HAMP 10 THE Metropolitan Borough of Hampsted. REPORT FOR THE YEAR 1903, OF THE Medical Officer of Health. HERBERT LITTLEJOHN, M.B., C.M., F.R.C.S. (Edin.), D.P.H. 3 STAFF OF THE PUBLIC HEALTH DEPARTMENT, 1903. Senior Sanitary Inspector. William G. Kershaw. Divisional Sanitary Inspectors. R. Geary, No. 1 District. J. Grimsley, No. 2 District. P. A. Heath, No. 3 District. W. H. Edmonds, No. 4 District. Special Sanitary Inspectors. F. H. Hudson. Mrs. T. Fisher. Clerks. W. Sell, First Clerk. F. S. Hill, Second Clerk. J. E. Stone, Third Clerk. Clerk-Draughtsman. E. J. Cooper. Disinfectors. T. H. Rider. G. Allaway. F. Dakin. Assistants to Inspectors. G. Rowe. W. Larkin. Public Mortuary Keeper. W. Larkin. Public Analyst. A. W. Stokes, F.C.S., F.I.C. Medical Officer of Health. Herbert Littlejohn, M.B., C.M., F R.C.S. (Edin.), D.P.H. 4 INDEX. page. Accidents, Deaths from 27 Alcoholism 26 Ambulance Service in the Metropolis 76 Analyses, Results of 66-68 Apoplexy 27 Area of Borough 16 Bacteriological Examination 34-35 Bakehouses 48-50, 54-59 „ Underground 48-50, 55-59 Birth Rate 17 „ (Illegitimate) 19 Births, Number of (Legitimate and Illegitimate) 17, 18 „ „ in Wards 18 Bronchitis 27 Bye-laws, drainage 87-91 Cancer and other Malignant Disease 27 Carcinoma 27 Chicken-pox 36 Circulatory System, Diseases of 27 Cirrhosis of Liver 26 Common Lodging Houses 74 Continued Fever 35 Cowhouses 74 Cremation Act, 1902 112 Customs and Inland Revenue Act, 1890 65 Dairies, Cowsheds and Milkshops 69-72 Dangerous Structures 107 Death Rate 20 „ Infantile 23 Deaths, at various ages 22 „ Causes of 26-38 „ Chart shewing Weekly Number of 20 5 PAGE Deaths, Infantile Death Rate 23 „ Infantile Deaths 22 „ Number of 22 „ Senile Mortality 26 Diarrhœa, Epidemic 37, 38 Diphtheria 34, 35 Drainage Bye-laws 87-91 Effluvia Nuisances 77 Employment of Children Act, 1903 112 Expiring Laws Continuance Act 112 Enteric Fever 32, 33 Epidemic Diarrhœa 37, 38 Epilepsy 27 Epithelioma 27 Erysipelas 35 Factories 49, 52 Factory and Workshop Act 48-59 Food and Drugs Act 65-69 Food, Unsound 68, 69 General Tuberculosis 26 Habitable Rooms 92 Heart Diseases 27 Houses Let in Lodgings 74-76, 130 Housing of the Working Classes 60-64, 112-114 Ice Creams 72, 73 Illegitimate Births 17, 18 Infantile Death Rate 23 Infantile Deaths 22 Infectious Disease, Cases notified 28 „ „ „ in each Month 29 „ „ „ „ Ward 30 „ „ Deaths from 28 Infectious Disease Charts 28, 32, 33, 34 Influenza 38 Inspections 76 Kilburn Vale Area 60-62, 64 6 PAGE King's College Mews East 62 Laundries 49, 53 Legal Proceedings 107-109 Local Government Board Tables 116-120 Marriage Rates, 1894-1903 17 Marriages, Number of 16 Measles 36, 37 Membranous Croup 34, 35 Meningitis 27 Midwives Act, 1902 114 Milkshops 69-72 Mortuary 105, 106 Natural Increase of Population 17 Nervous System, Diseases of 27 Nuisances, Effluvia 77 „ Inspection of 76 „ Smoke 78 „ Steam 78 Phthisis, Pulmonary 26 Pleurisy 27 Pneumonia 27 Population, Density of 16 „ Estimated to Middle of 1903 16 „ In Wards 16 „ Natural Increase of 17 Public Mortuary 105, 106 Puerperal Fever 35 Pulmonary Phthisis 26, 38, 39 „ „ Voluntary Notification of 39, 40, 41 Respiratory System, Diseases of 27 Sanatoria for Consumptive Patients 41-46 Sanitation at Railway Stations 79-87 Sarcoma 27 Scarlet Fever 32 Scirrhus Cancer 27 Senile Mortality 26 Sewers, Ventilation of 92-105, 134, 135 7 PAGE Silver Street Area 63, 64 Slaughter-houses 73, 74 Small-pox 31, 32 Smoke Nuisances 78 Staff of Department 3, 107 Steam Nuisance 78 Suicides 27 Tables 116-132 Tenement Houses 74-76, 130 Trough Closets 78 Tubercular Diseases 26 Tubercular Meningitis 26 Tuberculosis, General 26 Underground Bakehouses 55-59 Unsound Food 68, 69 Vaccination 31, 32 Ventilation of Sewers 92-105, 134, 135 Water Supply, Certificates as to 92 Whooping Cough 36 Workshops and Workplaces 49, 53 Zymotic Diseases 28 „ „ Deaths from 28 „ „ Notified in each Month 29 „ „ „ „ Ward 30 „ Death Rate 28 TABLES. Table shewing death rate for Hampstead, as compared with the County of London, the City of London and the other Metropolitan Boroughs, for 1903 21 Table shewing causes of death of children under the age of one year for 1903 24 Table shewing percentage proportion of the total Infantile deaths due to various causes in 1903 and previous year 23 8 PAGE Table shewing Infantile death rate for Hampstead, as compared with the County of London, the City of London and the other Metropolitan Boroughs, in 1903 24 Table giving a comparison of annual death rates from all causes and the 7 principal Zymotic diseases, and the Infantile death rate in Hampstead, England and Wales, 76 Great Towns, 103 Smaller Towns, and England and Wales less the 179 Towns, during 1903 28 Table shewing notifications of infectious disease in each month 29 Table shewing notifications of infectious disease in each Ward 30 Tables re Factories, Workshops and Workplaces 49-54 Premises certified under the Customs and Inland Revenue Act, 1890 65 Premises represented under the Housing of the Working Classes Act, 1890 64 Summaries of replies received re Ventilation of Sewers 96-104 APPENDIX I. TABLES. Table I.—Population. Births and Deaths for the whole Borough, from 1893 to 1903, including Deaths of Non-residents in the District, also Deaths in Public Institutions in the District, Deaths of Residents registered beyond the District. Institutions inside and outside the District receiving sick and infirm persons from the District 116, 117 Table II.—Population, Births registered, Deaths at all ages, and Deaths under 1 year for each Ward 118 Table III.—Cases of Infectious Disease notified, at all ages, at various ages, and distributed according to Wards 119 9 PAGE Table IV.—Deaths at all ages, at various ages, from all Causes, and distributed according to Wards 120 Table V.—Particulars of Milk shops, Cow sheds, Slaughter houses, Offensive trade premises, Ice cream premises, Houses let in Lodgings, Overcrowding, Underground rooms, &c., Certificates under Customs and Inland Revenue Acts, Prosecutions, &c., in 1903 121, 122 Table VI.—Natural Increase of Population, and Notifiable Zymotic Disease Rate in Hampstead: Birth rate, 7 principal Zymotic Diseases Death Rate, and General Death Rate in England and Wales and Hampstead, from 1875 to 1903 123 Table VII.—Number of Inhabited Houses and Persons to each House in all Metropolitan Boroughs at Census, 1901 124 Table VIII.—Extent in Acres and number of Persons to the Acre in all Metropolitan Boroughs at Census, 1901 125 Table IX.—Disinfection carried out during 1903 126 Table X.—Number of Complaints and Requests received during 1903 127 Table XI.—Number of Inspections, &c., made, notices served, letters sent, and sanitary works, &c., carried out during 1903 128, 129 Table XII.—Registered Houses arranged in Wards 130 Table XIII —Bakehouses arranged in Wards 131 Table XIV.—Restaurant Kitchens arranged in Wards 132 APPENDIX II. Report of the Joint Sub-Committee on the Ventilation of Sewers 134, 135 11 The Metropolitan Borough of Hampstead. REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1903. Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W. 8th March, 1904. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Gentlemen, In presenting my Report on the Health and Sanitary Condition of the Borough for 1903, I desire to thank you for the support I have received in the discharge of my duties during the past year. I am, Gentlemen, Your obedient Servant, HERBERT LITTLEJOHN, Medical Officer of Health. VITAL STATISTICS. 15 Summary of Vital Statistics for 1903. Area of Borough (excluding water) 2253 acres. Population (Census, 1901) 81,942. ,, Estimated to middle of 1903 85,197. Density 37.6 persons per acre. Inhabited Houses (Census, 1901) 11,294. Marriages 597. Marriage Rate 7.0. Births 1453. Birth Rate 17.05. Deaths 837. Death Rate 9.8 Infantile Mortality 86.7 per 1000 births. 16 POPULATION. Estimated Population. For the purpose of calculating the death and other rates, the population employed is that estimated to the middle of 1903, and by the usual method of computation, that amounted to 85,197. The following is an estimate of the population of the various Wards of the Borough:— Ward 1 (Town) 12,550 „ 2 (Belsize) 13,520 „ 3 (Adelaide) 10,600 „ 4 (Central) 9,357 „ 5 (West End) 12,850 „ 6 (Kilburn) 15,370 „ 7 (Priory) 10,950 The whole Borough 85,197 Density of Population. The area of the Borough is 2265 acres, and the estimated number of persons to the acre is 37.6. The proportion of persons to the acre at the Census, 1901, was 36.17 of the estimated population. As compared with the other Metropolitan Boroughs in Table VIII., page 125, Hampstead stood fifth on the list. It will be seen on reference to Table VII., page 124, that the average number of persons per house in the Borough at the Census, 1901, was 7.25. I would point out, however, that for Census purposes a block of model dwellings or residential mansions is counted as a single house, whatever may be the number of separate tenements contained therein. MARRIAGES. According to the Returns of the Registrar-General, 597 marriages were registered in the Borough during 1903; they were distributed in the four quarters of the year as follows:– 1st quarter 105 2nd „ 161 3rd „ 194 4th „ 137 Total 597 17 This figure is a decrease on that for the year 1902, when 629 marriages were registered. The following Table gives the marriage rate in the decade 1894-1903: Year. Marriage rate Per 1000 of the Population. 1894 6.1 1895 6.6 1896 6.9 1897 6.6 1898 7.6 1899 7.0 1900 6.7 1901 6.6 1902 7.5 1903 7.0 BIRTHS. During the year, 1453 births were registered, a decrease of 63 as compared with the 1516 registered in the previous year. Of the total, 729 were of male, and 724 of female children. The birth rate was 17.05 per 1000 of the population, as compared with the rate of 18.1 per 1000 in 1902, and 19.2, the average for the 10 years 1893-1902. These 1453 births are distributed among the various Wards as follows:— No. 1 (Town) 194 No. 2 (Belsize) 211 No. 3 (Adelaide) 95 No. 4 (Central) 99 No. 5 (West End) 243 No. 6 (Kilburn) 417 No. 7 (Priory) 194 The Natural Increase of the population for the year, being the excess of births over deaths, was 616 as compared with an increase of 612 in 1902. Reference to Table VI., page 123, shews the birth rates for Hampstead as compared with those for England and Wales since 1875, and it will be noted that the rate for the year under review is the lowest recorded since that date. 18 Of the total births registered, 1411 were of legitimate and 42 of illegitimate children. The following table shews the Ward and Sex distribution of these illegitimate births:— Males. Females. Total. Ward 1 (Town) 10 13 23 „ 2 (Belsize) 3 4 7 „ 3 (Adelaide) 1 — 1 „ 4 (Central) — 2 2 „ 5 (West End) — 1 1 „ 6 (Kilburn) 4 2 6 „ 7 (Priory) 1 1 2 The whole Borough 19 23 42 After correction, having regard to the home addresses of the mothers, these births are distributed as follows:— Males. Females. Total. Ward 1 (Town) 3 4 7 „ 2 (Belsize) 4 5 9 „ 3 (Adelaide) 3 1 4 „ 4 (Central) — 3 3 „ 5 (West End) 1 3 4 ,, 6 (Kilburn) 7 4 11 „ 7 (Priory) 1 3 4 The whole Borough 19 23 42 19 Illegitimate birth rate. The following are the illegitimate birth rates for the various Wards and the whole Borough, after the distribution referred to:– WARD. Illegitimate Birth Rate, per 1000 births. No. 1 (Town) 36.08 No. 2 (Belsize) 42.65 No. 3 (Adelaide) 42.10 No. 4 (Central) 30.30 No. 5 (West End) 16.46 No. 6 (Kilburn) 26.37 No. 7 (Priory) 20.61 The whole Borough 28.90 The illegitimate birth rate for the year 1902 in the whole Borough, was 25.7 per 1000 births. DEATHS. The total deaths registered during the year amounted to 1049. Of these, however, no less than 312 were of persons not belonging to the Borough, while 100 residents of Hampstead died in outlying districts. The total number of deaths, therefore, amongst persons belonging to Hampstead amounted to 837. Table IV., page 120, affords all available information as to the causes of deaths of persons belonging to the Borough. The following Chart shews the number of deaths of persons resident in, or belonging to, the Borough, occurring during each week of 1903. 20 Death Rate. The crude death rate was 12.3 per 1000 of the population, but after subtracting from the total registered deaths, the deaths of nonresident persons dying in Hampstead, and adding the deaths of Hampstead residents who died outside the district, the true or corrected death rate was 9.8 per 1000 of the population, as compared with the rate of 10.7 per 1000 of the population in 1902, and the average rate for the 10 years 1893—1902, which is 11.5. It is of interest to note that this is the lowest rate ever recorded for Hampstead; the next lowest being that of 10.56 in 1888. The following are extracts from the Reports of Dr. Lord, formerly Medical Officer of Health for Hampstead. "During the past year (1856-7) 260 deaths have occurred, which shews a mortality of 17 in 1000, calculating the present population at 15,000." "The average for the 10 years ending in 1850, has been 17 in 1000." In Table VI., page 123, the death rates of Hampstead may be compared with those of England and Wales since 1875. The following Table, which is issued by the Registrar General, shews the death rate for Hampstead as compared with the County of London, the City of London, and the other Metropolitan Boroughs. It will be noted that the death rate for Hampstead here stated, is slightly different to that which I have calculated; this is accounted for by the fact that the commencement and termination of the Registrar General's registration year varies slightly. Chart shewing the number of Deaths of persons resident in or belonging to, the borough, occurring during each week of 1903. In the 52nd week are included only those deaths occurring on days of that week which were in 1903. 4 DEATHS ALSO OCCURRED BEFORE THE lst WEEK, viz FROM lst TO 3rd JANUARY. 21 Table shewing the Death Rates from All Causes in the County of London, the City of London, and the Metropolitan Boroughs during the 52 Registration Weeks of 1903. Death Rate from all Cause. County of London 15.2 City of London 14.6 Hampstead 10.0 Lewisham 11.1 Wandsworth 12.4 Stoke Newington 12.6 Paddington 13.2 Greenwich 13.3 Woolwich 13.5 City of Westminster 13.6 Camberwell 13.7 Fulham 13.9 Hackney 13.9 Kensington 13.9 Hammersmith 14.1 Battersea 14.2 Islington 14.3 Deptford 14.9 Lambeth 15.2 Chelsea 15.3 St. Pancras 16.2 St. Marylebone 16.4 Stepney 18.0 Southwark 18.1 Bethnal Green 18.2 Poplar 18.2 Bermondsey 18.4 Holborn 18.6 Shoreditch 19.4 Finsbury 20.3 22 DEATHS AT VARIOUS AGES. The following table shews the number of deaths at the various age periods, the causes of such deaths being shewn in Table IV., page 120. Age Periods. Under 1 Year. 1 to 5 5 to 15 15 to 25 25 to 65 65 and upwards. At all Ages. Deaths 126 51 22 37 322 279 837 Under one year, the mortality was 126, a decrease of 7 as compared with the previous year. The following table shows that while Whooping Cough, Epidemic Diarrhoea, and Pneumonia have contributed more deaths than in the previous year, the diminished mortality is due to a fewer number from Accidents, Measles, Tubercular Diseases, and other unclassified causes. Table showing the Causes of Death of Children under the Age of One Year. Measles 3 Pneumonia 17 Whooping Cough 6 Other Diseases of Respiratory Organs 1 Diphtheria and Membranous Croup 1 Venereal Diseases 1 Epidemic Influenza 1 Premature Birth 23 Diarrhœa 4 Heart Diseases 1 Epidemic Diarrhoea 8 Accidents 1 Tubercular Diseases 2 Murder 1 Bronchitis 5 All other causes 51 Total 126 23 Table showing the percentage proportion of the total Infantile Deaths due to the following causes, in 1903 and the previous year. CAUSES OF DEATH. Percentage proportion of the total Infantile Deaths, due to the following causes. 1903. 1902. Measles 2.38 4.51 Whooping Cough 4.76 .75 Diphtheria and Membranous Croup .79 — Epidemic Influenza .79 1.50 Diarrhœa 3.18 2.26 Epidemic Diarrhœa 6.35 3.01 Other Septic Diseases — .75 Tubercular Diseases 1.59 4.51 Bronchitis 3.97 6.02 Pneumonia 13.50 4.51 Other Diseases of Respiratory Organs .79 1.50 Venereal Diseases .79 — Premature Birth 18.26 18.80 Heart Diseases .79 1.50 Accidents .79 4.51 Murder .79 — All other causes 40.48 45.87 Infantile Death Rate. The infantile death rate for 1903 was 86.7 per 1,000 births, a figure lower than that for the year 1902 when the rate was 87.7. The rate for England and Wales during 1903 was 132. The following Table, which is issued by the Registrar General, shows the infantile death rate for Hampstead as compared with the County of London, the City of London, and the other Metropolitan Boroughs. It will be noted that the infantile death rate for Hampstead here stated is slightly different to that which I have calculated; this is accounted for by the fact that the commencement and termination of the Registrar General's registration year varies slightly. 24 Table showing the Infantile Death Rates of the County of London, the City of London, and the Metropolitan Boroughs during the 52 Registration Weeks of 1903. Deaths under 1 year to 1000 Births Registered. County of London 130 City of London 136 Hampstead 88 Lewisham 92 Holborn 95 St. Marylebone 96 Woolwich 108 Wandsworth 109 Hackney 119 Paddington 119 Stoke Newington 119 Camberwell 123 City of Westminster 123 Lambeth 125 Islington 126 Fulham 127 Greenwich 127 St. Pancras 133 Battersea 134 Deptford 134 Finsbury 135 Stepney 138 Bethnal Green 141 Hammersmith 141 Chelsea 142 Kensington 145 Southwark 148 Poplar 154 Bermondsey 158 Shoreditch 171 25 The deaths of children under one year of age, in Hampstead, though small in comparison with most of the other Metropolitan Boroughs, are sufficiently numerous to call for special notice. No less than 126, or 71 per cent. of the total deaths under 5 years of age occurred in children who did not attain the age of twelve months. The following is a summary of the results of an investigation conducted by Inspector Mrs. Fisher into the circumstances attending infant deaths during the year. 81 deaths were investigated, the remaining 45 being cases in which either no evidence was available or in which it was not considered necessary to institute enquiries. In 28 instances the children had been nursed by the mother, in 33 they had been hand fed, in 14 partly nursed and partly hand fed; while in the case of 6 premature infants neither method was practicable. Of the 18 deaths amongst children under one year from such causes as Epidemic Diarrhœa, Diarrhœa (simple), and Marasmus, it was ascertained that in 15 cases the method of feeding was by spoon or bottle. Following upon the above investigation, an inspection was made of the sanitary conditions of the dwellings, and in 40 instances defects were discovered and ultimately remedied. Overcrowding was found to exist in 12 cases, due in the majority to an unnecessary and faulty arrangement of the sleeping accommodation. From Mrs. Fisher's investigations, it appears that while there exists a lamentable ignorance on the part of many mothers of household hygiene and infant feeding, it is equally evident that in many of the homes of the working classes the facilities for the safe storage of such an article of food so susceptible to contamination as milk, are practically wanting. I have in many instances reported that various houses in the Borough were in my opinion uninhabitable, and by no means the least of my reasons for so doing has been the absolutely bad internal arrangement of these houses, which of necessity exposed the family food to contamination of one kind or another. 26 Senile Mortality. The deaths of persons of 65 years of age and upwards numbered 279, as compared with 302 in 1902. The ages of persons who died over 85 years of age were as follows:— 6 at 86 5 „ 87 3 „ 88 4 „ 89 4 „ 90 2 „ 91 1 „ 92 1 „ 93 1 „ 96 CAUSES OF DEATH. Pulmonary Phthisis Accounted for 66 deaths, as compared with 73 deaths during 1902, and representing 7.9 per cent. of the total deaths, of which number 15 occurred in persons under the age of 25 years, and 46 between 25 and 65 years of age. The Ward distribution of these deaths will be found on page 38. Other Tubercular Diseases. In addition to the deaths classified under the previous heading. 14 were due to Tubercular Meningitis, 6 to General Tuberculosis, and 4 to other forms of Tuberculosis. The total mortality, therefore, from Tuberculosis in 1903 was 90, or 10.8 per cent. of the total deaths from all causes, as compared with 97 or 10.7 per cent. in 1902. Alcoholism and Cirrhosis of the Liver. In all, 16 deaths were recorded from Alcoholism and Cirrhosis of the Liver, the latter a condition most frequently associated with alcoholic intemperance. 27 Cancer and other Malignant disease. 105 deaths, or 12.5 per cent. of the total deaths, were certified as being due to Cancer and other Malignant disease, as compared with 91 or 10.0 per cent. in 1902. Of the total deaths under this heading, 8 were certified as due to Epithelioma, 7 to Sarcoma, 3 to Scirrhus Cancer, and 87 to other malignant growths, merely described in the death certificates as Carcinoma, Cancer, or Malignant disease. Of the total deaths from this disease, 79 were of females and 26 of males, and all occurred in persons of over the age of 25, of which 50 were of persons of 65 years of age or upwards. Diseases of the Circulatory System. These accounted for 76 deaths, or 9.0 per cent. of the total deaths, of which 30 were due to chronic valvular disease of the heart and 46 to other diseases of the heart and vessels. Diseases of the Respiratory System. The total mortality from this class of disease was 116, or 13.8 per cent. of the total deaths, of which 33 or 28.4 per cent. occurred in children under the age of 5 years, and 44 in persons of 65 years of age or upwards. Of the total deaths, 56 were due to Pneumonia, 48 to Bronchitis, 3 to Pleurisy, and 9 to other diseases of the respiratory organs. Diseases of the Nervous System. Of the 93 deaths from diseases of the nervous system, 9 were due to Meningitis, 5 to Epilepsy, 32 to Apoplexy, and 47 to other nervous diseases. Accidents. Of the 11 deaths classified under this heading, 5 were due to falls, 2 to street accidents, 3 to suffocation, and 1 to a railway accident. Suicides. Of the 10 deaths from this cause, 3 were due to poisoning, 1 to hanging, 4 to shooting, 1 to drowning, and 1 to cut throat. 28 ZYMOTIC DISEASES. Of the notifiable Zymotic diseases, 323 cases, comprising 1 of Small-pox, 165 of Scarlet Fever, 24 of Enteric Fever, 79 of Diphtheria and Membranous Croup, 1 of Puerperal Fever, 41 of Erysipelas, and 12 of Chicken-pox, were notified during the year, with a mortality of 16; while Whooping Cough, Measles, and Epidemic Diarrhœa, to which notification does not apply, contributed 27 deaths. It should be noted, however, that the Order of the London County Council, making Chicken-pox a notifiable disease, was only in operation during the year from 1st to 7th January, thus accounting for the small number of cases notified. The total mortality from all the Zymotic diseases was 43, representing a Zymotic death rate of 0.50 per 1000 of the population, as compared with 62, or 0.74 per 1000 of the population in 1902. The mortality from the 7 principal Zymotic diseases was 42, representing a death rate of 0.49 per 1000 of the population. The mortality from the 7 principal Zymotic diseases in 1902 was 58, and the death rate was 0.69 per 1000 of the population. The following table gives a comparison of the annual death rate from all causes, and from the 7 principal Zymotic diseases in Hampstead, England and Wales, 76 Great Towns, 103 Smaller Towns, and England and Wales less the 179 Towns, during 1903:— All Causes. 7 Principal Zymotic Diseases. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhœa. Deaths under 1 year per 1000 Births. England and Wales 15.4 1.46 0.02 0.27 0.12 0.18 0.27 0.10 0.50 132 76 Great Towns 16.3 1.89 0.03 0.36 0.14 0.20 0.33 0.12 0.71 144 103 Smaller Towns 14.6 1.41 0.02 0.29 0.12 0.16 0.28 0.11 0.43 135 England and Wales less the 179 Towns 14.8 1.08 0.02 0.17 0.10 0.17 0.22 0.09 0.31 118 Hampstead 9.8 0.49 — 0.09 0.03 0.12 0.18 0.02 0.05 87 Chart shewing the monthly Notifications of all Notifiable Infectious Diseases (excepting Chickenpox) during 1903, and previous year. Dotted lines denote Monthly Notifications of all Notifiable Infectious Diseases (excepting Chickenpox) in 1902. 29 Cases of Infectious Disease occurring in each Month during 1903. Disease. January. February March. April. May. June. July. August. September. October. November. December. Total. Small-pox .. .. .. .. .. .. .. .. .. 1 .. .. 1 Diphtheria and Membranous Croup 8 6 10 9 6 2 9 .. 8 7 8 6 79 Erysipelas 4 3 2 4 1 2 2 4 6 5 3 5 41 Scarlet Fever 14 12 18 14 8 15 23 14 15 12 11 9 165 Typhoid and Enteric Fever 2 1 .. 1 .. 2 1 7 1 3 3 3 24 Puerperal Fever .. 1 .. .. .. .. .. .. .. .. .. .. 1 Continued, Typhus, and Relapsing Fevers, and Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox 12 .. .. .. .. .. .. .. .. .. .. .. 12 Totals 40 23 30 28 15 21 35 25 30 28 25 23 323 30 Cases of Infectious Disease occurring in each Ward during 1903. Disease. No. 1 * (Town) No. 2† (Belsize) No. 3 (Adelaide) No. 4 (Central) No. 5 (West End) No. 6 (Kilburn) No. 7 (Priory) Totals. Small-pox .. .. .. .. .. 1 .. 1 Diphtheria & Membranous Croup 7 15 3 8 17 11 18 79 Erysipelas 6 5 3 1 5 18 3 41 Scarlet Fever 21 37 14 23 24 26 20 165 Typhoid and Enteric Fever 4 3 2 2 9 2 2 24 Puerperal Fever .. .. .. .. .. 1 .. 1 Continued, Typhus and Relapsing Fevers, and Cholera .. .. .. .. .. .. .. .. Chicken-pox .. 2 .. 2 7 .. 1 12 Totals 38 62 22 36 62 59 44 323 * In this Ward are included 1 case of Erysipelas, and 1 of Enteric Fever, occurring in the Workhouse. † In this Ward are included 1 case of Diphtheria and 1 of Scarlet Fever, occurring in the North-Western Hospital, Lawn Road. 31 Smallpox. Although Small-pox in epidemic proportions has for the time disappeared from the Metropolis, Hampstead may consider itself fortunate in only having to account for one case during 1903. Other districts, such as the Borough of Lambeth and the City of Westminster, have had to deal with 73 and 45 cases respectively. The only case in Hampstead occurred on 24th October, in the person of a cabinet maker's assistant, aged 25 years, of Italian birth, who shortly after his arrival from abroad shewed symptoms of the disease. In his case there can be no doubt but that the disease was contracted before his landing in this country. The usual steps were promptly taken to remove the patient and otherwise to prevent the spread of the disease. The house—in Kylemore Road—in which the patient resided contained 3 families, consisting of 6 persons. All of these, and in addition 5 persons who had been in contact with the patient —in all 11 persons—were re-vaccinated. No secondary case occurred. All Authorities agree that re-vaccination of contacts and disinfection of their clothing, etc., are the methods of prime importance in dealing with cases of Small-pox; and it is to the immediate carrying out of these precautions I attribute the absence of any spread from this case and previous cases. With regard to re-vaccination, the advantages of all emergency Public Vaccinator resident in the Kilburn district were as evident as in the outbreak of 1901-2, as on no less than three separate occasions was it necessary to requisition his services. The occurrence of a case of Small-pox must, in my opinion, be always regarded as one of emergency, and, while a single Public Vaccinator might successfully carry out the duties of primary vaccination over the whole Borough, I am convinced that where re-vaccination is necessary in the case of Small-pox "contacts" a more adequate provision than at present exists should be made for this purpose. 32 In other words, the large and thickly populated district to the west of Finchley Road should have a resident Public Vaccinator for emergency purposes. Scarlet Fever. 165 cases were notified, as compared with 251 in 1902. Three deaths were recorded, equal to 1.2 per cent. of the cases notified, or 0.03 per 1000 of the population. Of the cases notified, 111 or 67 per cent. were removed to hospital. The houses in which cases occurred were inspected and the drains examined. Defective drains were found in 38 instances, defective soil pipes in 30 instances, and defective water supplies, &c., in 37 instances. Cases of Scarlet Fever notified in each Month. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. 14 12 18 14 8 15 23 14 15 12 11 9 165 Cases of Scarlet Fever notified in each Ward. Ward 1 (Town). Ward 2 (Belsize). Ward 3 (Adelaide). Ward 4 (Central). Ward 5 (West End). Ward 6 (Kilburn). Ward 7 (Priory). Total. 21 37 14 23 24 26 20 165 It should be noted that of the cases notified from the Belsize "Ward 1 occurred in the North-Western Fever Hospital. This was in the person of a servant of the Hospital Enteric Fever. 24 cases of this disease were notified, being considerably less than the number occurring during 1902, which was 44. It will be seen from the following table that the disease was rather more prevalent in August than any other month. Chart shewing the Monthly Notifications of Scarlet Fever during 1903, and previous year. Dotted lines denote Monthly Notifications of Scarlet Fever in 1902. Chart shewing the Monthly Notifications of Enteric Fever, During 1903, and previous year. Dotted lines denote Monthly Notifications of Enteric Fever in 1902. 33 Of the total cases 2 proved fatal, giving a case mortality of 8.3 per cent., or 0.02 per 1000 of the population. The sanitary condition of houses in which the cases occurred was investigated and the drains tested. Defective drains were found in 10 instances, defective soil pipes in 4 instances, and defective water supplies, &c., in 7 instances. Of the cases notified, 9 or 37 per cent. were removed to hospital. Cases of Enteric Fever notified in each Month. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. 2 1 .. 1 .. 2 1 7 1 3 3 3 24 Cases of Enteric Fever notified in each Ward. Ward 1 (Town). Ward 2 (Belsize). Ward 3 (Adelaide). Ward 4 (Central). Ward 5 (West End). Ward 6 (Kilburn). Ward 7 (Priory). Total. 4 3 2 2 9 2 2 24 It should be noted that of the cases in the Town Ward 1 occurred in the Hampstead Workhouse, but this had not been contracted in the Institution. During the past year, owing to outbreaks of Enteric Fever attributed to the eating of infected shell fish, much attention has been drawn to the conditions under which such are produced, and there can be no doubt that in certain instances, beds in which oysters and other shell fish grow or are fattened, were exposed to serious contamination. In Hampstead, I am glad to say, in no instance was any case of infectious illness attributable to the eating of shell fish. With regard to infection from other kinds of food, it is interesting to note that the Medical Officer of Health for Hackney, after extensive enquiries into an outbreak of Enteric Fever in his district, came to the 34 conclusion that it had unquestionably originated and been spread by means of infected watercress. Diphtheria and Membranous Croup. 79 cases were notified as compared with 85 in 1902. As a result of the inspection of the houses in which the cases occurred, defective drains were found in 24 instances, defective soil pipes in 17 instances, and defective water supplies &c., in 21 instances. The mortality was 10 or 12.8 per cent. of the cases notified, or 0.12 per 1000 of the population. Of the cases notified, 56 or 70 per cent. were removed to hospital. Cases of Diphtheria and Membranous Croup notified in each Month. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. 8 6 10 9 6 2 9 .. 8 7 8 6 79 Cases of Diphtheria and Membranous Croup Notified in each Ward. Ward 1 (Town.) Ward 2 (BelBize.) Ward 3 (Adelaide.) Ward 4 (Central.) Word 5 (West End.) Ward (Kilburn.) Ward 7 (Priory.) Total. 7 15 3 8 17 11 18 79 It should be noted that of the cases notified from the Belsize Ward, 1 was reported from the North-Western Fever Hospital. This occurred in the person of a servant of the Hospital. BACTERIOLOGICAL EXAMINATION IN SUSPECTED CASES. At present the Council affords no facilities for such examinations, and it appears to me to be desirable that in suspected cases, more Chart shewing the Monthly Notifications of Diphtheria and Membranous Croup, during 1903, and previous year. Dotted lines denote Monthly Notifications of Diphtheria and Membranous Croup in 1902. 35 especially of Diphtheria and Enteric Fever, that the medical practitioner should be enabled, free of charge, to have specimens examined and reported on. There are two methods by which this object might be attained, viz.:—the establishment of a municipal laboratory, or an arrangement with one of the several institutions in London which, on payment of a small fee, make such examinations and forward reports. In my opinion the latter suggestion is the one which, if carried out, would meet all requirements and at the same time entail practically no initial and certainly less annual expense. Puerperal Fever. Only one case was notified as compared with 6 cases with 4 deaths in 1902. The house in which the case occurred was inspected, but no defects were discovered. Erysipelas. 41 cases were notified, and 1 death occurred, as compared with 56 cases and no deaths in 1902. The case mortality was 2.4 per cent. Of the cases notified 4, or 9 per cent., were removed to hospital. Cases of Erysipelas notified in each Month. Jan. Feb. Mar. April May. June. July. Aug. Sept. Oct. Nov. Dec. Total. 4 3 2 4 1 2 2 4 6 5 3 5 41 Cases of Erysipelas notified in each Ward. Ward 1 (Town). Ward 2 (Belsize). Ward 3 (Adelaide.) Ward 4 (Central). Ward 5 (West End). Ward 6 (Kilburn) Ward 7 (Priory). Total. 6 5 3 1 5 18 3 41 Continued Fever. No case has been notified during 1903. 36 Chicken-pox. The period during which Chicken-pox was a notifiable disease, expired on the 7th January, and from the beginning of the year to that date, 12 cases were notified; these were distributed as follows:—Belsize Ward 2, Central Ward 2, West End Ward 7, and Priory Ward 1. So far as I am aware in no case was the diagnosis in doubt. Whooping Cough. This disease accounted for 15 deaths during the year, as compared with 10 in 1902. Measles. 8 deaths were recorded from this disease, as compared with 15 in 1902. The mortality was 0.09 per 1000 of the population. In the early part of the year, the London County Council obtained the approval of the Local Government Board to include Measles amongst the dangerous infectious diseases in so far as Sections 60, 61, 62, 63, 64 65, 68, 69, 70, 72, 73, and 74 of the Public Health (London) Act, 1891, apply. The Sections in question, while they did not make the disease compulsorily notifiable, extended to it provisions relating to isolation and disinfection. The operation of this law has now been in force since the 1st April, and during this period 100 cases have been brought to my knowledge, the sources of information of which were as follows:— Cases notified by doctors 50 „ parents or guardians 30 „ schoolmasters 17 „ employer 1 Death Returns 2 100 37 The following table shews the Ward distribution of the cases:— Cases of Measles notified in each Warm. Ward 1 (Town.) Ward 2 (Belsize.) Ward 3 (Adelaide.) Ward 4 (Central.) Ward 5 (West End.) Ward 6 (Kilburn.) Ward 7 (Priory.) Total. 18 7 10 7 18 17 23 100 Of the 18 cases in the Town Ward, 8 occurred in the Soldiers' Daughters' Home, Rosslyn Hill. The following circular letter was sent to a large number of Schools in the Borough:— 1st May, 1903. Dear Sir, Measles. The London County Council have obtained the sanction of the Local Government Board to Measles being treated as a dangerous infectious disease, without compulsory notification. The object of this stop is to, as far as possible, prevent the spread of the disease in the homes of patients attacked, and in Schools. In order that I may exercise such control, may I ask you to be good enough to give me early information of any cases you become aware of amongst your scholars, their relations, or other inmates of the houses in which they reside. Yours faithfully, HERBERT LITTLEJOHN, Medical Officer of Health. To the Head Teacher, Epidemic Diarrhœa. The number of deaths registered from this cause was 4, a similar number to that recorded in 1902. The death rate per 1000 of the population from this disease was 0.04. 38 Deaths from Diarrhœa in Wards. Wards. Under 1. Over 1. Total. 1 (Town) .. .. .. 2 (Belsize) .. .. .. 3 (Adelaide) .. .. .. 4 (Central) .. .. .. 5 (West End) .. .. .. 6 (Kilburn) 3 .. 3 7 (Priory) 1 .. 1 Totals 4 .. 4 Influenza. 12 deaths resulted from this disease, as compared with 26 in 1902. Of the total deaths, 4 occurred to persons between 25 and under 65 years of age, and 4 to persons of 65 years of age or upwards. Pulmonary Phthisis. The deaths from this disease amounted to 66, as compared with 73 in 1902. In the following table the deaths arc distributed in Wards, and it will be noted that the mortality was greatest in the Kilburn Ward. Phthisis Deaths arranged in Wards. Ward 1 (Town.) Ward 2 (Belsize.) Ward 3 (Adelaide.) Ward 4 (Central.) Ward 5 (West End.) Ward 6 (Kilburn.) Ward 7 (Priory.) Total Deaths from Pulmonary Phthisis. 11 13 1 4 12 18 5 64* * 2 deaths occurring in outlying institutions are unclassifiable, owing to definite addresses not being given. 39 Of these 66 deaths, 7 were of "residents" who died outside the district, leaving the number of deaths of "residents" in the Borough at 59. Of these 59 deaths, 20 were of notified cases and 39 were of nonnotified cases. Deaths of Notified Cases.—Of these 20 deaths, 14 were notified during 1903 and 6 in 1902. 10 deaths occurred in the Workhouse Infirmary and 10 at the homes of the patients. Disinfection was carried out in all of the cases dying at their own homes. Of the 10 deaths in the Workhouse, 2 were of inmates resident for some considerable time. In 6 cases the homes of the patients were disinfected on their removal to the Workhouse. Deaths of Non-notified Cases.—In addition to the notification by medical practitioners, cases were also brought to my notice either by the investigations of your Inspectors or by information received from district visitors of the local Health Society. In addition, the returns of deaths from this disease furnished by the Registrar of Births and Deaths has afforded me means of acquiring information as to the deaths from Phthisis, which I could not otherwise have obtained. The total number of these deaths during the year was 39. Of these 39 deaths, 32 occurred in private houses, and 7 in institutions. Of the 32 deaths in private houses, 10 were not visited on account of the social position of the deceased, 22 were visited and disinfection was offered but only accepted in 6 instances. In some of the other cases, partial measures of disinfection were carried out by the families of the deceased. VOLUNTARY NOTIFICATION. 37 cases were notified, 14 less than in the previous year. Of these cases, 3 had been previously notified: there were therefore 34 new cases notified during the year. 40 Of these, 23 were of males and 11 females. Of the total cases notified, 14 died during the year and 8 within one month after notification. In 32 instances the circumstances in connection with the patient and his disease were investigated, with the following results:— In 12, or 37.5 per cent. of the cases, a definite history of Phthisis in other members of the family was obtained. In 16, or half of the investigated cases, there was no family history of Phthisis or of other Tubercular disease, but in 5 instances it appeared that members of the family had suffered from chest affections. In 4 cases, or 12.5 per cent., no particulars as to family history was obtainable. Disinfection and removal of bedding was carried out in 22 instances of the cases notified during the year, and in 3 cases was twice performed during the year. The following is a list of the occupations of the 32 cases where investigations were made:— Builder's Labourer 1 Cab Driver 1 Cab Washer 1 Caretaker 1 Coachmen 2 Coal Porter 1 Clerk 1 Domestic Servant 1 Dressmaker 1 Gardener 1 Gasfitter 1 House Painters 2 Housewives 3 Ironer 1 Labourers 3 Odd Work 1 Carried forward 22 41 Brought forward 22 Piano Factory Hand 1 Piano Tuner 1 Porter 1 Printer's Compositor1 School Girls 3 Veterinary Surgeon 1 Watchman 1 No occupation 1 Total 32 In 18 instances where inspection of the dwellings was permitted, defects of a more or less insanitary condition were discovered, and overcrowding existed in 4 instances. In connection with cases notified or otherwise brought to the knowledge of the Health Department, disinfection was carried out in 45 instances. SANATORIA FOR CONSUMPTIVE PATIENTS. For some time various Metropolitan Borough Councils have felt that some provision should be made for the housing of persons suffering from Phthisis, and the Royal Borough of Kensington has taken a leading part in promoting this object. There can be no doubt that such provision is urgently needed, and I am of opinion that it would be best undertaken by a central authority such as the Metropolitan Asylums Board. Representations were made to the Metropolitan Asylums Board, with the result that at a meeting of the Board on the 28th November, the following letter was directed to be forwarded to the various Metropolitan Boroughs. Metropolitan Asylums Board. Embankment, E.C. 4th December, 1903. Sir, From time to time during the last two years the Managers have received communications from the several Metropolitan, City and 42 Borough Councils and Boards of Guardians in which the establishment by the Managers of sanatoria for the treatment of consumptive patients has been strongly advocated. At their meeting on the 28th ultimo the Managers had before them a report on the subject (copy of which I enclose) from the General Purposes Committee of this Board, and as the result of their consideration of this report and of the recommendation embodied therein, I am now directed to state that, in the opinion of the Managers, the question of the proposed establishment of sanatoria for consumptive patients is one of such vital and far-reaching importance to the community at large, and the proposal one which, if adopted by the Managers, would entail so considerable an extension of their duties and responsibilities, and so large an increase in their expenditure, as to call for some authoritative expression of opinion by the Local Government Board before the Managers are asked to take any definite action in the matter, or to make any further inquiries in regard thereto. I may add that the Local Government Board have been duly informed of the decision of the Managers on this subject as above set forth. I am, Sir, Your obedient Servant, T. Duncombe Mann, To the Medical Officer of Health, Clerk to the Board. Borough of Hampstead. Metropolitan Asylums Board. Report of the General Purposes Committee submitted to the Board at their meeting on the 28th November, 1903. 23rd November, 1903. Proposed establishment of sanatoria for consumptives.—At the meeting of the Board on the 26th July, 1902, we were instructed to consider and report (in connection with other letters previously received on the same 43 subject) upon a letter, dated 12th July, 1902, which the Bermondsey Borough Council had addressed to the Board, and in which they advocated the establishment by the Managers of sanatoria for the treatment of consumptive persons. When we discussed this matter at our meeting on the 24th November, 1902, and decided to defer consideration of the question for twelve months, we were informed that from the replies then received by the Bermondsey Borough Council from the other Metropolitan Borough Councils, it appeared that of the 26 Councils who had been asked to support the action taken by Bermondsey 10 approved of the suggestion that the Managers should provide sanatoria for the purpose proposed, 5 approved of the principle of the need for open-air treatment of consumptives, but were not agreed as to who should be the authority for giving effect to the same, whilst the remaining 11 Councils had either taken no action in the matter or were not at the time in favour of the proposal. Since November, 1902, further letters on the subject have been received from most of the other Borough Councils, and also from certain of the Boards of Guardians of the Metropolis, the following brief synopsis giving the purport of the communications received up to date, viz.:— The Westminster City Council and the Borough Councils of Battersea, Bermondsey, Chelsea, Fulham, Hackney, Kensington, Poplar, St. Marylebone, St. Pancras, Shoreditch, Stepney, and Woolwich, together with the Guardians of the Poor of Chelsea, Holborn, Paddington, Poplar, and Wandsworth and Clapham, approve of the proposal. The Borough Council of Finsbury approve of the principle, but are unable to form an opinion as to the authority who should administer the proposed sanatoria. The Borough Council of Stoke Newington agree to the posal, but think that the cases treated should bo limited to those in which it is necessary to prevent the exposure of others to serious risks of infection. 44 From the replies received, through the Bermondsey Borough Council, it would appear that the remaining Borough Councils of the Metropolis have decided as follows:— Lambeth.—Approve of the principle and need for open air treatment. Southwark.—Have already petitioned the Local Government Board to confer powers on the Poor Law Guardians to erect sanatoria for consumptive poor, and on the London County Council for those who do not fall within the scope of the poor law. Islington.—Consider that sanatoria for consumptives are desirable, but that the time has not yet arrived when they should be provided by public authorities. Greenwich.—Cordially agree with the principle, but consider that the present is an inopportune time to adopt the measure Deptford.—Are impressed with the importance of the scheme, but do not consider that the matter is yet sufficiently advanced to justify them in taking any action. Hampstead.—In view of the large expenditure on small-pox, are not disposed at the present time to support the proposal. Paddington.—Consider it inadvisable to impose further duties upon the Metropolitan Asylums Board, especially such as involve responsibilities so great as suggested. Hammersmith.—Have taken no action. Lewisham. - Have taken no action. Wandsworth.—Are not in favour of the establishment of sanatoria as suggested. Camberwell and Holborn.-Have the matter still under consideration. Bethnal Green. — Have not replied. At the last meeting of the Board, the Managers remitted to us for consideration and report in connection with the foregoing reference a 45 letter, dated 9th inst., from the London Branch of the Incorporated Society of Medical Officers of Health, with which they forwarded copies of certain resolutions having reference to the provision of sanatoria for London consumptives, and, in expressing the opinion that the Managers should undertake the establishment of these sanatoria, suggested the Gore Farm Hospital as suitable for the purpose. We have also had before us a letter, dated 20th inst., from the Local Government Board, which will be submitted to the Managers on the 28th inst., and in which the Board forward copy of a letter on the subject of the "provision of suitable institutions for the treatment of "pauper patients suffering from phthisis" which they have received from the Guardians of the Poplar Union, and ask "to be furnished with "the observations of the Managers on the suggestion in the Guardians' "letter as to the Managers being authorised to establish sanatoria for "the treatment of persons suffering from phthisis who are chargeable to " the Metropolitan Unions and parishes." Having given careful consideration to the whole question and to the representations made in the several communications which have been addressed to the Managers on the subject from time to time during the past two years, we have come to the conclusion that the question of the establishment of sanatoria for consumptive patients is one which calls for an authoritative expression of opinion of the part of the Local Government Board. We accordingly recommend the Managers to adopt the following resolution, viz.:— That the Managers, having duly considered the question of the proposed establishment of sanatoria for consumptive patients, and the letters received from the Local Government Board and the various Metropolitan Local Authorities and Medical Officers of Health in regard thereto, are of opinion that the matter is one of such vital and far-reaching importance to the community at large, and the proposal one which, if adopted by the Managers, would entail so considerable an extension of their duties and responsibilities, and so large an increase in their expenditure, as to call for some authoritative expression of opinion by the chief health authority of the country, viz., the Local Government Board, before the Managers are asked to take any definite action in the matter or to make any 46 further inquiries in regard thereto; and that the Local Government Board, the several Boards of Guardians, the Borough Councils, and the Medical Officers of Health be so informed. [Adopted. (Signed) R. Strong, Chairman. It appears to mo that this is a question of much importance, and that the provision of Sanatoria for consumptive patients in London can only be dealt with by a central authority, and that the Metropolitan Asylums Board, controlling as it does hospital accommodation for infectious cases throughout the whole of the Administrative County of London, is the body which should take in hand this important work. SANITARY ADMINISTRATION. 48 FACTORY AND WORKSHOP ACT, 1901. For the purpose of enforcing the provisions of this Act, the Inspection of Factories, Workshops and Workplaces (except those relating to underground bakehouses) within the Borough, have been carried out by Inspectors Mrs. Fisher and Mr. Hudson in a very thorough manner; the work achieved is shewn in the accompanying tables. 49 INSPECTION OF FACTORIES, WORKSHOPS, AND WORKPLACES. Class of Works. Number of Places. Number of Inspections. 1903. Number of Notices. 1903. Number of Prosecutions. 1903. On Register at end of 1902. Added in 1903. Removed in 1903. On Register at end of 1903. Premises. Rooms. Factories Factory Laundries 5 - - 5 15 7 — — Factory Bakehouses 2 1 l 2 — 11 — — Other Factories 19 10 3 26 — 46 9 — Workshops Workshop Laundries 22 1 8 (4 of these have become Workplaces) 15 41 26 3 — Workshop Bakehouses 39 2 2 39 — 78 27 — Other Workshops 478 178 45 611 743 1515 129 2 Workplaces Outworkers' Premises 64 29 9 84 — 128 6 — Places where Food is prepared for Sale * 630 — 630 — 2037 56 - Workplaces other than the above - - — - — - - - Laundries 25 17 (13 new-4 formerly Workshop Laundries.) 4 38 65 45 9 - * The Special Register was compiled during 1903. 50 Cases reported to H.M. Inspector. Abstracts not affixed. 70 As to action taken in cases notified by H.M. Inspector - Other cases 22 Domestic Workshops reported. 5 Workshops reported as supplied with Old Abstract only. Number of underground bakehouses in use at the end of 1903 25 Certificates granted (s. 101) 11 Number of Workshop rooms measured 123 LISTS OF OUTWORKERS (S. 107.). Class of Homework. 1903. Number of Lists Received. No. of Addresses of Outworkers February Lists. August Lists. Forwarded to other Authorities. Received from other Authorities. No. of Lists. No. of Outworkers. No of Lists. No. of OutWorkers. Wearing Apparel— Dressmaking 3 3 3 3 3 4 Tailoring 9 30 11 40 45 12 Bootmaking 15 21 14 29 25 1 Underclothing 5 18 4 16 15 2 Lace .. .. .. .. .. .. Cabinet Making and Upholstery 7 25 8 23 15 .. Fur Pulling .. .. .. .. .. .. Other 3 27 12 67 69 5 Total 42 124 52 178 172 24 Number of Notices prohibiting homework in unwholesome premises (S. 108) — Number of Orders prohibiting homework in infected premises (S. 110) - 51 MATTERS DEALT WITH. Particulars. Number of Defects. Notices issued. Prosecutions. Found. Notified by Home Office. Remedied. Notified to Home Office. Matters under the Public Health (London) Act, 1891. Want of cleanliness 49 — 49 — 16 — Want of ventilation 8 — 8 — 4 — Want of air-space—Overcrowding 13 — 13 — 13 Sanitary Accommodation, s. 38— Insufficient 18 — 18 — 18 3 Unsuitable 21 — 21 — 16 — Not separate for the sexes 12 — 12 — 10 — Want of drainage of floors 1 — 1 — — — Other nuisances 275 — 275 — 96 1 Contraventions of Factory and Workshop Act, 1901. Occupying Underground Bakehouse without certificate - - - - - - Breach of Special Sanitary Requirements for Bakehouses, ss. 97-100 - - - - - - Failure as regards Lists of Outworkers, s. 107 - - - - - - Giving out work to be done in premises which are— Unwholesome, s. 108 - - - - - - Infected, s. 110 — — - - - - Allowing wearing apparel to be made in premises infected by Scarlet Fever or Small-pox, s. 109 1 - 1 - - - Other Contraventions— Workrooms insufficiently warmed 14 - 11 3 - - Total 412 .. 409 3 173 4 52 Factories in Wards. Trade or Business. Ward 1 (Town) Ward 2 (Belsize) Ward 3 (Adelaide) Ward 4 (Central) Ward 5 (West End) Ward 6 (Kilburn) Ward 7 (Priory) Art metal worker ... ... ... ... ... ... 1 Bookbinder ... 1 ... ... ... ... ... Bootmaker ... ... ... ... 1 ... ... Carpet beating ... 1 ... ... ... 1 ... Coach builder & wheelwright ... 1 ... ... ... ... ... Engineers ... ... ... 1 1 ... ... Joiners and plasterers ... 1 ... ... ... ... ... Manufacturing stationer ... 1 ... ... ... ... ... Monumental mason ... ... ... ... 1 ... ... Photographic paper manufacturer ... 1 ... ... ... ... ... Pianoforte maker ... 1 ... ... ... ... ... Pianoforte string makers ... 2 ... ... ... ... ... Printers 2 1 ... 2 1 1 2 Upholsterers 1 ... ... ... ... ... 1 Total 3 10 ... 3 4 2 4 53 Workshops and Laundries in Wards. Trade or Business Ward 1 (Town). Ward 2 (Belsize). Ward 3 (Adelaide) Ward 4 (Central). Ward 5 (West End). Ward 6 (Kilburn). Ward 7 (Priory). Artists Colour maker ... ... ... 1 ... ... ... Art Metal workers ... 1 ... 1 ... ... ... Blind makers ... 1 ... 2 ... 1 1 Bootmakers 12 17 7 3 13 19 14 Builders and Carpenters 3 4 ... 3 2 7 ... Cabinet makers and polishers 3 1 ... 1 ... 2 1 Carriage builders 2 ... ... 1 1 2 5 Corset makers 1 ... ... ... ... 1 1 Cycle makers and repairers 2 ... 2 1 2 2 1 Dressmakers & ladies' tailors 30 18 16 18 36 74 35 Dyers and cleaners ... 1 ... ... ... 1 1 Embroiderers ... 2 1 ... ... 2 ... Fibrous plaster works ... 2 ... ... ... ... ... Harness makers 2 ... 2 2 1 ... 2 Ironmongers 3 ... 1 3 3 2 ... Lace menders and cleaners ... ... ... ... ... 2 ... Laundries (Hand) 24 7 ... ... 5 15 4 Laundries (Steam) 1 2 ... 1 ... ... 1 Mantlemakers ... 1 ... ... ... 2 ... Milliners 8 1 3 5 4 5 7 Miscellaneous 5 6 6 2 11 6 Monumental Masons ... ... 1 2 ... 1 Needlewomen 4 2 1 2 1 Organ works ... ... ...... ... 1 ... ... Outfitters ... ... ... 4 ... 2 Pianoforte key makers ... 2 ... ... ... ... ... Pianoforte makers ... 3 ... ... ... ... ... Picture frame makers 3 2 3 2 2 ... 4 Smiths 2 1 1 1 1 Stained glass workers 1 ... ... ... ... 1 1 Surgical instrument maker ... 1 ... ... ... ... ... Tailors 3 5 5 1 5 20 5 Trunk makers ... ... ... 1 1 ... ... Umbrella makers and repairers ... ... ... ... 1 2 2 Upholsterers Watchmakers & 3 2 3 2 9 ... 2 Jewellers ... 2 2 3 ... 2 2 Total 110 84 46 62 91 176 100 54 Nature and Number of Businesses, Character of Workshop, and number and sex of Persons employed therein. Trade or Business. No. of Premises. Workshops. Domestic Workshops and Workplaces. Number of Workrooms. Number of Employees. Males. Females Artists' colour maker 1 1 ... 1 1 ... Art metal workers 2 1 1 1 2 ... Blind makers 5 3 2 6 6 7 Boot makers 85 41 44 52 95 ... Builders and Carpenters 19 12 7 12 17 ... Cabinet makers and polishers 8 6 2 9 14 1 Carriage builders 11 10 1 20 37 ... Corset makers 3 3 ... 3 ... 6 Cycle makers and repairers 10 8 2 12 23 ... Dressmakers & ladies' tailors 227 128 99 160 7 735 Dyers and cleaners 3 2 1 5 ... 8 Embroiderers 5 3 2 3 ... 9 Fibrous plaster works 2 2 ... 5 19 ... Harness makers 9 8 1 9 20 ... Ironmongers 12 12 ... 13 17 ... Lace menders and cleaners 2 1 1 1 ... 4 Laundries (Hand) 53 15 38 41 2 88 Laundries (Steam) 5 5 ... 15 29 244 Mantlemakers 3 1 2 8 ... 35 Milliners 33 29 4 31 ... 100 Miscellaneous 36 25 11 32 49 19 Monumental Masons 4 4 ... 6 20 ... Needlewomen 10 ... 10 ... ... ... Organ works 1 1 ... 1 5 ... Outfitters 6 6 ... 25 10 203 Pianoforte key makers 2 1 1 1 1 ... Pianoforte makers 3 3 ... 5 34 ... Picture frame makers 16 11 5 14 28 1 Smiths 6 6 ... 7 14 ... Stained glass workers 3 3 ... 5 11 ... Surgical instrument makers 1 1 ... 1 2 ... Tailors 44 21 23 28 41 31 Trunk makers 2 2 ... 3 5 ... Umbrella makers & repairers 5 ... 5 ... ... ... Upholsterers 21 14 7 20 28 1 Watchmakers and Jewellers 11 9 2 11 20 ... Total 669 398 271 566 557 1492 Bakehouses. At the end of 1903 there were 41 bakehouses on the Register, 27 being under and 14 over ground. Above-ground Bakehouses. These were regularly inspected during the year. The inspections made and works carried out at these bakehouses during the year are set forth in the following table:— 55 Number of inspections made 44 Instances where cleansing and limewashing has been carried out 4 Water closet apparatus renewed 1 Water closets cleansed 2 Gullies cleansed 2 Sink waste pipes repaired and trapped 1 Gutter repaired 1 Foul and defective dust-bin abolished 1 Dust receptacles provided 2 Roof repaired 1 Yard paving repaired 1 Window built up between water-closet and bakehouse 1 Skylight fixed in bakehouse 1 Underground Bakehouses. In view of the provisions of section 101 of the Factory and Workshop Act, 1901, coming into operation on the 1st January, 1904, the Public Health Committee appointed a Bakehouse Sub-Committee, consisting of Councillors Andrews (Chairman), Rider, and Farmer, to advise them on all questions relating to the certification of these premises. A letter was first addressed to the occupier of each underground bakehouse within the Borough, drawing his attention to the provisions of the Act, and enquiring whether he desired to apply for a Certificate. All replied in the affirmative. The Sub-Committee then drew up the following list of requirements, applicable to all such premises, which the Public Health Committee and the Council finally approved. This schedule was, however, only taken as a basis, as, in the opinion of the Council, each bakehouse should be considered on its merits. Minimum requirements for Underground Bakehouses. A. Construction. 1.—The bakehouse shall be of a minimum capacity of 1,000 cubic feet (with a floor space of not less than 120 superficial feet), 56 and shall be in every part thereof at least 8 feet high, measured from the floor to the ceiling. 2.—The walls throughout shall be rendered smooth and impervious with cement trowelled to a fine surface, or with some other equally suitable material. 3.—The ceilings shall be properly ceiled with smooth and impervious material. 4.—The floors shall be of durable, smooth, and impervious material throughout. 5.—No gully or other opening to a drain shall be within the bakehouse. Any drain or sewer under the bakehouse shall be constructed of gas and water tight pipes with cement or caulked joints, and shall have proper means of access provided thereto. 6.—Every underground bakehouse shall be provided with sufficient and suitable accommodation in the way of sanitary conveniences separate from the bakehouse. 7.—Provision shall be made for safe and suitable means of access to the bakehouse. 15. Light. 8. —That the bakehouse shall be provided with sufficient and suitably placed windows or other means for the admission of daylight, so as to effectually light every part thereof. C. Ventilation. 9.—The bakehouse shall bo properly and effectually ventilated, and in addition to the windows, there shall be provided permanent openings of suitable size and position, communicating directly with the open air. 10.—All means of lighting and ventilation shall be so placed and constructed as to prevent, so far as is possible, the entrance into the bakehouse of dust and other dirt. 57 D. All Other Respects. 11.—All troughs and tables shall be mounted on castors or wheels. No shelving or cupboards other than those absolutely necessary shall be within the bakehouse, and all shelving and cupboards shall be so constructed as to be easily moved for cleansing purposes. 12.—Any coal cellar or receptacle for fuel shall be so shut off from the bakehouse as to prevent the entrance into the bakehouse of dust. 13.—Provision for the proper storage of flour shall be made elsewhere than in the bakehouse itself. 14.—The water supply for the bakehouse shall be drawn from the rising main and not from a storage cistern. 15. —Properly covered receptacles of suitable size and material shall be provided for the temporary storage of refuse matters arising from the process of baking, and such receptacle shall be emptied at least twice in every day. 16.—Where a gas stove or other similar apparatus bo used, proper and sufficient means shall be provided for preventing the escape of fumes arising therefrom into the bakehouse. 17.—Proper dressing room and lavatory accommodation shall bo provided, separate from the bakehouse. 18. —No bakehouse shall be used for any purpose other than that of baking, or processes incidental thereto. A careful inspection was made by the Sub-Committee, and at their direction a separate specification of works was prepared in 26 cases and served upon the occupier, with an intimation that when the works therein specified were completed, a Certificate would be granted. In one instance, however, the bakehouse, which was situated almost entirely under the public way, presented such difficulties in the way of ventilation, (which had previously been obtained by open gratings in the pavement), that it was not proposed to approve it. The difficulty was, 58 however, surmounted by the Council permitting the erection of two standard lamp posts of 5 inches internal diameter, as ventilators, with results so satisfactory that the certificate was granted. The amount of work achieved, and the time devoted by your SubCommittee and the Departmental Staff in carrying the provisions of this Act to a successful issue, has been very considerable. It has, however, been more than justified by the results that have been obtained, and will ensure that work will bo carried on, and bread and confectionery produced in the future, under considerably improved hygienic conditions. To maintain this improvement, however, and in addition to ensure that Overground bakehouses are brought up to and kept at the same standard in all respects, it is essential that Bye-laws similar to those which already govern the businesses of dairymen and slaughterhouse keepers should be made and enforced. Underground Bakehouses for which certificates were granted during 1903, under the Factory and Workshop Act, 1901:— Date of Certification. Premises. 1st October 44, England's Lane. 1st „ 4, Kelson Street. 1st „ 279, West End Lane. 15th „ 202, Belsize Road. 29th „ 228, Belsize Road. 29th „ 289, Finchley Road. 29th ,, 63, Hemstal Road. 29th „ 2, King's College Road. 26th November 98, West End Lane. 10th December 10, Belsize Park Terrace. 10th „ 7, Fairhazel Gardens. Schedule of works carried out at the Underground Bakehouses certified during 1903:— Height increased to 8 feet 5 Walls, rendered in cement, trowelled to a fine surface 10 „ scraped and repaired 1 59 Ceilings renewed, finished in cement, trowelled to a fine surface 7 „ scraped and repaired 4 Floors relaid in cement 7 „ relaid in tiles 2 „ repaired 2 Gullies or other opening to drain removed from within bakehouse 7 Drains reconstructed 7 „ partially reconstructed 3 Means of access—stairs improved 2 „ existing approach closed and new provided 3 Lighting—pavement lights provided 3 „ light reflecting stallboards provided 9 Means of ventilation by shafts, &c., provided 10 Troughs and tables mounted on castors 11 Shelvings or cupboards made movable for cleansing purposes 11 Coal cellars separated from bakehouses by proper door 7 Flour and other stores provided, separate from bakehouse 6 Water supply—cisterns abolished 8 „ provided direct from main 9 Refuse receptacles provided 11 Gas stoves provided with proper hoods or flues 2 Waterclosets provided for use of workmen 1 „ removed to more suitable position 1 „ apparatus reconstructed 8 „ apartments ventilated or approach altered 6 Dressing rooms provided 8 Underground Bakehouses certified in 1903 11 „ „ where works are in progress but not completed 11 „ „ where works have not been started 2 „ „ closed 3 27 No. of inspections made 310 60 HOUSING OP THE WORKING CLASSES ACT, 1890. Part I. Kilburn Yale Area. Acting under the instructions of the Housing Committee, I made an inspection of the premises contained in this Area, and as a result submitted the following representation:— "8th June, 1903. "To the Chairman, Aldermen and Councillors of the London County Council. "Gentlemen, "Housing of the Working Classes Act, 1890. "Part I. "I herewith make a representation that in an area in the "Priory Ward of the Borough, bounded on the N.W. by West "End Lane, on the N.E. by Abbey Lane, on the S.W. by "Providence Place, and on the S.E. by the London General "Omnibus Company's Depot and an open space at the junction of "Abbey Lane, Kilburn; the generally bad condition of the houses "and groups of houses, the want of light, air, ventilation, proper "conveniences, and the closeness and bad arrangement of such "houses and groups of houses are, in my opinion, dangerous or "injurious to the health of the inhabitants of the buildings in such "Area, and that the evils connected with such houses, and groups "of houses cannot be effectually remedied otherwise than by an "improvement scheme. "I am, Gentlemen, "Your obedient Servant, "(Signed) Herbert Littlejohn, "Medical Officer of Health." 61 This representation was in accordance with section 4 of the Act, forwarded to and considered by the London County Council, who, on November 10th, passed the following resolutions, which were forwarded to this Council:— (a) That the case of the houses and courts comprised in the Kilburn Vale area, in relation to which the Medical Officer of Health of the Metropolitan Borough of Hampstead has made an official representation, dated 9th June, 1903, under Part I. of the Housing of the Working Classes Act, 1890, is not of general importance to the County of London, and should be dealt with under Part II. of the Act. (b) That the foregoing resolution be submitted to the Secretary of State for the Home Department, in accordance with the provisions of section 73 (I) (b) of the Housing of the Working Classes Act, 1890, and that a copy of the report of the Housing of the Working Classes Committee on the subject bo also submitted to the Secretary of State. On November 25th the Secretary of State wrote as follows:— [Copy.] Whitehall, 25th November, 1903. Sir, I am directed by the Secretary of State to transmit to you, herewith, copies of a letter and enclosure which have been received from the London County Council on the subject of the official representation made by the Medical Officer of Health of the Metropolitan Borough of Hampstead under Part I. of the Housing of the Working Classes Act, 1890, in relation to an area in that Borough known as the Kilburn Vale Area, and I have to request that you will be so good as to lay the same before your Council. Before taking any further steps, in pursuance of section 73 of the Housing of the Working Classes Act, 1890, the Secretary of State will be glad to be favoured with any observations which your Council may wish to make upon the matter, and he will be glad to be informed specially whether your Council are satisfied that such 62 evils as exist in the Area cannot be remedied by the application of the provisions of Part II. as to closing orders, and by the enforcement by them of their powers to secure the necessary sanitary appliances being kept in proper condition. I am, Sir, Your obedient Servant, The Town Clerk of Hampstead, Henry Cunyinghame. Hampstead, N.W. Both letters were referred by the Housing Committee to the Joint Kilburn and Priory Wards Committee for consideration and report. Part II. King's College Meas East. The condition of the houses in this Mews had been the subject of several complaints, amongst others two from the Mansion House Council on the Dwellings of the Poor, who described the Mews as being in a terrible condition. In February the Health Committee viewed these houses, and came to the conclusion that the houses in the Mews generally were unfit for habitation, and that closing orders should be proceeded for in the cases of Nos. 11 and 23 in the first instance. On March 31st, 1903, I represented under Section 30 all these houses. The usual notices were served in respect of Nos. 11 and 23, giving the owner 21 days in which to render the premises habitable. On the expiry of this period the time was extended, on the owner's application, for a further term of 12 days. During this time no works beyond that of a decorative character were carried out and consequently summonses were taken out. The Magistrate after some adjournments, during which considerable works of a more or less structural nature were proceeded with, viewed the premises and at a further hearing decided that the premises had been rendered habitable and dismissed the summonses, but without costs. 63 In view of the foregoing instance, it appears to me desirable that where the Council are of opinion that any dwelling houses are unfit to be inhabited proceedings should be taken without delay for their closing. The Act of 1903, Section 8, specially provides for the adoption of such a course by the issue of a summons without any preliminary notice to the owner. Silver Street Area. A number of houses which were individually represented by me appeared to afford facilities for being treated as an area, their "closeness, narrowness, and bad arrangement, &c.," being such as rendered them best dealt with under a scheme of reconstruction. A plan was prepared shewing the various premises included in this Area, and this, together with further particulars, was forwarded to the London County Council. Since then further information has been required, and the matter is still in abeyance. 4, Fairfax Yard.—The accompanying plan represents a stable dwelling which, upon inspection, was found to present most of the undesirable features peculiar to this kind of dwelling. The stairs leading to the dwelling house were approached from the coachhouse, which communicated directly with a stable. The water-closet was approached from the scullery, and one bedroom was without a flue or any means of ventilation other than the window, whilst the back bedroom was entirely without external light or ventilation of any kind. Notices were served upon the Owner under the Public Health Act, with the result that the alterations as shown were agreed to and carried out. By this arrangement, the water-closet has a window in the external wall and is approached from a well-lighted and ventilated passage. The bedroom without light or ventilation was converted into an open flat, which enabled a window sash and frame to be provided to the back bedroom, and, at the same time, makes provision for the storage of house refuse in the open air. The front bedroom which had no flue was provided with means of constant ventilation by the insertion of a 9in. by 6in. air brick in the external wall at ceiling level, and the entrance to the house was cut off 64 from all communication with the coachhouse and stable, and is now approached directly from the external air. In addition to this work, the whole of the drains and sanitary fittings were reconstructed, and the stable and coachhouse repaved. Premises "represented" by the Medical Officer of Health under the Housing of the Working Classes Act, 1890:— Premises. Date of Representation Part of Act and Section under which represented. Remarks. †1-9, 9a, 10-21, and 23, King's College Mews East 1903 31st March Part 2, Section 30 Caroline House and Holly Cottage, and 1 & 2, Silver Street 5 th June Part 2, Section 38 Suggested Silver Street Area 3, 4 & 5, Silver Street, 4, 5, 6, 7, 8, & 8a, Golden Square, 1, 2, & 3, Money's Cottages. 5th June Part 2, Section 30 7-12, and Stables 1 & 2, Abbey Lane; "Halton Cottage," 6a, 6, 8, 10, 12 & 14, West End Lane, Kilburn Vale, King's Cottages, Munden Cottages, Edward Terrace, William Terrace, Providence Place 8th June Part 1, Section 4 Kilburn Vale Area 5, Golden Yard 16th June Part 2, Section 38 ‡ Brewers Yard 1, 3, 5, 7, 9, 38, 40, 42, & 44, Flask Walk, 2, 3, 4, 6, 7, Golden Yard, 5, 6, 7, 8, Holly Mount Stamford Place, 2, 3, 4 & 5, Streatley Place, 1-4 White Bear Lane. 16th June Part 2, Section 30 † 11 and 23, King's College Mews East, made habitable. ‡ Brewers Yard voluntarily closed. 65 CUSTOMS AND INLAND REVENUE ACT, 1890. The following is a list of premises which have been certified by me during the year, under Section 26 of this Act, together with the date of certification:— Date when Certified. Premises. No. of Dwellings. Remarks. 16th July 1-24, The Flats, Grove Place 24 The Medical Officer of Health reported that the w.c.'s were, in his opinion, approached directly from the sculleries where food was prepared and stored. The Public Health Committee inspected the premises and came to the conclusion that no actual infringement of the bye-law existed. 5th December 3, Belsize Crescent 2 Certain sanitary defects were found to exist, which the Owner remedied. Applications were also made in the case of 4 other premises comprising 15 dwellings, which, owing to the existence of sanitary defects, I was unable to grant. FOOD AND DRUGS ACTS. During the year, 366 samples were taken for analysis, and of these, 14, or 3.8 per cent., were found to be adulterated. 66 The samples were as follows:— Nature of Article. Number of Samples taken. Arrowroot 2 Butter 105 Camphorated Oil 1 Carbolic Acid Supplied by Contract to Borough Council 1 „ Powder 1 Cheese 22 Cocoa 10 Coffee 48 Gall Ointment 2 Gin 1 Glycerine 2 Ground Ginger 4 Ground Rice 2 Ice Cream 2 Lard 22 Margarine 1 Milk 95 Mustard 11 Oatmeal 1 Olive Oil 2 Pepper 12 Preserved Green Peas 1 Rum 2 Sago 2 Sarsaparilla 1 Sweets 4 Tapioca 3 Tea 5 Whiskey 1 366 67 The following statement shows the nature of the samples which were found on analysis to be adulterated, and in each case the percentage of samples adulterated to those analysed:— Nature of Article. Number adulterated. Percentage of adulterated to total taken. Butter 6 5.7 per cent. Cocoa 1 10.0 „ Coffee 1 2.1 „ Milk 4 4.2 „ Mustard 1 9.1 „ Sago 1 0.5 „ 14 In addition to the above mentioned adulterated samples, 5 samples of milk, and the sample of margarine, have been reported as being of poor quality. The following table gives a comparison of the work accomplished in 1901, 1902, and 1903:- Year. Samples analysed. Number adulterated Percentage adulterated. Fines and Costs. £ s. d. 1901 306 6 1.9 13 15 0 1902 315 15 4.7 42 7 6 1903 366 14 3.8 37 3 0 The following table shews a comparison of the Wards in the Borough in respect of Food Adulteration:— Ward. Samples analysed. Number adulterated. Percentage adulterated. No. 1. Town 66 l 1.5 „ 2. Belsize 70 l 1.4 „ 3. Adelaide 17 l 5.8 „ 4. Central 24 1 4.1 „ 5. West End 70 3 4.2 „ 6. Kilburn 87 7 8.0 „ 7. Priory 32 0 .. Totals 366 14 3.8 68 Prosecutions were ordered in 11 instances, with the following results:— Fine. Costs. £ s. d. £ s. d. Adulterated sample, No. 104, Milk 3 0 0 0 14 6 „ „ 129, Butter 2 0 0 0 14 6 „ „147, Milk 1 0 0 0 12 6 „ „ 154, Butter 1 0 0 0 12 6 Second offence „ „ 165, ,, 3 0 0 0 14 6 „ „ „ 169, Milk 1 10 0 0 12 6 „ „ 229, Butter 5 0 0 0 12 6 „ „ 230, „ 2 0 0 0 12 6 „ „ 300, Coffee 2 0 0 0 12 6 „ „ 301, Cocoa 3 0 0 0 12 6 „ „ 307, Butter 5 0 0 2 2 0 Third offence £28 10 0 8 13 0 An average penalty of £2 11s. 10d. and 15s. 9d. costs. With regard to sample No. 99, Milk, and No. 200, Mustard, the adulteration was very slight, and no proceedings were taken, but the Council ordered the vendors to be cautioned, whilst in the case of sample No. 112, Sago, the sample consisted entirely of Tapioca, commercially known as Pearl Sago, a food stuff very similar to Sago, and of equal value, consequently no action was taken in the matter. It is satisfactory to note that although 51 samples more than last year were taken, the percentage of adulteration has fallen from 4.7 to 3.8. Unsound Food. During the year the inspection of food supply has been systematically carried out. 69 The following table shows the seizures or surrenders which have taken place. Date. 1903. Premises. Unsound Food Seized or Surrendered. January 18th The Parade, Cricklewood 1 liver. February 2nd Kelson Street 4 lbs. onions. February 5th Mill Lane 1 piece of pig's liver. June 12th Fortune Green Road 7 lbs. cherries. June 17th The Parade, Cricklewood 1 tin preserved peas. June 24th High Road 2 lbs. cherries. July 7th New End 6 lbs. fish. July 17th Quex Road 2 lbs. gooseberries and 6 lbs. tomatoes. July 22nd High Road, Kilburn 6 lbs. strawberries. July 28th The Parade, Cricklewood 1 tin peaches. October 1st High Street 2 sheep's heads. November 12th Fleet Road 1 piece sheep's liver. November 13th High Street 2 lbs. meat. December 2nd Fairfax Road 1 sheep's liver. December 8th High Road, Kilburn 43 bottles strawberries, 3 bottles gooseberries, 2 bottles fruit syrup, and 16 jars (7 lb.) jam. December 11th Boundary Road 2 small boxes fruit (apples and oranges). December 22nd Mill Lane 1 liver. December 28th Mill Lane 1 rabbit liver. Dairies, Cowsheds, and Milkshops. The inspection of these premises has been carried out by Inspector Hudson in a highly satisfactory manner, and, in many cases, has led to a great improvement of the conditions under which milk is stored and distributed. From the definitions of dairy and dairymen contained in Section 141 of the Public Health (London) Act, 1891, it appears that a person occupying premises in which milk is stored for the purpose of sale, is required to be registered. At the end of the year 1902 there were 84 persons, occupying 103 shops, on the register as milk sellers; during 1903 the following additions have been made to the register:— 70 Persons registered as milk sellers (previously trading without being registered) 11 Persons registered as milk sellers owing to change of proprietorship 6 New premises opened as milk shops by persons already registered 2 The names of 6 persons who had discontinued selling milk were removed, so that at the end of the year the register comprised 89 persons, occupying 110 shops, as follows:— Dairies 51 Bakers and Confectioners 28 Restaurants and Coffee Shops 10 General Shops 21 These orders only require the registration of persons, any of whom may occupy more than one shop in the Borough. This accounts for the difference between the number of persons registered and the shops occupied. Inspections of premises where milk is sold 638 On August 12th enquiry was made at the various railway stations in the Borough, when it was ascertained that about 389 churns, containing 4,718 gallons, arrived; the largest number of churns is delivered at Maida Vale station, but many of these are for ultimate delivery in adjoining districts. A large quantity of milk is delivered in the Borough by outside firms and from farms near by, in addition to which there are vendors living in other districts. On November 25th a sample of milk was obtained from a street vendor in Maygrove Road who was found not to have been registered. He stated that he had only that week started in business. An inspection of his premises was made, when it was found that he occupied two rooms and had no suitable places in which to store milk or to wash utensils. As he at once gave up the sale of milk he was cautioned for not having been registered, but no further proceedings were taken. 71 One registered milk seller removed to fresh premises, where it was found that the milk was stored in a dark, unventilated cupboard situated in a living room. The premises generally were dirty and insanitary. Notices were promptly served, which resulted in the sale of the business to another firm, and the place being closed as a milk shop. Two milkmen were cautioned for using dirty milk utensils, one of whom has since given up business. Table of sanitary works carried out at milk shops within the Borough:— Premises or parts of premises cleansed and whitewashed 22 Lumber removed from premises 13 Water cisterns cleansed 10 Water cisterns covered 2 Premises provided with proper water supply 2 Drains amended or reconstructed and ventilated 5 Soil pipes reconstructed 3 Water closet apparatus reconstructed (pans and traps) 8 Water closet apparatus reconstructed (flushing cisterns) 7 Water closet accommodation provided 3 Improperly placed water closets altered or abolished 2 Water closets unstopped 4 Water closets cleansed 10 External ventilation (constant) provided to water closets 2 Defective drain traps abolished 5 Improperly placed gully traps removed 7 New gully traps fixed 3 Gully traps cleansed 13 Gully traps unstopped 3 Waste pipes of sinks trapped, renewed, or ventilated 5 72 Roofs and guttering repaired 3 Foul and defective dustbins abolished 4 Movable metal dustbins provided 4 Dustbin removed from inside premises 1 Yard paving repaired or renewed 12 Ducks and fowls removed from inside premises 1 Underground rooms illegally occupied 1 Sale of milk stopped owing to the occurrence of infectious disease on the premises 1 Ice Creams. The provisions of the London County Council (General Powers) Bill, 1902, dealing with the manufacture, storage, and sale of ice creams, came into operation at the end of last year. There are at the present time 69 premises in the Borough where ice cream is made or sold. These, and the barrows of itinerant street vendors, have been regularly inspected and found to be generally in good condition. In the following cases fault was found with the manner in which the business was carried on:— Shops. A.—The ice cream sold here was made in the neighbouring borough of St. Pancras. A portion of the shop had been screened off, and was used for sleeping purposes. As a result of the caution, the ice cream was not again stored inside, but was sold from a barrow outside until the end of the summer, when the premises were closed. B.—A considerable quantity of ice cream is made at this shop, the greater part of which is retailed from street barrows. On one occasion hot milk, with other ingredients used for making ice cream, was found standing to cool in large uncovered pans on the cement floor of a basement room, where barrow painting was in progress. At the instance of the Inspector, the painting was at once discontinued. 73 C.—The ice cream sold at this shop was made in a basement room where the dustbin was kept, and whore also was a coal cupboard and water closet. The further use of this room was at once prohibited. D.—Here a front basement was used for the double purpose of a kitchen, and jobbing builder's workshop. In this room the milk used for the manufacture of ice cream was boiled, and afterwards set to cool in the yard close to a gully, a w.c., and freshly mixed paint, a state of things which was promptly terminated. Barrows. A. —This barrow had no name and address on it, and dirty water was used to wash the glasses. The attendant was cautioned, and he has since given no cause for complaint. B.- At this barrow dirty water was being used to wash the glasses. The attendant wan cautioned, and has not since been seen within the borough. Number of ice cream shops inspected 84 Number of ice cream barrows inspected 48 These figures do not include inspections of ice cream barrows on Hampstead Heath on Bank Holidays. These number some 150, and were all carefully inspected and found on the whole satisfactory. Table of sanitary work carried out at premises where ice cream is sold within the Borough:— Premises cleansed 3 Accumulation of lumber removed 2 Water closets cleansed 2 Water flushing cisterns repaired 1 Yard paving repaired 1 Foul dustbin abolished 1 Slaughter-houses. There are 5 slaughter-houses within the borough, which have been regularly inspected during the year. In October the annual inspection 74 was made, in view of the approach of the licensing session, by the Public Health Committee, who decided not to oppose any of the licenses, but in one instance took exception to the storage of harness, sacks, shop blinds, and a tricycle in the slaughter-house, which the occupier undertook to remove. Table of inspections and work carried out:— Slaughter house inspections 175 Slaughter houses white and lime washed 20 Brine rooms lime washed 2 Lumber removed from slaughter house 2 Paving repaired 2 Water closets cleansed 2 Walls and ceilings repaired 2 Defective drain trap amended 1 The following is a list of the existing Slaughter houses in the Borough:—40, Englands Lane; 17, High Street; 69, High Street; 242, Belsize Road (in rear of); 6, Fairfax Mews. Cow houses. There has been no licensed cow-house in the Borough since the year 1898. Common Lodging Houses. The only remaining common lodging house in the Borough, viz., "Holly Mount Cottage," Holly Mount, which was registered to accommodate 35 men, was closed on the 25th June, 1903, the keeper having decided not to apply for a licence under the provisions of the London County Council (General Powers) Act, 1902, which requires these placcs to be licensed annually. Hampstead is now the only Metropolitan Borough which has no common lodging house within its boundaries. Tenement Houses. The effect of the decision in the King's Bench Court in the case of Weatheritt v. Cantlay had been such that considerable doubt existed as to how far the Bye-laws made under section 94 of the Public Health (London) Act applied to an ordinary tenement house. These doubts 75 had to a large extent been removed by subsequent cases, and arrangements were being made, as far as the staff would permit, to inspect the tenement houses, when the Town Clerk advised that under the Bye-laws at present in operation the lime washing of these places could only be enforced during the months of April and May every year, and, further, that a house let in lodgings or occupied by members of more than one family was, by virtue of Bye-law 2, exempt from the operation of the Byelaws until the present landlord had been required to make a return in pursuance of Bye-law 5; the result being that a very large number of houses on the register were exempted owing to a change of "landlord" having taken place, consequently no work has been accomplished under the provisions of the Bye-laws beyond requiring the landlord in every case where there had been a change to make the return required, so that a proper inspection could be proceeded with in April and May of next year. This exemption clause in the Bye-laws is highly unsatisfactory, as the landlords of many tenement houses are constantly changing, and it is interesting to note that the Public Health Committee of the London Count}' Council have taken the opinion of Mr. C. A. Cripps, K.C., as to "whether there is power under section 94 of the Public Health (London) Act, 1891, to exempt any house from the operation of Bye-laws for the registration of houses let in lodgings or occupied by members of more than one family, or whether every local authority is bound to make Bye-laws for the registration of every such house in its district?" Mr. Cripps gave the following opinion:— "In my opinion, section 94 of the Act of 1891 is imperative, and there is no power to exempt from the operation of the Bye-laws for the registration of lodging houses any houses so occupied as to come within the lodging house definition. A bye-law in the Bethnal Green form, which enables the local authority to exempt any or all lodging houses within their district, is not a compliance with the requirements of the Act, and I am unable to agree with the view put forward by the Local Government Board." The Local Government Board's model by-laws for the guidance of Sanitary Authorities framing Bye-laws, under section 94, contain an 76 exemption clause, and the Board have in most cases made it a condition precedent to the approval of Bye-laws made by the Metropolitan Sanitary Authorities that an exemption clause of some kind or other should be inserted. There are other unsatisfactory features in these Bye-laws which require alteration, not the least important of which is that at present the landlord is made responsible for the lime washing and decorative work and for the maintenance of the sanitary appliances of all kinds. These are obligations which, in my opinion, should rest with the owner. Ambulance Service in the Metropolis. The removal by ambulances of cases of infectious disease from their homes to hospitals in London may be fairly described as excellent, but the general ambulance arrangements for medical, surgical, and other non-infectious cases is unquestionably extremely defective. The facilities that are at present afforded to the general public for the removal of persons suffering from injuries or non-infectious ailments are under present circumstances of a most meagre and, I might say, unattainable description. There are, no doubt, charitable institutions which can place ambulances at the disposal of persons requiring them, but the difficulty of securing these at reasonably short notice is so great as to render their services of little value. It has been suggested that the Metropolitan Asylums Board should, in conjunction with their present ambulance service, provide one for general non-infectious use; and, while during the recent Small-pox epidemic I deprecated the Board taking on so new and important a duty, I am now of opinion that this body is the one which, in London, can organise and carry out successfully a system of ambulance service. The recent proposal of the Board to station ambulances at the Mead Ambulance Station, Fulham, for use in this Borough appears to me, however, unsatisfactory and not likely to be of much use. Inspection of Nuisances. During the year 8,002 inspections have been made by the District and other Inspectors, and in 13,865 instances premises were re-inspected. 77 I have tabulated on page 128 the nature of the nuisances investigated. Many of these inspections were made on complaint, but in a number of instances the nuisances were discovered during the ordinary inspection of the District. Effluvia Nuisances. The complaints of effluvia nuisances were few in number, and consisted of nuisances arising from— Japanning chambers at bedstead factory 1 Ballast burning 5 Vulcanizing telephone cables 1 Fat boiling 1 Fried fish shop 4 Referring to the nuisance arising from the fumes given off by the Japanning Chambers at the bedstead factory in Dunboyne Street (see Annual Report, 1902, page 49), the occupier, having acquired premises outside the County of London, closed his factory and the summons against him was withdrawn. The Ballast fires were, in all but one instance, put out upon the service of notice, but in this case, as the process was continued, I certified it under Section 21 of the Public Health (London) Act, 1891, with the result that proceedings were taken against the offender, who was fined £5 and 8 guineas costs. The vulcanizing of the telephone cables was only carried on for short periods at rare intervals, and upon it being brought to the notice of the Company that effluvia from the process set up a serious nuisance, an undertaking was given that it should be entirely discontinued, and so far as I am aware no nuisance has since arisen. The nuisance from the fried fish shop is still under consideration. Complaint was received of a nuisance arising from the storage and boiling of fat and other offensive refuse, but on investigation it was found that while the storage of fat and bones, £c., was carried on without due regard to cleanliness, no boiling took place. The premises have been under observation, and so far there has been no reason for complaint. 78 Steam Nuisance. Serious complaints were received of the emission of considerable quantities of steam from the General Electric Supply Company's Electric Works, which was not only excessively laden with moisture, but also appeared to be charged with oily vapour. A Notice was served upon the responsible person under Section 23 (2c) of the Public Health (London) Act, 1891, with the result that condensing plant has been erected and no further complaints received. Smoke Nuisances. 15 complaints were received of the emission of smoke, viz.:—8 from the chimneys of business premises, 4 from private houses, 1 from an excavator, 1 from a locomotive, and 1 from a stationary engine. The chimneys were kept under special observation from time to time, with the result that in some instances the complaints were found to be well founded. In every such case it was found that the nuisance arose either from careless stoking or the use of improper fuel, and was abated after the service of notice. Trough Closets. This form of sanitary convenience at one time enjoyed considerable popularity amongst sanitary engineers, especially when making provision for works, institutions, or schools, where accommodation had to be provided for a large number of persons. Experience has shown, however, that from a sanitary point of view they have proved a failure. The Bye-laws made by the London County Council under Section 39 (1) of the Public Health (London) Act, 1891, prohibit this form of apparatus from being newly erected, and during the year existing troughs, where found insanitary, have been abolished and replaced by proper pan and trap receptacles in the following cases:— Broomsleigh Street Board School. Fleet Road Board School. Field Lane Ragged School (Hillfield Road). The Sailors' Daughters' Home (Fitzjohn's Avenue). Willow Buildings (Willow Road). Wheelwright's Works (44, Birchington Road). Fibrous Plaster Works (Agincourt Road). 79 Sanitation at Railway Stations. On January 8th it was found that alterations were in progress at Finchley Road (Metropolitan) Railway Station, which involved the removal of the Ladies' Waiting Room from the Entrance Office to a room on the Down Platform, in which two sanitary conveniences were in course of construction. No notice had been given to the Council, either by the Railway Company or their Contractor, before commencing the works, and in other respects the provisions of the Bye-laws made under the Metropolis Local Management Act, 1855, and the Public Health (London) Act, 1891, had not been complied with. The attention of the Company's Resident Engineer and Contractor was directed to the matter, but they contended that Section 16 of the Railway Consolidated Clauses Act, 1845, which authorises a Railway Company from time to time to make and alter such conveniences as they think fit, exempted them from the operation of any General Act or Bye-laws in force in the Borough. The works having in the meantime been completed, the Public Health Committee recommended the Council to take proceedings against the Contractor. Summonses were consequently taken out, and the case was heard at the Marylebone Police Court on 29th May, 1903, by Mr. Curtis Bennett, who on 15th June gave the following considered decision:— "In this case there are seven summonses, three under Bye-laws 1, 2, and 14, made by the London County Council under the Public Health (London) Act, 1891; one under the Metropolis Management Acts, 1855 (Section 76), and 1862 (Section 88); one under Bye-law 4 of the Act of 1855 (Section 202); one under Bye-law 8 of the Act of 1855 (Section 232); and one under Bye-law 9 of the same Act. They all raise really the same legal question, whether or no the Public Health Act of 1891, and the Metropolis Local Management Acts apply to a railway station, so that the requirements of those Acts can be enforced against the Railway Company, should either the conveniences provided at the railway station not be in accordance with the requirements of those Acts, or should any alteration be made in any of the conveniences so 80 provided at any railway station. It was argued before me by Mr. Glen, on behalf of the Metropolitan Railway Company, who are the real Defendants to the Summons, that as under their original Act of 1874 they had power given them by Parliament to make, inter alia, stations, and to provide all necessary conveniences for the working of their railway, they are not affected by any Act which is inconsistent with such powers, which he contended was so in this case. On behalf of the Borough Council, Mr. Courthope Munroe argued that although originally created under a special Act of Parliament, all general Acts apply to any buildings erected by them, unless specially excepted by statute, or are so inconsistent as to make it clearly the intention of the Legislature that they should not apply. No doubt the Building Act (London), 1894, in many parts expressly excepts the application of such parts to railways, but under the Acts of Parliament under which these summonses are taken, there is no such general exception in favour of the Railway Company. The only exception that is to be found is under Section 45 of the Public Health (London) Act, 1891. The cases of the London County Council v. Wandsworth and Putney Gas Company, the London and Blackwall Railway Campany v. Lewisham District Board of Works, the City and South London Railway v. London County Council, the Uckfield Rural District Council v. Crowborough District Water Campamy, were relied upon by both sides, and generally I think there was an agreement that the general Acts apply to buildings erected under special Acts unless they are inconsistent, or so inconsistent with the provisions of the general Acts as would lead to the opposite inference. I think you will agree that that was the line adopted. I referred to the London County Council v. London School Board, where the latter body purchased certain lands for the erection of a school, and in laying out part as a playground unfenced, came within twenty feet of the centre of a highway, where the Court supported a decision of mine, that as the special Act gave power to use the ground for a school they were entitled to place the fence where it was, notwithstanding that it was contrary to Sections 4 and 6 of the Metropolis Management and Building Acts Amendment Act. I should like to deal with the facts of this case before I allude to another case. I am not going to allude to those authorities very fully, because we had them thrashed out on the last occasion. I think that was really the point, that unless they are so inconsistent as not to apply, 81 that the rule is that they would apply. The facts of this case appear to be these, that the Metropolitan Railway Company have been altering their Finchley Road Station, and have been moving—I think I am right in the facts—the conveniences from the ground floor on to the platform, and in so doing they have constructed some new water-closets at the end and on either side of one general waiting room. The Borough Council say: 'We ought to have had notice; this is a matter which required notice under the Public Health and the Metropolis Management Acts.' No notice was given before the work was entered on. Secondly they say: 'Besides that, your water-closet does not comply with the Bye-laws. We have power, under the Acts referred to, to make Bye-laws, and we have made certain Bye-laws, and one, of which we complain, is that you did not take the closet partitions up to the top of the building, and you left these closets so that when they are used on both sides there is a space, about 4 ft. between the ceiling and the partition, and that when these closets are used the effluvia from the closets would naturally waft its way over this partition into the general waiting room.' The Borough Council say that the rule is that you must carry that right up, and not leave a space. Next they say: 'You have not complied with the Bye-law which requires you to put in a 4-in. pipe for ventilation purposes. You have only put in 2-in. pipes instead of 4-in., and that is not in accordance with our Bye-laws.' Thirdly, they say: 'Instead of taking your gully outside the building, which you ought to have done, you have put it underneath the floor, and that is contrary to the Bye-law. You must take the gully outside.' Again they say: 'You have done another thing. By our Bye-laws each closet or compartment ought to have a window and ventilator, and you have not got either,' and for those reasons the Borough Council say : 'You have infringed against these Bye-laws; you have not given us notice, and you have not complied with the Public Health Act. Also another complaint is, that you have made a drain, and that you have connected this with the sewer without giving us notice, so that we could see how the work was carried on.' Those are the real complaints. What the Railway Company say is: 'True; we admit the facts, but we say that as we are established by an Act of Parliament the Public Health Act does not apply.' The Counsel on behalf of the Borough Council says, and truly says,' If it does not apply, how is it that Section 45 expressly excepts that particular Section 82 in regard to Railway Companies?' And that Section simply deals with the question of, if you erect conveniences of this sort, charging so much for the use of them. That special Section, and only that Section, has an exemption in favour of Railway Companies. Mr. Courthope Munroe says, and very strongly says: 'If the Act did not apply what is the necessity of excepting that Section only? 'I think that is a very strong ground, because if the Act did not apply there was no necessity to except it at all, whereas if the Act applied altogether, or if it did not apply, it seems to prove that the Railway Company at the time the Act was before Parliament had their attention called to it—they had their representative there, people represented them in Parliament, that particular Section was legislated for, and that particular Section does not apply to Railway Companies. I think it is a very strong ground, as Mr. Courthope Munroe says, that excepting that one Section shows that the General Act does apply, except, that is, it is so inconsistent that it ought not to apply. As to the inconsistency, Mr. Glen put it that the Railway Company have powers, powers which are granted to them by the Act of Parliament, and powers which make it very necessary that the very greatest care should be taken in any works that are thought necessary to be done in reference to the Railway, or otherwise you might have a very serious accident occurring, for which the Railway Company would be responsible, although the action was brought about by an interfering body who came in and required certain work to be done, or if, as he put it, they had power under the Act of Parliament to come in and do it themselves, if inexperienced people came and did the work on the Railway, they might cause a state of affairs which would be harmful and detrimental to the public, and also to the Railway Companies themselves. In answer to that, I think one must take it that a public body must be supposed, if they have powers such as that, which they undoubtedly would have under the Public Health Act, to enter and do the work in case of its not being done. They can enter, but at the same time they are not bound to enter. They might take out summonses, either at this Court or any other Court—because this decision applies to the whole of England as far as it goes—and complain that the work was not done, according to the notice, and have the work done against the Company. And in default of their doing so, there is power then to enforce it being done by imposing daily penalties until it is done. 83 Therefore the question is, whether the public body would in such a matter as a Railway Company undertake themselves to do what undoubtedly they might have the power of doing, but probably in their discretion they might not attempt to do—meddle with the main line of a Railway, so as to prevent trains running in an ordinary way, or take any risk of that sort on their shoulders which might not only render them liable in damages, but might certainly, if they did things which caused the death of people, render them liable to be prosecuted for manslaughter. I think probably the reasonable ground for the Council is to say that if these things are not complied with we may do the work, but we shall not do it, we shall call upon the Railway to do it, and if they do not do it, take proceedings at law and compel them. Then the Company said there is no authority—both sides agreed—there is no authority about the matter at all; the question never seems to have been raised. But I am indebted to my clerk, Mr. Withrington, for finding a case which was not alluded to, where it appears that really the question of whether or no the Nuisances Act applies in regard to Railways, has been raised. It was raised in the case of the Great Western Railway v. Bishop. It was heard in the Queen's Bench on the 1st June, 1872, and it is reported in 41 Law Journal, New Series, at p. 120. The state of the facts there was as follows:—The Great Western Railway had a bridge over a public road and the railway bridge got into such a state of disrepair or non-repair that when heavy rain occurred the bridge leaked, and people passing under the bridge had the unpleasant sensation of getting a stream of water on them through the bridge. They were proceeded against under the Nuisances Act, and the Company took the point, not at all that the Nuisances Act did not apply and that they were not liable to be proceeded against under the Nuisances Act,—but that the dripping of water as he passed under the bridge was not a nuisance injurious to health, and the point was argued in the Queen's Bench upon that, and upon that ground Lord Justice Cockburn said: 'I am of opinion that this conviction cannot be upheld. I agree that it might be very convenient if this summary mode of procedure were applied to such a case, but that feeling must not influence us, unless we see clearly that the matter complained of falls within this particular Act which speaks throughout of matters injurious to health. I think that it was intended by the Legislature to secure means for preventing the occurrence of such 84 matters as would affect the health of the public, and also of private individuals, and that it was only intended to apply the provisions of the Act to such things as were injurious to health.' Then Mr. Justice Lush said: 'I am of the same opinion. It is clear that the word 'nuisance' is not used in the 8th Section in the general sense as applied by the Common Law. It must be limited in some way or other. Many instances might be given where nuisances would be indictable, but would not come within the purview of this Act. I can find no other guide than by looking to see what is the scope of the Act, and in deciding in accordance with that.' Mr. Justice Hannen said: 'I think that the clue to the construction of the Act is to be found in the terms of Section 8. The word 'nuisance' shall include' any premises in such a state as to be a nuisance or injurious to health'; it was not intended to limit the operation of this Act to cases where there would be a nuisance injurious to health, but to extend it to cases whore, although there might not be a nuisance, yet there was something injurious to the health of individuals. But still, to bring a nuisance within the operation of this Act, it must be such a one that would be injurious to health.' I cannot help saying that one perfectly agrees with that decision—the dripping of water is not likely to be injurious to health: it is likely to be injurious to your clothes or your hat, but the dripping of water from a bridge that you pass under would not probably be injurious to health. On that ground the conviction was quashed. But that is not like this case really at all, because in this case you have a Railway Company making new conveniences, and the conveniences that they are making are, I am bound to say, in my opinion not such as should be made from the health point of view, because to make your closets with a 4 ft. escape into the public waiting room, and no windows at all, means that when the closets are used—as Mr. Courthope Munroe said—when you pull the plug the whole of the effluvia must go somewhere, and it therefore goes over the top of the partition into the general waiting room, and circulates there. It cannot be said that that is the best sanitary precaution that could be taken for persons travelling on the Railway or other persons using those conveniences who have to travel on the Railway. Then supposing Mr. Glen's contention is right, that the Public Health Act does not apply, and that the Sanitary Acts do not apply, the Railway Company might—I do not say they do, but they might —allow their closets to 85 become a source of danger to people living in the neighbourhood. If they allow their closets to get into such a condition as to be absolutely insanitary, and the people who use them, who continually have to travel, in consequence of using these things contract disease, and that disease is circulated, either in the neighbourhood or elsewhere, the contagion being taken from the Railway Company, can it be said that the only remedy against the Railway Company is that by indictable action at Common Law, and that that expensive and prolonged mode is the only possible way in which you can compel a Railway Company to make their stations sanitary, and make their conveniences comply with the Sanitary Acts of this Country? I cannot think it can be held to be inconsistent with the powers given by the original Act of Parliament to the Metropolitan or to any Railway Company—it does not matter which—that they should have powers simply to erect what they choose, but that they are not to comply with the requirements of the Sanitary Authority in which that station happens to be situated. If so, it seems to me that such a power must have been given by express words, and if the Companies are to be exempt from the Sanitary Acts and from the Public Health Act I should have expected to find that exception there, as you find it in the Building Act of London, a very large portion of which is excepted, and does not apply to Railway Companies—buildings erected for the purposes of Railway Companies are expressly excepted by that Act of Parliament in very many cases; the whole of the third part of the Act is entirely excepted: there are many Sections whore it is enacted they shall not apply to Railway Companies. There is no such exception in the reference to the Public Health Act of London, 1891. As I say, the only exception is Section 45, which has nothing on earth to do with this question. Therefore that being so, it seems to me a very strong ground for saying that the Legislature had their attention called to the fact at the time the question was before Parliament, because they inserted that exception to that particular Section, and only that particular Section, and therefore to my mind that is a very strong ground for saying that the Legislature never intended to except the whole of the property of Railway Companies from the Act in its entirety. That being so, I have come to the conclusion that the Railway Company have offended in reference to all these various Sections of these various Acts of Parliament under which the summonses are taken. They did not give the notice 86 they have not carried, as the Bye-law requires them, the partition right up to the ceiling as it ought to be: they have left it about 4 ft. from the top: they did not give notice to the Borough Council when they made the drain in connection with the sewer, they have not placed the gully externally, which they ought to have done: they have not provided a 4-in. pipe, but have provided a 2-in. pipe, and they have not provided anything which could give ventilation to the closets themselves. It was said and argued on behalf of the Railway Company that there is a difficulty, because there was a railway bank, and the earthwork came right up to the wall of the closet. But surely a brick chamber could be constructed into which this window could be opened. That chamber could be made of brick work on two or three of the sides of it, and the fourth side could be against the wall, and you would have not only the light from heaven, but you would have a ventilating place for the closet itself. I do not see any insuperable difficulty at all about that. With an embankment 25 feet high it is only a question of a little expense, but expense is not what the Legislature considers with reference to the health of the public. With these facts, and upon the facts of the case to which I have alluded, and which were not alluded to in the case when it was argued before me—it seems to me admitted in the Great Western case that in that case the Sanitary Act did apply, and the only reason why they said it did not apply was because what was complained of was not injurious to health—this would be to my mind injurious to health, if the Acts allowed that this should be done, when it ought not to be done under the Public Health Act, and on this ground I must convict the Railway Company on the summonses. As far as I know this is the first case that has ever been raised in the country, and my decision, if it is right, affects every Railway Company. Mr. Glen: On behalf of the Railway Company I am instructed to give notice of appeal in respect of the two summonses involving the giving of notice which will raise the question of law involved. The Magistrate : On the two summonses for not giving notice the fine will be 20s. and 23s. costs each. The others will be 5s. and 23s. costs. It is 20s. and 23s. costs in two cases, and 5s. and 23s. costs in each of the others. The two under notice are one as to the Bye-laws, made under the Public Health (London) Act, 1891, and one under the 87 Metropolis Local Management Acts. This is a very important case, because if I am right it applies to all railway stations in England. If I am wrong, it does not. Will you yourselves draw the case ? If you cannot agree, come to me, and I will settle it. Extract from "The Times," Monetary, July 6th, 1903. At Marylebone recently, Mr. Curtis Bennett had before him the case of the Hampstead Borough Council v. Tennant. The latter, it will be remembered, traded as Isaac Tennant & Co., builders, of Grange Road, Willesden Green, and had to answer seven summonses in respect to certain sanitary work done by them at the Finchley Road Station of the Metropolitan Railway. It was urged that the Railway Company were not amenable to the Local Authority ; but the Magistrate decided against them, and consented to state a case. The facts were given very fully in The Times of June 16th. An intimation was now given that the Company were content to accept the Magistrate's ruling, and that the case would not be proceeded with. New Drainage Bye-laws. In my annual report for the year 1901 I drew your attention to the fact that the Metropolis Local Management Amendment (Bye-laws) Act, 1899, which had been promoted by the London County Council, had become law. On the 20th of August, 1903, the Local Government Board gave their assent to the Bye-laws which the London County Council framed under the additional powers given by that Act. All persons about to construct, re-construct, or alter the pipes, drains, or other means of communicating with sewers, or the traps and apparatus connected therewith, are required to deposit in duplicate with the Sanitary Authority of the district such plans, sections, and particulars of the proposed construction, re-construction, or alteration as may be necessary for the purpose of ascertaining whether such construction, re-construction, or alteration is in accordance with the Statutory provisions relative thereto, and with the Bye-laws made under section 202 of the Metropolis Local Management Act, 1855. 88 Such deposits (except in case of urgency) are to bo made at least fifteen days before such work, or in the case of a new building, before such building is commenced. For cases in which the alteration of the drains must be carried out at once, it is sufficient if notice in writing of such proposed alteration is sent to the Sanitary Authority and the other particulars deposited within two weeks. The records, which the provisions of these Bye-laws enable the Council to compile, will be of the greatest value, as from the date of their coming into full operation there will be available the complete history of the sanitary arrangements and any alteration of all premises within the Borough; and the chance of a drain being surreptitiously converted into a sewer or of drainage alterations being made in such a manner as likely to be dangerous to health, is reduced to a minimum by the clauses which make it obligatory to give notice to the Council before any such work is commenced. To facilitate as far as possible the task of those who have to supply the particulars required by these Bye laws and in the interests of uniformity, the following schedule form of application, and form for use in cases of emergency, have been adopted by the Council with highly satisfactory results. 89 DETAILED DESCRIPTION OP PROPOSED WORK AND SPECIFICATION OF MATERIALS. (To be filled in by Applicant.) Concrete. Composition of Thickness and width of beds of concrete Traps. Interceptor Gullies Waste pipes Water closets Manholes and Inspection Chambers. Thickness of walls Description of bricks „ rendering Size and description of cover and manner of fixing Ventilation of Drains. General description of method to be adopted Connections (Description of). Lead soil pipe, &c., with iron drain,&c. Stoneware trap, &c., with lead soil pipe, &c. Lead soil pipe, &c., with stoneware drain, &c. Iron soil pipe, &c., with stoneware drain, &c. Stoneware trap of Closet with iron soil pipe, &c. Ventilation of Trap of Water Clout (Anti- Syphon) Description of method to be adopted (Note.—Connection with arm of soil pipe to be not less than 3 inches or more than 12 inches from the highest part of the trap.) Water Closets. Means of approach to Size of window made to open Means of constant ventilation Description of apparatus including flushing Other Work. Description, &c., of any work to be carried out, but not mentioned above, is to be given here. Note.—The size and materials of the pipes and their respective falls are to be indicated on the accompanying plans, and the general description given in the accompanying Schedule. 90 SCHEDULE OF PIPES REFERRED TO IN THE FOREGOING SPECIFICATION. Materials. Diameter. Weight. Method of Jointing. Drains Soil pipes Ventilating pipes, other than soil pipes Waste pipes Subsoil drains .Rainwater pipes DRA WINGS. All drawings must be submitted in duplicate, and must be prepared on linen in ink. 91 Urgency Form. Borough of Hampstead. METROPOLIS MANAGEMENT ACT, 1855, sec. 202, and METROPOLIS MANAGEMENT ACTS AMENDMENT (BYELAWS) ACT, 1899. Notice of proposed construction, reconstruction, or alteration of pipes, drains, or other means of communicating with sewers, or the traps and apparatus connected therewith, in cases oj urgency. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Gentlemen, Whereas* on behalf of† have received instructions to carry out the following work:—** at the premises situate on the side of now numbered or known as and it being necessary by reason of†† that such alterations should be carried out at once, hereby give notice of intention to commence the work forthwith, and I undertake to deposit the plans, sections, and written particulars required by the Bye-laws within two weeks from date. (Signature) day of 190 *Insert here Name and Address of Applicant. †lnsert here Name and Address of Owner of premises to be drained. **Insert here particulars as to the nature of proposed work. ††lnsert here the grounds for urgency. 92 Habitable Rooms. The provisions of Section 70 of the London Building Act, 1894, contain some very important regulations from a public health point of view, governing the construction of habitable rooms. I find, however, that in some cases these enactments are evaded and apartments, constructed since the passing of this Act and originally designed for stores or other similar purposes, are being used as habitable rooms. During the year I have reported three such cases to the London County Council. Certificates as to Water Supply. During the year 286 Certificates have been issued under Section 48 of the Public Health (London) Act, 1891, in respect to proper and sufficient supplies of water to houses. 16 cases were discovered of houses occupied without a water certificate having been obtained, and in 8 proceedings were instituted and penalties imposed. Ventilation of Sewers. In my Annual Report for 1902 I reported that owing to repeated complaints of nuisance from the existing method of sewer ventilation the system was a most unsatisfactory one and should be abolished. A Joint Sub-Committee of the Public Health and Works Committees was appointed to consider the whole matter. To this Sub-Committee I presented the following Report: — Town Hall, Hampstead, N.W. 21-s/ December, 1903. To the Chairman and Members of the Special Sub-Committee on Ventilation of Sewers. Gentlemen, Ventilation of Sewers. In accordance with your instructions, I beg to report as follows upon the above subject. 93 It is unnecessary for me to remind you that this matter is one which has specially engaged the attention of the late Vestry on more than one occasion. As Medical Officer of Health, I am, however, of opinion that this question of Sewer Ventilation in Hampstead, from a public health point of view, has not been solved, and I further maintain that the system at present in use is a source of annoyance, nuisance, and possible danger to health. Before, however, attempting to substantiate these opinions, it appears to me necessary that as some mis-apprehension exists as to the exact meaning of the remarks on this subject in my Annual Report for 1902, I should make my interpretation of them clear. The present system I describe as "most unsatisfactory" and " improper." In my judgment, a system which has been the subject of so much investigation by the Sanitary Authority and which is still a source of general complaint, may, without exaggeration be so described. In the same Report, I express the opinion that "where practicable, the present system should be abolished." It does not appear to me to admit of argument that, where a system of sewer ventilation liable to affect the public health is in the opinion of your Medical Officer of Health "most unsatisfactory "and "improper," he should recommend that it be " abolished." No one, however, practically acquainted with sewer ventilation would suggest that the abolition of the system at present employed in Hampstead, should or could be carried out satisfactorily in other than a gradual manner, or that regard should not be paid to special districts of the Borough. The facts are, that during 1902 complaints to the number of 58 were received by me of offensive odours from sewer ventilators, and I cannot but think that similar complaints, though perhaps less in number, may have reached the Borough Surveyor. 94 Such complaints as were addressed to me, were forwarded to the Borough Surveyor, and, doubtless, brought to the notice of the "Works Committee, in whose care the general condition of Sewers and their ventilation are vested. An analysis of the complaints shews that practically no district of the Borough was free from them, and I have no reason to doubt, indeed every reason for believing, that such complaints were well founded. My own experience, as well as that of the Sanitary Inspectors, both tend to confirm me in this opinion. In my official capacity, I have daily opportunity of judging of the annoyance caused by emanations from these surface ventilators, and to me it appears unreasonable that, while the Borough Council should insist upon air and watertight house drains, they should continue to ventilate their sewers at street level to the inconvenience and possible danger to health of the inhabitants of the Borough. As a system of surface sewer ventilation exists in most Metropolitan Boroughs, and in many Provincial Towns, I have obtained from a number of them replies to questions on this subject, a tabular statement of which I submit, along with the text of the questions contained in my circular letter addressed to the Medical Officers of Health. In addition, I submit tabular statements of replies to questions oil this same subject received by the Strand District Board, and the Borough of "Wandsworth. The information I have been able to gather, points conclusively to the fact that where a system of surface ventilation of sewers is employed, it has, practically without exception, given rise to complaint. It will be noted that in a number of instances where this system exists and complaints have been received, three remedial measures have been found effectual, viz.:— 1. Closing of surface ventilators. 2. Closing of surface ventilators and the erection of ventilating shafts. 3. Erection of ventilating shafts—the surface ventilators being kept open. 95 While placing on record the experience of other towns, I do not at present feel called upon to recommend definitely any of the above mentioned measures. I would, however, point out, that, in an undoubted instance of nuisance from a surface ventilator, the Works Committee authorised the closing of the opening in the road and the erection of a ventilating shaft, with the result that the nuisance was at once abated. In this particular instance the exhalations from the surface ventilator immediately in front were distinctly perceptible inside the house. The question of danger to health from the present system of sewer ventilation is a most important one, and while in my Annual Report I state that my experience does not warrant me in ascribing disease to it in Hampstead, I am nevertheless of opinion, that, under certain circumstances, exhalations from sewers are quite as capable of producing disease as those which, through some defect in a drainage system, are permitted to enter dwelling houses. That I am not alone in this contention may be gathered from a study of the statistics submitted; and I would point out that your late Medical Officer of Health in his reply to the Medical Officer of Health of the Strand District in 1896, stated that "the only apparent cause of certain cases of Diphtheria in Hampstead, was effluvia from street gullies or ventilators in near proximity." I am, Gentlemen, Your obedient Servant, HERBERT LITTLEJOHN, Medical Officer of Health. 96 97 BOROUGH OF HAMPSTEAD. Sewer Ventilation. Summary of replies by the Medical Officer of Health in answer to his enquiry as to the means adopted for the Ventilation of Sewers.–1903. Town. Are the Sewers ventilated, entirely or in part, by surface gratings ? If surface gratings are employed, has this system been found a source of complaint ? What steps have beem taken to remedy complaints? What results have been obtained ? Note.—In the majority of instances no definite mention is made as to the results obt ained by any system which may have been adopted, but in the greater number of \such cases the replies indicate that they have been successful. Metropolitan Boroughs, and City of London. 1. City of London (No return) 2. Battersea In part Yes Shafts erected. Surface gratings left as inlets or closed - 3. Bermondsey In part In some places great nuisance Shafts erected - 4. Bethnal Green Almost entirely Many complaints No effective step, taken at present - 5. Camberwell (No return) 6. Chelsea Very largely by surface gratings Often found offensive Shafts erected and special ventilating standards Generally satisfactory. 7. Deptford In part Always been a source of complaint Shafts erected - 8. Finsbury In part Occasional complaints Shafts erected - 9. Fulham Surface gratings and shafts Many complaints about surface gratings Shafts erected Satisfactory. Town. Are the Sewers ventilated, entirely or in part, by surface gratings? If surface gratings are employe???, has this system been found a source of complaint ? What steps have been taken to remedy complaints ? What results have been obtained? Metropolitan Boroughs. 10. Greenwich In part Frequent source of complaint Gratings closed. Shafts erected. (Occasional complaints of shafts) - 11. Hackney Almost entirely Yes Gratings stopped and shafts erected Mostly satisfactory. 12. Hammersmith In part Yes Closing gratings - 13. Holborn By surface gratings as a general rule A few cases of complaint Gratings closed. Shafts erected Nuisance abated. 14. Islington (No return) 15. Kensington Mainly by surface gratings Yes Closing of gratings. Shafts erected - 16. Lambeth Mainly by surface gratings At very rare intervals Closing of gratings. Shafts erected, or shafts erected and gratings left as inlets - 17. Lewisham Mainly by surface gratings Yes Shafts substituted for surface gratings in some instances - 18. Paddington Gratings almost entirely Complaints occasionally received Carbolic acid interceptors provided Indefinite. 19. Poplar Principally by gratings Gratings a nuisance, especially from London County Council sewers Shafts erected - 20. St. Marylebone (No return) 21. St. Pancras Mainly by surface gratings Yes Shafts erected where permitted - 22. Shoreditch To a great extent by surface gratings Yes Various. Cleansing; shafts; ventilating lamps Ventilating lamps not satisfactory. 23. Southwark Mainly by surface gratings Complaints small in number, due to highly efficient house drainage Shafts erected Satisfactory. 98 99 Town. Are the Sewers ventilated, entirely or in part, by surface gratings ? If surface gratings are employed, has this system been found a source of complaint ? What steps have been taken to remedy complaint ? What results have been obtained ? Metropolitan Boroughs. 24. Stepney (No return) 25. Stoke Newington Mainly by surface gratings Very few complaints Flushing. Closing of gratings. Shafts erected Satisfactory. 26. Wandsworth Partly by surface gratings Complaints frequent Shafts erected Generally satisfactory Reeve's system recently adopted. 27. Westminster,City of Partly by surface gratings Yes Ventilating lamps. Gauze screens—flushing Satisfactory. 28. Woolwichban Districts. Not now Originally a serious source of complaint Gratings closed. Shafts erected 29. Croydon In most part Complaints not infrequent Shafts erected, and special devices - 30. Hornsey Very few surface gratings. Mainly by shafts Necessarily a source of complaint Shafts erected - 31. Streatham (No return) 32. Walthamsow In part Yes Shafts erected - 33. West Ham Originally Yes Shafts erected Usually satisfactory, 34. Willesden In part Yes Abolition of surface gratings. Shafts erected Satisfactory. 35. Wimbledon.. Originally. (In all roads taken over by Council, surface gratings have been plated down and where possible upcast shafts erected) Continual complaints prior to plating down Surface gratings plated down. Shafts erected Satisfactory. Tow. Are the Sewers ventilated entirely or in part, by surface gratings ? If surface gratings are employed, has this system been found a source of complaint ? What steps have beeu taken to remedy complaints ? What results have been obtained. Towns. 36. Aberdeen Very largely Certain gratings a periodical source of complaint Charcoal trays and gas lamps Not practically successful. 37. Bath Not now; there were many Complaints were frequent The whole were closed years since. Ventilators have been erected 30 ft. in height - 38. Bedford Principally surface gratings Occasional complaints Shafts erected - 39. Birkenhead Mostly surface gratings, but some upcast shafts Surface grids are a constant source of complaint The abolition of surface grids entirely from narrow streets, and from the wider streets gradually. No deleterious results on health returns; death rate steadily deelining Satisfactory. 40. Birmingham Almost entirely Complaints occasionally of smells from certain gratings. Never been found to produce disease Shafts at dead ends of sewers Doubtful. 41. Blackburn Entirely Many complaints made Erection of sewer-ventilating shafts under consideration of Committee - 42. Blackpool Mostly surface gratings Frequently been the cause of complaint and a source of nuisance Proposal to increase number of high ventilating shafts and close all surface ventilators causing nuisance - 43. Bolton Entirely Few complaints Gratings sealed up - 44. Bradfcrd Almost entirely Complaints made when sewers improperly used No steps taken - 100 101 Town. Ara the Sewers ventilated, entirely or in part, by surface gratings ? If surface gratings are employed, has this system been found a source of complaint ? What steps have been taken to remedy complaints ? What results hare been obtained ? Towns. 45. Brighton In part Very rarely Shafts erected. Occasionally gratings closed - 46. Bristol No. Sewers totally unventilated - - - 47. Burnley Almost entirely Source of complaint. A nuisance Subject being considered - 48. Cardiff Partly Occasional complaints Gratings closed. Shafts erected Satisfactory. 49. Devonport Not now Complaints were received Surface gratings sealed up in most cases - 50. Edinburgh Partly Complaints occasionally made Gratings are, if possible, removed to more suitable place, or sealed up 51. Gateshead (No return) 52. Glasgow Entirely Occasional complaints Solid cover to grating - 53. Grimsby Partially Complaints frequent Gratings closed. Shafts erected Satisfactory (so far). 54. Halifax In part, and by untrapped gullies Occasional complaints Deoderising filters to gratings - 55. Ipswich Partly Constant complaints All gratings closed. Shafts erected where permitted - 56. Leeds In part. Majority of street gullies untrapped Frequent complaints about gullies Occasionally, where open gullies are close to house door, we trap, putting ventilator up house side. - 57. Leicester In part Complaints frequently received When well founded, gratings closed down and shafts erected - 58. Liverpool Chiefly. Shafts in certain districts Complaints relatively infrequent Sewer kept flushed Usually satisfactory. Town. Are the Sewers ventilated, entirely or in part, by surface gratings ? If surface gratings are employed, has this system been found a source of complaint ? What steps have been taken to remedy complaints? What results have been obtained ? Towns. 59. Lytham (No return) 60. Manchester Partly Some complaints Gratings closed. Shafts erected In some cases satis- factory 61. Middlesbrough In part Many complaints Shafts being erected with gas extractors at worst part - 62. Newcastle Almost entirely Moderate number of complaints Flushing, and carbolic powder - 63. Northampton Almost entirely Occasional complaints Flushing Satisfactory. 64. Norwich In part Yes Trapping Satisfactory (on whole). 65. Nottingham In part Yes Fixing high tubular ventilators i Satisfactory. 66. Oldham Mostly by surface gratings and untrapped gullies Occasional complaints Shafts erected - 67. Portsmouth In part Very great nuisance Closure of gratings. Erection of shafts - 68. Preston In part Occasional complaints Adam's disinfector. Flushing or ventilator closed - 69. Richmond Not now All closed owing to serious complaints Ventilating shafts where permitted Satisfactory. 70. Sheffield Practically only by surface gratings Few complaints every year Connecting dead ends with other sewers. Altering position of manholes and lampholes - 71. Southend-on-Sea Not now All closed owing to frequent complaints "Ham Baker's" ventilating columns Completely satisfactory. 72. Southampton Surface gratings have been constructed as inlets Yes Plugged up - 102 Town. Are the Sewers ventilated, entirely or in part, by surface gratings? If surface gratings are employed, has this system been found a source of complaint ? What steps have been taken to remedy complaints ? What results have been obtained? Towns. 73. Southport Partly Continual cause of complaint for years Gratings are closed whereever possible. Reeves system and Webb's patent ventilating lamps (the former costly) Satisfactory. 74. South Shieids Few surface gratings (mostly upcast shafts) Sometimes a nuisance Replaced by upcast shafts Satisfactory. 75. Sunderland Entirely by surface gratings Considerable number of complaints received Some gratings blocked by air-tight covers. Ventilation shafts - 76. Sutton Partly Yes Gratings closed down. Sewers now generally ventilated by ventilating columns - 77. Windsor Formerly Frequent Nearly all gratings have been closed. Shafts erected - 78. York Partly Numerous complaints Shafts erected Satisfactory. 103 Summary of Replies received by Medical Officer of Health of the Strand District Board of Works.—1896. Name of Tovrn, or Sanitary District. Have you had complaints with reference to sewer ventilators ? Have you been able to trace any deleterious influences upon health from emanations from sewer ventilators? (a) At the street level. (b) From shafts. Do you consider it desirable that Sanitary Authorities should have power to erect ventilating shafts on private property where necessary ? (a) Have you any experience of "Sewer Gas Destructors ?" (b) Have they proved satisfactory ? 58 54 Yes. 2 Not since certain measures had been taken. 1 Sewers not ventilated. 1 No reply to this query. a b 31 Yes. 11 No. 3 Doubtful. 2 No reply to the query. 11 Replies indefinite. a b Yes. 12 No. 31 Yes. 3 No. 30 Yes. 21 No. 27 Yes. 11 No. 16 In other returns these questions are not answered or the replies are not definite. In several cases the replies received were indefinite, and in 5 instances these queries were not answered. 104 Summary of Replies received by Medical Officer of Health of the Metropolitan Borough of Wandsworth.—1903. Name of Authority. Methods adopted in the district for the ventilation of sewers. Complaints of offjnpive smells from surface ventilators in streets. Ability to trace any connection between offensive smells from sower ventilatois and diphtheria and other disease. Is each house drain intercepted from the main sewer ? Ventilator required on the sewer side of the intercepting trap. 57 32 Surface ventilators and shafts. 45 Yes. 5 Yes. 19 Yes. 10 Yes. 17 Surface ventilators. *11 No. 3 No. 10 No. 47 No. 6 Shafts. † 1 No reply. 18 Doubtful. 28 Partly yes and no. 2 Sewers not ventilated. 1 No reply. 2 No ventilators. * Of the 11 Authorities where no complaints were received, 6 only use shafts as ventilators, and 1 does not ventilate the sewers. † This refers to a district where the sewers are not ventilated. 105 In Appendix II. will be found the report of the Joint Sub-Committee, which was submitted to the Public Health and Works Committees, and approved and adopted by them. The recommendations contained in the report were adopted by the Council on 17th March, 1904. During the year under review, 42 complaints were received of smells from sewer ventilators. Public Mortuary. During the year the bodies of 74 persons were brought to the Mortuary as against G4 last year—40 by order of the Coroner, 22 by the Police, and 12 at the request of friends of the deceased persons. In 63 instances, or 85 per cent, of the bodies admitted, inquests were held, and in 37 instances, or 50 per cent., post-mortem examinations were made. The following table indicates the causes of death of the persons whose bodies were received into the Mortuary:— Cause of Death. Number of Bodies received. Deaths from natural causes 40 Accidental deaths 11 Suicide 20 Neglect at birth 3 Total 74 It will be noted that in no instance was the body of a person who had died from an infectious disease brought to the Mortuary. 106 MORTUARY RECORD FOR THE YEAR 1903. Month. Bodies Admitted. No. of Post-Mortems. No. of Inquests. No. of Funerals from Mortuary. Males. Females. Total. Males. Females. Total. January 2 3 5 2 3 5 5 4 February 6 3 9 1 2 3 9 4 March 6 — 6 4 — 4 6 5 April 5 — 5 1 — 1 4 3 May 1 3 4 1 1 2 3 4 June 4 2 6 — 1 1 3 4 July 5 3 8 3 — 3 7 8 August 5 1 6 — — — 3 5 September 4 3 7 3 1 4 8 4 October 4 2 6 2 2 4 5 5 November 1 5 6 1 3 4 4 3 December 2 4 6 2 4 6 6 5 Total 45 29 74 20 17 37 63 54 107 Staff of the Public Health Department. Clerks.—In October, Mr. C. G. Flaxman, Third Clerk, resigned, and Mr. J. E. Stone was appointed in his stead. Clerk-Draughtsman.—In April, Mr. Edmund J. Cooper was appointed as temporary Clerk-Draughtsman, and his services were subsequently continued until the end of the year. He has since been permanently appointed in that capacity. Dangerous Structures During the year 9 Dangerous Structures were reported to the Superintending Architect of the London County Council. Legal Proceedings. During the year, legal proceedings have had to be resorted to in several cases, the details of which I append. Statement of Summary Proceedings taken during the Year 1903. Ward No. Date when proceedings ordered. Date of Hearing. Court. Offence. Result of Hearing. 6 1902. 16th Dec. 1903 2nd Jan. Marylebone Police Court Selling (1) adulterated butter, and (2) margarine without label on wrapper Fined £2 and 12s. 6d. costs on first summons, and 2s. costs on second. 6 Do. 1903. Do. Do. Do. (1 and 2) Ditto ditto 7 13th Jan. 1902. 23rd Jan. Do. No proper water supply to w.c. Fined 10s. and 23s. costs. 5 2nd Dec. 1903. 4th Feb. Hampstead Petty Sessional Court Nuisance- Summons withdrawn on payment of costs. 5 13th Jan. 13th Feb. Marylebone Police Court Non-compliance with Order Summons dismissed on technical point, with £2 2s. costs. 6 27th Jan. Do. Do. Nuisance Work done ; summons withdrawn on payment of co sts. 5 13th Jan. 4th Mar. Hampstead Petty Sessional Court Non-compliance with Bye-laws at two premises Work done; summonses withdrawn. 6 Do. 27th Mar. Marylebone Police Court Nuisance Work done; summons withdrawn on payment of costs, ,£1 4s. 6d. 4 10th Mar. Do. Do. Ballast burning Fined Z5, and ,£8 8s. costs. 4 27th Jan. 1st Apri Hampstead Petty Sessional Court Nuisance Work done. Costs paid summons withdrawn. 108 Ward No. Date when proceedings ordered Date of Hearing. Court. Offence. Result of Hearing. 3 1903. 28th April 1903. 20th May Hampstead Petty Sessional Court Allowing premises to be occupied without Water Certificate Fined £1 and costs. 3 Do. Do. Do. Do. Do. 2 1902. 16th Dec. 22nd May Marylebone Police Court Nuisances at three premises Closing Order made in respect of two premises, and Abatement Order in respect of one premises. Costs in all three cases. 6 1903. 12th M ay 5th June Do. Selling adulterated milk Fined (1) £3 and 12s. 6d. costs, (2) 2s. costs. 2 1902. 24th April 12tli June Do. Nuisance Premises closed; summons withdrawn. 4 1903. 13th Jan. 15th J une Do. Breaches of Byelaws Fines and costs, amounting to £11 6s., imposed. 4 28th April 22nd June Do. Breaches of Byelaws Fines and costs, amounting to £6 4s. imposed. 1 27th Jan. 24th June Hampstead Petty Sessional Court Nuisance Abatement Order and costs. 5 27th May 26th June Marylebone Police Court Selling (1) adulterated butter, and (2) margarine without proper wrapper Fined |(1) £2 and 12s. 6d. costs; (2) 2s. costs. 3 31st March 8th July Do. Summons under Housing of the Working classes Act Dismissed without costs. 5 9th June 10th July Do. Selling adulterated milk Fined £1 and 12s. 6d. costs. 6 Do. L o. Do, Selling (1) adulterated butter, and (2) margarine without proper wrapper Fined £1 and 12s. 6d. costs. 7 Do. Do. Do. Breach of Byelaws Dismissed with £1 Is. costs. 6 Do. Do. Do. Breach of Byelaws Fined £1 and 2s. costs. 5 12th May Do. Do. Allowing premises to be occupied withoutWaterCertificate Fined 10s. and 2s.costs. 6 Do. Do. Do. Do. Do. 1 26th May 15th July Hampstead Petty Sessional Court Breach of Bye-laws Fined 10s. and 6s. 6d. costs. 3 23rd June 17th July Marylebone Police Court Do. Dismissed without costs. 6 Do. Do. Do. Do, Fined £2 and 2s. costs. 6 26th May 24th J uly Do. Nuisance, and breach of Bye-laws Work done, Summonses withdrawn. 109 Ward No. Date when proceedings ordered. Date of Hearing. Court. Offence. Result of Hearing. 3 1903 31st Mar. 1903 24 th July Marylebone Police Court Summons under Housing of the Working Classes Act Work done, Summons withdrawn. 2 23rd June Do. Do. Selling (1) adulterated butter; and (2) margarine without proper wrapper (1) Fined £3 and 12s. 6d. costp; (2) 2s. costs. 3 Do. Do. Do. Selling adulterated milk Fined £1 10s. and 12s. 6d. costs. 7 12th May 31st July Do. Nuisance Work done, Summons withdrawn. 4 Do. 7th Aug. Do. Do. Abatement Order, one month. 6 22nd Sept. 1902 23rd Oct. Do. Selling adulterated butter (2 samples) (1) Fined £5 and 12s. 6d. costs; (2) Fined £2 and 12s. 6d. costs. 6 18th Nov. 20th Nov. Do. Insufficient water closet accommodation Summons withdrawn; no costs allowed. 4 15th Dec. London County Council Appeal Committee Appeal against notice of the Sanitary Authority to reconstruct drains Appeal allowed ; no costs. 5 22nd Sept. 13th Dec. Do. Not having proper door, Ac., to w.c. Order made for work to be done and 6s. costs. G Do. Do. Do. Nuisance Order made and 6s. costs. 3 23rd June Do. Do. Do. Order made and 13s. costs. 5 17th Nov. & 1st Dec. Do. Do. Allowing premises to be occupied without WaterCertificates Fined 15s. and 2s.costs on each Summons; total, ,£3 and 8s.costs. 6 23rd June Do Do. Nuisances, (3 premises) Orders made, together with 6s. costs in each case. PUBLIC HEALTH LEGISLATION, 1903. 112 The Cremation Act, 1902. This Act, described as "an Act for the regulation of the Burning of Human Remains, and to enable Burial Authorities to establish Crematoria," came into operation on April 1st, 1903. The main object of the Act is to empower burial authorities to pro vide and maintain Crematoria under certain conditions and subject to regulations to be made by the Secretary of State. Employment of Children Act, 1903. This Act will come into force on the 1st January, and in London will be administered by the London County Council. By its provisions Bye-laws may be made, prescribing the age at which, and the time and hours during which, children may be employed, and prohibiting their employment during specified periods and at certain occupations. One code of Bye-laws may bo framed applicable to all children, or boys and girls may be governed by separate rules. Street trading by children under 16 years of age may be prohibited unless the provisions of the Bye-laws made under the Act are complied with, or unless a licence to trade is granted by the County Council. Where any breach of the Act is committed by a manager or foreman without the knowledge ot the principal, proceedings may be taken against the persons offending. This Act, although it no doubt deals more with the moral than the public health aspect of childhood, is so nearly related to the Factory and Health Acts that I have made this special mention of it. The Expiring Laws Continuance Act. The Vaccination Act of 1898, which expired on the 31st December, is by the provisions of this Act continued in operation for another year. Housing of the Working Classes Act, 1903. The law relating to the Housing of the Working Classes is considerably modified by this Act in many important respects. 113 The maximum period for which the Local Government Board may sanction the repayment of loans raised for housing purposes, is extended from 60 to 80 years, and such loans are not reckoned in the debt of a local authority for the purposes of limitation of borrowing. An Order in Council may now be made constituting the Local Government Board the only central authority in the County of London. Hitherto this duty has been shared by the Local Government Board and the Secretary of State. If the confirming authority is satisfied that a scheme ought to have been prepared for the improvement or reconstruction of the whole or part of an area which has been represented, they may order the local authority to make such a scheme as they direct. Any such order of the confirming authority may be enforced by mandamus. The procedure for obtaining confirmation of an improvement or reconstruction scheme is considerably amended, and the power given to the Local Government Board (if they think fit) to modify a scheme which is petitioned against, must considerably facilitate the carrying of such to an early and successful issue. It is now no longer necessary to serve a notice on the owner of a dwelling house before proceedings are taken for a Closing Order, if the local authority are of the opinion that the house is not reasonably capable of being made fit for habitation, or that the occupation thereof should be immediately discontinued. Where a house has to be demolished by a local authority, and the expenses incurred are not covered by the sale of the materials, the balance becomes a civil debt recoverable against the owner. The recovery of possession of a dwelling house, in respect of which a closing order has been obtained, can now be obtained by a local authority or the owner, by the same procedure as if the local authority or the owner were landlord. Shops and recreation grounds may, with the consent of the Local Government Board, be included as part of any scheme which a local authority may be carrying through for the provision of dwelling accommodation for the working classes. 114 Section 75 of the Act of 1890 implies a condition (under certain circumstances) that any contract made after the 14th August, 1885, for the letting of a house or part of a house for habitation by persons of the working classes, that the premises were at the time of such letting fit for habitation, but it appears that it was possible for the parties concerned to contract themselves out of the provisions of the section. Henceforth any such contract, if made, is declared to be void. Hitherto a Metropolitan Borough Council has been unable to contribute to the cost incurred by the London County Council in carrying out an improvement scheme under Part I. within its district; such disability is now removed, and the necessary borrowing powers are given. The Midwives' Act, 1902. The above Act, the purpose of which is to secure the better training of midwives and to regulate their practice, came into force on April 1st, 1903. A Central Midwives' Board has been appointed, and in London the "local supervising authority" is the London County Council, who, however, have power to delegate the local administration of the Act to the Borough Council. The County Council, however, have decided to retain the control in its own hands. APPENDIX I. 116 TABLE I. Vital Statistics of whole District during 1903 and Previous Years. Year. Population estimated to Middle of each year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Non-residents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Number Rate.* Under 1 Year of Age. At all Ages. Number Rate.* Number Rate per 1000 Births registered. Number Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1893 72608 1495 20.5 166 111.0 1452 19.9 695 605 91 938 12.9 †l894 73503 1472 20.0 177 120.2 1323 17.9 667 581 56 798 10.8 1895 74399 1453 19.8 203 139.7 1265 17.0 476 403 69 931 13.4 1896 76216 1462 19.1 187 127.9 1308 17.1 548 472 80 916 12.0 1897 78549 1479 20.0 193 130.4 1219 15.5 472 397 89 911 11.6 1898 80623 1516 18.1 198 130.6 1296 16.0 552 460 81 917 11.4 †l899 80926 1576 19.5 206 130.7 1262 15.5 487 398 62 926 11.4 1900 81230 1621 20.0 170 104.8 1200 14.7 458 372 94 922 11.3 1901 82280 1506 18.3 155 102.0 1196 14.5 532 424 101 873 10.6 1902 83743 1516 18.1 155 102.2 1199 14.3 482 390 95 904 10.7 Averages for years 1893-1902 78407 1509 19.2 181 119.8 1272 16.2 536 450 81 903 11.5 1903 85197 1453 17.05 155 106.7 1049 12.3 424 312 100 837 9.8 † The figures for these years have been corrected. * Rates in Columns 4, 8 and 13 calculated per 1000 of estimated population. Note.—The deaths included in Column 7 of this Table are the whole of those registered during the year as having actually occurred within the district or division. The deaths included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non-residents" is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there ; and by the term "Residents" is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. The "Public Institutions" taken into account for the purposes of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses and lunatic asylums. A list of the Institutions in respect of the deaths in which corrections have been made is given on the next page. Area of District in acres (exclusive of area covered by water), 2253. Total population at all ages, 81,942.} At Census of Number of inhabited houses, 11,294. Average number of persons per house, 7.2. 1901. 117 TABLE I. (continued). I. II. III. Other Institutions, the deaths in which h%ve been distributed among the several localities in the District. Institutions within the District receiving sick and infirm persons from outside the District. Institutions outside the District receiving sick and infirm persons from the District. Consumption Hospital, Mount Vernon Bethlehem Hospital Cancer Hospital Central Throat Hospital The Creche, Hemstal Road Children's Hospital, Paddington Green City of London Asylum Friedenheim, Upper Avenue Road Claybury Asylum Colney Hatch Asylum Great Ormond Street Ilampstead Hospital, Parliament Hill Hospital Guy's Hospital Hanwell Asylum Hampstead Workhouse, New End Horton Asylum King's College Hospital Leavesden Asylum North Western Fever Hospital, Lawn Road London Hospital London Temperance Hospital St. Francis' Hospital, Denning Road Metropolitan Imbecile Asylum Middlesex Hospital St. Peter's Home, Mortimer Road National Hospital North Eastern Hospital North West London Soldiers' Daughters' Home, Rosslyn Hill Hospital Queen Charlotte's Hospital Royal Chest Hospital Royal Free Hospital Royal Hospital for Incurables St. Bartholomew's Hospital St. George's Hospital St. Gile's Workhouse St. Luke's Asylum St. Mary's Hospital St. Pancras Workhouse St. Thomas' Hospital Samaritan Free Hospital Sick Asylum, Hendon University Hospital Westminster Hospital West London Hospital The Workhouse is within the Borough and situate at New End in No. 1 (Town) Ward. 118 TABLE II. Vital Statistics of Separate Localities in 1903 and Previous Years. Names of Localities. Ward No. 1 (Towu). Ward No. 2 (Belsize). Ward No. 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). Year. Population estimated to middle 1 of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. 6. c. d. 1893 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1834 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1895 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1896 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1897 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1898 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1899 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1900 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1901 11944 ... 142 26 12968 ... 139 29 10438 ... 98 9 9137 ... 60 9 12222 ... 112 27 14838 ... 200 44 10733 ... 113 11 1902 12240 192 163 20 13280 239 135 18 10500 103 95 3 9233 110 71 11 12550 275 107 20 15100 435 219 45 10840 162 110 16 Averages of years 1893 to 1902. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1903 12550 194 127 14 13520 211 121 13 10600 95 101 9 9357 99 60 8 12850 243 111 21 15370 417 184 39 10950 194 116 21 Notes.—Deaths of residents occurring in public institutions beyond the district are included in sub-columns c of this Table, and those of non-residents registered in public institutions in the district excluded. (See note on Table I. as to meaning: of terms "resident" and "non-resident.") Deaths of residents occurring in public institutions, whether within or without the district, are allotted to the respective localities according to the addresses of the deceased. In 1901 there were 9 deaths of persons over 1 year of age, occurring in outlying institutions, which were not able to be classified in wards owing to a definite address not having been registered. In 1902 there were 4 deaths of persons over 1 year of age, occurring in outlying institutions, which were not able to be classified in wards owing to a definite address not having been registered. In the cases of 12 outlying deaths, the address given being simply "Hampstead Workhouse," these were placed in No. 1, or Town Ward. In 1903, there were 16 deaths of persona over 1 year of age, and 1 infantile death occurring in outlying institutions, &c., which were not able to be classified in wards owing to a definite address not having been registered. 119 TABLE III. Cases of Infectious Disease notified during the Year 1903. Notifiable Disease. Cases Notifi«d in whole District. Total Cases Notified in each Locality. Number of Cases Removed to Hospital from each Locality. At all Ages. At Ages—Tears. Ward No. 1 (Town). Ward No, 2 (Belsize). Ward No. 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No. 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small-pox 1 - - - - 1 - - - - - - 1 - - - - - - 1 - Cholera - - - - - — - - - - - - - - - - - - - - Diphtheria 79 2 14 39 13 11 — 7 15 3 8 17 11 18 6 14 1 5 8 8 14 Membranous croup — — - — - — - - - - - - - - - - - - Erysipelas 41 — 2 3 33 3 6 5 3 1 5 18 3 - 1 1 - - 2 - Scarlet fever 165 42 80 26 17 — 21 37 14 23 24 26 20 9 32 6 15 15 22 12 Typhus fever — - — — - - - - - - - - - - - - - - - Enteric fever 24 — 1 3 9 11 — 4 3 2 2 9 2 2 2 - - - 6 - 1 Relapsing fever — — — — — — — — — — - — - - - - - - - - Continued fever — - — — — — — — — - - - - - - - - - - Puerperal fever 1 - — — — 1 - - - - - - - - 1 - - - - - - - - Plague — — — — — - - - - - - - - - - - - - - - Chicken-pox 12 2 2 7 1 - — — 2 — 2 7 — 1 Totals 323 4 59 131 62 74 3 88 62 22 36 62 59 44 17 47 8 20 29 33 27 120 TABLE IV. Causes of, and Ages at, Death during Year 1903. Causes of Death. Deaths in or belonging to whole District at subjoined ages. Deaths in or belonging to Localities (at all ages). L'otal Deaths in Public Institutions in the District. All ages. Under 1 year. 1 and under 5. 5 ani under 15 15 and under 25. 25 and under 65. 65 and upwards. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No. 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn).* Ward No. 7 (Priory). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 8 3 5 ... ... ... ... 6 ... ... ... ... 1 1 1 Scarlet Fever 3 ... 3 ... ... 3 50 Whooping Cough 15 6 8 1 ... ... ... 3 1 ... ... ... 9 2 ... Diphtheria & Membranous Croup 10 1 3 6 ... ... ... 1 2 ... 1 1 2 3 45 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fever { Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric 2 ... ... ... ... 2 ... ... ... 1 ... 1 ... ... 10 Other continued ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 12 1 1 1 1 4 4 ... 1 4 2 2 1 2 2 Cholera ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea 4 ... ... ... ... ... ... ... ... ... ... ... 3 1 2 Enteritis 11 8 2 ... ... ... 1 1 ... ... 1 4 3 2 5 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... Other Septic Diseases 2 ... ... ... 1 1 ... 2 ... ... ... ... ... ... ... Phthisis 66 ... ... 1 14 46 5 11 13 1 4 12 18 5 94 Other Tubercular Diseases 24 2 10 4 2 5 1 5 2 1 1 3 8 4 12 Cancer, Malignant Disease 105 ... ... ... ... 55 50 14 17 18 9 16 17 14 39 Bronchitis 48 5 1 ... 13 29 5 10 3 3 4 12 10 5 Pneumonia 56 17 9 1 ... 17 12 9 8 6 2 7 20 3 11 Pleurisy 3 ... ... ... ... 3 ... 1 ... 2 ... ... ... ... ... Other Diseases of Respiratory Organs 9 1 ... ... ... 5 3 ... 1 ... ... 1 2 3 2 Alcoholism,Cirrhosis of Liver 16 ... ... ... ... 15 1 4 2 3 ... 2 3 1 5 Venereal Diseases 1 1 ... ... ... ... ... ... ... ... ... 1 ... 3 Premature Birth 23 23 ... ... ... ... ... 2 3 2 1 1 5 6 3 Diseases & Accidents of parturition 5 ... ... ... ... 5 ... 1 ... ... ... 2 2 ... ... Heart Diseases 76 ... ... ... 6 36 33 10 12 12 7 9 14 10 25 Accidents 11 1 1 ... 1 6 2 2 1 1 1 1 3 2 6 Suicides 10 ... ... ... ... 10 ... 2 ... 1 ... 1 3 2 14 Murder 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... All other causes 315 51 8 8 12 98 138 43 48 46 25 41 56 44 84 All causes 837 126 51 22 37 322 279 127 121 101 60 111 184 116 424 Note. It will be noted that the total number of deaths in the Ward distribution is 17 less than the total number of deaths at the age periods. This is accounted for by the fact that in these case3 a definite address was not registered. (See Note at foot of Table II.) 121 Table V. PREMISES. NUMBER OF PLACES. Number of inspections, 1903. Number of notices, 1903. Number of prosecutions, 1903. On register at end of 1902. Added in 1903. Removed in 1903. On register at end of 1903. Milk premises 103 13 6 110 638 - - Cowsheds - - - - - - - Slaughter-houses 5 - - 5 175 - - Other offensive trade premises - - - - - - - Ice cream premises 69 - - - 84 - - Registered houses let in lodgings 908 - - - - (a)*- (a)*- (b)*- (b)*- * (a) For overcrowding. * (4) For other conditions. Overcrowding, 1903— Number of dwelling rooms overcrowded 33 Number remedied 33 Number of notices issued 33 Number of prosecutions — Underground rooms— Number closed during year 3 Insanitary houses— Number closed under the Public Health (London) Act, 1891 2 Shelters provided under sec. 60 (4) of the Public Health (London) Act, 1891 — Number of persons accommodated during the yea — Customs and Inland Revenue Acts— Number of houses for which applications were received during year 8 Number of dwellings comprised therein 41 Number of certificates granted 26 122 Number of prosecutions under Bye-laws under Public Health Act, 1891 — (a) For prevention of nuisance arising from snow, ice, salt, filth, &c. - (b) For prevention of nuisance arising from offensive matter running out of any manufactory, &c. 1 (c) For the prevention of keeping of animals in such a manner as to be injurious to health — (d) As to paving of yards, &c., of dwelling houses 4 (e) In connection with the removal of offensive matter, &c. — (f) As to cesspools and privies, removal and disposal of refuse, &c. — (g) For securing the cleanliness of tanks, cisterns, &c. — (h) With respect to water closets, earth closets, &c. 7 (i) With respect to sufficiency of water supply to water closets — (j) With respect to drainage, &c. (Metropolis Management Act, Section 202) 5 (k) With respect to deposit of plans as to drainage, &c. (Metropolis Management, Section 202) — Mortuaries— Total number of bodies removed 74 Total number of infectious bodies removed — 123 TABLE VI. Year. Birth rate per 1000. Natural increase (Hamp- stead). Seven Principal Zymotic Diseases death rate per 1000. Notifiable Zymotic disease rate per 1000, Hamp. stead. General death rate per 1000. Hampstead. England and Wales. Hampstead. England and Wales. Hampstead. England and Wales. 1875 22.6 35.4 394 - 3.4 - 12.5 22.7 1876 24.4 36.3 367 — 3.1 — 15.2 20.9 1877 24.0 36.0 413 — 2.7 — 13.7 20.3 1878 24.5 35.6 409 — 3.4 — 14.8 21.6 1879 22.8 34.7 365 — 1.9 - 13.2 20.7 1880 24.1 34.2 521 1.2 3.3 — 12.6 20.5 1881 23.8 33.9 502 2.0 2.3 — 12.7 18.9 1882 23.6 33.8 546 2.2 2.7 — 13.0 19.6 1883 23.8 33.5 685 1.8 2.3 — 11.2 19.5 1884 22.0 33.6 554 1.9 2.8 — 12.5 19.5 1885 21.2 32.9 593 1.4 2.2 - 11.5 19.0 1886 21.0 32.8 554 1.2 2.4 — 12.2 19.3 1887 21.9 31.9 628 1.1 2.4 — 11.0 18.8 1888 20.5 31.2 616 1.0 1.8 - 10.56 17.8 1889 21.0 31.1 728 0.95 2.2 - 10.7 17.9 1890 21.9 30.2 613 1.5 2.1 — 13.1 19.1 1891 21.5 31.4 670 1.0 1.9 4.5 12.2 22.5 1892 20.4 30.5 591 1.7 1.8 8.0 12.4 19.0 1893 20.5 30.8 547 1.3 2.47 ll.l 12.9 19.2 1894 19.6 29.6 674 1.4 1.76 6.2 10.8 16.6 1895 19.8 30.2 452 1.0 2.14 7.3 13.4 18.7 1396 19.1 29.7 546 1.8 2.18 7.8 12.0 17.1 1897 20.2 29.7 568 1.1 2.15 5.1 11.6 17.4 1898 18.1 29.4 599 1.4 2.22 5.7 11.4 17.6 1899 19.7 29.3 650 1.1 2.21 6.0 11.4 18.3 1900 20.0 28.7 699 1.0 2.0 5.8 11.3 18.3 1901 18.3 28.5 633 0.77 2.05 5.6 10.61 16.9 1902 18.1 28.6 612 0.69 1.64 *5.4 10.7 16.3 1903 17.0 28.4 616 0.49 1.46 *3.8 ‡9.8 †l5.4 * Excluding Chicken-pox. ‡ This is the lowest rate on record for Hampstead. † This is the lowest rate on record for England and Wales. 124 TABLE VII. Shewing Number of Inhabited Houses and Number of Persons to each House, at Census 1901. Name of District. Number of Inhabited Houses. Census 1901. Number of Persons to each House. Census 1901. Lewisham 22,750 5.60 Wandsworth 37,764 6.14 Woolwich 18,086 6.47 Stoke Newington 7,717 6.64 Greenwich 14,240 6.72 Deptford 15,823 6.97 Camberwell 36,671 7.07 Hackney 30,634 7.15 Battersea 23,462 7.19 Hampstead 11,294 7.25 Lambeth 41,511 7.27 Hammersmith 15,198 7.38 Fulham 18,534 7.40 Poplar 22,613 7.46 Kensington 22,131 7.98 Paddington 17,684 8.14 Bermondsey 15,817 8.26 Chelsea 8,641 8.54 Islington 38,645 8.66 Bethnal Green 14,005 9.25 Shoreditch 12,743 9.28 Stepney 31,462 9.49 St. Marylebone 13,536 9.84 Southwark 20,878 9.87 St. Pancras 23,715 9.92 City of Westminster 18,366 9.96 Finsbury 9,280 10.93 Holborn 4,703 12.63 125 TABLE VIII. Showing Extent in Acres, and Number of Persons to the Acre at Census 1901. Name of District. Extent, in Acres, Census 1901. Number of persons to the Acre. Census 1901. Woolwich 8,276.6 14.15 Lewisham 7,014.4 18.17 Greenwich 3,851.7 24.86 Wandsworth 9,129.7 25.41 Hampstead 2,265.0 36.17 Hammersmith 2,286.3 49.09 Camberwell 4,480.0 57.88 Stoke Newington 863.5 59.38 Hackney 3,288.9 66.68 Dcptford 1,562.7 70.67 Poplar 2,327.7 72.54 City of Westminster 2,502.7 73.14 Lambeth 4,080.4 73.82 Kensington 2,291.1 77.09 Battersea 2,160.3 77.73 F ulham 1,703.5 80.61 Bermondsey 1,499.6 87.23 St. Pancras 2,694.4 87.34 St. Marylebone 1,472.8 90.55 Paddington 1,356.1 106.17 Islington 3,091.5 108.37 Chelsea 659.6 112..05 Holborn 405.1 146.67 Stepney 1,765.6 169.11 Bethnal Green 759.3 170.85 Finsbury 589.1 172.26 Shoreditch 657.6 180.57 Southwark 1,131.5 182.29 126 TABLE IX. Disinfection. Number of premises disinfected 421 Number of Articles disinfected — Beds 221 Palliasses 18 Mattresses 515 Bolsters 425 Pillows 1122 Blankets 1494 Sheets 878 Counterpanes 525 Articles of Clothing 3120 Carpets 148 Miscellaneous 5192 Total 13658 The Number of Premises disinfected during 1902 was 420, and the Number of Articles 15246. 127 Table X. 984 complaints were received during the year 1903,and related to the following matters:– Accumulations, offensive 13 „ of refuse 8 Animals, keeping of 13 „ dead 14 Dampness in premises 27 Dirty premises 17 Drains, bad condition of 36 „ defective 17 ,, stopped 32 Dust, manner of removal 5 „ non-removal 115 Dust receptacles, foul or defective 33 „ absence of 14 „ improperly placed 1 Effluvia nuisances 12 Insanitary premises 24 Manure not removed 11 „ receptacles improperly placed 1 Overcrowded premises 25 Bats, nuisance from 7 Roadways, condition of 3 Road gullies stopped 6 Roofs defective 6 Rubbish, offensive 10 ,, burning 11 Smells 1 „ on premises 45 „ from sewer ventilators 42 „ „ stables 2 ,, „ drains, &c. 31 „ „ water closets 2 „ „ manure 13 ,, „ dust bins 4 Smoke nuisances 15 Streets, condition of 3 Urinals, condition of 3 Uninhabitable premises 2 Water closets, absence of 2 „ insanitary condition 12 „ stopped 6 „ without water 2 „ ,, proper flush 5 „ position of 1 Water, absence of 1 „ cut off 266 ,, leakage of 7 Water supply, insufficient 1 Water cisterns, dirty, &c. 3 Miscellaneous 86 1016 During 1902, 568 complaints were received. 128 TABLE XI. Number of Inspections, &c., Made; Notices Served; Letters Sent; and Sanitary Works Carried Out. 1901. 1902. 1903. Number of Inspections 6320 8557 8002 „ Re-inspections 7532 11282 13865 „ Intimation Notices issued 1208 1763 1037 „ Statutory Notices issued 530 358 366 ,, Letters issued (excluding all " circulars) 955 1208 2408 Number of Notifications of infectious disease sent to "Head Teachers" of Schools in 1903 338 1903. Houses or parts of houses cleansed 255 Dampness in houses or parts of houses abated 73 Dilapidated „ „ „ repaired 53 Inlets or surface drains trapped 32 Improperly constructed water closets altered 24 Defective water closets repaired or renewed 680 Water closets unstopped 48 Improperly placed water closets removed 24 External ventilation provided to water closets 45 Water closet accommodation provided 85 Soil pipes repaired, renewed or ventilated 357 Improperly placed gully trap removed 37 Gully trap cleansed 66 Yards drained 19 Waste pipes of sinks disconnected from drains, trapped, or renewed 413 „ „ lavatories disconnected from drains, trapped, or renewed 153 ,, ,, baths ,, ,, ,, 93 Water cisterns repaired or renewed 21 Accumulations or deposits of refuse, manure, &c., removed 417 Foul or defective dustbins or ashpits abolished 63 Foul drains cleansed 61 Defective drains amended or reconstructed 605 Drains unstopped 109 Rainwater pipes disconnected from drains 93 „ „ „ soil pipes 22 „ repaired or renewed 47 129 TABLE XI.—con. 1903. Water supplies used for domestic purposes disconnected from the cistern for flushing the water closet 11 Houses provided with proper water supply 141 Roofs repaired 80 Gutterings repaired or renewed 27 Areas cleansed 8 „ drained 8 Washhouse pavings repaired or renewed 33 Scullery „ „ „ 14 Animals ceased to he kept in such a manner as to be a nuisance 13 Cases of overcrowding abated 33 Underground rooms ceased to be occupied as dwellings 3 Tents, vans, sheds, or similar structures in such a state as to be injurious or dangerous to the health of the inmates, ceased to be used for human habitation - Spaces below floors in the basement or ground floors ventilated 57 Chimneys carried to a sufficient height 1 Ventilating pipes of drains carried to a sufficient height above windows 17 Fresh air inlets repaired or renewed 63 Separate and sufficient water closet accommodation provided for persons of each sex 11 Water closets cleansed 91 ,, „ provided with a sufficient water supply 56 Flushing cisterns to water closets repaired or renewed 134 Water closets provided with means of constant ventilation 37 Sufficient water closet accommodation provided 6 Yard pavings repaired or renewed 145 Area ,, ,, ,, 37 Defective or improper manure receptacles abolished 7 Manure receptacles provided 18 Dust „ „ 190 Covers to dust receptacles provided 17 Water cisterns cleansed 142 „ „ fitted with close fitting covers 60 Improperly placed water cisterns removed 4 Stable pavings repaired or renewed 11 130 TABLE XII. Houses Let in Lodgings. Number of Registered Houses in the Borough, 908. Number of Registerd Houses in Words. Number in Ward 1 (Town) 156 „ „ 2 (Belsize) 163 „ ,, 3 (Adelaide) — „ „ 4 (Central) 7 „ „ 5 (West End) 134 „ „ 6 (Kilburn) 384 ,, ,, 7 (Priory) 64 Total 908 131 TABLE XIII. Bakehouses. Bakehouses in Wards. Those marked * are underground bakehouses. No. 1 (Town) Ward— *106, Heath Street. 3, High Street. 43, do. 48, do. *67, do. 26, New End. (6) No. 5 (West End) Ward—con. *43, Mill Lane. 44, do. 4, Munro Terrace, Fortune Green. 1, The Parade, Cricklewood. 26, do. *251, West End Lane. *279, do. (9) No. 2 (Belsize) Ward— 6, Fleet Road. *65, do. 2, Heath Hurst Road. (3) No. 6 (Kilburn) Ward— *63, Hemstal Road. *94, High Road, Kilburn. *132, do. *354, do. *4, Kelson Street. *70, Kingsgate Road. 67, do. *99, Palmerston Road. (8) No. 3 (Adelaide) Ward— *44, England's Lane. *90, Haverstock Hill. *2, King's College Road. (3) No. 4 (Central) Ward— *10, Belsize Park Terrace. *225, Finchley Road. *289, do. 307, do. *98, West End Lane. (5) No. 7 (Priory) Ward) — *202, Belsize Road. *228, do. *98, Boundary Road. *55, Fairfax Road. *93, do. *7, Fairhazel Garden. *137, Finchley Road. (7) No. 5 (West End) Ward— 2, Burgess Parade,Finchley Road. Field Lane School, Hillfield Road. Bakehouses—Underground 27 ,, Above ground 14 41 132 TABLE XIV. Restaurant Kitchens in Wards, inspected during the year. No. 1 (Town) Ward— Jack Straw's Castle, Hampstead Heath. 37, Heath Street. 63 and 65, Heath Street. 70, ,, 109, ,, 38 and 39, High Street. Bull and Bush, North End. 60, Rosslyn Hill. No. 4 (Central) Ward—con.— 104, Finchley Road. 100, West End Lane 1, Central Parade, „ No. 5 (West End) Ward — 92, Fortune Green Road. 58, Mill Lane. 3, The Parade, Cricklewood. West End Coffee House, West End Lane. 8, Cavendish Parade, West End Lane. No. 2 (Belsize) Ward— 2, Elm Terrace, Constantine Road. 2, Fleet Road. 25, ,, 98, ,, 106, „ 210, Haverstock Hill. 11, South End Road. 17, ,, 8, Station Parade ,, No. 6 (Kilburn) Ward— 188, High Road, Kilburn. 272, „ „ 308, „ ,, 368, ,, „ Towers' Coffee Rooms, Love- ridge Road. 96, Palmerston Road. No. 7 (Priory) Ward— 121, Abbey Road. 21, Alexandra Road. 203, Belsize Road. 264, „ 274, „ 114, Boundary Road. 65, Fairfax Road. 115, Finchley Road. 34, High Road, Kilburn. 38, ,, „ 43, Loudoun Road. Swiss Cottage Tavern, Upper Avenue Road. No. 3 (Adelaide) Ward — 1, Adelaide Road. 143, „ 97, Haverstock Hill 11, King's College Road. Winchester Hotel, Winchester Road. No. 4 (Central) Ward— 14, Belsize Park Terrace. 17, ,, 159, Broadhurst Gardens. 1, Canfield Place. APPENDIX II. 134 BOROUGH OF HAMPSTEAD. VENTILATION OF SEWERS. Report of the Joint Sub-Committee, consisting of three members of the Public Health Committee and three members of the Works Committee. 24th February, 1904. To the Public Health and Works Committers— Your Sub-Committee beg to state:— (a) That they have carefully considered the whole question as to the ventilation of sewers, raised in the report of the Medical Officer of Health for the year 1902, and in connection therewith have considered:— (i) The paragraph on the subject contained in the above mentioned report of the Medical Officer of Health. (ii) Reports made to the late Vestry on the subject up to the year 1898. (iii) Report of the Medical Officer of Health on the reasons which led him to make the statements contained in his annual report,—together with tabular statements of replies to enquiries made of other Boroughs, &c. (A print of the report is sent herewith.) (iv) Report of the Borough Engineer on the works carried out to the sewers in this Borough (excluding the sewers belonging to the London County Council), for improving their ventilation and flushing, since Mr. Mansergh reported to the Vestry thereon in 1886. 135 (b) That they found that at the present time there were;— 40 flushing tanks supplied from the water companies' hydrants. 45 other tanks formed by alterations in manholes and ventilators, as well as new manholes built expressly for the double purpose of ventilation and flushing purposes, the water being obtained (i) through the flashing hose, and (ii)—within a small area—from the White Stone Pond. 32 tall ventilating shafts (an increase of 26 since Mr. Mansergh reported); and 980 surface ventilating shafts, including ventilating manholes. (c) That the tall ventilating shafts were chiefly at "dead-ends" and apices of sewers, and were of great utility in those positions; and— Your Committee recommend— (d) That it is at present inadvisable to make any alteration in the system of ventilating the sewers of the Borough. (e) That in all cases of complaint of bad smells arising from open grids in the roadway, tall ventilating shafts shall be erected wherever practicable and necessary. (f) That the proposed enlargement of 62 open grids in the vicinity of Agamemnon Road, as recommended by the Works Committee to the Council on the 26th November, 1903, be held over for the present. (Signed) WILLIAM R. RIDER, Chairman.