50 destruction. The meat was then destroyed in the Council's destructor. The matter was reported to your Public Health Committee, who gave instructions for proceedings to be taken against the Contractors, Messrs. J. Lyons & Co., Ltd. (Result of proceedings will be reported in my Annual Report for 1915.) SANITARY NOTICES AND ADMINISTRATION. In February the Local Government Board under the powers conferred upon them, issued a General Order whereby the disease known as Ophthalmia Neonatorum was made a notifiable disease, and made the following Regulations, which came into force on the 1st day of April, 1914. PUBLIC HEALTH, ENGLAND. Prevention of Epidemic, Endemic and Infectious Diseases. The Public Health (Ophthalmia Neonatorum) Regulations, 1914. Dated February 5th, 1914. 60,088. To the Mayor, Aldermen, and Commons of the City of London, in Common Council assembled;— To the Councils of the several Metropolitan Boroughs, Municipal Boroughs, and other Urban Districts-in England and Wales; — To the Councils of the several Rural Districts in England and Wales;— To all Medical Practitioners;— To all Certified Midwives;— And to all others whom it may concern. Whereas We, the Local Government Board, are empowered by section 130 of the Public Health Act, 1875, as amended by the Public Health Act, 1896, from time to time, to make, alter, and revoke Regulations with a view to the treatment of persons affected with any endemic or infectious disease and for preventing the spread of the disease; and to provide for the enforcement and execution of the Regulations; 51 And whereas Ophthalmia Neonatorum as hereinafter defined is an endemic and an infectious disease: Now therefore, We, by this Our Order and in the exercise of the powers conferred upon Us by the Public Health Act, 1875, the Public Health (London) Act, 1891, and the Public Health Act, 1896, and of every other power enabling Us in that behalf, do hereby make the following Regulations, that is to say:— Definitions. Article I.—In these Regulations, unless the contrary intention appears:— (a) Words importing the masculine gender include females; (b) Words in the singular include the plural, and the words in the plural include the singular; (c) Expressions referring to writing include reference to printing, and to other modes of representing or reproducing words in a visible form, and references to printing include references to other mechanical modes of so representing or reproducing words; (d) The expression "Local Authority" means, as the case may be, the Mayor, Aldermen, and Commons of the City of London in Common Council assembled, the Council of a Metropolitan Borough, the Council of a Municipal Borough or other Urban District, or the Council of a Rural District; (e) The expression "District" means the District subject to the jurisdiction of the Local Authority for the purposes of the Public Health (London) Act, 1891, or of the Public Health Act, 1875, as the case may be; (f) The expression "Medical Officer of Health" means Medical Officer of Health of a Local Authority; (g) The expression "Medical Practitioner" means any person for the time being registered under the Medical Acts; (h) The expression "Certified Midwife" means a woman certified under the Midwives Act, 1902; (i) The expression "Ophthalmia Neonatorum" means a purulent discharge from the eyes of an infant commencing within twenty-one days from the date of its birth. 52 Commencement of Regulations. Article II.—These Regulations shall come into operation on the First day of April, One thousand nine hundred and fourteen, and shall then and thereafter apply and have effect throughout England and Wales, and shall be enforced and executed by every Local Authority. Supply Forms oj Notification. Article III.—For the purposes of these Regulations every Local Authority shall provide and maintain a sufficient supply of printed copies of the Form set out in the Schedule to these Regulations, and shall as soon as practicable after these Regulations come into operation, and afterwards from time to time when application is made to them, furnish printed copies of the said Form to every certified midwife resident or practising within the District of the Local Authority. Notice of Provisions of Regulations. Article IV.—The Local Authority shall forthwith cause notice to be given to all Medical Practitioners and to all Certified Midwives resident or practising within the District of the Local Authority of the duties imposed upon them by these Regulations. Notification by Medical Practitioners. Article V.—(1) Subject to the provisions of these Regulations every Medical Practitioner, on first becoming aware that a child upon whom he is in professional attendance is suffering from Ophthalmia Neonatorum, shall forthwith make and sign a notification of the case in the Form prescribed for the purpose of certificates under Section 3 of the Infectious Disease (Notification) Act, 1889, at the same time stating in writing, either on the form or on a separate sheet attached to the form, the date of birth of the child, the name and address of the parent or other person, if any, having charge of the child, and the date of the onset of the disease, and shall transmit the notification and statement aforesaid to the Medical Officer of Health for the District within which the place of residence of the parent or other person, if any, having charge of the child is situate at the date of notification: 53 Provided that a Medical Practitioner shall not be required to notify a case of Ophthalmia Neonatorum under these Regulations in any of the following cases; that is to say,— (а) If the case is notifiable or has been notified under the Infectious Disease (Notification) Act, 1889, Section 55 of the Public Health (London) Act, 1891, or under the provisions of any Local Act or Order made thereunder; or (b) If the case has been notified by a Certified Midwife as hereinafter provided. (2) Every Medical Practitioner who transmits to a Medical Officer of Health a notification of a case of Ophthalmia Neonatorum under the infectious Disease (Notification) Act, 1889, Section 55 of the Public Health (London) Act, 1891, or under the provisions of any Local Act or Order made thereunder, shall at the same time state in writing, either on the form or on a separate sheet attached to the form, the date of birth of the child, the name and address of the parent or other person, if any, having charge of the child, and the date of the onset of the disease. Notification by Certified Midwives. Article VI.—Subject to the provisions of Article X. of these Regulations every Certified Midwife who has reasonable grounds for supposing that a child upon whom she is in attendance or whom she is called in to visit in the course of her practice is suffering from Ophthalmia Neonatorum, shall, unless the case has been already notified by a Medical Practitioner, forthwith make and sign a notification of the case in the Form set out in the Schedule to these Regulations, and shall transmit the notification to the Medical Officer of Health for the District within which the place of residence of the parent or other person, if any, having charge of the child is situate at the date of notification. Transmission of Notifications. Article VII.—A notification to be transmitted to a Medical Officer of Health in pursuance of these Regulations shall be enclosed in a sealed envelope addressed to that Officer and may be transmitted by being delivered to him or by being delivered at his office or residence, or may be sent by prepaid letter post addressed to him at his office or at his residence. 54 Fees for Notification. Article VIII.—(1) The Local Authority shall pay to every Medical Practitioner a fee of two shillings and sixpence for each notification duly made, signed and transmitted by him under these Regulations if the case occurs in his private practice, and of one shilling if the case occurs in his practice as medical officer of any public body or institution. (2) The Local Authority shall pay to every Certified Midwife a fee of one shilling for each notification duly made, signed and transmitted by her under these Regulations. (3) Every fee shall be paid as soon as practicable after the end of the quarter during which the notification was sent, and the Local Authority shall not require before payment an account of fees claimed under these Regulations. (4) The said fees shall in each case be deemed to cover all expenses, including the cost of transmission. Duties of Medical Officers of Health. Article IX.—The duties assigned to the Medical Officer of Health by the Sanitary Officers (London) Order, 1891, or the Sanitary Officers (Outside London) Order, 1910, as the case may be, shall be deemed to extend to and to include all action by the Medical Officer of Health in the execution of these Regulations. Notification not required in certain cases. Article X.—Nothing in these Regulations shall be deemed to require a notification to be transmitted to a Medical Officer of Health in respect of the child of an inmate of any building, ship, vessel, boat, tent, van shed or similar structure belonging to His Majesty the King. Short Title. Article XI.—These Regulations may be cited as "The Public Health (Ophthalmia Neonatorum) Regulations, 1914.'' During the Year the London County Council issued By-laws made by them under Section 9 of the London County Council (General Powers) Act, 1908, for regulating the conduct of the business of a Fish Curer and a Vendor of Fried Fish. 55 FISH CURER. By-laws made by the Council under Section 9 of the London County Council {General Powers) Act, 1908, for regulating the conduct, within the Administrative County of London (elsewhere than in the City of London and so much of the Port of London as established for the purposes of the laws relating to the customs of the United Kingdom as is within the county) of the business of a fish curer, and with respect to the premises in or upon which such business is carried on, and the apparatus, utensils and appliances used for the purposes of or in connection with such business. 1.—A person carrying on the business of a fish curer shall not knowingly allow any person suffering from an infectious disease to take part or assist in the preparation, storage or distribution of food in connection with his business in such a manner as may be likely to spread such infectious disease. 2.—A person carrying on the business of a fish curer shall not, for the purposes of his business, cause, suffer or permit the gutting, cleansing, curing (otherwise than by drying or smoking) or storing of fish or other article of human food in any room or place which is not constructed in accordance with the following requirements— (a) Such room or place, if used as aforesaid in wet weather, shall be provided with a rainproof ceiling or roof. (b) Such room or place shall be adequately lighted, and if provided with windows or other openings for the purpose of lighting, the aggregate area of such windows or openings shall be equal to at least one-tenth of the floor area of such room or place, and the windows shall be so constructed that a portion equal to at least one-twentieth of the floor area can be opened. (c) Such room or place shall have permanent openings to the external air for ventilation, the aggregate area of such openings shall be equal to at least one-fortieth of the floor area of such room or place, and such openings shall be so placed as to secure the efficient ventilation of the whole of the air space of such room or place. (d) So far as may be necessary to prevent the absorption of any filth or refuse or any noxious, offensive or other similar matter which may fall or be 56 splashed thereon, or come into contact therewith, the surface of the walls and floor of such room or place shall be constructed of, or covered with, suitable smooth impervious material. Adequate provision shall be made for the draining or removal of liquid matter falling or placed upon the floor. 3.—A person carrying on the business of a fish curer shall at all times employ such means and adopt such precautions as may be necessary for preventing effluvium arising from the gutting, cleansing, curing, drying, smoking or storing of fish or other article of human food for the purposes of his business. 4.—A person carrying on the business of a fish curer shall not for the purposes of his business cause, suffer or permit the gutting, cleansing, curing, drying, smoking or storing of fish or other article of human food in any place in which any poultry (including any domestic fowl, turkev, goose, duck, guinea-fowl or pigeon), horse, ass, mule, pig, goat, dog or other animal may be kept, or in any place communicating with a place in which any such animal may be kept, except through the open air or through an intervening ventilated space. 5.—A person carrying on the business of a fish curer shall not cause or suffer to be kept upon his premises for a period longer than twenty-four hours any hamper, basket, box, trunk, or barrel which has contained wet fish, for the purposes of his business, and which may be in an offensive condition. 6.—A person carrying on the business of a fish curer shall cause to be provided and properly maintained at all times on his premises adequate and efficient means for securing the personal cleanliness of any person taking part or assisting in the preparation or storage of food in connection with his business. 7.—A person carrying on the business of a fish curer— (a) Shall provide a sufficient number of vessels or receptacles properly constructed of galvanised iron or other non-absorbent material and furnished with closely fitting covers for the purpose of receiving and subject as is hereinafter provided for conveying away from his premises all fish skins, gut, garbage or other putrescible refuse produced in carrying on his business, and all fish roe or 57 other article of human food dealt with in his business which is diseased, unsound, unwholesome or unfit for human consumption and which is upon his premises. (b) Shall cause all such aforesaid fish skins, gut, bage or other putrescible refuse to be placed in such vessels or receptacles immediately on its production, and all such aforesaid fish roe or other article of human food to be at all times kept in such vessels or receptacles. (c) Shall cause all such aforesaid fish skins, gut, bage or other putrescible refuse and all such aforesaid fish roe or other article of human food to be removed from his premises at least once every twenty-four hours, either in the vessels or receptacles provided in accordance with paragraph (a) or in like vessels or receptacles provided by the person removing such refuse or article. (d) Shall cause all vessels or receptacles provided in accordance with paragraph (a) to be thoroughly cleansed at least once in every twenty-four hours whilst upon his premises and the external surfaces of such vessels or receptacles to be at all times whilst upon his premises maintained in a cleanly condition. 8.—A person carrying on the business of a fish curer shall cause the floor, inner surface of walls, and the ceiling or roof of every room, yard, hauling way or other place in which any process of his business is carried on, and all apparatus, utensils and appliances used for the purposes of or in connection with his business to be kept and maintained at all times in proper order and repair. 9.—A person carrying on the business of a fish curer shall cause the inner surfaces of every wall and the ceiling or inner surface of the roof of any part of the premises on which any process of his business is carried on to be thoroughly washed with hot limewash at least four times in every year, that is to say, between the first and tenth days of the months of March, June, September and December respectively, and at such other times as may be necessary for the purpose of keeping the premises in a clean and wholesome condition. Provided, nevertheless, that this by-law shall not apply to any 58 part of such ceilings and surfaces which is property painted and varnished, or covered with hard, smooth, impervious material. 10.—A person carrying on the business of a fish curer shall cause every smoking or drying kiln used for the purposes of his business to be constructed of hard and smooth brick, stone, or other suitable fireproof material, and to be so constructed and used that all vapour or smoke discharged therefrom shall be effectually conveyed away in such a manner as to admit of its diffusion without noxious or injurious effects. 11.—A person carrying on the business of a fish curer shall, for the purposes of his business, provide adequate gutting surfaces of slate, glazed earthenware or other smooth impervious material. 12.—A person carrying on the business of a fish curer shall cause all tanks, vats or similar receptacles used for salting or brining for the purposes of his business to be constructed with internal surfaces of a suitable smooth and impervious material. 13.—A person carrying on the business of a fish curer shall cause the surface of every yard and hauling way used in connection with his business to be properly paved with impervious material. He shall cause every such yard and hauling way to have a proper slope and channel towards a trapped drain inlet, and to be effectually drained by adequate drains communicating with a public sewer. 14.—A person carrying on the business of a fish curer who shall offend against any of the foregoing by-laws, shall be liable for every such offence to a penalty of five pounds, and, in the case of a continuing offence, to a further penalty of forty shillings for each day during which the offence may be continued after written notice of such offence from the Sanitary Authority within whose district the premises on which the business of the fish curer is carried on are situate, or in cases where the London County Council are empowered to act in pursuance of the provisions of section 101 (2) of the Public Health (London) Act, 1891, from the London County Council. Provided nevertheless that the Court before whom any information may be laid, or any proceedings may be taken in respect of any such offence, may, if the Court think fit, 59 adjudge the payment as a penalty of any sum less than the full amount of the penalty imposed by this by-law. The foregoing by-laws were made by the London County Council on the 17th day of June, 1913, and the common seal of the London County Council was hereunto affixed on the I ith day of September, 1913. James Bird, Deputy Clerk of the London County Council. Allowed by the Local Government Board this 28th day of February, 1914. Walter T. J erred, Assistant Secretary, Acting on behalf of the said Board under the authority of their General Order, dated the 26th day of May, 1877. In pursuance of the powers conferred on me by section 9 (5) of the London County Council (General Powers) Act, 1908, as regards any business carried on in any factory or workshop to which the Factory and Workshop Act, 1901, applies, I hereby confirm the foregoing by-laws. R. McKenna, One of His Majesty's Principal Secretaries of State. Whitehall, 24th March, 1914. VENDOR OF FRIED FISH. By-laws made by the London County Council under Section 9 of the London County Council (General Powers) Act, 1908, for regulating the conduct, within the Administrative County of London (elsewhere than in the City of London and so much of the Port of London as established for the purposes of the laws relating to the customs of the United Kingdom as is within the County) of the business of a vendor of fried fish, and with respect to the premises in or upon which such business is carried on, and the apparatus, utensils, and appliances used for the purposes of or in connection with such business. 1. A person carrying on the business of a vendor of fried fish shall not knowingly allow any person suffering from an infectious disease to take part or assist in the preparation, storage, or distribution of food in connection with his business in such a manner as may be likely to spread such infectious disease. 60 2. A person carrying on the business of a vendor of fried fish shall not for the purposes of his business cause, suffer, or permit the gutting, cleansing, or storing of fish or other article of human food in any room or place which is not constructed in accordance with the following requirements— (а) Such room or place, if used as aforesaid in wet weather, shall be provided with a rain-proof ceiling or roof. (b) Such room or place shall be adequately lighted, and if provided with windows or openings for the purpose of lighting, the aggregate area of such windows or openings shall be equal to at least one-tenth of the floor area of such room or place, and the windows shall be so constructed that a portion equal to at least one-twentieth of the floor area can be opened. (c) Such room or place shall have permanent openings to the external air for ventilation, the aggregate area of such openings shall be equal at least to one-fortieth of the floor area of such room or place, and such openings shall be so placed as to secure the efficient ventilation of the whole of the air space of such room or place. (d) So far as may be necessary to prevent the absorption of any filth or refuse or any noxious, offensive, or other similar matter which may fall or be splashed thereon, or come into contact therewith, the surface of the walls or floor of such room or place shall be constructed of or covered with suitable smooth, impervious material. Adequate provision shall be made for the draining or removal of liquid matter falling or placed upon the floor. 3. A person carrying on the business of a vendor of fried fish shall at all times employ such means and adopt such precautions as may be necessary for preventing effluvium arising from the gutting, cleansing, or storing of fish or other article of human food for the purposes of his business. 4. A person carrying on the business of a vendor of fried fish shall not, for the purposes of his business, cause, suffer, or permit the gutting, cleansing, frying, or storing of fish or other article of human food in any place in which any poultry (including any domestic fowl, turkey, goose, duck, guinea-fowl, or pigeon), horse, ass, mule, pig, goat, dog, or other animal may be kept, or in any place communicating with a place in 61 which any such animal may be kept, except through the open air, or through an intervening ventilated space. 5. A person carrying on the business of a vendor of fried fish shall not cause or suffer to be kept upon his premises for a period longer than twenty-four hours, any hamper, basket, box, trunk, or barrel which has contained wet fish for the purposes of his business, and which may be in an offensive condition. 6. A person carrying on the business of a vendor of fried fish shall cause to be provided and properly maintained at all times on his premises adequate and efficient means for securing the personal cleanliness of any person taking part or assisting in the preparation, storage, or distribution of food in connection with his business. 7. A person carrying on the business of a vendor of fried fish shall cause all fish deposited on his premises for the purposes of his business to be thoroughly gutted and cleansed before being fried. 8. A person carrying on the business of a vendor of fried fish— (a) Shall provide a sufficient number of vessels or receptacles properly constructed of galvanised iron or other non-absorbent material and furnished with closely fitting covers for the purpose of receiving and subject as is hereinafter provided for conveying away from his premises all fish skins, gut, garbage, or other putrescible refuse produced in carrying on his business, and all fish roe or other article of human food dealt with in his business which is diseased, unsound, unwholesome, or unfit for human consumption, and which is upon his premises. (b) Shall cause all such aforesaid fish skins, gut, garbage, or other putrescible refuse to be placed in such vessels or receptacles immediately on its production, and all such aforesaid fish roe or other article of human food to be at all times kept in such vessels or receptacles. (c) Shall cause all such aforesaid fish skins, gut, garbage, or other putrescible refuse and all such aforesaid fish roe or other article of human food to be removed from his premises at least once every twenty-four hours, either in the vessels or receptacles provided 62 in accordance with paragraph (a) or in like vessels or receptacles provided by the person removing such refuse or article. (d) Shall cause all vessels or receptacles provided in accordance with paragraph (a) to be thoroughly cleansed at least once in every twenty-four hours whilst upon his premises, and the external surfaces of such vessels or receptacles to be at all times whilst upon his premises maintained in a cleanly condition. 9. A person carrying on the business of a vendor of fried fish shall cause the floor, inner surface of walls, and the ceiling or roof of every room, yard, hauling way or other place in which any process of his business is carried on, and all apparatus, utensils, and appliances used for the purposes of or in connection with his business to be kept and maintained at all times in proper order and repair. 10. A person carrying on the business of a vendor of fried fish shall cause the inner surfaces of every wall and the ceiling or inner surface of the roof of any part of the premises on which any process of his business is carried on to be thoroughly washed with hot limewash at least four times in every year, that is to say, between the first and tenth days of the months of March, June, September, and December respectively, and at such other times as may be necessary for the purpose of keeping the premises in a clean and wholesome condition. Provided, nevertheless, that this by-law shall not apply to any part of such ceilings and surfaces which is properly painted and varnished, or covered with hard, smooth, impervious material. 11. A person carrying on the business of a vendor of fried fish shall cause the external surface of every furnace used for the purposes of his business and the surfaces of all walls and floors adjacent to such furnace to be constructed of of a hard, smooth, fireproof and impervious material. He shall cause every such furnace to be provided with side screens and a suitable hood of a hard, smooth, fireproof, and impervious material for the purpose of collecting all gas or vapour emitted during the process of frying, and shall cause such hood to be connected with a flue having a good draught. He shall in every case cause the gas or vapour either to be discharged from such flue into the external air in such a manner and at such a height as to admit of its diffusion without noxious or injurious effects or to pass from such flue 63 through a fire or into a suitable condensing apparatus in such a manner as effectually to consume the gas or vapour or to deprive the same of all noxious or injurious qualities. 12. A person carrying on the business of a vendor of fried fish shall for the purposes of his business provide adequate gutting surfaces of slate, glazed earthenware, or other smooth and impervious material. 13. A person carrying on the business of a vendor of fried fish shall cause the surface of every yard and hauling way used in connection with his business to be properly paved with impervious material. He shall cause every such yard and hauling way to have a proper slope and channel towards a trapped drain inlet, and to be effectually drained by adequate drains communicating with a public sewer. 14. A person carrying on the business of a vendor of fried fish, who shall offend against any of the foregoing by-laws, shall be liable for every such offence to a penalty of five pounds, and in the case of a continuing offence to a further penalty of forty shillings for each day during which the offence may be continued after written notice of such offence from the Sanitary Authority within whose district the premises on which the business of the vendor of fried fish is carried on are situate, or, in cases where the London County Council are empowered to act in pursuance of the provisions of section 101 (2) of the Public Health (London) Act, 1891, from the London County Council. Provided, nevertheless, that the Court before whom any information may be laid, or any proceedings may be taken in respect of any such offence, may, if the Court think fit. adjudge the payment as a penalty of any sum less than the full amount of the penalty imposed by this by-law. The foregoing by-laws were made by the London County Council on the 17th day of June, 191J, and the common seal of the London County Council was hereunto affixed on the 11th day of September, 1913. James Bird, Deputy Clerk of the London County Council. Allowed by the Local Government Board this 28th day of February, 1914. Walter T. Jerred, Assistant Secretary Acting on behalf of the said Board under the authority of their General Order, dated the 26th day of May, 1877. 64 In pursuance of the powers conferred on me by section 9 (5) of the London County Council (General Powers) Act, 1908, as regards any business carried on in any factory or workshop to which the Factory and Workshop Act, 1901, applies, I hereby confirm the foregoing by-laws. R. McKenna, One of His Majesty's Principal Secretaries of State. Whitehall, 24th March, 1914. SANITARY STAFF. On the 14th September I submitted to your Public Health Committee the following report, dealing with the rearranging of the duties of the Sanitary Staff, which was adopted and came into operation on the 19th October, 1914. 14th September, 1914. To the Public Health Committee of the Hammersmith Borough Council. Gentlemen,—i wish to bring before you for your consideration a scheme for rearranging the duties of the Sanitary Staff. I understand that the matter has been the subject of much correspondence and difference between this Council, the Local Government Board, and the London County Council, and that many reports have been made on the subject during the past ten years. The main contention of the Local Government Board and the London County Council appeared to be that too many of the Sanitary Inspectors were detailed for special duties. This was alleged to cause overlapping, extra labour, waste of time, and consequently a lesser degree of efficiency. In 1902 Dr. Young, of the London County Council, made an enquiry into the administration of the Public Health Department of Hammersmith. In his report he mentions the fact that there were at that time four of the Inspectors engaged on special duties, which made it possible for all four of the Inspectors and one District Inspector to be inspecting in the same road at the same time. At the present time there are five Special Inspectors, and therefore it is now possible for six Inspectors to be in the same road at the same time. The same defect in the administration was pointed out by 65 Councillor Pascall in a report made by him to the Public Health Committee when Chairman. It was recommended by Dr. Young that the Borough be subdivided into six districts, that an Inspector be appointed to each district to carry out the whole of the sanitary duties with the exception of the Factory and Workshops Act and the inspection of houses let in lodgings. These duties were to be undertaken by Special Inspectors. I have gone into the question very thoroughly, and find that there is under the present system a considerable amount of overlapping, unnecessary labour and waste of time. In my opinion the work can be much more efficiently done by dividing the Borough into eight districts. The inspectors appointed to the districts to carry out the whole of the sanitary duties with the exception of the Food and Drugs Act, Ice Cream Vendors and Milk Vendors. These duties for the present to be carried out by a Special Inspector. In this scheme each inspector will be responsible for his own particular district. His work will be condensed into a comparatively small area, and he should be able to keep every street and house under perfect control. In this particular I should like to emphasise the importance of each Inspector becoming intimately conversant with every street, alley and house in his own district. It is only by this close knowledge that it is possible to achieve satisfactory results in public health work. At the present moment this country is in some danger of serious and widespread epidemics of smallpox, enteric fever, and possibly cholera being introduced through soldiers returning from the front and immigration of refugees, some of whom are resident in Hammersmith even now. Therefore the Committee will see how essential it is to organise the Public Health Department to its best possible degree of efficiency, and that this should be done without loss of time. Of course it is quite possible that this scheme which I advise the Committee to adopt may require, at a future time, revising in some of the details. In that case I shall bring the matter to the notice of the Committee. On the appended sheet the boundaries of each suggested district are given with population and number of tenements. In mapping out the districts regard has been paid to the population, number of tenements, and character of each area. In this way the Borough has been divided in such a way as F 66 to give each Inspector as nearly as possible an equal amount of work to do. Proposed New Districts. District No. 1. Population 14,704. Tenements 3,682 (Olympia). Boundary. South. Hammersmith Road. East. West London Railway. North. Goldhawk Road. West. Shepherd's Bush Road, Blythe Road, Girdler's Road, and Brook Green. District No. 2. Population 16,416. Tenements 3,923. Boundary. East. Shepherd's Bush Road, Blythe Road, Girdler's Road, Brook Green, and Edith Road. South. District Railway, Yeldham Road, Chancellors Road, and River Thames. West. Hammersmith Bridge Road, Broadway, and Metropolitan Railway. North. Goldhawk Road. District No. 3. Population 14,068. Tenements 3,543. Boundary. East. Metropolitan Railway. South. Hammersmith Bridge Road, Bridge Avenue, and King Street. West. Studland Street, Glenthorne Road, Lamington Street, Bradmore Park Road, Carthew Road, and Brackenbury Road. North. Goldhawk Road. District No. 4. Population 15,934. Tenements 3,806. Boundary. East. Brackenbury Road, Carthew Road, Lamington Street, Glenthorne Road, Studland Street, King Street, and Bridge Avenue. South. River Thames. West. British Grove and Goldhawk Road. North. Goldhawk Road. District No. 5. Population 13,838. Tenements 3,301. Boundary. South. Goldhawk Road and Stamford Brook Road. West. North and South Western Junction Railway. North. Boundary Line from Worple Way to St. Elmo Road and Uxbridge Road. East. Percy Road, Davisville Road, and Askew Road. District No. 6. Population 15,140. Tenements 3,698. Boundary. West. Percy Road, Davisville Road, and Askew Road. North. Uxbridge Road. South. Goldhawk Road. East. Junction of Goldhawk Road and Uxbridge Road. District No. 7. Population 13,106. Tenements 3,201 (Shepherd's Bush Exhibition). Boundary. South. Uxbridge Road. West. Old Oak Road, and Old Oak Common Lane. North. Great Western Railway. East. Scrubbs Lane and Wood Lane. District No. 8. Population 14,511. Tenements 3,323. Boundary. West. Wood Lane, Scrubbs Lane, Great Western Railway, and Old Oak Common Lane. North. Harrow Road and Borough Boundary. East. Borough Boundary Line from Harrow Road to Brewster Gardens, and Eastern Boundary Line from Latimer Road to Uxbridge Road. South. Uxbridge Road. 67 HOUSE TO HOUSE. During the year the House to House Visitation was carried out by the Inspector appointed for that purpose up to the middle of October, when the work was taken over by the Inspectors appointed to the districts. As a result of this work, 1,378 inspections were made, 479 notices served, and 576 complied with. HOUSES LET IN LODGINGS. During the last year the Public Health Committee gave directions for the registration of 215 "houses let in lodgings or occupied by the members of more than one family," making a total with those previously registered of 2,732 premises. Upon the registration a copy of the By-laws of your Council, under which such houses are registered, was forwarded to the landlord (within the meaning of the By-laws) for his guidance. From various causes 60 houses have been removed from the list, leaving a total number now on the Register of 2,672. During the year 709 notices were served and 765 were complied with. The registered premises were visited as often as time would allow by the special Inspectors appointed for that purpose. NOTICES. The following is a list of Preliminary Notices served and complied with during the year:— No. of Notices served. No. of Notices complied with. Bakehouses 94 94 Customs and Inland Revenue 28 23 Houses let in Lodgings 709 765 House to House 479 576 Housing and Town Planning Act 326 303 Factories and Workshops, etc. 293 310 Smoke 6 6 Ice Cream Vendors 14 13 Milk Vendors 9 8 Miscellaneous 1,819 1,626 3,777 3,724 68 SHEPHERDS BUSH EXHIBITION. White City. During the year this Exhibition was opened as The Anglo-American Exhibition. The whole of the sanitary arrangements were under daily inspection by the Sanitary Inspector appointed to supervise the same. In a few instances it was found necessary to serve notices calling upon the owners to carry out certain work which was immediately attended to. At the close of the Exhibition, the grounds and buildings were taken over by the London Territorial Association for the purpose of housing troops. The premises were kept under inspection, and many improvements were carried out for the comfort of the troops. The number of troops stationed at this encampment varied from 4,000 to 10,000 officers and men. Every assistance was rendered by this department to the military authorities in the camp. The Sanitary Inspector visited the premises almost daily, and assisted in the inspection of food and gave advice as regards the sanitary arrangements. Many cases of infectious disease including measles, scarlet fever, diphtheria and chickenpox, were notified and immediately removed to appropriate hospitals. Twenty-one cases of scarlet fever, 20 cases of diphtheria, 4 cases of measles, and 1 case of chickenpox were notified and removed to the hospitals of the Metropolitan Asylums Board. Six cases of scarlet fever and 9 cases of diphtheria were, however, returned from the hospitals as not suffering. OLYMPIA. At the commencement of the war, Olympia was taken over by the War Office and used as a detention camp for German prisoners of war. The premises were kept under constant inspection and every precaution taken to keep them in a proper sanitary condition. Towards the end of the year arrangements were made for the removal of the prisoners to other detention 69 camps in the country and the premises were subsequently and are still being used for the purpose of storing army clothing and bedding. A small party of men under the command of an officer are stationed in the building. Two cases of diphtheria were notified and removed to the hospitals of the Metropolitan Asylums Board. One case was returned from the hospital as not suffering. HOUSING AND TOWN PLANNING ACT, 1909. Regulations of Local Government Board. During the year 662 inspections were made by Sanitary Inspector Cosson, having inspected the houses in the list of streets adopted by your Council. As a result of his inspection 290 Intimation Notices were served and 276 complied with, a list of which follows:— Notices served. Complied with. Notices served. Complied, with. Bridge Street 10 10 Melina Road 31 29 Aspen Place 11 11 Hunt Street 42 42 Trafalgar Street 21 21 Latimer Mews 7 7 Felgate Mews 3 2 Southbrook Street 33 32 Orris Mews 6 6 Coleman's Buildings 6 6 Grove Mews 10 8 Lycett Place 8 8 Brook Green Place 8 8 Priory Mews 4 3 Rayleigh Road 58 53 Barb Mews 5 4 Leffern Road 27 26 290 276 In July, Dr. Jackson, who was then Acting Medical Officer of Health, made a representation to the Public Health Committee under the Housing and Town Planning Act, 1909, in reference to the premises, Nos. 20-30, Boxmoor Street, Notting Hill, when your Committee decided to issue Closing Orders on the properties. This matter is being dealt with and will be reported upon in my next Annual Report. In December I submitted to your Public Health Committee the following report dealing with the insanitary conditions that existed in the houses situated in Aspen Place, Trafalgar Street, Lower Mall, Hermitage Cottages and Cove Cottages:— 70 14th December, 1914. To the Public Health Committee of the Hammersmith Borough Council. Gentlemen.—Acting under your instructions I have, together with the Inspector for the district, made an inspection of some of the houses in the River Ward as to their sanitary and hygenic condition. Before giving the result of this inspection, I should like to say that I had intended carrying out this work before the Committee paid their visit to this area, and had already discussed the matter with the Town Clerk. It was my intention originally, to embrace in the inspection and report, the whole of that district which lies between King Street on the North and the River on the South, Waterloo Street on the East and Hog Lane on the West. Unfortunately, owing to pressure of other work it has been impossible in the time to carry out the whole of the work originally intended, and in this report, I have only included that area which was in most urgent need of attention. This consists of some property in Aspen Place, Trafalgar Street, Lower and Upper Mall. Aspen Place. This is little more than a pathway, the width of which in its widest place is only 11 feet, and in its narrowest is as little as 5 feet 6 inches. It is often obstructed by the barrows of the residents. The part extending from Waterloo Street as far as the Common Lodging House is fairly wide, but about 10 feet of the path is railed off and not in public use. No. 1, Aspen Place is a Motor Car works. No. 2, Aspen Place is a Common Lodging House which is in good structural condition. A small one-story addition has been built to this and projects on to the pathway. Nos. 3 to 15, Aspen Place consist of cottages situated on the North side. Nos. 3, 4 and 5, are situated to the East of Trafalgar Street, whilst Nos. 6 to 15, lie to the West. They consist generally of four-roomed cottages and are badly lighted and ventilated. For the most part they are in an extremely bad condition of repair, some are even dangerous. Generally speaking the defects of most importance are the lack of damp proof courses and ventilation under floors, dampness of the walls which in many cases extends to the ceiling of the ground 71 floor. As a result of this most of the ceilings are sagging and unsound. The ceilings of the upper floors are sagged and unsound and some are dangerous, as a result of past or present dampness due to the dilapidated and defective roofs. Practically all the ground floor walls are hoarded for a distance of 3 to 4 feet from the ground. This has evidently been done to cover up the damp condition of the walls. In some cases the boards are worn through and the damp condition of walls can be demonstrated above the boards. The wall of No. 5, Aspen Place, abutting on Trafalgar Street, bulges in a dangerous manner from the level of the first floor up to the roof. The ground floors of the houses are below the street level. The rooms are small, badly lighted and ventilated. Some of the windows open at the bottom, but few at the top. Very few windows were found open during the inspection, and they are the principal and practically the only means of ventilation. This is not entirely the fault of the occupier as the windows are old and decayed and of defective construction. The floors are in many cases worn, the woodwork perished and defective. The tenants invariably complain of being overrun with rats, some of which have been seen on the bed and in two cases children have been bitten. The area of some of the yards of the houses are very limited. In the case of Nos. 3, 4 and 5, Aspen Place, there is an area of only about 465 square feet between three houses. This is unevenly divided, but the average is only 155 square feet. There are only two water closets for the three houses. In the case of Nos. 6, 7 and 8, Aspen Place, there is only a back area of 12 feet by 8 feet=96 square feet per house, and this is very badly paved. There is a water closet for each house, but two have no doors and are in a dangerous condition. These houses are in a worse condition of dilapidation than Nos. 3, 4 and 5, and are very badly infested with rats. There is an archway under No. 8 leading to the back, which is used by the occupier as an access to his stable in the rear and also for sheltering his barrow. The walls of the houses on either side of this archway have been much damaged by the passage of the coster's barrow, and the wall on the right is dangerous. With regard to Nos. 9, 10, 11 and 12, Aspen Place, these are structurally not so dilapidated as Nos. 6, 7 and 8. The roofs are somewhat better and the walls not so defective. The 72 same conditions exist in these with regard to dampness, defective floors and unsound ceilings as in all the others. These houses are also rat infested. The yards are larger and although they have been paved this is now worn. There is a water closet to each house. No. 13, Aspen Place, is in a similar condition as Nos. 9, 10, 11 and 12, but has a smaller yard which has been reduced by additional buildings probably erected subsequent to the building of the house. No. 15, Aspen Place, is also in a similar dilapidated condition as No. 13. The light in most of the houses in Aspen Place is cut off to a large extent by the buildings opposite, which are only about 10 feet away. No. 15, is well lighted, no building being opposite. Cove Cottages. Nos. 5 and 6, Cove Cottages, in Aspen Place and opposite Trafalgar Street. These houses are in a better structural condition than the foregoing, but the same defects are present in a lesser degree. They are both infested with rats. Nos. 16 to 19, Aspen Place, known as Banner's Yard. These four houses are not actually in Aspen Place, but are situated at right angles to it and run down towards the Lower Mall and are continuous with two houses known as Nos. 31 and 32, Lower Mall. Most of these houses have no through ventilation. The rooms are small and badly lighted, the walls are damp and the floors not ventilated. The ceilings are sagging and some are dangerous. The side wall of No. 16, Aspen Place is out of the perpendicular and leans outwards. The roofs are in an extreme condition of dilapidation. They have no space behind, but there is a fairly large yard in front of Nos. 16 to 19, Aspen Place, with two water closets for the four houses. Nos. 31 and 32, Lower Mall, which are continuous with Nos. 16 to 19, Aspen Place, are in quite as bad condition of dilapidation, moreover the yard in front is very small and badly paved. The light to these houses is obstructed very much by two houses Nos. 33 and 34, Lower Mall, which are only about 8 feet distant. Lower Mall. This pathway is very narrow, in some places being as little as 8 feet wide. It is too narrow to allow any but pedestrian traffic, and the houses on either side obstruct each other's light and ventilation. 73 No. 35, Lower Mall. One room of this house is used as a shop, the rest of the house is used for storing old iron and general rubbish. It is kept in a very dirty condition excepting the shop. The walls are damp, ceilings dilapidated, windows small and fixed, light bad. Hat infested. There is no yard or open space connected with the house, and no through ventilation. The water closet at end of covered way is ventilated very inefficiently by an air-brick. Nos. 33 and 34, Lower Mall (these are two-roomed houses). The front walls are out of perpendicular. The walls are damp and the floors are not ventilated. There is no through ventilation which gives them all the bad qualities of back to back houses. The roofs are defective allowing dampness to appear in the ceilings which are also defective. The window sashes are decayed. At the rear a small portion of Banner's Yard appears to have been cut off and enclosed as a yard. This measures only 6 feet wide and there is only one water closet for the two houses. No. 30, Lower Mall. This house has one room and a scullery on the ground floor and one room on the first floor, neither of which has through ventilation. There is a small attic which is well ventilated. The level of the ground floor of this house is 1 foot 8 inches below the street level. The only window is small and rises practically from the roadway. This condition in addition to the proximity of the opposite houses (12 feet 6 inches) makes the lighting of this room bad and ventilation impossible, the front room is practically in a well. The walls are damp. The ceiling in the attic sagged. There is a fair amount of space behind the house. No. 29, Lower Mall. This is a four-roomed house. There does not appear to be a damp proof course, but the walls appear to be hollow. The level of the ground floor is 9 inches lower in the front than the roadway and 16 inches lower at the back. The front room is badly lighted owing to the small window space and obstruction to light from the opposite building. The ceiling of first floor back is unsound and the same remark applies to front room ground floor. There is a fair amount of space behind the house and there is a separate water closet. 74 Nos. 40, 41, 42 and 43, Lower Mall. These four houses are built on a small area on the river side of the Lower Mall with small yards intervening. Two houses, Nos. 40 and 42, face the river, whilst Nos. 41 and 43 face the Lower Mall. The two houses facing the river have no apparent damp proof course and there is dampness in each. The walls shew a certain amount of subsidence and the window sashes are decayed. There is no through ventilation in No. 42 and only on the first floor in No. 40. The ceilings are unsound. The water closets are built against the wall of the house in each case and dampness exists in one. The two houses facing the Mall, Nos. 41 and 43. There are no damp proof courses and both have damp walls and the ceilings are defective. The front rooms are very dark owing to obstruction from the houses opposite. There is a subsidence in the back wall of No. 43. There is a small yard and a water closet to each, both of which are defective structurally. No. 38, Lower Mall. This is a workshop and store for engineering materials. These premises are very defective for similar reasons to those given in the preceding cases. No. 37, Lower Mall. This is used by the Hampshire House Trust as a Boy's Club. It consists of an old building of two rooms, one on the first and one on the ground floors, to which some alterations and addition have been made. The level of the lower floor has been lowered to about a foot below the adjoining roadway and is considerably lower still in relation to the adjoining ground behind. The floor has been covered with tiles. There is no apparent damp proof course. The walls are very damp and on the East side almost wet. The ceiling is sagging in places and unsound all over the old portion, and deficient in part. The first floor is usually used as a play room for the boys and is now used as a temporary workshop for a Belgian refugee. The ceiling is all old, has several patches of dampness from a defective roof, sagged and appears to be unsafe. The window overlooking the river allows the rain water to percolate into the room. No. 36, Lower Mall. This house is occupied by the caretaker of and communicates with No. 37. There appears to be no damp proof course. It consists of two rooms on the ground floor and three on the first floor. 75 The ceiling on ground floor appears to be unsafe in places, and the staircase walls are exceedingly damp. The ceiling in front room first floor which is occupied by the caretaker is exceedingly unsound, looks dangerous and in many places was wet from recent percolation of rain through the roof. The rain also appeared to have come through that part of the ceiling which was above the bed. This ceiling is probably one of the worst in this area. In this room there is a casement window, made to open inwards. The rain beating against the window was running in and down the wall beneath the window, in spite of the efforts of the caretaker, who had placed cloths to soak up the water. The windows of the other two rooms also open inwards, and although of recent construction allow the rain to enter. The light in front of this house and No. 37 is obstructed by the houses opposite which are only about 10 feet distant. There is ample space behind with proper and sufficient light. The sanitary arrangements are of recent construction and good. Trafalgar Street. This street is situated at right angles to Aspen Place, running up from that street towards the back gardens of South Street and ends in a cul-de-sac. It is well paved, but the blind end is frequently filled with coster barrows, empty boxes, crates, etc. The houses in this street are practically all in the same degree of dilapidation and decay. The walls have no damp proof course and are damp without exception and many are unsound. The copings on top of walls are loose and in some cases appear to be dangerous. The roofs in some cases appear to have been patched, but as a whole they are unsound, dilapidated and quite inefficient. The windows in almost every house are decayed, worn, and some are broken. The rooms are small, badly lighted and the floors are in many cases not ventilated. The walls inside are damp and defective. The floors and stairs are worn and in bad condition. The ceilings in most cases are sagged and unsound. In every case the houses are infested with rats, and recently a child was bitten. 76 The yards on the East side are small and measure from 16 feet in the smallest to 23 feet in the largest from the rear wall of house to the boundary wall behind. They abut on the premises of the Motor Car Works and the Telephone Exchange, which is on this side bounded by a wall varying in height from 18 to 20 feet. The smallness of the yards, together with the obstruction of light and ventilation by the above-mentioned boundary wall, renders these yards very unhealthy. Each house has a separate water closet, but in most houses more than one family live and the water closets are used in common. The water closets with few exceptions are in a fair condition of construction. The yards are paved, but they are worn and uneven. At the rear of the houses on the West side there are small yards more or less inefficiently paved. Each house has a separate water closet which is used generally by more than one family. They are 13 feet from the house. The water closets are badly constructed with a low roof which compels those entering to stoop. They are all out of the perpendicular and some lean over in a dangerous manner. Some have been buttressed with brickwork. A heavy slate cistern is placed on the roof of the water closet and adds to danger of its collapsing. Behind the small paved yard there is a garden to each house about 45 feet long. These gardens are worn down hard, the ground is uneven and they are generally in a dirty condition. Most contain fowls and various kinds of accumulation, which add to its insanitary condition. In addition to the foregoing, I should like to draw the attention of the Committee to two houses known as Nos. 1 and 2, Hermitage Cottages. These are situated on the West side of the Creek, and are approached through an archway under No. 7, Upper Mall. These houses consist of two rooms each, the ground floor level is 2 feet 6 inches below the adjoining garden. The walls have no damp proof course and are damp. There is no ventilation under floor. The rooms are very small and badly lighted. There is no through ventilation in No. 1, but in No 2 the occupier has cut holes through the walls of the first floor room. The stairs are defective and unsafe and the ceiling is unsound. There is one water closet for the two houses. 77 In conclusion, it is my purpose in a further report, at a later date, to deal with the remainder originally included in the area above-mentioned, much of which needs attention. At the end of the year your Committee were considering the question of serving Closing Orders with a view to removing the existing insanitary conditions. INSPECTION OF FACTORIES, Etc. During the year 293 notices were served in reference to insanitary conditions and defects found to exist during the inspection of the factories, workshops, and workplaces in the Borough, and during the same period 310 notices have been complied with. During the previous year there were 287 notices served and 281 complied with. The following is a list of the Factories and Workshops upon the Register:— Restaurants, Hotels, etc. 160 Bakehouses (9 not used at present as Bakeries) 61 Bootmakers 52 Motor and Cycle Makers and Engineers 45 Dressmakers and Milliners 178 Laundries 267 Letterpress Printers and Bookbinders 16 Electrical and Mechanical Engineers 19 Smiths, Wheelwrights and Coachbuilders 27 Tailors 43 Bottle Washing Works 4 Dry Cleaning, Dyeing and Carpet Beating Works 6 Firewood Cutters 14 Builders and Joiners (Machine) 19 Outworkers 773 Miscellaneous 196 1,880 The whole of these premises have been under a systematic inspection by your special Inspector appointed for that purpose, and by the District Inspectors since October, and numerous improvements in the sanitary condition of these premises have been carried out under their supervision. 78 TABLE I. Prepared in accordance with the form required by the Home Office on the administration of the Factory and Workshop Act, 1901, in connection with Factories, Workshops, Workplaces and Homework. 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 630 63 - Workshops (including Workshop Laundries) 1,335 145 - Workplaces (other than out-workers premises included in Part 3 of this report) 991 75 - Total 2,956 283 — 79 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:—* Want of Cleanliness 42 50 ... ... Want of Ventilation 1 1 ... ... Overcrowding 1 1 ... ... Want of Drainage of Floors 25 25 ... ... Other Nuisances 121 110 ... ... Sanitary Accommodation. insufficient 25 7 ... ... unsuitable or defective 80 72 ... ... not separate for sexes 5 1 ... ... Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) ... ... ... ... Breach of special Sanitary requirements, for bakehouses (SS. 97 to 100) 94 94 ... ... Other Offences (excluding offences relating to outwork, which are included in Part 3 of this report.) ... ... ... ... Total 394 361 ... ... * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 80 3.—HOME WORK. Nature of Work. Outworkers' List, Section 107. Outwork in Unwholesome Premises, Sec. 108. Outwork in Infected Premises, Sees. 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Twice in the year. Once in the year. Instances. Notices served. Prosecutions. Instances. Orders made (S. no). Prosecutions (S. 109, no). Failing to keep or permit inspection of Lists. Failing to send Lists. Lists. Outworkers. Lists. ( Outworkers. Contractors Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing apparel— (1) making, etc 46 26 56 2 ... 3 ... ... ... 10 10 ... ... ... ... (2) cleaning and washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Household linen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace, lace curtains, and nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Curtains and furniture hangings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Electro-plate ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tile making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brass and brass articles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fur pulling ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cables and chains ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anchors and grapnels ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cart gear ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Locks, latches, and keys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Artificial flowers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nets, other than wire nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tents ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sacks ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Racquet and tennis balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper, etc., boxes, paper bags ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brush making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pea picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather sorting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carding, etc., of buttons, etc ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stuffed toys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... I'asket making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chocolates and sweetmeats ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cosaques, Christmas crackers, Christmas stockings, etc ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Textile weaving ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 46 26 56 2 ... 2 ... ... ... 10 10 ... ... ... ... 81 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year. Number. Important classes of workshops such as workshop bakehouses may be enumerated here bakehouses 43 dressmakers 178 laundries 217 pothers 273 Total number of workshops on Register 711 5.—OTHER MATTERS. Class. Number. Matters notified to H. M. Inspector of Factories— Failure to affix Abstract of the Factory and Workshop Act 1901 (S. 133) — Action taken in matters referred by H. M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act 1901 (S. 5) Notified by H. M. Inspector 34 Reports (of action taken) sent to H. M. Inspector 34 Other 13 Jnderground bakehouses (S. 101)— Certificates granted during the year — In use at the end of the year 33 NOTE.—The Factory and Workshop Act, 1901 (S. 132), requires the Medical Officer of Health in his Annual Report to the District Council to report specifically on the administration of that Act in workshops and workplaces, and to send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State (Home Office). If the Annual Report is presented otherwise than in print, it is unnecessary to include in the copy sent to the Home Office the portions which do not relate to factories, workshops, workplaces, or homework. The duties of Local Authorities and the Medical Officer of Health under the Act of 1901 are detailed in the Home Office Memorandum of March, 1912. 82 ICE CREAM MANUFACTURERS. The London County Council (General Powers) Act, 1902, which came into operation on the 1st November, 1902, by Part VIII., made provision for the regulation, manufacture, and sale of ice cream or other similar commodities. The duty of obtaining the necessary information for the registration of premises upon which ice creams are made was carried out by Sanitary Inspectors S. Huggons Brown and C. Gee. At the present time there are 230 premises upon the register and 14 notices have been served, all of which have been complied with. The following is a table in reference to the above-named premises, etc. PROCEEDINGS DURING 1914. PREMISES. NUMBER OF PLACES. Number of inspections, 1914. Number of notices, 1914. Number of prosecutions, 1914. On register at end of 1913. Added in 1914. Removed in 1914. On ter at end of 1914. Slaughter-houses 8 nil. 1 7 143 11 nil. Offensive trade premises nil. nil. nil. nil. nil. nil. nil. Ice Cream premises 199 35 4 230 142 14 nil. DAIRIES, COWSHEDS, AND MILKSHOPS ORDER, ETC. The registration of milk vendors and the inspection of milk premises situated in the Borough was carried out by Sanitary Inspector Gee. The following is a table in reference to the milk premises and cowsheds. PROCEEDINGS DURING 1914. PREMISES. NUMBER OF PLACES. Number of inspections, 1914. Number of notices, 1914. Number of prosecutions, 1914. On register at end at 1913. Added in 1914. Removed in 1914. On register at end of 1914. Milk premises 338 22 58 302 726 9 2 Cowsheds nil. nil. nil. nil. nil. nil. nil. 83 These registered premises were under regular inspection. During the year ten cases of infectious disease occurred upon premises where milk was sold. The regulations under the above Order appertaining to the stoppage of sale of milk, disinfection, and the granting of certificates were strictly enforced under my directions. There were 22 applications made during the year for registration of premises for sale of milk, and after inspection certificates were granted. In no case was a milkshop taken off the Register on the grounds that the premises were unsuitable. PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. In accordance with the circular communications from the Local Government Board dated the 27th October and 17th December, 1913, I beg to present a tabular statement in the form prescribed by the Local Government Board in reference to the proceedings taken under the direction of your Committee in nection with the Public Health (Milk and Cream) Regulations, 1912. 1. Milk ; and Cream not sold as Preserved Cream. (a) (b) Number of samples examined lor the presence of a preservative. Number in which a preservative was reported to be present. Milk Nil. Nil. Cream 9 5 Nature of preservative in each case in column (b) and action taken under the Regulations in regard to it :— (10) 0-32 per cent., or 22-4 grains per lb. of crystallised boric acid. 47 6 per cent, of milk fat. Summons under Food and Drugs Acts: fined £2 and 12s. 6d. costs. Summons under Regulations: fined 10s. and £1 13s. 6d. costs. 84 (ii) 0.136 per cent., or 9.5 grains per lb. of crystallised boric acid. 46 per cent. of milk fat (statutory label 0.5 per cent.). A notice was exhibited in the shop stating that all cream sold contained a proportion of boron preservative. No action. (13) 0.3 per cent., or 21.9 grains per lb. of crystallised boric acid. 52.8 per cent. of milk fat (statutory label 0.5 per cent.). No action under Regulations. Summons under Food and Drugs Acts : lined 10s. and 12s. 6d. costs. (17) 0.15 per cent., or 10.5 grains per lb. of crystallised boric acid. 56.6 per cent. of milk fat (statutory label 0.5 per cent.). Cuplet labelled in front of purchaser. Notice in shop stating that all cream sold is preserved cream. No action. (18) 0.2 per cent., or 14 grains per lb. of crystallised boric acid. 44.8 per cent. of milk fat (statutory label 0.5 per cent.) No action under Regulations. Summons under Food and Drugs Acts : fined £1 and 12s. 6d. costs. 2. Cream sold as Preserved Cream. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct:— (1) Correct statements made 1 (2) Statements incorrect 0 Total 1 (15) 0.3 per cent., or 21 grains per lb., of crystallised boric acid. 49 per cent. of milk fat (statutory label 0.5 per cent.). (6) Determination made of milk fat in cream sold as preserved cream:— (1) Above 35 per cent 1 (2) Below 35 per cent 0 Total 1 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article 5(1) and the proviso in Article 5(2) of the Regulations have been observed Nil. (d) Particulars of each case in which the Regulations have not been complied with and action taken Nil. 85 3. Thickcning Substances. Any evidence of their addition to cream or to preserved cream. Action taken where found Nil. 4. Other Observations. Every vendor in the Borough was supplied with a copy of the Regulations by the Borough Council. In all cases before proceedings have been instituted the Council has, in accordance with Article 6 of the Regulations, afforded the vendor an opportunity of furnishing an explanation in writing, and in two cases (Nos. 11 and 17) the explanations given were considered satisfactory. Sample No. 31.—Milk was found to contain 6 per cent, of added water and a preparation of nitric acid, equivalent to 7 parts of potassium nitrate per 100,000 parts of milk. Sample No. 32.—Milk was found to contain 5 per cent. of added water and a preparation of nitric acid equivalent to 7 parts of potassium nitrate per 100,000 parts of milk. Proceedings under the Regulations and Food and Drugs Acts in both cases are pending. Notes on Report for the year 1913. Case 5.—Conviction upheld by High Court, King's Bench Division (Batchelour v. Gee . Case 7.—Fined £2 and 2 guineas costs. RAG FLOCK ACT, 1911. The Rag Flock Regulations, 1912. No samples of Flock were taken by your inspector during the year. SUMMONSES ORDERED. During last year your Council and the Public Health Committee gave authority for 82 summonses to be taken out against persons for having failed to comply with the requirements of notices which had been served. It was not found necessary to proceed in the great majority of cases, as the work was carried out before the issue of the summonses. In 7 cases summonses were taken out, a list of which, together with the result of the proceedings follows. 86 SUMMONSES HEARD. SITUATION OF PREMISES, &C. NATURE OF OFFENCE. RESULT OF PROCEEDINGS. 18, Bassein Park Road Failing to comply with statutory notice. Summons withdrawn. 5, Brackenbury Road Offence under by-laws for houses let in lodgings. Summons withdrawn. Geremia Rea, 96, Princes Road, Notting Hill. Failing to exhibit name and address on ice cream barrow Summons withdrawn. John Mills, 21, Masbro Road Carrying on the trade of a dairyman or purveyor of milk without being registered. Adjourned sine die. John Mills, 21, Masbro Road Failing to comply with regulations made by the London County Council in reference to the precautions to be taken by purveyorsof milk against infection or contamination. Adjourned sine die. Cockeran Bros., Marsh Gate Lane, Stratford Offence against bylaws of the London County Council with reference to the removal of obnoxious matter. 2s. costs. 10, Mardale Street Offence against bylaws of the London County Council with respect to water closets. Fined 3s. and 2s. costs. PUBLIC MORTUARY. During last year 190 bodies were removed to the mortuary at Fulham Palace Road. There were 107 bodies brought to the mortuary by order of the Coroner or the Police; 51 bodies were taken from the West London Hospital, 30 bodies were received for accommodation, and 2 bodies were received for isolation. 87 SMOKE ABATEMENT. During last year observations were made in reference to the amount of black smoke emitted from the under-mentioned premises. Six preliminary notices were served, four statutory notices were issued, and no summonses were taken out. The chimneys of the following premises were the subject of the before-mentioned observations:— Swan Laundry, Blytlie Road, West Kensington Park. Kensington Palace Laundry, Spring Vale Terrace, West Kensington Park. Hammersmith Borough Council's Electricity Works. Eton Laundry, Orchard Road, Shepherd's Bush. Glen Laundry, Landor Road, Shepherd's Bush. Carpet Beating Works, Wharf Road, Latimer Road. Kensington and Notting Hill Electric Lighting Company, Wood Lane, Fuller's Limited, Great Church Lane, Hammersmith. Royal Chiswick Laundry, British Grove. Gwynne's Iron Works, Hammersmith. Lyons & Company, Limited, Cadby Hall, Hammersmith. 74, Goldhawk Road. Bakehouse. Hammersmith Infirmary, Wormwood Scrubs. Addison Feather Mills, Woodstock Road. West London French Laundry, British Grove. Victoria Laundry, Great Church Lane. Central London Railway, Wood Lane. London United Electric Tramways. Ltd. Albert Mills, Upper Mall. A number of complaints were received from the London Countv Council and the Coal Smoke ment Society, and in each instance observations were kept upon the premises until no evidence of the emission of black smoke could be obtained. METEOROLOGY. The average mean temperature registered in London during last year was 51.5° Fahrenheit. The highest air temperature registered was 920 in July. The lowest air temperature was 20° in January. Rain fell on 180 days. The total amount of rainfall was 23.85 inches Printed by JAS. TRUSCOTT & SON, Ltd Suffolk Lane, E.C.