HOL 6 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, 1899. LONDON: PRINTED BY ORDER OF THE BOARD. 1900. ANNUAL REPORT ON THE VITAL STATISTICS AND SANITARY CONDITION OF THE HOLBORN DISTRICT, For the Year 1899, 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 H0LB0RN DISTRICT, LONDON. FOB THE YEAR ENDED 31sr DECEMBER, 1899. TO THE BOARD OF WORKS FOR THE HOLBORN DISTRICT. Gentlemen, I have the honour to submit my Report for the year ending December 31st, 1899. 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. In comparison with the preceding year the general death-rate, the phthisis, and also the zymotic death rates, are all less. On the other hand, the London general and phthisis death-rates are higher. In the Holborn District, also, the number of notifications of infectious disease was less than that of the preceding year, although for London the number was greater. One hundred and sixty-nine cases of overcrowding were dealt with. The great majority of these were in the Italian Colony, in which night inspections were made on seven occasions. On the first four of these overcrowding was found in each of the 14 houses visited. In one house as many as 4 rooms out of 5 were overcrowded; in one 8 out of 11 rooms ; and in one 6 out of 10 were overcrowded. On the fifth night inspection some overcrowding was found in 2 out of 7 houses visited. On the sixth occasion no overcrowding was found. 4 Medical Officer's Report. On the last occasion 9 houses were inspected to see how far the notices had been complied with. Only 3 out of 40 rooms were then overcrowded. In the one case in which the time given in the statutory notice had expired a summons was taken out, but it was dismissed by the Magistrate. The owners had a printed notice in Itilian and English put up in every room, stating the greatest number of persons allowed by this District Board if used for sleeping and living; also the greatest number if for sleeping only. Much attention was also given to maintain the houses of the Italian Colony in a clean and sanitary state. The Union Buildings Area between Leather Lane and Gray's Inn Road was represented by me under Part I. of the Housing of the Working Classes Act. For details see pages 16 to 20. The improvement in the condition of the Meat Market continues, for the amount of diseased meat " seized " was less than that of the preceding year, 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 109 such cases, the diphtheria bacillus was isolated in 35 of them. The majority of the cases were patients at the London Homceopathic 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 and diphtheria that required to be removed to their hospitals. In October and November on account of the large increase of cases of typhoid fever in London, and notwiihstanding the arrangements made with other hospitals, there was some delay in the removal of a few of our cases. Many of our cases of diphtheria were received at the Children's and Homceopathic Hospitals. The treatment of diphtheria by antitoxic serum still continues to give satisfactory results. Since the 25 th 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 first quarter of the year there was such a large increase in the number of notices that the Contractor was requested to appoint another 5 Medical Officer's Report. foreman to attend to the removal of dust. Although the number of notices the latter half of the year were much diminished, the total for the year was 988; in 1898 the number was 849. However, in 1896 the number was 1,361, and in 1895, as many as 2,114. 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. The Sanitary Committee considered the desirability of the daily removal of stable refuse at the expense of the Board, but on account of the cost that would be incurred it was not recommended. The arrangements made with the Clerkenwell Vestry for articles to be disinfected in their steam apparatus have been continued. The Board's Shelter (conjointly used by the Clerkenwell Vestry) was used by 13 families, consisting of 52 persons, belonging to the District, who slept there during the disinfection of their rooms. SANITARY LEGISLATION, 1899. The following is a short abstract of the sanitary provisions of the Acts that were passed in 1899 affecting the Metropolis:— "The Metropolis Water Act, 1899," which enables and requires the Metropolitan Water Companies to supply each other with water in cases of emergency, and to construct the necessary works if so required by the Local Government Board. "The London Government Act, 1899," an Act to make better provision for Local Government in London, by making Metropolitan Boroughs, the Councils of which shall each consist of a Mayor, Aldermen, and Coun. cillors. By this Act the following powers and duties will be transferred from the London County Council to the Borough Councils. The registration of dairymen, and the duty of enforcing the bye-laws and regulations with respect to dairies and milk, and with respect to slaughter houses, knackers' yards, and offensive businesses (Sec. 6 (4) and 2nd Schedule, Part I.). The power to adopt Part III. of the "Housing of the Working Classes Act, 1890," that is, the power of providing "lodging houses for the working classes" (2nd Schedule, Part II.). "The Metropolis Management Acts Amendment (Bye-Laws) Act, 1899," authorises the London County Council to make bye-laws requiring 6 Medical Officer's Report. persons about to do any drainage work to deposit with the Sanitary Authority all necessary plans, sections and particulars. "The Seats for Shop Assistants'Act, 1899," provides for seats being supplied in the proportion of not less than one for every three female assistants in each room of retail shops. It is to be enforced by the London County Council. "The Board of Education Act, 1899," provides for the inspection of secondary schools by officers of that Board to ascertain the provisions made for the health of the scholars. "The Small Dwellings Acquisition Act, 1899," empowers Local Authorities (in London any Sanitary Authority) to advance money for enabling persons to acquire the ownership of small houses in which they reside. "The Sale of Food and Drugs Act, 1899." Abstracts of this Act have already been printed by the Board and distributed in the District to those who sell food or drugs. The Local Government Board issued a circular and orders, together with Model Regulations for Dairies, Cow Sheds and Milkshops, in accordance with the recommendation of the Royal Commission on tuberculosis. By an order of the Home Secretary the 17th March, 1899, all cases of mercurial poisoning contracted in any factory or workshop have to be notified to the Home Office. As the result of an important decision of the Lord Chief Justice in the Queen's Bench Division of the High Court, in the appeal by the London County Council in the case of Logsdon v. Booth, Salvation Army Shelters and similar institutions must be registered as Common Lodging Houses. AREA, POPULATION, HOUSES. The area of the District is 168 acres. The population for 1899, estimated in the usual way to the middle of the year, is 29,853. 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. 7 Medical Officer's Report. BIRTHS. The total number of births registered during the 5 2 weeks ending December 30th, 1899, were 725, 393 being male and 332 female children; giving a birth-rate of only 24-4 per thousand. The corresponding rate for the whole of Registration London was 29.4. 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 the 52 weeks was 716, giving a corrected annual death-rate of 24.1 per thousand. The corresponding rate for London was 19.3. For 1898 the rates were 24 5 and 18.3 respectively, so that although the London death rate has increased, that for the Holborn District has diminished. Further details are given in Tables I. and III. DEATHS OF CHILDREN UNDER ONE YEAR OF AGE. There were 162 deaths of children under one year of age; that is, the number of deaths of children under one year of age to 1000 births was 223. The corresponding rate for London was 167 per 1000 births. In the preceding three years, the numbers in Holborn were, 212 per 1000 births in 1895, 189 in 1896, 181 in 1897, and 219 in 1898. The causes of these 162 deaths were:— Premature birth and congenital defects 30 Malnutrition, marasmus and debility 16 Diarrhoea and gastro-enteritis 28 Tubercular diseases 8 Bronchitis 13 Pneumonia 19 Measles 5 Whooping cough 7 Diphtheria 0 Suffocation in bed 7 Convulsions 13 Congenital syphilis 3 Other diseases 13 162 8 Medical Officer's Report. PHTHISIS OR CONSUMPTION. The number of deaths from phthisis during the year was 89, which is equivalent to a death-rate of 2.99 per 1000, rather less than last year, when it was 3.11. The corresponding rate for London was 1.82 per 1000, which is rather more than for 1898, when the rate was 1.72. The number of deaths from other tubercular diseases was 20. The prevention of consumption and other tubercular diseases was considered in my last annual report. INFLUENZA. Influenza was prevalent in the district during the year, the number of deaths assigned to it was 21. The number in London was 1817, the highest number recorded since 1895. ZYMOTIC DISEASES. During the year, the number of deaths from the principal zymotic diseases was 64, the rate being 2.15 per 1000. The corresponding rate for London was 2.46. These rates are less than the corresponding rates for last year, and the Holborn rate is less than that for London. During the past five years the number of deaths was: from— 1895. 1896. 1897. 1898. 1899. Measles 45 32 8 36 11 Small-pox 0 1 0 0 0 Scarlet Fever 6 0 4 2 3 Diphtheria 7 9 17 21 5 Whooping Cough 8 26 19 12 12 Typhoid Fever 0 5 5 2 7 Typhus Fever 0 1 0 0 0 Diarrhœa 24 19 35 29 26 Totals 90 93 88 102 64 The number of deaths in London from these diseases have been for the past four years:— 9 Medical Officer's Report. 1895. 1896. 1897. 1898. 1899. Measles 2,633 3,697 1,929 3,075 2,143 Small-pox 55 9 16 1 3 Scarlet Fever 829 942 780 583 398 Diphtheria 2,316 2,683 2,261 1,772 1,964 Whooping Cough 1.483 2,937 1,842 2,160 1,720 Fever (Typhoid, etc.) 629 609 593 598 804 Diarrhoea 3,600 3.223 4,104 4,376 4,196 Totals 11,545 14,100 11,525 12,565 11,228 THE NOTIFICATION AND PREVENTION OF INFECTIOUS DISEASE. During the year there were notified 258 cases of infectious disease: the corresponding number for 1895, 1896, 1897, and 1898 being 333, 280, 339, and 283 respectively. The numbers of the separate diseases were :— 1895. 1896. 1897. 1898. 1899. Small-pox 31 1 0 0 0 Scarlet Fever 160 114 114 96 117 Diphtheria and Membranous Croup 60 67 158 138 63 Puerperal Fever 1 2 0 2 1 Typhus Fever 0 1 0 0 0 Typhoid or Enteric Fever 20 29 25 9 32 Continued Fever 0 1 0 0 2 Erysipelas 61 65 42 38 43 Totals 333 280 339 283 258 For further details see Table II. And in Registration London the notifications have been :— 1895. 1896. 1897. 1898. 1899. Small-pox 979 225 104 32 29 Scarlet Fever 19,757 25,647 22,848 16,894 18,112 Diphtheria 10,772 13,362 12,803 11,543 13,363 Membranous Croup 451 446 389 312 338 Enteric or Typhoid Fever 3,506 3,103 3,024 4,460 Typhus Fever 14 6 4 16 14 Other continued Fevers 108 106 68 56 69 Puerperal Fever 236 277 264 247 329 Cholera 29 13 38 23 15 Erysipelas 5,660 6,436 5,794 5,169 5,615 Totals 41,512 49,708 45,1415 37,316 42,344 Medical Officer's Report. The "corrected" return for 1898 has not yet been received from the Metropolitan Asylums Board. SCARLET FEVER. One hundred and seventeen cases were notified, and 103 of them were removed to hospitals of the Metropolitan Asylums Board or the London Fever Hospital. There were more notifications of this disease, both in the District and in London, than in 1898. The principal incidence of the disease was from the middle of September to the middle of November. Of the District cases, three died; and of the London cases, 398—the smallest number yet recorded. DIPHTHERIA. The number of cases of diphtheria was 63, including one case of membranous croup. Last year the number was 138, and in 1897 it was 158. Of these, 56 were removed to hospitals for treatment. 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 5, or a mortality of only 8 per cent. In London the number of cases notified was 13,701 (including 338 cases of membranous croup), and the number of deaths was 1964, or a mortality of 14.3 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. The bacteriological examination of material from doubtful cases of diphtheria has been continued by the Jenner (late British) Institute of Preventive Medicine. Of 109 such cases the diphtheria bacillus was isolated in 35, and the pseudo-diphtheria bacillus, which is non-virulent to animals, was isolated in 13 cases. In the remaining 61 cases it was not isolated. Most of the material was sent by the London Homoeopathic Hospital. At the Hospital for Sick Children, where also many cases of diphtheria from various parts of London are treated, the bacteriological examination is carried out by their own staff. 10 11 Medical Officer's Report. TYPHOID FEVER. Daring the year the number of cases notified was 34, including 2 cases of continued fever, in comparison with 9 in 1898, 25 in 1897, and 30 in 1896. At least 6 of these were probably contracted by direct infection from previous cases. Of these, 2 were nurses and 1 a patient at Hospital, and 2 others had been in attendance on relatives suffering from this disease. In 3 cases there was good evidence that shellfish might have caused the disease. In ODe case the patient washed linen at a public wash-house next to a person who was washing soiled linen from a typhoid patient. Four cases were not contracted in this District. Of the 34 cases, 9 died. In London there were 4529 cases of Fever notified and 804 deaths—large increases in comparison with 1898. MEASLES. The number of deaths assigned to measles was only 11 in comparison with 36 last year, and in London 2143, in comparison with 3075 the previous year. Disinfection is carried out when possible in those cases that come to my knowledge, by obtainiag 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 about the same as in London. The number of deaths in Holborn was again only 12. All the deaths were of children under five years of age. The number of deaths in London was 1720. The remarks as to disinfection, &c., after measles, apply also to whooping cough. 12 Medical Officer's Report. DIARRHŒA. The number of deaths assigned to diarrhoea was 26, of which 21 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 4196 deaths assigned to diarrhoea in London, 3651 took place in the third quarter, and 3330 were of children under one year of age. The temperature of the summer quarter was 2.80 above the average of the preceding 128 years, and the rainfall of that quarter was very much less than the average. DISINFECTION. During the year ending December, 1899— 313 rooms were fumigated and cleansed. The rooms were also stripped and lime-whited when necessary. 2008 articles were disinfected by steam:— 181 Beds. 551 Pieces of wearing apparel. 33 Mattresses. 15 Curtains, 107 Bolsters. 2 Rugs. 312 Pillows. 8 Books. 268 Blankets. 49 Sundries. 255 Sheets. 9 Carpets. 179 Quilts. 2008 39 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 family shelter at 47, Northampton Road (conjointly used by the Clerkenwell Vestry) was used for sleeping accommodation by 13 families, consisting of 52 persons, from this District during the disinfection of their rooms. THE MEAT MARKET. During the past four years the amount of meat "seized," offal excluded was:— 13 Medical Officer's Report. 1896. Diseased. Decomposed. Total. St. lbs. St. lbs. St. lbs. 1st Quarter 4,069 3 378 4 4 447 7 2nd ,, 7io 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 Total for year 1897 1,881 2 2,331 0 4,212 2 Total for year 1898 1,012 6 3,316 1½ 4,328 7½ 1899. 1st Quarter 382 4 154 7 537 3 2nd „ 181 7 882 2 1,064 1 3rd 122 6 1,221 7 1,344 5 4th 201 5 842 4 1,044 1 Total for year 1899 888 6 3,101 4 3,990 2 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, in 1898 the amount was less than one-fourth of that "seized" in the first quarter of 1896, and last year still less. 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 „ „ In 1899, 3 „ „ of beef „ „ The average weight of the 3 tubercular carcases of beef was 45 stone, or 360 lbs., all being also emaciated. A large proportion of the decomposed meat and offal was foreign (principally Dutch), and was also diseased. DISEASED MEAT AND OFFAL SEIZED DURING 1899. 44 quarters of beef. 44 sheeps' lungs. 2 carcases of mutton. 37 bullocks' livers. 163 carcases of veal. 84 bullocks' lungs. 5 carcases of stirks. 3 pig's livers. 6 carcases of pork. 2 bullocks' tongues. 2703 sheeps' livers. 2 bullocks' kidneys. Total weight (less offal) 886 st. 6 lbs. 14 Medical Officer's Report. DECOMPOSED MEAT AND OFFAL SEIZED DURING 1899. 27 quarters of beef. 3 hampers of bullocks' livers. 12 carcases of mutton. 1 barrel of bullocks' kidneys. 119 pieces of beef. 1 bag of bullocks' heels. 54 pieces of mutton. 6 cases of bullocks' cheeks. 1 carcass of veal. 82 bullocks' tripes. 6 quarters of veal. 18 barrels of bullocks' tripes. 2 carcases of pork. 36 lambs' heads. 26 sides of pork. 400 pigs tops (lungs and hearts). 99 pieces of pork. 89 pigs' plucks. 2 barrels of pork. 27 barrels of pigs' plucks. 1 case (1 cwt.) of pork. 71 barrels of pigs' kidneys. 4 sides of bacon. 2 hampers of pigs' plucks. 260 stones of bacon. 11 baskets of pigs' livers. 50 lbs. of French sausages. 146 baskets of pigs' livers. 3 cases of sheep's plucks. 37 calves' heads. 2928 sheeps' plucks. 84 hampers of mixed offal. 1279 sheeps' heads. 1 calve's pluck. 1 crate of sheeps' heads. 39 cases of rabbits. 48 bags of hearts. 21 rabbits. 2 hampers of kidneys. 3 bags of haddock. 508 bullocks' livers. 1 case (100 tins) of filleted herrings. 166 bullocks' lungs. 56 bullocks' tails. 2 cases of p'aice. 1 bullock's pluck. 2 cases of grapes. 40 bullocks' melts. 17 tins of lobster. 42 bullocks' heads. 16 fowls. 13 bullocks' hearts. 5 pigeons. 4 hampers of bullocks' hearts. 20 guinea fowls. 8 hampers of bullocks' kidneys. 1 turkey. Total weight (meat only) 3101 st. 4 lbs. Diseased (meat only) St. lbs. 888 6 Decomposed (meat only) 3101 4 3990 2 Grand total, 3990 st. 2 lbs. = 31,922 lbs. A large proportion of the above was foreign meat and offal, and was also diseased. 15 Medical Officer's Report. 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. HOUSES CLOSED VOLUNTARILY, DEMOLISHED, REBUILT, &c. 8, 9, and 10, Brownlow Street, demolished for extension of Fifth Avenue 1, 2, 3, and 4, Warwick Place, Hotel. 90 and 91, High Holborn, being rebuilt. 8 and 9, Gray's Inn Passage, new warehouse, being built. 51, Gray's Inn Road, do. do. 70, Lamb's Conduit Street, new post office, flats, and shop, rebuilt. Edwards' Stables, Eagle Street, new stables and warehouses. Dalmeny Mansions, built. Italian Hospital, rebuilt. " Three Cups," public house, Sandland Street. 21, Sandland Street taken into " Three Cups," public house, being rebuilt. 2 and 3, John's Place, houses closed, reported coming down. Boswell Buildings, Boswell Court, new warehouses on site of Nos. 2, 3, 4, 5, and 6, Boswell Court. 1, Boswell Court. House closed to be rebuilt. 4 and 5, Fullwood's Rents, new warehouses built. 85, Leather Lane, premises rebuilt for clothing store. 25, Southampton Buildings (the Patent Office), being rebuilt. 36, Verulam Street, demolished, and factory built on site. 37. do. Furnival's Inn, demolished for the extension of the "Prudential Life Assurance "buildings, which are now being built. Reid's Brewery, being demolished. 326 to 332 (inclusive), High Holborn, demolished for Birkbeck Bank extension. 5 to 9, Staple Inn Buildings, demolished for Birkbeck Bank extension. 16 Medical Officer's Report. 85, Great Saffron Hill, warehouse and offices erected. 151 and 152, Great Saffron Hill, being built. 121, Great Saffron Hill, factory and workshops built. 109 and 111, Charterhouse street, being built. 2, Bleeding Heart Yard, new workshops built. 22 and 23, Charles Street, rebuilt. 57, St. John's Street, " White Bear," public house, rebuilt. 59, St. John's Street, workshops built. 63, St. John's Street, workshops built. 1 a, New Court, stables and dwellings built. Gamage's new premises, Holborn and Leather Lane, rebuilt and extended. Booth's Distillery, 55, Cowcross Street, being rebuilt. HOUSE TO HOUSE INSPECTION. Boswell Court. Emerald Street. Fulwood's Rents. Eagle Street (greater part). Gloucester Street (part). Devonshire Street (part). Leigh Street. Robert Street (part). Lamb's Conduit Passage. Portpool Lane. Verulam Street. Providence Place. Baldwin's Place. Dove Court. Half-Moon Court. Union Terrace and Buildings. Italian Colony (all). Little Saffron Hill. Great Saffron Hill (greater part). Charles Street (greater part). Mitre Court. Hat and Mitre Court. Benjamin Street. Peter's Lane. Pump Court. White Horse Alley. Glasshouse Yard (greater part). "HOUSING OF THE WORKING CLASSES ACT, 1890." Union Buildings Area. Aylesbury Place, Clerkenwell, and Union Buildings, Holborn, Improvement Scheme, 1899. In March, 1896, I reported to the Board the greater part of the Union Buildings Area, under Sec. 39, Sub-sec. (1) (6) of the "Housing of the Working Classes Act, 1890," which is as follows:— "Where it appears to the local authority that the closeness, narrowness, and bad arrangement or bad condition of any buildings, or the want of light, air, ventilation, or proper conveniences, or any other sanitary defect in any Medical Officer's Report. 17 buildings, is dangerous or prejudicial to the health of the inhabitants either of the said buildings or of the neighbouring buildings, and that the demolition, or the reconstruction and rearrangement, of the said buildings or of some of them is necessary to remedy the said evils, and the area comprising those buildings and the yards, outhouses, and appurtenances thereof, and the site thereof, is too small to be dealt with as an unhealthy area under part I. of this Act; "The local authority shall pass a resolution to the above effect, and direct a scheme to be prepared for the improvement of the said area." The following is a short abstract of that report:— In nearly all of the houses of this area the drainage is defective; the drains are not ventilated, and in many of them there is no water supply, and other defects. For a large number of the houses and tenements there is not a sufficient w.c. accommodation. In some the w.c.'s are placed in an insanitary position. All the houses of Half-Moon Court, Providence Place, and Dove Court have no ventilation under the ground floors, and no damp courses; the basements of the houses of the area which have them are in a very dirty and insanitary state—some of them have not been cleansed for several years. Some of the houses in Half-Moon Court, Union Terrace, and Union Buildings have no through ventilation. Many of the rooms in the area are very badly lighted on account of the close proximity of other buildings; some of them being almost in darkness, having only borrowed light. Many of the houses have only small areas at the back, and some have no back area at all. Many of the houses are dangerous on account of fissures in the walls, or the bulging of them in part, or the walls being out of the perpendicular from sinking of the foundations and other causes; or on account of the broken and dilapidated condition of the stairs, passage floors, walls, roofs, or chimneys. Many of the tenements are dangerous to health on account of dampness of the walls. In most, the dustbins are defective; some have no proper dustbins at all. In many, refuse and dust is allowed to accumulate. The paving of the back yards is generally defective, and the yard walls very filthy. 18 Medical Officer's Report. Many of the rain-water pipes and gutters are defective, and in some altogether absent. In some the rain-water pipes are not disconnected from the drains. In many of the tenements the rooms are dangerously overcrowded, and so badly ventilated that on entering one is almost stifled by the foul and poisonous and polluted air. Many of the rooms and passages are in a foul, dirty, and filthy condition, and some have not been cleansed for years. The ground floor of Union Terrace is a large cowshed, and at No. 70, Leather Lane there is an underground bakehouse. On account of our inspection and action with regard to Dove Court, I am glad to learn that these houses are soon to be demolished. A small area, south of Crown Court and to the north of Union Terrace, is already cleared. Many of these grave sanitary, structural, and architectural defects can only be remedied by rearrangement and reconstruction. The only way of effecting a satisfactory and permanent improvement is to treat the whole as an insanitary area, and for this Board to pass a resolution and direct such a scheme to be prepared. If any other course be adopted, at the most only a partial and patchwork amelioration will be the result. New buildings will be more or less unsatisfactorily intermingled with the old, and, like the proposed reconstruction of Dove Court, which has already been sanctioned by the Board, the new paths will be still more devious than the old, and factories or warehouses take the place of dwelling'!. I am sorry I cannot give you the death-rate of this area, as this Board does not possess the requisite death returns, and it was only at the beginning of this year that I obtained the consent of the Sanitary Committee, confirmed by the Board, to have the mortality returns sent to us from the Registrars. I know, however, that in insanitary areas in which statistics have been taken, the death-rate invariably is very high in comparison with that of hygienic and sanitary areas. The population of this area was, at the time of our enumeration, 965 persons, 225 being under 10 years old. Details of the sanitary condition of each of the houses and premises were also given in my report. The following was added in my Annual Report for 1896. Medical Officer's Report. 19 From the death returns of 1896, I find that there were 43 deaths of persons belonging to this area, n of whom died from phthisis, or a death rate of 44.6, and a phthisis death-rate of 11.4 per 1000. But taking into consideration the houses and rooms that were closed, the average population for the year was less than 900: taking it at 900 would give a very high death-rate of 47.8, and a phthisis death-rate of 12.2 per 1000. The above report was considered by the Sanitary Committee and the Board, and it was decided that the sanitary defects should be dealt with under the "Public Health (London) Act, 1891." Notices, accordingly, for every house in the area, were served for the abatement of the insanitary conditions that could be dealt with under that Act The proposed diversion of Dove Court, and erection of a warehouse on part of the site, was abandoned; and instead all the eight houses have been closed; and the four on the north side have been demolished and rebuilt. Nos. 1, 2, 3, 4 and 5, Half Moon Court, and Nos. 15 and 17, Portpool Lane adjacent, have been closed and demolished, and a large warehouse is now being built on the site. The rooms in Union Buildings in which light and ventilation were defective, are no longer used for human habitation. Most of the back areas are small, and some have no back area at all. The great majority of the houses are let in lodgings, and require constant supervision to maintain in a sanitary state. They are houses which it is desirable to have registered, as they require, at least, a thorough annual cleansing, and the rooms ought to be measured and a record kept of their cubic capacity, so that the landlord may know how many persons each room may at most accommodate, and make it easier for an inspector to know when a room is overcrowded. In 1898, after the appointment of an additional Sanitary Inspector, many of the houses in the area were registered and inspected monthly. Last year preparations were made by the London County Council to include this area, reported in 1896, extended by comprising also the remaining premises in Leather Lane and Portpool Lane as far as the corner of these lanes, and, in addition, Aylesbury Place, Clerkenwell area, in an improvement scheme under Part I. of the Act. The late Medical Officer of Health of Clerkenwell made the representation of the part in that District, and the part in Holborn was represented by me. 20 Medical Officer's Report. The following are the mortality statistics for the Union Buildings area, giving the average general death-rate, phthisis death-rate, and the zymotic death-rate for the four years, 1896-1899, inclusive. I give also the corresponding rates for the Holborn District, and for London as a whole. This Board was not supplied with the details of deaths in the District until the year 1896, so that I can only give the statistics for the four years 1896-1899 inclusive. The population as enumerated by the London County Council in June, 1899, viz., 817, may, I think, be fairly taken as the average of the population during the four years 1896-1899 inclusive, for although the population was greater in the beginning of 1896, the greater part of that year and in 1897 it was less on account of the closing and demolition of parts of the Area. General. Death-rate. Phthisis. Death-rate. Zymotic. Death-rate. Area 48.6* 7 .96* 6.12* Holborn District 23.4 3.11 2.89 London 19.3 1.77 2.45 Per 1,000 persons. * The true death rates of the Area are most probably greater than the above high figures, because a large number of the inhabitants of that Area, when they are ill or infirm, go to Hospitals, Infirmaries, Asylums, and Workhouses, and at death the address is often given as Holbo'n, St. Andrew's, or some other inexact address, and these deaths therefore cannot be included as of persons belonging to the Area. The local inquiry was held at the Holborn Town Hall on the 15th and 16th March, 1900. At this inquiry the past and present District Poor Law Medical Officers, Dr. Gabe and Dr. Gahagan, gave evidence of the large proportion of sickness, especially phthisis or consumption, other respiratory diseases and zymotic diseases, that had been prevalent amongst persons living in the Area. Many other witnesses (including Dr. Hamer, Assistant Medical Officer of Health to the London County Council, and myself) were also examined and cross-examined. 21 Medical Officer's Report. HOUSES LET IN LODGINGS. The following is a list of the houses in lodgings that are now on the register, and the number of tenements in each:— Leather Lane Buildings 48 28, Eagle Street 7 14, Emerald Street 6 17, Verulam Street 3 16, Do. 6 18, Do. 6 18, Do. 4 19, Do. 5 20, Do. 1 15. Do. 4 22, Do. 6 16, Do. 5 24, Do. 1 20, Do. 6 22, Princeton Street 4 21, Do. 6 24, Do. 1 46, Eagle Street 11 11 and 12, Peter's Lane 13 45, Do. 7 58, Red Lion Street 5 6, Half Moon Court 5 53, Eagle Street 7 7, Do. 9 1, Mitre Court 6 8, Do. 8 2, Do. 3 9, Do. 10 3, Do. 3 19 and 21, Portpool Lane 13 4, Do. 3 9, Eagle Street 11 26, Red Lion Street 5 1, Dove Court 4 2, New North Street 6 2, Do. 4 4A, Charles Street 5 3, Do. 4 5, Castle Court 7 4, Do. 4 6, Do. 6 52, Devonshire Street 7 21, Fulwood's Rents 7 4, Leigh Street 4 Evelyn Buildings 47 8, Do. 4 63, Mount Pleasant 4 4, Devonshire Street 7 1, Baldwin's Place 6 17, Lamb's Conduit Passage 10 2, Do. 4 20, New North Street 9 3, Do. 4 31, Do. 10 4, Do. 4 5, Red Lion Passage 5 5, Do. 7 20, Eagle Street 3 6, Do. 4 Total 335 7, Do. 7 8, Do. 4 24, Princeton Street is now occupied by only one family. The last 13 of these houses were ordered to be registered during 1899, and the registration is now completed. These premises are inspected monthly. The registration of other houses repo.ted u; on was postponed. 22 Medical Officer's Report. 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 „ 4, Greville Street, „ 55 „ 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 1567, or a few less than in 1898, when the number was 1614. Details of these are given in Table V. SANITARY WORK. The following is an abstract of nuisances abated and sanitary work accomplished during the year ending December 31st, 1899:— Western Division Mr. Bennett. Central Division, Mr. McQuinn. Eastern Division, Mr. Freeman. Total. Written complaints received attention 112 25 31 168 Premises inspected and re-inspected 3406 2376 2056 7838 Preliminary notices have been served 172 114 91 377 Statutory 30 33 13 76 Houses cleansed, repaired, lime-whited, etc 293 364 203 860 Houses have had their over-crowding abated 23 134 12 169 Underground rooms illegally and separately occupied have been closed 9 1 0 10 Rooms disinfected and cleansed after infectious disease 157 87 69 313 New drains have been laid 97 45 90 232 Drains repaired, ventilated, etc. 30 17 15 62 Cesspools filled up 7 2 9 18 Water-closets re-constructed 113 77 130 320 New water-closets constructed 65 47 80 192 Water-closets cleansed and repaired 197 185 151 533 Water-closets supplied with water 263 164 226 653 Houses supplied with water for domestic purposes after water being cut off 8 3 2 13 Yards re-paved and repaired 109 45 27 181 Dustb:ns repaired and provided 46 25 35 106 Accumulations of offensive refuse have been removed 11 3 21 35 Bakehouses inspected twice during the year 14 5 2 21 Notices received for the removal of dust ... ... ... 988 Houses registered as "Houses let in lodgings," inspected monthly 27 26 7 60 Medical Officer's Report. 23 Also a considerable amount of sanitary work has been done in the district (such as new buildings, etc.) without notices being served. UNSOUND FOOD, Etc. Details of diseased and decomposed meat "seized" during the year are given on pages 12 to 15. SMOKE INSPECTION. The Smoke Inspector, Mr. Thomas Madden, reports that there are 56 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 9 kinds of smoke consumers in the District, which are as follows:— Ventilated Doors 4 Dr. Annan's Patent 3 Nicholson's „ 3 Caddy's „ Bars 2 Juke's „ 2 Galloway's „ 6 Gregory and Veal's Patent 1 Gosling's Patent 2 Total of Smoke Consumers 35 The number of furnaces and boilers without smoke consumers is 21, The 13 furnaces that were at Reid's Brewery have been removed from the register, as the premises were closed in September, and are now being demolished. During the year 3 new smoke consumers have been supplied. Six preliminary, 5 recurring, and 2 statutory notices were served to abate smoke nuisances, and were all complied with. THE MORTUARY. There were 158 bodies brought into the mortuary from 1st January to December 31st, 1899. Coroner's inquests were held on 63 of these. 24 Medical Officer's Report. The verdicts were:— Natural causes 44 Accidental Death 8 Suffocation 9 Suicide 2 Total 63 METEOROLOGY. Details' are given in Table VI. The mean temperature for the year was 50.6° F., or 1.9° F. above the mean of the preceding 128 years. The rainfall was 22.34 inches, being 2.50 inches below the average of the preceding 84 years. 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. Medical Officer's Report. 25 LEGAL PROCEEDINGS UNDER PUBLIC HEALTH (LONDON) ACT, 1891. Nuisance Cases. Date. Name. Address of Premises. Offence. Result. Inspector. 1899. February 7th James Goss 8, Gray's Inn Passage Premises unfit for human habitation Closing order, 6s. costs Bennett. June 6th George Spencer 9, Eagle Street Contravention of Board's Regulations for "Houses let in lodgings " Case withdrawn, defendant having sold the house; 24s. costs Do. „ 21st Thos. F. Halsey 45 and 46, Eagle Street Do. do. Case withdrawn on work being completed and payment of costs 48s. Do. July 4th C. C. Davis 12a, Dean Street Nuisance from soil pipe, &c. Order made with 12s. costs. Do. December 8th C. C. Davis 20, Eagle Street Contravention of Board's Regulations for "Houses let in lodgings" Fined £5, 2s. costs Do. „ 29th D. Morris 35 and 36, Devonshire Street This summons was issued to decide a question of trade refuse, the magistrate decided it was trade refuse Ordered 6s. per load to be paid, with 24s. costs Do. July 26th E. G. Jones 73, Hatton Garden Closet unventilated Abatement order, 6s. costs . Freeman. January nth G. Freeman Stable Yard, Laystall Street Nuisance from defective paving £2 and 2s. costs McQuinn. June 20 th Sage & Co. Gray's Inn Road Defective drainage Summons withdrawn on payment of costs. Work done. Do. 27t. A. J. Walke Evelyn Buildings Contravention of Board's Regulations for "Houses let in lodgings " 10s., and 2S. costs. Work done Do. October 24th E. Ferguson 30, Duncan Buildings Obstruction in not giving information of whereabouts of person suffering infectious disease Summons withdrawn Do. December 8th A. H. Shaw j 7, 8 and 9, Half Moon Court 19 and 21, Portpool Lane (4 Summonses) Contravention of Board's Regulations for "Houses let in lodgings" Fined £1, and 8s. costs in all. Work done Do. „ „ P. Verioni 4, Summer Court Nuisance from overcrowding Dismissed. Nuisance abated. No costs Do. 26 Medical Officer's Report. PROCEEDINGS UNDER PUBLIC HEALTH (LONDON) ACT, 1891, Section 47. Diseased and Unsound Meat. Date. Name. Address. Offence Charged. Results. Inspector. 1899. April 2nd Francis George Bolton Glastonbury, Somerset Depositing for sale at 93, Cowcross Street one carcase of diseased beef Fined £50 Billing. „ 25th Walter Fisher Sprowston, Norwich Depositing for sale at 93, Cowcross Street four quarters of diseased beef Six weeks' imprisonment without option of a fine Do. December 15th Fredk. William Brushett Leather Lane, Holborn Depositing for sale at 12, Leather Lane twenty-one rabbits and one piece of unsound pork Fined £10 and 2s. costs 60. Medical Officer's Report. 27 LEGAL PROCEEDINGS (SALE OF FOOD AND DRUGS ACTS). Date. Name. Address. Offence. Result. Inspector. 1899. Elizabeth Bray 3, Devonshire Street Selling milk with 16 per cent. of fat abstracted Fined 10s. Costs 12s. 6d. Bennet'. March 24 th ,, ,, Joseph Clarke 53, Gloucester Street Selling milk from which l6.6 percent. of the fat had been abstracted ,, 10s. ,, 12s. 6d. Do. ,, ,, Elizabeth Bray 3, Devonshire Street Selling butter adulterated with 65 per cent. of foreign fat ,, 10s. ,, 12s. 6d. Do. April 11nth John Evans 32, Rosoman Street Selling milk from which 15.3 per cent. of the fat had been abstracted ,, 40s. „ 12s. 6d. Do. ,, ,, Fredk. Brushett 12, Leather Lane Selling butter adulterated with 80 per cent. of foreign fat ,, 20s. ,, 12s. 6d. Do. ,, ,, George William Charter 73, Theobald's Road Exposing for sale margarine not labelled "margarine" Defendant decamped before summons could be served Do. ,, ,, William Richard Nelson 30, Cross Street Selling butter adulterated with 25 per cent, foreign fat Fined costs 12s. 6d. Do. June 16th Lugi Fraulo 31, Eyre Street Hill Selling milk from which 20 per cent. of the fat had been abstracted Fined 20s. Costs 12s. 6d. Do. March 21st Ann Jones 49, Devonshire Street Skimmed milk to the extent of at least 8'6 per cent. ,, costs 12s. 6d. Freeman. ,, ,, David Jones 3, Princeton Street Skimmed milk to the extent of at least 18'6 per cent. ,, 20s. and 12s. 6d. costs Do. ,, ,, Alice Cardon 32, New North Street Margarine ,, 10s. „ 12s. 6d. ,, Do. June 28th P. Verioni 19, Eyre Street Hill Skimmed milk to at least 19.6 per cent. ,, 20s. ,, 12s. 6d. ,, Do. January 24th J. Milbourne 13, Beauchamp Street Milk adulterated 29.4 per cent. added water ,, 10s. „ 12s. 6d. „ McQuinn. ,, 31 R, Wakelin 15, Do. Milk adulterated 33.8 per cent. added water ,, 12s. 6d. costs Do. ,, 24 M. Benjamin 87, Cowcross Street Butter adulterated 80 per cent. foreign fat ,, 10s. and 2s. costs Do. ,, ,, Do. Do. Selling margarine not properly labelled ,, 25. ,, 12S. 6d. ,, Do. TABLE I. (as required by the Local Government Board). TABLE OF DEATHS during the Tear 1899 (for the 52 weeks ending 31st December, 1899), 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. (i) Mortality from subjoined causes, distinguishing Deaths of Children under 5 Years of Age. 1 2 3 4 51 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 A t all ages. Under 1 year. 1 and under 5 5 and under 15 15 and under 25 25 and under 65 65 and upwards Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhœa and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia, and Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases. Total. Typhus. Enteric or Typboid. Continued. Relapsing. Puerperal. (a) b) (c) (d) (e) (f) (g) (h) St. George the Martyr 219 75 17 2 4 85 36 Under 5 5 upwds. ... ... 1 ... ... ... ... ... ... ... ... 3 3 9 ... 1 21 ... ... 5 49 92 ... ... ... ... ... 2 ... ... ... 1 ... ... ... 1 ... 19 47 14 4 5 34 127 St. Andrew Eastern 172 50 18 6 3 76 19 Under 5 5 upwds. ... 1 ... ... ... ... ... ... ... ... ... 5 8 8 ... 2 11 1 ... 5 27 68 ... ... 1 ... ... ... ... ... ... ... 1 ... ... 2 2 15 22 10 13 2 36 104 5 ... ... ... ... 2 3 Under 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glasshoase Yard ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 ... ... ... 1 5 In District (Not of District) 7 ... ... ... ... ... ... Under 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Children's Hospital District 17 8 6 1 ... 2 ... Under 5 5 upwds. ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 6 ... ... ... 7 14 Not of District 300 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lond. Homœop. Hospt. District 23 6 6 2 2 7 ... Under 5 5 upwds. ... ... 1 ... ... 1 ... ... ... 1 ... 1 1 1 ... 1 ... ... ... 5 12 Not of Dist. 39 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 1 2 ... ... 1 5 11 National Hospital District ... ... ... ... ... ... ... Under 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Not of District 59 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Italian Hospital District ... ... ... ... ... ... ... Under 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Not of District ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. John & Elizab. H. District ... ... ... ... ... ... ... Under 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Not of Dist. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Alexandra Hospital District ... ... ... ... ... ... ... Under 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Not of Distict. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... City Orthopædic Hosp. District ... ... ... ... ... ... ... Under 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Not of Dist. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Workhouse (not of District) 4 ... ... ... ... ... ... Under 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gray's Inn, Charterhouse, Furnival and Staple Inns (not of District) 14 ... ... ... ... ... ... Under 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals Of District 436 139 47 11 9 172 58 Under 5 5 upwds. ... 1 3 ... ... 1 ... ... ... 1 ... 9 12 18 ... 3 39 1 ... 10 88 186 Not of District 423 ... ... ... ... ... ... ... ... 1 ... ... 5 ... ... ... 1 1 ... ... 3 2 36 74 24 17 8 78 250 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. 280 23 13 6 18 140 80 Under 5 5 upwds. ... 1 1 ... ... ... ... ... ... ... ... 2 ... 3 ... ... 11 ... ... ... 18 36 ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 2 50 51 20 4 10 103 244 Deaths occurring within the district among persons not belonging thereto 423 ... ... ... ... ... ... 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 1899, in the Holborn (London, W.C.) District; classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics; public institutions being shown as separate 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. Census 1896. Estimated to middle of 1899. 1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 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 30,540 29,210 718 Under 5 5 upwds. ... 20 11 ... ... 2 ... ... ... ... 1 ... ... ... 20 10 ... ... 2 ... ... ... ... ... ... ... ... 39 22 ... ... 17 ... ... ... ... 22 ... ... ... 31 21 ... ... 14 1 ... ... ... 8 ... ... Under 5 5 upwds. ... 16 10 ... ... ... ... ... ... ... 2 ... ... ... 12 9 ... ... ... ... ... ... ... 1 ... ... St. Andrew Eastern ... 41 13 ... .... 11 ... ... 1 ... 17 ... ... ... 36 10 1 ... 11 ... ... ... ... 7 ... ... Glasshouse Yard 6 643 7 Under 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... Under 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Children's Hospital ... ... ... ... 5 ... ... ... ... ... ... ... ... ... ... ... ... 5 ... ... ... ... ... ... ... ... ... ... Under 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... London Homoeopathic Hospital *** ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 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. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... St. Marylebone Workhouse ... ... Under 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 31,208 29,853 725 Under 5 5 upwds. ... 36 21 ... ... 2 ... ... ... ... 3 ... ... ... 32 19 ... ... 2 ... ... ... ... 1 ... ... ... 81 41 1 ... 30 2 ... 1 ... 40 ... ... ... 71 37 1 ... 27 1 ... ... ... 16 ... ... 30 Medical Officer's Report. TABLE III. DEATHS OF PERSONS BELONGING TO THE DISTRICT IN OUTLYING INSTITUTIONS, Etc., 1899. Holborn Workhouse, Hoxton 62 St. Bartholomew's Hospital 14 „ „ Mitcham 12 St. George's „ 1 Holborn Infirmary 111 Banstead Asylum 1 City „ 2 Caterham „ 7 Brompton Hospital . 1 Colney Hatch Asylum 4 British Lying-in „ 1 Central London Sick Asylum 1 Charing Cross „ 2 Darenth Asylum 3 City of London Chest „ 1 Hoxton House Asylum 1 French ,, 4 Hanwell Asylum 1 Gt. Northern Central ,, 1 Ilford „ 1 Heart Hospital, Soho 1 Leavesden „ 5 Hospital for Women, Euston Road 1 33, Beaumont Street 1 St. Joseph's Home 1 King's College Hospital 9 St. Elizabeth's Home 1 London „ 1 Portugal Street 1 „ Temperance,, 1 Convent, Homerton 1 Middlesex „ 3 On a cab 1 North Western Fever ,, 4 Total 280 Queen Charlotte „ 1 Royal Free „ 15 Royal Chest „ 1 TABLE IV. INFECTIOUS DISEASES RETURN for 52 weeks ending December, 1899. DATE. 2 weeks, ending— 7 Jan. 21 Jan. 4 Feb. 18 Feb. 4 March. 18 March. 1 April. 15 April. 29 April. 13 May. 27 May. 10 June. 24 June. 8 July. 22 July. 5 August. 19 August. 2 Sept. 16 Sept. 30 Sept. 14 October. 30 October. 11 Nov. 25 Nov. 9 Dec. 23 Dec. Small-pox. Scarlatina and Scarlet Fever. 4 7 1 4 3 1 1 4 1 2 3 2 6 8 7 6 6 4 4 10 6 2 12 1 7 3 Diphtheria and Membranous Croup. 6 7 4 1 2 2 1 1 2 1 1 2 3 6 2 4 3 1 4 1 3 2 4 1 Typhoid Fever and Enterio Fever. 2 2 1 2 4 1 2 2 1 1 2 1 1 4 3 2 2 2 Erysipelas. 1 1 1 5 1 1 3 1 1 2 2 5 5 3 2 1 2 6 1 Typhus Fever. Puerperal Fever. Continned Fever. 2 TABLE V CASES OF SICKNESS under the care of the District Medical Officers during the 52 weeks ending 30th December, 1899. 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. Rheumatic Fever. Ague. Delirium Tremens. Insanity. Syphilis. Congenital Syphilis. Lead Poison. Other Diseases. Total. Bronchitis and Catarrh. Pleurisy. Pneumonia. Dr. Taylor ... ... 4 4 ... 6 21 ... 2 2 7 ... ... 94 4 2 46 ... ... 5 ... ... ... 363 560 Dr. Gahagan ... 1 10 1 ... 24 54 ... ... 2 107 ... ... 163 13 2 49 ... ... 2 3 ... ... 575 1007 Total ... 1 14 5 ... 30 75 ... 2 4 114 ... 1 257 37 4 95 ... ... 7 3 ... ... 938 1567 Corresponding weeks, 1898. ... 2 45 ... 1 15 45 ... ... 3 52 ... 1 380 16 9 114 ... ... 6 10 ... 1 914 1614 TABLE VI. 1899. MONTHS. Mean Reading of the Barometer. Temperature of the Air. Rain. Highest by Day. Lowest by Night. Range in Month. Mean of ail Highest. Mean of all Lowest. Mean Daily Range. Mean for the Month. Departure from Average of 128 Years, 1771-1898. N umber of Days it Fell. Amount Collected. in. o o o o o o o o in. January 29.655 55.3 29.3 26.0 47.5 37.5 10.0 42.7 + 6.0 18 2.53 February 29.732 63.9 21.9 42.0 48.3 35.7 12.6 41.9 + 3.1 12 1.93 March 29.911 61.2 20.3 40.9 49.9 32.5 17.4 40.8 —0.4 10 0.61 April 29.652 64.1 30.7 33.4 54.7 40.2 14.5 46.7 + 0.5 20 3.00 May 29.847 72.7 33.7 39.0 60.5 42.2 18.3 50.9 —1.7 12 1.65 June 29.890 81.5 42.1 39.4 72.0 50.3 21.7 60.7 + 2.3 6 0.76 J uly 29.900 88.5 49.2 39.3 76.9 56.2 20.7 65.7 + 4.0 8 1.74 August 29.918 90.0 47.2 42.8 77.1 55.7 21.4 65.m + 4.8 6 0.35 September 29.689 87.3 37.1 50.2 67.4 49.7 17.7 57.7 + 4.1 15 2.23 October 29.898 63.6 31.2 32.4 57.5 41.5 16.0 49.1 —0.4 10 2.34 November 30.019 62.0 28.9 33.1 53.0 42.3 10.7 48.1 + 5.5 9 3.73 December 29.730 54.9 19.3 35.6 41.4 31.9 9.5 37.0 —2.1 15 1.47 Means 29.820 70.4 32.6 37.8 58.9 43.0 159 50.6 + 1.9 141 sum. 22.34 sum.