HOL 5 BOARD OF WORKS, HOLBORN DISTRICT. METROPOLIS LOCAL MANAGEMENT ACT, and PUBLIC HEALTH (LONDON) ACT. Report OF THE MEDICAL OFFICER OF HEALTH, For the Year ending December 31st, 1898. LONDON: PRINTED BY ORDER OF THE BOARD. 1899. AN N UAL REPORT ON THE VITAL STATISTICS AND SANITARY CONDITION OF THE HOLBORN DISTRICT, For the Year 1898, BY WILLIAM ARTHUR BOND, M.A., M.D., B.C. and D.P.H. CAMB., M.R.C.P. LOND. Fellow and Member of Council of the Royal Institute of Public Health; Lecturer and Demonstrator of the Sanitary Institute; Fellow of the Society of Medical Officers of Health; Member of the Epidemiological Society, &c. &c.; Medical Officer of Health to the Board of Works for the St. Olave's District, Southwark, and Medical Officer of Health TO THE BOARD OF WORKS FOR THE HOLBORN DISTRICT. REPORT RELATING TO THE VITAL STATISTICS AND SANITARY CONDITION OF THE HOLBORN DISTRICT, LONDON. FOR TEE YEAR ENDED 31st DECEMBER, 1898. TO THE BOARD OF WORKS FOR THE HOLBORN DISTRICT. Gentlemen, I have the honour to submit my Report for the year ending December 31st, 1898. This Report will show that much work in the abating and removal of insanitary conditions has been carried out in the District during the past year. An additional Sanitary Inspector was elected on the 21st March, and began his duties on the 13th April. In connection with the re-arrangement of the duties of the Sanitary Inspectors, I reported as follows:— "I think the best re-arrangement will be the following: "The new Inspector to undertake the duties of registration of houses let in lodgings and their monthly inspection, the duties in connection with the bakehouses of the District and the Sale of Food and Drugs Acts. His time can thus be fully occupied. "Inspectors Bennett and Freeman, being relieved of the duties just mentioned, will be enabled to more thoroughly carry out their other duties under the Public Health Act, bye-laws, etc., including house-to-house inspection. "Inspector Billing to continue his duties of inspection of meat of all kinds in all parts of the District and the inspection of the two slaughterhouses and the cowhouse. 4 Medical Officer's Report. "I may mention another alternative—namely, for the District to be divided into three parts, Inspectors Bennett, Freeman, and the new one having each a district, Inspector Billing having the duties as mentioned above." The Sanitary Committee preferred the latter alternative, and recommended the division of the District as follows: — Western Division.—West of the Gray's Inn Road and north of Holborn. Central Division.—Between Gray's Inn Road and Leather Lane, and Back Hill; also the part of the District south of Holborn. Eastern Division.—The part east of Leather Lane and Back Hill. Under "The Food and Drugs Act" each Inspector is to take the whole District for a month alternately, and the Meat Inspector to continue his duties as before. Three-fourths of the population live in tenements; so that there are very many houses in the District let in lodgings. I am glad to report that 25 additional houses have been registered and inspected monthly. The Board adjourned the registration of the houses in the "Italian Colony" as the owners had had the rooms measured and agreed to comply with our regulations. The improvement in the condition of the Meat Market continues, for the amount of diseased meat "seized" was about one-half that of 1897, and less than one-fourth that "seized" in the first quarter of 1896, just after the appointment of the Meat Inspector. The bacteriological examination of doubtful cases of diphtheria has been continued by the Jenner (late British) Institute of Preventive Medicine, at the expense of the Board. Of 104 such cases, the diphtheria bacillus was isolated in 49 of them. The majority of the cases were patients at the London Homoeopathic Hospital. This does not include the examination of the doubtful cases that attend the Children's Hospital, which is carried out by their own staff. The Metropolitan Asylums Board was able to receive all the cases of scarlet fever, diphtheria, and typhoid that required to be removed to their hospitals. Many of our cases of diphtheria were received at the Children's and Homoeopathic Hospitals. The treatment of diphtheria by antitoxic serum still continues to give satisfactory results. The various mortality rates continue to be higher than the corresponding rates for London. 5 Medical Officer's Report. The number of notices received for the removal of dust was 849, rather more than for 1897, when the number was 802. In 1896 the number was 1,361, and in 1895, as many as 2,114. Since the 25th March, 1896, the Board's contract has provided for the removal of house refuse at least once a week. Many of the notices that dust has not been removed show that the contract is not strictly carried out, and the Contractor's attention to the matter has frequently been requested by the Board. The Board is endeavouring to have this work and the cleansing of the streets, etc., more satisfactorily carried out by paying the Contractor a larger amount, and by the appointment of an Inspector of Cleansing in addition to the Street Inspector. Arrangements were made with the Clerkenwell Vestry for articles to be disinfected in their new steam apparatus after June 24th, 1898. The Board's Shelter (conjointly used by the Clerkenwell Vestry) was used by 17 families belonging to the District, who slept there during the disinfection of their rooms. "The Vaccination Act, 1898," was passed on the 12th August, from which date the "Conscience Clause" came into operation, and the rest of the Act on the 1st January, 1899. By this Act the following changes are introduced:— Vaccination is to be within six months after birth, instead of three months. The Public Vaccinator of the District must, if required, vaccinate at the home of the child. If the child is not vaccinated within four months after birth, the Public Vaccinator must visit the home of the child and offer to vaccinate the child with glycerinated calf lymph. Vaccination may be postponed if it cannot safely be performed on account of the condition of the home, or the prevalence of infectious disease in the district. Notice of the certificate of postponement must be forthwith given to the Medical Officer of Health for the district. The method of procedure under the "Conscience Clause" is too well known to require any comment. For the first four months after the passing of the Act the certificate might be obtained for a child of any age, but now, only within four months of the birth of the child. Provision is made against repeated penalties. A person imprisoned for non-compliance with the Vaccination Act must be treated as a firstclass misdemeanant. 6 Medical Officer's Report. The Act is to continue in operation for five years, till the 1st January, 1904. In April, 1898, was issued the Report of the Royal Commission on Tuberculosis, appointed to enquire into the administrative procedures for controlling danger to man through the use as food of the meat and milk of tuberculous animals. On pages 22 and 23 I give an abstract of the recommendations of this Royal Commission. CONSUMPTION AND OTHER TUBERCULAR DISEASES. Although sanitary improvements have already done much, there are still about 60,000 deaths annually in England and Wales from consumption and other forms of tuberculosis, such as consumption of the bowels, or tabes mesenterica, diseases of the brain, glands, bones, and joints, the latter leading to hump-back, hip-joint disease, and other deformities. It is now known that "this terrible waste of life, with all the protracted suffering attending it, and the distress, moral and material, which it involves, is in great measure preventable." I am, therefore, very glad that during the year much has been done to educate the public and arouse their interest in this most important subject. The National Association for the Prevention of Consumption and other Forms of Tuberculosis has been formed. For a subscription of five shillings anyone can become a member, or a life-member for a donation of five guineas. A leaflet and pamphlet have already been issued, and the Board gave its consent for copies of these to be sent to members of the Board. In my Annual Report for the year 1895 I mentioned that, for the prevention of consumption and allied diseases, it is necessary that there should be— Good ventilation of houses and workshops, and their sanitary construction and arrangement so as to secure fresh air, good light, and dry walls. No overcrowding. Proper drainage of the soil. Inspection of cowsheds, dairies, and cows, so as to insure good milk, free from the germs of tuberculosis. Inspection of animals intended for food, and adequate supervision of them at the time of slaughter. Disinfection of the sputum of phthisical patients, infected articles and rooms. 7 Medical Officer's Report. To these I will now add— The bacteriological examination of sputum, so that cases may be detected in their earliest stage, when cure can be most easily effected. The provision of sanatoria for the open-air treatment of consumption. LONDON WATER SUPPLY. The Board expressed the opinion to the Royal Commission on London Water Supply that there should be one authority for the management and control of the water undertakings. I may here mention that the Royal Commission issued its first report the latter part of December, recommending the inter-connexion of the mains of the different Companies, and that, in order to be prepared for various accidents or exceptional drought, the Companies generally should provide additional storage reservoirs and filter beds. In the event of the Companies' undertakings being amalgamated or purchased by one authority, such inter-connexions would be practically in continuous use, and would be available for more various purposes, such as the equitable distribution of water and the economical regulation of pressures throughout the whole water area. DRAINAGE BYE-LAWS. The Board approved of the London County Council making bye-laws respecting drainage for the use of the London Sanitary Authorities. OUTWORKERS IN THE CLOTHING TRADES. The Board considered that the lists for each sanitary district should be prepared by the Home Office. PUBLIC ABATTOIRS FOR LONDON. The Board expressed the opinion that it was opposed to the provision of public abattoirs in London. I had the honour of opening a discussion on the subject at the Sanitary Institute, and shall be happy to let any Member of the Board have a printed copy of my paper and the discussion. PROPOSED CASUAL WARDS ON THE SITE OF THE WORKHOUSE, GRAY'S INN ROAD. My report on this subject was printed, and copies sent to Members of the Board, and also the Local Government Board and the London County 8 Medical Officer's Report. Council. At the request of the Holborn Board of Guardians copies were sent for the Members of that Board. It is not necessary therefore to include it in this Annual Report. I am glad to learn that the site is to be used, as recommended by me, for dwellings for the working classes. I thank the Members and Officers of the Board for the kindness, courtesy and co-operation that I have received. I am, Gentlemen, Your obedient servant, W. A. BOND. AREA, POPULATION, HOUSES. The area of the District is 168 acres. The population for 1898, estimated in the usual way to the middle of the year, is 30,263. The number of inhabited houses in the District at the census of 1891 was 3,437. In 1881 the number was 3,244. Although the resident population is diminishing, the "daily" population is increasing, on account of the increase in the number of factories, workshops, and offices. Just half the population (49.8 per cent.), at the census of 1891 occupied tenements of only one or two rooms. BIRTHS. The total number of births registered during the 52 weeks ending December 31st, 1898, were 813, 396 being male and 417 female children; giving a birth-rate of 26-9 per thousand. The corresponding rate for the whole of Registration London was 29.5. This is the lowest London birth-rate on record. DEATHS. The total number of deaths of persons in the district, after making the usual corrections (i.e. excluding those of persons who died in public institutions, who did not belong to the district, and including those of persons who belong to the district, but died in public institutions outside the district), for 9 Medical Officer's Report. the 52 weeks was 739, giving a corrected death-rate of 24.5 per thousand. The corresponding rate for London was 18.3. If correction be made for age and sex distribution, the death-rate of Holborn was 26.5 per 1000. Further details are given in Tables I. and III. DEATHS OF CHILDREN UNDER ONE YEAR OF AGE. There were 178 deaths of children under one year of age; that is, the number of deaths of children under one year of age to 1,000 births was 219. The corresponding rate for London was 166 per 1000 births. In the preceding three years, the numbers in Holborn were, 212 per 1000 births in 1895, 189 in 1896, and 181 in 1897. The causes of these 178 deaths were:— Premature birth and congenital defects 31 Malnutrition, marasmus and debility 19 Diarrhoea and gastro-enteritis 45 Tubercular diseases . 11 Bronchitis 16 Pneumonia 16 Measles 10 Whooping cough 4 Diphtheria 2 Suffocation in bed 11 Convulsions 4 Congenital syphilis 3 Other diseases 6 178 PHTHISIS OR CONSUMPTION. The number of deaths from phthisis during the year was 94, which is equivalent to a death-rate of 3.1 per 1000—the same rate as last year. The corresponding rate for London was 1.7 per 1000. The number of deaths from other tubercular diseases was 28. See introduction, p. 6, respecting the prevention of consumption and other tubercular diseases. 10 Medical Officer's Report. ZYMOTIC DISEASES. During the year, the number of deaths from the principal zymotic diseases was 102, the rate being 3.38 per 1000. The corresponding rate for London was 2.77. These rates are greater than the corresponding rates for last year. The chief cause of the increase was the epidemic of measles. The deaths from diphtheria, unfortunately, continue to increase. During the past four years the number of deaths was: from— 1895. 1896. 1897. 1898. Measles 45 32 8 36 Small-pox 0 1 0 0 Scarlet Fever 6 0 4 a Diphtheria 7 9 17 21 Whooping Cough 8 26 19 12 Typhoid Fever 0 5 5 2 Typhus Fever 0 1 0 0 Diarrhoea 24 19 35 29 Totals 90 93 88 102 The number of deaths in London from these diseases have been for the past four years:— 1895. 1896. 1897. 1898. Measles 2,633 3,697 1,929 3,075 Small-pox 55 9 16 1 Scarlet Fever 829 942 780 583 Diphtheria 2,316 2,683 2,261 1,772 Whooping Cough 1,483 2,937 1,842 2,160 Fever (Typhoid, etc.) 629 609 593 598 Diarrhoea 3,600 3.223 4,104 4,376 Totals 11,545 14,100 11,525 12,565 11 Medical Officer's Report. THE NOTIFICATION AND PREVENTION OF INFECTIOUS DISEASE. During the year there were notified 283 cases of infectious disease: the corresponding number for 1895, 1896, and 1897 being 333, 280, and 339 respectively. The numbers of the separate diseases were :— 1895. 1896. 1897. 1898. Small-pox 31 1 0 0 Scarlet Fever 160 114 114 96 Diphtheria and Membranous Croup 60 67 158 138 Puerperal Fever 1 2 0 2 Typhus Fever 0 1 0 0 Typhoid or Enteric Fever 20 29 25 9 Continued Fever 0 1 0 0 Erysipelas 61 65 42 38 Totals 333 280 339 283 For further details see Table II. And in Registration London the notifications have been :— 1895. 1896. 1897. 1898. Small-pox 979 225 104 35 Scarlet Fever 19,757 25,647 22,848 16,917 Diphtheria 10.772 13,362 12,803 11,561 Membranous Croup 451 446 389 310 Enteric or Typhoid Fever 3.506 3,190 3.103 3,032 Typhus Fever 14 6 4 17 Other continued Fevers 108 106 68 55 Puerperal Fever 236 277 264 250 Cholera 29 13 38 23 Erysipelas 5,660 6,436 5,794 5,180 Totals 41,512 49,708 45,415 37.38o The "corrected" return for 1898 has not yet been received from the Metropolitan Asylums Board. 12 Medical Officer's Report. SCARLET FEVER. Ninety-six cases were notified, and 81 of them were removed to hospitals of the Metropolitan Asylums Board or the London Fever Hospital. This is the smallest number of notifications during the past four years. The principal incidence of the disease was from the middle of September to the middle of November. An Italian woman was fined 40s. and costs for wilfully permitting the exposure of her daughter in the streets while suffering from scarlet fever. DIPHTHERIA. The number of cases of diphtheria was 135, or 138, including 3 cases of membranous croup. Last year the number was 158. Of these, 123 were removed to hospitals for treatment, viz.:— To the Hospitals of the Metropolitan Asylums Board 53 ,, Children's Hospital 37 ,, London Homoeopathic Hospital 25 „ other general hospitals not in the District 8 For five weeks, from the 20th August, there was a small outbreak, limited to a small portion of the western part of the District, for, of 27 cases notified in the whole District in this period, 23 occurred in the small portion west of Lamb's Conduit Street, north of Theobald's Road, the northern boundary being formed by East Street, Boswell Court, and Gage Street. Of the remaining 4 cases, 2 occurred at houses near the small area just mentioned. In many cases the transfer of infection from person to person could be traced. Many of the children of the neighbourhood play together in the streets after school hours. With the exception of these five weeks, the cases were sparsely scattered throughout the District, two or three cases sometimes occurring in the same house. The number of deaths from diphtheria was 21, or a mortality of 15.2 per cent. In London the number of cases notified was 11,871 (including 310 cases of membranous croup), and the number of deaths was 1772, or a mortality of 14.9 per cent. The treatment of diphtheria by its antitoxin continues to give improved results, especially in laryngeal and tracheotomy cases, and those that come under the treatment within two or three days of the onset of the illness. 13 Medical Officer's Report. The bacteriological examination of material from doubtful cases of diphtheria has been continued by the Jenner (late British) Institute of Preventive Medicine. Of 104 such cases the diphtheria bacillus was isolated in 49, and the pseudo-diphtheria bacillus, which is non-virulent to animals, was isolated in 3 cases. In the remaining 52 cases it was not isolated. Most of the material was sent by the London Homoeopathic Hospital. At the Hospital for Sick Children, where many cases of diphtheria are treated, the bacteriological examination is carried out by their own staff. TYPHOID FEVER. During the year the number of cases notified was only 9, in comparison with 20 in 1895, 29 1896, and 25 in 1897. One case was contracted while the patient was out of town for a holiday. In another case the cause may have been the consumption of infected oysters. Of the 9 cases 2 died. In London there were 3032 cases notified and 585 deaths. MEASLES. The epidemic which began the last quarter of 1897 was continued in this District and London generally during the first two quarters of the year. The number of deaths in this District during the year was 36, but all but one occurred in the first half of the year, and all but one were children under five years of age. The death-rate in Holborn from measles was nearly double the London rate. In London the number of deaths was 3075. Disinfection is carried out when possible in those cases that come to my knowledge, by obtaining the addresses of patients attended by the District Medical Officers; also in the cases where death has occurred, as returned by the Registrar, and in the very few cases reported by the teachers of schools. All absences from schools on account of illness ought to be reported to the Medical Officer of Health of the District, and other children in infected houses prohibited from attending schools. As mentioned in other reports, notification by the head of the family ought to be compulsory. WHOOPING COUGH. The death-rate in Holborn from whooping cough was rather less than in London. The number of deaths in Holborn was 12, much the smallest number of the past three years. All the deaths were of children under five years of age. The number of deaths in London were 2160. 14 Medical Officer's Report. The remarks as to disinfection, &c., after measles, apply also to whooping cough. DIARRHŒA. The number of deaths assigned to diarrhoea was 29, of which 27 were of children under five years of age, the great majority being infants under one year of age, and took place in the third or summer quarter. Of 4376 deaths assigned to diarrhoea in London, 3588 took place in the third quarter, and 3461 were of children under one year of age. Dr. Klein has found the bacillus enteriditis sporogenes associated with many cases of diarrhoea, also in many samples of milk. He states that "amongst the sources of this bacillus are the evacuations of cases of diarrhoea, sewage, water, soil, and dust polluted with sewage; as also horses' dung." The spores are highly resistant, and have a wide distribution in nature, so that there is ample opportunity for them to gain access to milk and other articles of food. DISINFECTION. During the year ending December, 1898— 322 rooms were fumigated and cleansed. The rooms were also stripped and lime-whited when necessary. 2262 articles were disinfected by steam:— 192 Beds. 466 Pieces of wearing apparel. 91 Mattresses. 23 Curtains. 127 Bolsters. 18 Rugs. 344 Pillows. 21 Shawls. 283 Blankets. 14 Books. 262 Sheets. 113 Sundries. 187 Quilts. 74 Pillow cases. 2262 47 Cushions. Arrangements were made with the Clerkenwell Vestry for articles to be disinfected in their new steam apparatus after the 24th June, 1898. Prior to this the articles were disinfected by Messrs. Armfield & Sons. The shelter at 47, Northampton Road (conjointly used by the Clerkenwell 15 Medical Officer's Report. Vestry) was used for sleeping accommodation, &c., by 17 families from this District during the disinfection of their rooms. THE MEAT MARKET. During the past three years the amount of meat "seized," offal excluded was:— 1896. Diseased. Decomposed. Total. St. lbs. St. lbs. St. lbs. 1st Quarter 4,069 3 378 4 4,447 7 2nd ,, 7 10 1 1,215 4 1,925 5 3rd ,, 653 6 3,476 4 4,130 2 4th ,, 1,701 5 311 3 2,013 0 Total for year 1896 7,134 7 5,381 7 12,516 6 1897. 1st Quarter 912 3 209 3 1,121 6 2nd ,, 192 0 877 5 1,069 5 3rd „ 376 2 727 1 1,103 3 4th ,, 400 5 516 7 917 4 Total for year 1897 1,881 2 2,331 0 4,212 2 1898. 1st Quarter 377 2 537 7½ 915 4½ 2nd „ 316 4 818 0 1,134 4 3 ,, 53 0 1,071 7 1,124 7 4th ,, 266 0 888 3 1,154 3 Total for year 1898 1,012 6 3,316 1½ 4,328 7½ These figures show the marked change that has been effected in the Meat Market; the amount of diseased meat "seized" in 1897 being little more than a quarter of that of the previous year, and last year the amount was less than one-fourth of that "seized " in the first quarter of 1896. In 1896, 80 tubercular carcases of beef and 6 of pork were "seized." In 1897, 16 „ „ „ „ „ In 1898, 6 „ „ and 2 top pieces of beef „ „ The average weight of the 6 tubercular carcases of beef was only 395 stone, or 316 lbs., all being also much emaciated. A large proportion of the decomposed meat and offal was foreign (principally Dutch), and was also diseased. 16 Medical Officer's Report. DISEASED MEAT AND OFFAL SEIZED DURING 1898. 64 quarters of beef. 48 pairs of bullocks' lungs. 2 pieces of beef. 4 bullocks' kidneys. 11 carcases of mutton. 1 bullock's head and tongue. 14 carcases of pork. 1 bullock's pluck. 4 carcases of veal. 1 bullock's tripe. 4 carcases of stirks. 4 pigs' plucks. 3983 sheep's livers. 1 pig's liver. 32 pairs of sheeps' lungs. 2 tubercular Dutch fowls. 93 bullocks' livers. Total weight (less offal) 1012 st. 2 lbs. DECOMPOSED MEAT AND OFFAL SEIZED DURING 1898. 26 quarters of beef. 102 barrels of pigs' kidneys. 342 pieces of beef. 3 barrels of pigs' livers. 6 carcases of mutton. 10 barrels of pigs' feet (about 16 cwt.) 56 pieces of mutton. 12 carcases of pork. 5 hampers of calves' plucks. 37 pieces of pork. 23 parcels of mixed offal. 31 casesofpork(American, frozen). 3 van loads of mixed offal. 130 carcases of veal. 2 barrels of ox heels. 13 pieces of veal. 12 bags and one barrel of sausage casings (25 cwt.) 2 carcases of stirks. 1094 sheeps' heads. 2 parcels of sweetbreads. 904 sheeps' plucks. 2 cases of cheese (112 st.). 1395 sheeps' kidneys. 8 cases of Russian geese. 2 stones of kidneys. 1 hamper of fowls. 879 sheeps' livers. 16 fowls. 200 pairs of sheep's lungs. 25 cases of rabbits. 12 stirks' plucks. 18 rabbits. 682 bullocks' livers. 14 turkeys. 894 pairs of bullocks' lungs. 12 hares. 250 bullocks' melts. 10 lbs. of eels. 215 bullocks' tripes. 600 tins of salmon. 17 barrels of bullocks' tripes. 2 cases of unsmoked bacon. 28 bullocks' tails. 1 case of tomatoes. 8 bullocks' heads 1 case of eggs. 48 stones of bullocks' kidneys. 2 pieces of bacon. 3 bullocks' tongues. 17 Medical Officer's Report. One hundred and forty-eight stones of mutton damaged by fire and water. A large proportion of the above was foreign meat and offal, and was also diseased. Total weight (less offal) 3316 st. 1½ lbs. Diseased and decomposed meat, total weight (less offal) 4328 st. 7½ lbs. The butchers' shops, stalls, slaughter-houses, and also the provision warehouses, &c., were regularly inspected by the Meat Inspector. FACTORIES AND WORKSHOPS. There is a large and increasing number of factories and workships in the District. Many more of these have this year been inspected, and the sanitary defects have been remedied. The Factory Inspectors of the Home Office have supplied us with information concerning a few of these. In the Eastern Division 850 workrooms of these premises received attention. HOUSES CLOSED VOLUNTARILY, DEMOLISHED, REBUILT, &c. 88, 89, High Holborn, rebuilt. 5, 6, and 7, Gray's Inn Passage, demolished. Richbell Place, all demolished. (Closing orders were obtained for Nos. 2, 3, 4, and 5 in 1897.) Emerald Street, Nos. 9 and 11, adjoining Richbell Place, also demolished, and warehouses being erected on the site. "Red Lion and Ball," public house, and 1, Red Lion Passage, demolished and rebuilt. 6, 7, and 8, Boswell Court, closed and demolished ; also Nos. 2, 3, 4, and 5 demolished the earlier part of 1899. "Old Red Lion," public house, Red Lion Street, rebuilt. " King's Arms," Little James Street and John Street, demolished and rebuilt. 33 and 33A, Red Lion Square, and 11, Old North Street, demolished, and residential flats, known as " Ashbourne House," erected on the site. " Holborn," public house, 4, High Holborn, demolished and rebuilt. 18 Medical Officer's Report. Dalmeny Mansions, Theobald's Road and Drake Street, being erected. Alexandra Hospital, Queen Square, rebuilt. Italian Hospital, Queen Square, being rebuilt. 83, 84, Leather Lane, demolished and rebuilt. 10, Beauchamp Street, partially rebuilt. Crown Court, new workshop built. Prudential Assurance Company, Limited, new buildings in progress. Birkbeck Bank, new buildings in progress. St. John Street, corner of St. John's Lane, three new warehouses erected. Black Horse Yard, workshop built. "Sutton Arms," 6, Carthusian Street, new premises, Greenhill's Rents : Link's stables built. 32, Leather Lane, rebuilt. "White Bear," St. John Street, rebuilt. 16 and 17, Charles Street, demolished, and new business premises built on the site. "Rose," public house, 58, Hatton Garden, rebuilt. 38, Charles Street, Messrs. Wallis & Co.'s stables rebuilt. 55, Hatton Garden, rebuilt. Great Saffron Hill, east of Hatton Yard, new warehouses built. "Hat and Tun," public house, Hatton Wall, rebuilt. Glasshouse Yard, Messrs. Pickford's warehouses reconstructed. HOUSE TO HOUSE INSPECTION. Boswell Court. Half-Moon Court. Emerald Street. Union Terrace and Buildings. Fulwood's Rents. Italian Colony (all). Hand Court. Mitre Court. Eagle Street (greater part). Hat and Mitre Court. Gloucester Street (part). Benjamin Street. Devonshire Street (part). Peter's Lane. Portpool Lane. Pump Court. Verulam Street. White Horse Alley. Baldwin's Place. Glasshouse Yard (greater part). 19 Medical Officer's Report. HOUSES LET IN LODGINGS. The following is a list of the houses in lodgings that have been registered, and the number of tenements in each:— Leather Lane Buildings 48 2, Baldwin's Place 4 14, Emerald Street 6 3, Do. 4 16, Do. 6 4, Do. 4 18, Do. 4 5, Do. 7 20, Do. 1 6, Do. 4 22, Do. 6 7. Do. 7 24, Do. 1 8, Do. 4 22, Princeton Street 4 28, Eagle Street 7 24, Do. 1 17, Verulam Street 3 11 and 12, Peter's Lane 13 18, Do. 6 58, Red Lion Street 5 19, Do. 5 53, Eagle Street 7 15, Do. 4 i, Mitre Court 6 16, Do. 5 2, Do. 3 20, Do. 6 3. Do. 3 21, Do. 6 4, Do. 3 46, Eagle Street 11 26, Red Lion Street 5 45. Do. 7 2, New North Street 6 6, Half Moon Court 5 4A, Charles Street 5 7, Do. 9 5, Castle Court 7 8, Do. 8 6, Do. 6 9, Do. 10 21, Fulwood's Rents 7 19 and 21, Portpool Lane 13 Evelyn Buildings 47 9, Eagle Street 11 63, Mount Pleasant 4 Total 260 1, Baldwin's Place 6 The last 25 of these houses were ordered to be registered during 1898, and the registration is now completed. These premises are inspected monthly. COMMON LODGING HOUSES. 18, Fulwood's Rents, Holborn 50 lodgers. 20, Fulwood's Rents, „ 114 „ 40, Eagle Street, ,, 50 „ 7, Castle Street, „ 57 „ 12, Took's Court, „ 70 „ 13, Took's Court, „ 61 „ 19, Fulwood's Rents, „ 32 „ 20 Medical Officer's Report. 4, Greville Street, Holborn 55 lodgers 7, Little Saffron Hill, „ 12 „ 65, Mount Pleasant, „ 9 „ 39, Hatton Wall, „ 101 „ 28, Red Lion Square, „ 70 „ These are under the supervision of the London County Council. SICKNESS RETURNS. The number of cases of sickness under the care of the District Medical Officers was 1614, or a few more than in 1897, when the number was 1572. Details of these are given in Table IV. SANITARY WORK. The following is an abstract of nuisances abated and sanitary work accomplished during the year ending December 31 st, 1898:— Western Division Mr. Bennett. Central Division, Mr. McQuinn. (9 months.) Eastern Division, Mr. Freeman. Total. Written complaints received attention 76 18 39 133 Premiss inspected and re-inspected 3607 1964 2079 7650 Preliminary notices have been served for the abatement of nuisances 160 78 63 301 Statutory notices ditto 33 15 12 60 Houses have been cleansed, repaired, lime-whited, &c. 271 240 260 771 Houses have had their over-crowding abated 44 67 25 136 Underground rooms illegally and separately occupied have been closed 12 1 0 13 Rooms disinfected and cleansed after infectious disease 155 106 61 322 New drains have been laid 133 6S 113 311 Drains repaired, ventilated, &c. 40 27 20 87 Cesspools filled up 12 0 10 22 Water-closets re-constructed 166 218 149 533 New water-closets constructed 117 20 215 352 Water-closets cleansed and repaired 65 87 45 197 Water-closets supplied with water 396 140 315 851 Houses supplied with water for domestic purposes after water being cut off 4 1 0 5 Yards re-paved and repaired 132 15 20 167 Dustbins repaired and provided 39 16 27 82 Accumulations of offensive refuse have been removed 24 4 18 46 Bakehouses inspected twice during the year 14 5 3 22 Notices have been received for the removal of dust ... ... ... 849 Houses registered as "Houses let in lodgings," inspected monthly 19 25 7 51 Also a considerable amount of sanitary work has been done in the district (such as new buildings, etc.) without notices being served. 21 Medical Officer's Report. UNSOUND FOOD, Etc. Details of diseased and decomposed meat "seized" during the year are given on pages 15, 16, and 17. SMOKE INSPECTION. The Smoke Inspector, Mr. Thomas Madden, reports that there are 67 furnaces and boilers on the register, and that he makes periodical inspection of them to see that they are in a proper working order, and consume their own smoke. There are 11 kinds of smoke consumers in the District, which are as follows:— Ventilated Doors Martin's Patent Dr. Annan's Patent Nicholson's „ Caddy's ,, Bars Juke's „ Galloway's „ Hyde's „ Revolving Bars Watt's „ Gregory and Veal's Patent Gosling's Patent Total of Smoke Consumers 14 5 4 4 2 2 4 2 1 1 2 41 The number of furnaces and boilers without smoke consumers is 26, There has, therefore, been an increase of 2 smoke consumes during the year. Twelve notices were served during the year, 11 of which have been complied with. Three statutory notices were served, two of which were complied with. There were 10 summonses served upon the Central London Railway Company and their engine-drivers. The summonses were heard at the Clerken well Police Court on the 31st of June. The magistrate considered that the furnaces were sufficiently well constructed for their particular kind of work, and that owing to the coal strike they were unable to get smokeless coal. Two of the neighbouring inhabitants gave evidence as to the great nuisance that was caused. The magistrate dismissed the summonses; the Company to pay their costs. The nuisance was never so bad after the proceedings were taken. They burnt mure coke, and gradually removed the engines and travelling crane, until now there is only one, which is in good working order. 22 Medical Officer's Report. THE MORTUARY. There were 161 bodies brought into the mortuary from ist January to December 31st, 1898. Coroner's inquests were held on 49 of these. The verdicts were:— Natural causes 31 Accidental Death 3 Suffocation 13 Suicide 1 Starvation 1 Total 49 METEOROLOGY. Details are given in Table V. The mean temperature for the year was 51.3° F., or 2.6° F. above the mean of the preceding 127 years. The rainfall was 18.85 inches, being 6.o7 inches below the average of the preceding 83 years. ABSTRACT OF THE RECOMMENDATIONS IN THE REPORT OF THE ROYAL COMMISSION ON TUBERCULOSIS Appointed to enquire into the administrative procedures for controlling danger to man through the use as food of the meat and milk of tuberculous animals. 1. Meat.—It appears desirable that in London the provision of public in substitution for private slaughter-houses should be considered in respect to the needs of London as a whole, and in determining their positions regard must be had for the convenient conveyance of animals by railway from the markets beyond the limits of London, as well as from the Islington market, to the public slaughter-houses which should be provided. At the present time no administrative authority has statutory power authorizing it to provide public slaughter-houses other than for the slaughter of foreign cattle at the port of debarcation. Also the general recommendations for Great Britain and Ireland, which may be thus briefly summarized. 23 Medical Officer's Report. When any local authority has provided a public slaughter-house power should be conferred on it to prohibit slaughter in any other place, except that a period of three years be allowed to the owners of existing registered private slaughter-houses to apply their premises to other purposes; also to require all meat brought into the district to be inspected, and reasonable charges made for this inspection. Also that the joints of all carcases passed as sound shall be stamped; and that it shall not be lawful to offer for sale the meat of any animal which has not been killed in a duly licensed slaughterhouse. No person is to be permitted to act as a meat inspector until he has passed a qualifying examination; and that the Local Government Board should issue instructions for the guidance of meat inspectors as to the seizure of a carcase or a part thereoof. 2. Milk.—That notification of every disease in the udder of cows shall be made compulsory. That powers should be given to Local Authorities for the purpose of excluding from their districts the milk of cows suffering from tuberculosis of the udder, or exhibiting clinical symptoms of the disease, and to slaughter any such cow ; and if it appears that the cow was not so suffering, the Local Authority should pay the full value of the cow immediately before slaughter. Also that Local Authorities should have powers for making analyses for tubercle bacilli in milk sold in their districts, and in foreign milk at the port of entry. That the Local Government Board should be empowered to require Local Authorities to adopt regulations as to dairies, cow sheds, and milk shops, where it is not already done. 3. Elimination of Bovine Tuberculosis.—That funds should be placed at the disposal of the Board of Agriculture in England and Scotland, and of the Veterinary Department of the Privy Council in Ireland, for the preparation of tuberculin, and that the gratuitous services of a veterinary surgeon should be offered to stock-owners on condition that the reacting animals are isolated from the healthy ones, and are kept under satisfactory sanitary conditions. That Agricultural Societies should distribute leaflets giving information respecting the above. 24 Medical Officer's Report. PROCEEDINGS UNDER PUBLIC HEALTH (LONDON) ACT, 1891, Section 47. Diseased and Unsound Meat. Date. Name. Address. Offence Charged. Results. Inspector. 1898. January 18th William J. Haynes Milton, Derbyshire Depositing for sale at 111, Charterhouse Street two quarters of beef Three month's imprisonment without option of a fine Billing. February 11th James Murdy Upper Charm wood Street, Leicester Depositing for Sale at 111, Charterhouse Street two sides of beef Fined £7 and £3 3s. costs. Do, March 11th Wm. Hy. Eustace Cranleigh, Surrey Depositing for sale at 93, Charterhouse Street four quarters 01 beef Fined £15 and 2s. costs Do. ,, 22nd Joseph Lincoln Henson 97, Charterhouse Street Exposing for sale at 97, Charterhouse Street two pairs of bullock's lungs and one bullock's liver Ordered to pay £2 2S. costs Do. April 19th Albert Williams Bridge Street, Leominster Depositing for sale at 111, Charterh use Street four quarters of beef Fined £15 Do. May 3rd Stephen Hagger Wenden, Essex Depositing for sale at 111, Charterhouse Street a carcase of veal Case dismissed Do. „ 3rd Robert Turner Cattle Market, Deptford Depositing for sale at 97, Charterhouse St. 34 Sheeps' livers Ordered to pay £2 2s. costs Do. October 4th S. Oppenheimer & Co., Ltd. St. John Street, West Smiths field Depositing for sale at John Street 10 bags and one barrel of sausage casings Case dismissed Do. „ 11th Edward Wright 66 & 67, Red Lion Street, Holborn Depositing for sale at 66&67, Red Lion Street 70 pieces of meat Fined £2 21 Do. November 22nd David Longley Angleside, Lingfield, Surrey Depositing for sale at 93, Cowcross Street ?? of beef and one head and tongue Fined £50 Do. 25 Medical Officer's Report. Diseased and Unsound Meat—continued. Date. Name. Address. Offence Charged. Results. Inspector. 1898. Fined £ 50 December 6th Thomas E. Harris Forda, Thornbury, Devon Depositing for sale at 93, Cowcros Street two sides of deef Billing. „ 13th Reginald Dymond Koapp Farm, Sidbury,Devon Depositing for sale at 47, Red Lion Street a carcass of mutton Fined £ 50 Do. „ 16th Hubert Selby Woodbury, Devon Depositing for sale at 95, Charterhouse Street two quarters of beef, and at 111, Charterhouse Street two quarters of beef Fined £ 20 Do. „ 23rd James Stone 72, Crayford Road, Holloway Depositing for sale at 101, Charterhouse St. 10 sheep's livers and four paiis of sheep's lungs Fined £ 10 Do. „ 30th Walter Fisher Constitution Hill, Sprowston, Norwich Depositing for sale at 93. Cowcross Street four quarters of beef Case dismissed Do. 26 Medical Officer's Report. LEGAL PROCEEDINGS UNDER PUBLIC HEALTH (LONDON) ACT; 1891. Nuisance Cases. Date. Name. Address. Offence. Result. Inspector. 1898. January 4th. D. Elsegood 108, Theobald s Road Underground room illegally occupied 20s. fine and 2s. costs Bennett. 7th R. Newman 20, Millman Street Depositing mattresses in public street 1os. ,, „ 2s. ,, Do. November 1st F. X. Bussinger 6o, Red Lion Street Defective sink waste and dirty state of walls and ceilings of rooms and staircase Abatement order within 7 days Do. ii H. Busby 14, 16, 18, and 22, Emerald Street Contravention of Board's Regulations for "Houses let in lodgings." Fined 40s. on first case, and 2s. costs on each of other three summonses; total 48s. Do. 29th A. J. Walke Evelyn Buildings Overcrowding at Evelyn Buildings £2 2s. od. costs, and abatement Older McQuinn. February 18th L. Marson 31, Ely Place Defective closets and drains Withdrawn on payment of £ 1 3s. od. costs Freeman. March 16th D. G. Staight 35, Kirby Street Defective closets and drains Adjourned for work to be done Do. ,, 16th Owners Cavendish Buildings Do. do. Do. do. Do. May 3rd ,, 68, Hatton Garden Do. do. Withdrawn on payment of costs, 6s. Do. June 7th and 21st E. J. Kyd 23, Cow Cross Street Defective traps to drains and not ventilated Adjourned for work to be done Do. 31St Central London Railway Co. and their stokers Chancery Lane Station, High Holborn Smoke nuisances Dismissed, but the Company to pay their own costs Madden. 27 Medical Officer's Report. PROCEEDINGS UNDER THE SALE OF FOOD AND DRUGS ACTS. Date. Name. Address. Offence Charged. Remarks. Inspector. 1898. January 4th W. H. Jones 73, Mount Pleasant Selling adulterated milk 15.2 per cent. added water Fined 40s. & 12s. 6d. costs. Bennett. ,, ,, P. Verioni 19, Eyre Street Hill Selling vinegar adulterated with water to the extent of 13 per cent. „ 10s. „ 12s. 6d. ,, Freeman. March 30th P. Lewis 19a, Charles Street Selling butter adulterated with at least 80 per cent. foreign fat ,, 20s. ,, 12s. 6d. ,, Do. ,, ,, E. Pearce 39c, Leather Lane Selling milk adulterated by the addition of 97 per cent. water ,, costs 12s. 6d. Do. April 22nd J. E. Shannon 3, Devonshire Street Selling adulterated butter 45 per cent. foreign fat „ 20s. & 12s. 6d. costs. Bennett. May 24th T. Couldrey 14, Peter's Lane Selling milk with 24 per cent. abstracted cream ,, 10s. ,, 12s. 6d. ,, McQuinn. ,, ,, K. Evans 19, Fann Street Selling butter adulterated by 75 per cent. foreign fat ,, costs 12s. 6d. Do. July 6th J. Lewis 15, Gt. Bath Street Selling adulterated milk 7.1 per cent. added water ,, 20s. and 2s. costs Bennett. ,, ,, Jenkins Bros. 6, Aylesbury Street Selling milk from which 16 per cent. of the cream had been abstracted (sample sent to Somerset House) Fined costs of summons, 12s. 6d. Do. ,, ,, Jones Bros. 122, St. John Street Selling adulterated milk 5.4 per cent. added water Fined 18s. and 2s. costs Do. ,, ,, J. Evans 12, Rosoman Street Selling adulterated milk 9 per cent. added water ,, 1 os. ,, 2s. ,, Do. ,, ,, The Farmers and Cleveland Dairy Coy. 12, East Street, Gifford Street, N. Selling adulterated milk 8 per cent. added water Case dismissed. Warranty proved Do. August 25th J. Evans 32, Rosoman Street Selling milk adulterated by the addition of 12 per cent. added water Fined £1 and 12s. 6d. costs Freeman. TABLE I. (as required by the Local Government Board). TABLE OF DEATHS during the Tear 1898 (for the 52 weeks ending 31st December, 1898), in the Holborn (London, W.C.) District, classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purposes of these Statistics; public institutions being shown as separate localities. Mortality from all causes at subjoined ages. Mortality from subjoined causes, distinguishing Deaths of Children under 5 Years of Age. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 At all ages. Under 1 year. 1 and under 5 5 and under 15 15 and under 25 25 and under 65 65 and up. wards Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas, Measles. W hooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia, and Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases Total. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) (f) (g) (h) (i) St. George the Martyr 218 72 22 6 6 80 32 Under 5 ... ... ... ... ... ... ... ... ... 1 ... 16 3 10 ... ... 22 2 ... 6 34 94 5 upwds. ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... 1 27 22 20 ... ... 49 124 St. Andrew Eastern 192 66 51 5 2 48 20 Under 5 ... ... 1 ... ... ... ... ... ... ... ... 17 ... 12 ... 1 19 ... ... 7 51 117 5 upwds. ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 15 23 6 ... 2 27 75 Glasshouse Yard 6 1 ... ... ... 1 4 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 3 5 In District (Not of District) 5 ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Children's Hospital District 24 12 10 2 ... ... ... Under 5 ... ... 7 ... ... ... ... ... ... ... ... 1 ... 1 ... ... 3 ... ... ... 10 22 Not of District 271 ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 2 Lond. Homœop. Hospt District 25 3 5 1 3 12 1 Under 5 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 5 8 Not of Dist. 48 ... ... ... ... ... ... 5 upwds. ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 7 2 ... 1 5 17 National Hospital District ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Not of District 46 ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Italian Hospital District ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Not of District ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. John & Elizab. H. District ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Not of Dist ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Alexandra Hospital District ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Not of District. 2 ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... City Orthopaedic Hosp. District ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Not of Dist. ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Workhouse (not of District) 4 ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ½ray's Inn, Charterhouse, Furnival and Staple Inns (not of District) 12 ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals Of District 465 154 88 14 11 141 57 Under 5 ... ... 9 ... ... ... ... ... ... ... ... 34 9 24 1 46 2 13 103 242 Not of District 388 ... ... ... ... ... ... 5 upwds. ... 1 2 ... ... 1 ... ... ... ... 1 1 1 43 54 30 2 3 84 223 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occurring outside the district among persons belonging thereto. 272 24 19 5 19 137 68 Under 5 ... ... 6 ... ... ... ... ... ... ... ... 1 3 3 ... ... 10 ... ... ... 20 43 5 upwds. ... 1 4 ... ... 1 ... ... 1 ... 3 ... ... 2 ... 50 46 17 1 14 89 229 Deaths occurring within the district among person s not belonging thereto 388 ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... TABLE II. (as required by the Local Government Board). TABLE OF POPULATION, BIRTHS, AND OP NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health during the year 1898, in the Holborn (London, W.C.) District; classified according to Diseases, Ages, and Localities. Population at all Ages. Registered Births. Aged under 5 or over 5. New Cases of Sickness in each Locality, coming to the knowledge of the medical officer of health. Number of such Cases removed from their homes in the several localities for treatment in hospital. Names of Localities adopted for the purpose of these Statistics; public institutions being shown as separate localities. Census 1896. Estimated to middle of 1898. 1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 1 6 1 7 8 9 10 11 12 13 Smallpox, Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Smallpox. Scarlatina Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas, Typhus. Enteric or Typhoid. Continued. Relapsing Puerperal. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) St. George the Martyr ... ... ... ... ... 12 33 ... ... ... ... ... ... 1 2 ... ... ... 10 33 ... ... ... ... ... ... 1 2 ... ... 5 upwds. ... 30 42 20 ... ... 6 ... ... ... 1 ... 18 ... ... ... 30 38 ... ... 6 ... ... ... ... 5 ... ... St. Andrew Eastern 30,540 29,612 808 ... 10 1 ... ... ... ... ... ... ... ... ... 8 16 1 ... ... ... ... ... ... ... ... ... 5 upwds. ... 39 34 2 ... 3 ... ... 1 ... 15 ... ... ... 28 27 2 ... 3 ... ... 1 ... 5 ... ... Glasshouse Yard 668 651 5 ... 2 1 ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Children's Hospital ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... 3 4 ... ... ... ... ... ... ... ... ... ... ... 3 4 ... ... 8 ... ... ... ... ... ... ... London Homoeopathic Hospital ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... National Homoeopathic Hospital ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Italian Hospital ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. John and Elizabeth Hospital ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Alexandra Hospital ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Orthopaedic Hospital ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Marylebone Workhouse ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... Totals ... ... ... Under 5 ... 24 72 54 1 ... ... ... ... ... 1 2 ... ... ... 20 50 1 ... ... ... ... ... 1 2 ... ... 5 upwds. ... 81 2 ... 9 ... ... 2 ... 36 ... ... ... 61 70 2 ... 9 ... ... 1 ... 13 ... ... 30 Medical Officer's Report. TABLE III. DEATHS OF PERSONS BELONGING TO THE DISTRICT IN OUTLYING INSTITUTIONS, Etc., 1898. Holbom Workhouse, Hoxton 52 Middlesex Hospital 4 „ „ Mitcham 13 French ,, 1 Holborn Infirmary 96 Hospital for Women, Euston Road 1 City„ 1 Strand Workhouse 1 Caterham Asylum 8 St. Olave's„ 1 Leavesden,, 7 Royal Free Hospital 9 Banstead„ 1 Brompton„ 2 Hanwell„ 2 St. Bartholomew's Hospital 22 Ilford 1 North West London„ 1 Peckham House Asylum 1 North Western Fever„ 9 St. Luke's„ „ 2 Fountain Fever Hospital 1 Colney Hatch„ i London„ „ 1 Central London Sick Asylum 2 Metropolitan„ 1 Aged Blind Home 1 King's College„ 13 St. Pelagias's Creche 1 Evelina„ 1 H.M. Prison, Wormwood Scrubbs 1 University College„ 4 River Thames... 1 Guy's„ 1 Hampstead Heath Ponds 1 Royal Chest „ 2 Total 272 Samaritan Free„ 1 Charing Cross„ 3 St. George's„ 1 TABLE IV. INFECTIOUS DISEASES RETURN for 52 weeks ending December, 1898. DATE. 2 weeks, ending— 8 Jan. 22 Jan, 5 Feb. 19 Feb. 5 March. 19 March. 2 April. 16 April. | 30 April. 14 May, 28 May. 11 June. 25 June. 9 July. 23 July. G August. 20 August. 3 Sept. 17 Sept. 1 October. 15 October. 29 October. 12 Nov. 26 Nov. 10 Dec. 24 Dec. Small-pox. Scarlatina and Scarlet Fever. 3 6 2 6 1 2 2 2 1 2 3 1 4 4 2 3 3 5 2 8 11 5 8 4 6 1 Diphtheria and Membranous Croup. 5 8 9 6 6 6 9 5 4 2 1 4 3 3 2 4 4 15 6 7 6 8 1 0 3 3 Typhoid Fever and Enteric Fever. 1 1 1 1 1 1 1 1 1 Erysipelas. 2 2 2 2 1 3 1 2 1 1 1 1 1 1 2 2 3 5 2 4 Typhus Fever. Puerperal Fever. 1 1 Continued Fever. TABLE V. CASES OF SICKNESS under the care of the District Medical Officers during the 52 weeks ending 24th December, 1898. Names of the Medical Officers. Small Pox. Chicken Pox. Measles. Scarlatina. Diphtheria. Whooping Cough. Diarrhoea and Dysentery. Cholera. Continued Fever. (Typhus and Typhoid). Erysipelas. Influenza. Puerperal Fever. Carbuncle. Acute Pulmonary Inflammation. Eheumatic Fever. Ague. Delirium Tremens. Insanity. Syphilis. Congenital Syphilis. Lead Poison. Other Diseases. . Bronchitis and Catarrh. Pleurisy. Pneumonia. Dr. Gabe (for 33 weeks) 2 21 I 7 20 I 10 I 147 5 3 39 ... ... ... 5 3 273 536 Mr. Taylor ... ... 11 ... 5 12 ... 1 4 ... ... 110 5 3 41 ... ... 4 1 ... ... 315 515 Dr. Gahagan ... ... 13 ... ... 3 13 ... ... 1 38 ... ... 123 6 3 31 ... ... 2 4 ... ... 326 563 Total ... 2 45 ... 1 15 45 ... ... 3 52 ... 1 380 16 9 114 ... ... 6 10 ... 1 914 1614 Corresponding weeks, 1897. ... 3 20 3 6 45 42 ... ... 5 43 ... ... 456 11 4 110 i 2 9 4 ... ... 808 1572 TABLE VI. 1898. MONTHS. Mean Reading of the Barometer. Temperature of the Air. Bain. Highest by Day. Lowest hy Night. Range in Month. Mean of all Highest. Mean of all Lowest. Mean Daily Range. Mean for the Month. Departure from Average of 127 Years, 1771—1897. Number of Days it Fell. Amount lected. January in. o o o o o o in. 30.151 54.5 30.0 24.5 47.1 39.3 7.8 43.6 + 6.9 8 0.65 February 29.771 55.8 26.1 29.7 46.9 36.0 10.9 41.2 + 2.4 12 1.19 March 29.702 60.0 27.2 32.8 46.8 34.0 12.8 39.8 —1.4 14 1.40 April 29.743 67.2 29.7 37.5 57.4 39.8 17.6 48.0 + 1.8 10 0.93 May 29.664. 75.0 36.0 39.0 60.2 44.9 15.3 51.7 —0.9 22 2.64 June 29.814 78.4 40.0 38.4 67.3 49.8 17.5 57.6 —0.8 11 1.75 July 29.935 82.0 44.6 37.4 72.3 52.7 19.6 61.5 —0.2 9 1.34 August 29.845 90.0 48.0 42.0 75.9 55.2 20.7 64.6 + 3.7 11 0.86 September 29.930 92.1 39.9 52.2 74.5 51.3 23.2 62.1 + 5.5 5 0.31 October 29.669 69 2 37.9 31.3 59.6 48.4 11.2 53.8 + 4.4 17 3.15 November 29.678 60.3 29.0 31.3 51.0 40.5 10.5 45.9 + 3.4 13 2.41 December 29.897 57.8 28.6 29.2 49.9 40.7 9.2 45.8 + 6.7 10 2.22 Means 29.816 70.2 34.8 35.4 59.1 44.4 14.7 51.3 + 2.6 142 18.85 sum. sum.