HOL 20 The Metropolitan Borough of Holborn. REPORT FOR THE YEAR 1902. OF THE MEDICAL OFFICER OF HEALTH WILLIAM ARTHUR BOND, M.A., M.D. CAMB., D.P.H. Camb., M.R.C.P. Lond. Fellow and Member of Council of the Incorporated Society of Mcdical Officers of Health; Fellow, and Member of Council, late Hon. Sec. of the Royal Institute of Public Health ; Member, late Lecturer and Demonstrator, of the Sanitary Institute; late Medical Officer of Health to the St. Olave District. Southwark, and the Holborn District Boards of Works. CONTENTS. PAGE- Introduction 6 Increase in the work of the Public Health Department in 1902 5, 6 Area, Houses and Population 7 Age and Sex Distribution of the Population 7 Alien Immigration 7 Number of Tenements 8 Estimated Population 1902 8 Births and Birth-rates 9 Mortality 9 „ Deaths registered in the Borough 9 „ Deaths in Public Institutions within the Borough 9 „ Deaths of Parishioners in Public Institutions outside the Borough 10 „ Corrected Deaths and Death-rates 10 Infantile Mortality 11 „ Deaths under 1 year per 1,000 births 11 „ Principal causes of deaths of children under 1 year of age 11 Senile Mortality 11 Deaths from Zymotic Diseases 12 „ during the year 1902 and during the preceding 10 years 12 Notifications of Infectious Diseases in the Borough during 1902 and during the preceding 10 years 13 Small-pox 14 „ Report of outbreak during 1901-02 14 „ Notifications and Deaths during the outbreak 15. ,, Summary of Notifications and Genuine cases 15 ,, Cases notified as Small-pox in the Metropolitan Cities and Boroughs during 1901 and 1902 and sickness rates for each year 16 ,, Deaths from in the Metropolitan Cities and Boroughs during 1901 and 1902 and death-rates for each year after distribution of Deaths in Public Institutions 17 „ Outbreaks in particular houses 17 „ Cases in Common Lodging-houses 20 „ Preventive measures 20 „ Vaccination and Re-vaccination 20 „ Examination of the arms of children attending schools in the parishes of St. Giles and Bloomsbury 21 „ Conscientious objectors 22 „ Re-vaccination of the Council's employees 22 „ The great importance and value of successful Vaccination and Re-vaccination 23 „ Statistics of large towns 24 „ Early Diagnosis of the Disease 24 „ Prompt removal of the Patient to Hospital 24 ,, Disinfection 25 „ Temporary Shelter or House Accommodation for persons during the disinftction of their rooms 25 ,, Visits to infected houses 25 ,, Information to Medical Officers of Health, &c., as to contacts 25 Conference on Small-pox 25 Resolutions as to Vaccination adopted by the Incorporated Society of Medical Officers of Health 26 Chicken-pox 28 Scarlet Fever 29 „ Reduction of stay of patients in hospital 29 Diphtheria 29 4 page. "Enteric Fever 29 Measles 30 Wnooping Cough 31 Diarrhœa 31 Plague and Cholera 31 Disinfections 32 Bacteriology 32 Phthisis or Consumption 32 Prevention of Consumption 32 „ „ Deaths and death-rat s from Consumption 32 ,, „ Deaths from Consumption in certain sanitary are.is for the years 1899, 1900, and 1901 33 „ „ Voluntary Notification 34 „ ,, Disinfection 35 ,, ,, Bacteriological Examination of Sputum 35 ,, „ Sanatoria 36 „ „ Spitting 36 „ „ Education of the Public 37 Influenza 38 Alcoholism 38 Sudden and Violent Deaths 38 Inquests 38 The Public Mortuary 38 Housing of the Working Classes Act 38 „ ,, ,, Part I.—Italian Colony 38 „ „ ,, „ Union Buildings Area 39 „ „ „ Part II.—Representations 39 „ „ „ Part III.—Reid's Brewery Site 39 „ „ „ Herbrand Street Site 40 Houses closed voluntarily, demolished, rebuilt, &c. 40 Sanitary Work 42 Legal Proceedings 42 House to House Inspections 42 Regulations as to Houses let in Lodgings 43 Common Lodging Houses 46 Dairies, Cowsheds, and Milkshops 46 Slaughter Houses 47 Offensive Businesses 47 Factories and Workshops 47 Bakehouses 48 Underground Bakehouses, Report on 49 Ice Creams 52 ,, London County Council (General Powers) Act, 1902 52 Kitchens of Restaurant 53 Other Food Shops 53 Unsound food 53 Smoke Abatement 53 Meteorology 53 APPEN DICES. Table I.—Vital Statistics of whole Borough during 1902 and previous ten years 54 Table II.—Vital Statistics of separate localities during 1902 and previous ten years 54 Table III.—Cases of Infectious D.sease notified during the year 1902 55 Table IV.—Causes of and Ages at Death during the year 1902 55 Table V.—Sanitary Inspector's Work 56 Table VI.—Legal Proceedings under the Public Health (London) Act, 1891 57-61 Table VII.—Legal Proceedings under the Sale of Food and Drags Acts 62-3 Table VIII.—Meteorology 63 The Metropolitan Borough of Holborn. REPORT OF THE MEDICAL OFFICER OF HEALTH. FOR THE YEAR 1902. PUBLIC HEALTH DEPARTMENT, 197, HIGH HOLBORN, W.C. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Holborn. Gentlemen, In this Annual Report for the year 1902, the various statistics for the year refer to the fifty-three weeks ending Saturday, January 3rd, 1903, as adopted by the Registrar-General, and known as the registration year. The Factory and Workshop Act of 1901, which came into force on the 1st January, 1902, has much increased the work of the Public Health Department. Under this Act the Council is made the Authority responsible for the sanitary condition of workshops and workplaces in the Borough, while the Factory Inspector is responsible for the sanitary condition of factories, although any sanitary defects reported by the Factory Inspector have to be attended to and remedied under the supervision of this department. The Council is also responsible for the provision of suitable and sufficient sanitary conveniences in factories as well as in workshops and workplaces. The Secretary of State for the Home Office has been advised that the word "workplace" is not to be limited to a place where something is being manufactured or made but is of a very wide signification and includes such premises as stables and stable yards, kitchens of restaurants, &c. 6 Under the new Act the Council must keep a Register of all the workshops in the Borough, and the Medical Officer of Health is required in his Annual Report to the Council to report specifically on the administration of the Act in workshops and workplaces, and to send a copy of the same to the Secretary of State. Very important powers of controlling the conditions under which certain classes of work are done in the homes of the workers were for the first time given to District Councils by the Act of 1901. These powers aim at the prevention of homework being done (1) in premises which are injurious or dangerous to the health of the workers themselves, e.g., overcrowding, want of ventilation, or other insanitary conditions, (2) any premises where there is any dangerous infectious disease. In accordance with section 107 of the Act lists of outworkers have to be kept in certain specified trades, and copies of this list have to be sent to the District Council on or before the 1st day of February and the 1st day of August in each year. The details of all outworkers who do not reside in the Borough have to be sent to the Councils of the district in which they work. Under section 101 new duties of great importance are placed on the Council in regard to underground bakehouses. The Act provides generally that no underground bakehouse whether factory or workshop shall be used as such unless it was so used on the 17th August, 1901, (passing of the Act). Moreover, after the 1st January, 1904, it will not be lawful to use any underground bakehouse wherever established unless the Council are satisfied that it is suitable for the purpose with regard to construction, light, ventilation, and in all other respects and have given a certificate of suitability. Under section 98 of the Act increased power is given for dealing with any bakehouse (whether underground or not) which is unfit on sanitary grounds for use or occupation. During the year 122 kitchens of restaurants were inspected and the notices that were served included 60 nuisances, all of which were abated. Under the London County Council (General Powers) Act, 1902, increased powers have been given to this Council for regulating the manufacture and sale of ice cream. Tbese increased powers came into force on the 1st November, 1902, and much attention has been given since then by this Department to premises where ice creams are manufactured, sold, or stored. The serious outbreak of small-pox in the Borough and the work of carrying out the various preventive measures occupied very much of the time of the Public Health Department during the last three months of 1901 and the first five months of 1902. In the latter part of December, 1901, there was such a large increase in the notifications of small-pox in this Borough, as many as 53 cases having been notified during the last week of December, and I had for some months generally been on duty long after office hours, that I advised the Public Health Committee that it was desirable that a temporary Sanitary Inspector should be engaged, who should be on duty in the evenings until 10 o'clock, and also on Sundays; especially as the new Factory and Workshop Act was coming into force on the 1st January, and the tenement houses in the Borough required much more supervision than had been paid to them during the preceding four months, and that very many more required to be added to the Register of Lodging Houses let in Lodgings. The Public Health Committee finally agreed to let me have the assistance of a medical practitioner, and from 15th January until the end of April Dr. Watkins-Pitchford was on duty after office hours, and he and I took Saturday evenings and Sundays alternately. I think it is due to the great activity of the Public Health Departments and the Public Vaccinators and the Vaccination Officers of the Metropolis that the outbreak of small-pox was so quickly stamped out and that there was practically no recrudescence of the disease last winter. 7 area, houses and population. From the Report of the Census 1901, the area of the Holborn Borough is 405.l acres, the number of inhabited houses 4,703, and the population was 59,405, 29,489 males and 29,916 females. Details for the different parts of the Borough, and details of the changes in the population due to the changes in the boundaries under the London Government Act were given in the Annual Report for the year 1901. age and sex distribution of the population. ages. Persons. Males. Females. All ages 59,405 29,489 29,916 Under 1 Year 1,095 556 539 Between 1 and 2 Years 965 482 483 „ 2 „ 3 „ 877 440 437 „ 3 „ 4 „ 958 467 491 „ 4 „ 5 „ 900 439 461 Total Under 5 Years 4,795 2,384 2,411 between 5-10 Years 4,385 2,202 2,183 „ 10-13 „ 2,461 1,200 1,261 „ 13-14 „ 899 408 491 „ 14-15 „ 874 463 411 „ 15-16 „ 968 492 476 „ 16-17 „ 990 488 502 „ 17-18 „ 1,090 540 550 „ 18-19 „ 1,249 615 634 „ 19-20 „ 1,301 619 682 „ 20-21 „ 1,320 626 694 „ 21-25 „ 5,512 2,515 2,997 „ 25-30 „ 6,735 3,184 3,551 „ 30-35 „ 5,416 2,711 2,705 „ 35-40 ,, 4,913 2,511 2,402 „ 40-45 „ 4,065 2,176 1,889 „ 45-50 „ 3.411 1,782 1,629 „ 50-55 „ 2,818 1,479 1,339 „ 55-60 „ 2,151 1,147 1,004 „ 60-65 „ 1,756 895 861 ,, 65-70 ,, 1,085 542 543 „ 70-75 „ 662 284 378 „ 75-80 „ 352 153 199 „ 80-85 „ 160 62 98 „ 85-90 „ 32 10 22 „ 90-95 „ 5 1 4 „ 95-100 „ — — — 100 Years and upwards — — — alien immigration. In connection with the subject of Alien Immigration, the following details are of interest:— Country of Birth of Foreigners at the Census, 1901. Country of Birth. County of London. Holborn Borough. Persons. Males. Females. Persons. Males. Females. Totals 135,377 79,804 55,573 5,706 3,978 1,728 EUROPE. Russia 3.8,117 20,519 17,598 240 141 99 Poland (Russian) 15,420 8,155 7,265 112 63 49 Sweden 1,675 1,180 495 44 29 15 Norway 1,067 857 210 14 12 2 Denmark 946 676 270 41 26 15 Holland 4,249 2,402 1,847 109 74 35 Belgium 2,102 1,108 994 113 68 45 France 11,264 5,462 5,802 660 374 286 Germany 27,427 17,215 10,212 1,098 793 305 Austria 6.189 4,048 2,141 179 161 18 Hungary 750 533 217 28 24 4 Carried forward 8 Country of Birth of Foreigners at the Census, 1901—continued. Country of Birth. County of London. Holborn Borough. Persons Males. Females. Persons. Males. Females. Brought forward EUROPE continued— Switzerland 4,419 2,920 1,499 247 202 45 Spain 606 502 164 50 40 10 Portugal 128 89 39 8 7 1 Italy 10,889 8,212 2,677 2,029 1,519 510 Greece 211 177 34 19 16 3 Servia, Roumania, and Bulgaria 2,110 1,179 937 23 16 7 Turkey 660 496 164 16 15 1 ASIA. Chin a 120 97 23 3 2 1 Japan 151 123 28 6 6 — Other Countries 148 116 32 19 16 3 africa. Egypt 61 43 18 — — — Other Countries 107 78 29 4 4 — AMERICA. United States 5,561 3,100 2,461 611 345 266 Mexico 58 35 23 4 4 — Other States of Central America 70 47 32 1 1 — Argeitine Republic 138 81 57 6 4 2 Brazil 142 75 67 8 7 1 Other States of South America 266 137 129 6 6 — Country not stated 251 142 109 8 3 5 Totals 135 377 79,804 55,573 5,706 3,978 1,728 number op tenements. At the Censuy of 1901, the total No. of tenements in the Holborn Borough was 13,790. The following table gives details of the tenements of one, two, three and four rooms.* Tenements with No. of Tenements. Percentage of all Tenements. Total Occupants. Percentage of Population in each Group of Tenements. Average Occupants per room. Overcrowding. No. of 1 to 4 roomed Tenements with more than 2 Occupants per room. No. of Occupants of such Tenements. Percentage of Population in such Tenements. 1 room 3,725 27.0 8,502 14.3 2.28 1,207 4,916 8.28 2 rooms 3,834 27.8 13,787 23.2 1.80 1,126 6,747 11 36 3 „ 2,224 16.1 9.175 15. 4 1.38 328 2,603 4.38 4 „ 989 7.2 4,260 7.2 1.08 62 609 1.03 Total 10,772 78.1 35,724 60.1 — 2,783 14.875 25.05 * The word "ovetcrowdin" is used in the sense that the tenements were occupied bv more than two persons per room, and not in the legal sense, for of the 2,783 "overcrowded" tenements there were probably comparatively few for which the Council could take action to abate overcrowding. The table shows that 60.1 per cent, of the population of the Borough lived in tenements of one to four rooms, and that 27.5 per cent, lived in only one or two rooms. estimated population, 1902. The following are the estimated populations at the middle of the year 1902:— Bloomsbury and St. Giles 31,020 Holborn Sub-District 27,522 Holborn Borough 58,542 London 4,613,812 England and Wales 33,378,338 United Kingdom 42,372,556 9 births. During the 53 weeks ending Saturday, January 3rd, 1903, the number of births registered was:— Bloomsbury and St. Giles. Holborn. Total. Males * 516 329 845 Females * 478 323 801 Total * 994 652 1,646 In London the number of births was 132,810 In England and Wales do. 942,822 birth-rates tor the year. Bloomsbury and St. Giles *31.6 per thousand. Holborn Sub-Division 23.3 ,, ,, Holborn Borough *27.7 ,, ,, London 28.5 ,, ,, England and Wales 28.6 ,, ,, *The births in Bloomsbury and St. Giles include all that take place at the British Lying-in Hospital, Endell Street, many of which are those of non-residents. Further details are not supplied by the Registrar-General, nor by the District Re istrar. mortality. The following deaths have been registered in the Borough (1902):— Bloomsbury and St. Giles. Holborn. Total. Males 256 416 672 Females 206 405 611 Total 462 821 1,283 Of these deaths the following occurred in Public Institutions, &c., within the area of the Borough:— INSTITUTION. Residents. Non-Residents St. Giles and Bloomsbury Holborn. St. Giles and Bloomsbury. Holborn. St. Giles Workhouse 72 3 12 French Hospital 8 2 34 — British Lying-in Hospital 1 1 17 — Children's Hospital 5 16 — 324 National Hospital - 1 — 54 London Homœopathic Hospital - 8 — 44 Italian Hospital 1 7 — 17 Alexandra Hospital — — - — Private - 1 7 8 Total 87 39 70 447 10 The following deaths of Parishioners occurred in Public Institutions outside the Borough (1902). INSTITUTION. Number. St. Giles and Bloomsbury. Holborn. Holborn Workhouse - 53 Holborn Workhouse, Mitcham — 21 Holborn Infirmary 2 136 Central London Sick Asylum 71 3 City of London Workhouse — 1 St. Pancras Workhouse — 2 Banstead Asylum 2 — Camberwell Asylum 1 — Cane Hill Asylum 1 1 Caterham Asylum 4 6 Claybury Asylum 1 — Colney Hatch Asylum 2 4 Darenth Asylum 1 1 Dartford Asylum 1 — Hanwell Asylum 2 1 Hoxton House Asylum 2 — London County Asylum — 1 Manor House Asylum 3 — Eastern Fever Hospital 1 1 North Western Fever Hospital 9 4 South Western Fever Hospital — 1 Gore Farm Small Pox Hospital 1 - Small Pox Hospital Ships 33 9 South Wharf Shelter I — Btompton Hospital 1 — Charinsr Cross Hospital 11 — Friedenheim Hospital 1 1 German Hospital — 1 Guy's Hospital 3 1 Heart Hospital 1 — Hospital for Women 1 — King's College Hospital 16 13 London Hospital — 1 London Temperance Hospital 1 1 Metropolitan Hospital 1 1 Middlesex Hospital 12 2 Queen Charlotte Lying-in Hospital 1 — Royal Free Hospital 1 9 St. Bartholomew's Hospital — 9 St. George's Hospital 1 — St. Thomas's Hospital 1 — University College Hospital 5 — St. Anne's Home. Stoke Newington — 1 St. Joseph's Home — 1 St. Pelagie's Crèche — 1 Salvation Army Maternity Home — 1 H. M Prison, Stepney Cause way — 1 H. M Prison, Wormwood Scrubs 2 — ' Public Way 6 3 Total 202 292 CORRECTED DEATHS AND DEATH RATES, 1902. District. Total Deaths at all ages registered in District. Deaths in Public Institutions in District. Deaths of nonresidents of Borough registered in District. Deaths of Residents registered beyond the District. Deaths at all ages. Nett. Death Rate for 1902 (53 weeks) Corresponding period 1901. In Borough. Beyond Borough. Bloomsbury and St. Giles 462 150 70 6 202 59 4 189 18.4 Holborn Sub-District 821 477 447 6 292 666 23.8 21.8 Whole Borough 1,283 627 517 494 1,260 21.2 20.0 Registration London Death Rate 17.2 17.1 No. of Deaths. Death Rate. Bloomsbury and St. Giles 594 18. 9 Holborn Sub-District 666 23 .8 Holborn Borough 1,260 21.2 London 80,105 17.2 England and Wales 537,080 16.3 11 infantile mortality. The number of deaths of children under five years of age was:— Bloomsbury and St. Giles 146 Holborn Sub-District 192 Holborn Borough 308 The number of deaths of children under one year of age, and the number of deaths of children under one year of age per thousand registered births, were the following for:— Deaths under 1 year of age. Deaths under 1 year per 1,000 births. 86 86 Holborn Sub-District 127 195 Holborn Borough 213 129 London 18,478 139 The principal causes of death of these 213 chi'dren under one year of age were:— Premature Birth 28 Malnutrition, debility, &c 65 Bronchitis 20 Pneumonia and Pleurisy 27 Tubercular Diseases 10 Small-pox 3 Measles 6 Whooping Cough 7 Diphtheria 5 Diarrhœa 11 Enteritis 3 Epidemic Influenza 1 Venereal Diseases 5 Septic Diseases 2 Heart Disease 3 Suffocation in bed and accidental 17 213 senile mortality. The number of deaths of persons 65 years of age and upwards was in:— Bloomsbury and St. Giles 121 Holborn Sub-District 145 Holborn Borough 266 Bloomsbury and St. Giles. Holborn Sub-District. Total. Of these the numbers were— 65 years and under 70 29 50 79 70 „ „ 75 37 30 73 75 „ „ 80 20 32 62 80 „ „ 85 23 21 44 . 85 „ „ 90 10 5 15 90 years of age 1 — 1 82 „ „ — 1 1 94 „ „ 1 — 1 121 145 266 12 deaths from zymotic diseases. During the year the number of deaths from the seven principal Zymotic Diseases, viz.:— Small-pox, Measles, Scarlet Fever, Diphtheria (including Membranous Croup), Whooping Cough, Fever (including Enteric or Typhoid, Typhus and Continued Fever) and Diarrhœa, and the death rate from these diseases were:— Number. Zymotic Death-Rate. Bloomsbury and St. Giles 80 2 .54 Holborn Sub-District 62 2'.22 Holborn Borough 142 2.39 And for London 10,280 2.21 The following are the numbers of deaths from the separate diseases:— Bloomsbury and St. Giles. Holborn Sab-District. Holborn Borough. Small-pox 37 9 46 Measles 11 19 30 Scarlet Fever 6 2 8 Diphtheria and Membranous Croup 5 6 11 Whooping Cough 11 16 27 Typhoid Fever 5 1 6 Typhus — - - Diarrhœa 5 9 14 Total 80 62 142 deaths FRom zymotic diseases occurring in the borough during the year 1902 and during the preceding ten years. St. Giles and Bloomsbury. Year. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhœa. Total. 1892 - 47 3 17 11 9 17 104 1893 4 15 12 21 18 6 25 101 1894 1 15 2 13 29 11 9 80 1895 1 13 5 13 13 2 30 77 1896 — 41 7 5 13 4 17 87 1897 — 9 7 6 18 6 17 63 1898 — 26 2 6 9 5 22 70 1899 — 16 — 4 1 4 30 55 1900 —. 11 4 9 13 6 20 63 1901 19 9 1 6 4 7 18 64 Average for 10 years 1892-1901 2.5 20.2 4.3 10 12.9 6.0 20.5 76.4 1902 37 11 6 5 11 5 5 80 13 Holborn Sub-Division. Year. Small-pox. Measles. Scarlet Fever. Whooping Cough. Enteric Fever. Diarrhoea. Total. Diphtheria. 1892 - 54 3 32 50 7 16 162 1893 22 4 54 15 11 25 131 1894 21 - 37 22 6 13 99 1895 - 45 6 7 8 — 24 90 1896 1 32 — 9 26 5 19 92 1897 - 8 4 17 19 5 35 88 1898 - 36 2 21 12 2 29 102 1899 - 11 3 5 12 7 26 64 1900 - 20 3 4 10 3 25 65 1901 11 13 2 8 6 5 24 69 Average for 10 years 1892-1901. 1.2 26.2 2.7 19.4 18.0 5.1 23.6 96.2 1902 9 19 2 6 16 1 9 62 Whole Borough. Year. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhœa. Total. 1892 - 101 6 49 61 16 33 266 1893 4 37 16 75 33 17 50 232 1894 1 36 2 50 51 17 22 179 1895 1 58 11 20 21 2 54 167 1896 1 73 7 14 39 9 36 179 1897 — 17 11 23 37 11 52 151 1898 — 62 4 27 21 7 51 172 1899 — 27 3 9 13 11 56 119 1900 — 31 7 13 23 9 45 128 1901 30 22 3 14 10 12 42 133 Average for 10 years 1892-1901. 3.7 46.4 7.0 29.4 30.9 11.1 44.1 172.6 1902 46 30 8 11 27 6 14 142 notifications op infectious diseases in the borough during 1902, and during the preceding ten years. St. Giles and Bloomsbury. Year. Small-pox. Diphtheria and Membranous Croup. Scarlet Fever. Enteric Fever. Continued Fever. Erysipelas. Puerperal Fever. Typhus Fever. Total. 1892 8 64 172 24 - 105 1 - 874 1893 72 81 235 34 — 91 2 — 515 1894 7 40 84 33 - 63 - - 227 1895 13 63 147 24 63 1 - 311 1896 — 60 180 21 - 83 2 - 345 1897 4 56 207 31 - 94 2 - 394 1898 — 39 65 23 - 7 2 1 - 200 1899 - 28 76 23 - 56 1 — 184 1900 - 58 98 31 - 49 1 - 237 1901 158 60 150 17 - 58 1 1 445 Average for 10 years 1892-1901. 26.2 54.9 141.4 26.1 — 73.4 1.1 1 323.2 1902 159 44 90 24 - 45 2 - 364 Diarrhœa in persons over 1 year of age was notifiable from August 11th to September 29th, 1894, inclusive, during which time 98 notifications were received. Chicken-pox was notifiable from October 19th, 1901, to January 6th, 1903, inclusive, during which time 114 notification were received. 14 Holborn Sub-District. Year. Small-pox. Diphtheria and Membranous Croup. Scarlet Fever. Enteric Fever. Continued Fever. Erysipelas. Puerperal Fever. Typhus Fever. Total. 1892 3 71 321 25 - 94 1 - 515 1893 26 135 327 46 2 115 2 2 655 1894 16 59 65 24 - 74 — — 238 1895 31 60 160 20 — 61 1 — 333 1896 1 67 114 29 1 65 2 1 280 1897 - 158 114 25 — 42 — — 339 1898 — 138 96 9 — 88 2 — 283 1899 — 63 117 32 2 43 1 — 258 1900 — 65 96 24 — 40 — — 225 1901 53 101 104 22 — 31 1 — 312 Average for 10 years, 1892-1901. 13.0 91.7 151.4 25.6 .5 60.3 1.0 .3 343.8 1902 58 69 112 15 — 40 4 — 298 Chicken-pox was notifiable from October 19th, 1901, to January 6th, 1903, inclusive, during which time 168 notifications were received. Whole Borough. Year. Small-pox. Diphtheria and Membranous Croup. Scarlet Fever. Enteric Fever. Continued Fever. Erysipelas. Puerperal Fever. Typhus Fever. Total. 1892 11 135 493 49 - 199 2 - 889 1893 98 216 562 80 2 206 4 2 1,170 1894 23 99 149 67 — 137 — — 465 1895 44 123 307 44 — 124 2 — 644 1896 1 127 294 50 1 148 3 1 625 1897 4 214 321 56 — 136 2 — 733 1898 — 177 161 32 — 110 3 — 483 1899 — 91 193 55 2 99 2 — 442 1900 - 123 194 55 — 89 1 — 462 1901 211 161 254 39 — 89 2 1 757 Average for 10 years, 1892-1901. 39.2 146.6 292.8 51.7 .5 133.7 2.1 •4 667.0 1902 217 113 202 39 — 85 6 — 662 Chicken-pox was notifiable from October 19th, 1901, to January 6th, 1903, inclusive, during which time 282 notifications were received. small-pox. The outbreak of Small-pox during 1901—02 is the largest that has occurred since that of 1893-94. Since the very serious epidemic of 1871 the following haye been the number of deaths from Small-pox in the Metropolis, and the annual rates per million of the population:- Years. Deaths from Small-pox. Years. Deaths from Small-pox. Annual Total. Annual Rate per Million of the Population. Annual Total. Annual Rate per Million of the Population. 1871 7,912 2,421 1886 24 5 1872 1,786 537 1887 9 2 1873 113 33 1888 9 2 1874 57 16 1889 — — 1875 46 12 1890 4 1 1876 736 207 1891 8 2 1877 2,551 709 1892 41 10 1878 1,417 387 1893 206 48 1879 450 120 1894 89 22 1880 471 124 1895 55 13 1881 2,367 617 1896 9 2 1882 430 110 1897 16 4 1883 136 34 1898 1 02 1884 1.236 307 1899 3 0-6 1885 1.419 347 1900 4 0-8 1901 229 51 1902 1.314 282 15 Excluding duplicates, the number of notifications of Small-pox during the outbreak was 429;318 belonging to Bloomsbury and St. Giles, and 111 to the Holborn Sub-Division. The number of deaths was 76, of which 56 belonged to Bloomsbury and St. Giles, and 20 to the Holborn Sub-Division. The following gives the ages of those notified and of the deaths:— Notifications. Deaths. 1901. 1902. Total. 1901. 1902. Total. Under 1 year of age 2 4 6 3 3 1 years and under 5 years of age 10 8 18 3 7 10 5 years and under 15 years of age 19 20 39 1 3 4 15 years and under 25 years of age 46 59 105 3 9 12 25 years and under 65 years of age 130 123 253 23 19 42 65 years and upwards 4 4 8 — 5 5 Total 211 218 429 30 76 46 All the 17 deaths under 15 years of age were of persons who were unvaccinated at the time of infection. SUMMARY Of Notification and genuine cases of Small-pox since the beginning of the outbreak. Month. Notifications. Genuine Cases. 1st Week. 2nd Week. 3rd Week. 4th Week. 5th Week. Total. 1st Week. 2nd Week. 3rd Week. 4th W eek. 5th Week. Total. 1902.—June - 1 - - - 1 - - - - - - August — — 1 2 2 5 — — 1 2 2 5 September 4 5 4 1 — 14 2 5 3 - — 10 October 2 1 2 2 — 7 1 1 2 2 - 6 November 36 14 10 14 11 85 33 13 9 11 11 77 December 20 8 18 53 — 99 19 7 17 52 - 95 1903.—January 29 48 15 11 — 103 27 47 15 9 - 98 February 5 10 6 15 — 36 4 9 6 13 — 32 March 12 8 12 7 8 47 12 8 11 7 8 46 April 4 2 3 2 - 11 4 2 2 2 — 10 May 3 1 — 3 1 8 3 1 — 3 1 8 June 2 2 4 1 — 9 2 2 4 - — 8 July — 1 — 1 - 2 — 1 — 1 — 2 August — 1 - - - 1 — — — — — — September ~~ - - - 1 1 - - - - - - 429 397 16 Cases notified as Small-pox in the Metropolitan Cities and Boroughs during 1901 and 1902; and sickness-rates for each year. The figures for each quarter have been taken from the Quarterly Reports of the Registrar-General. 1901. 1902. 1901. 1902. Outbreak 1901-02. Quarters. Quarters. Year. Rate.* Year. Rate. * Total Cases. Total Rate. 1 2 3 4 1 2 3 4 West— Paddington - — 4 17 62 45 6 — 21 0.14 113 0.77 134 0.91 Kensington 1 — 4 10 43 47 9 — 15 0.08 99 0.55 114 0.63 H ammersmith - — 4 41 61 27 8 4 45 0.39 100 0.87 145 1.26 Fulham 1 — - 15 54 31 6 3 16 0.11 94 0.66 110 0.77 Chelsea — 2 3 20 18 1 - 5 0.06 39 0.52 44 0.58 Westminster — — 9 91 174 56 2 -— 100 0.54 232 1.28 332 1.82 North— St. Marylebone 2 41 36 111 39 3 1 79 0.59 154 1.16 233 1.75 Hampstead 1 — 3 3 10 10 — — ... 7 0.08 20 0.23 27 0.31 St. Pancras 1 1 101 153 227 118 15 — 256 1.08 360 1.52 616 2.60 Islington 1 13 48 137 141 16 8 62 0.18 302 0.88 364 1.06 Stoke Newington - — 7 12 38 11 2 — 19 0.36 51 0.98 70 1.34 Hackney — 1 18 22 196 221 3 5 41 0.18 425 1.91 466 2.09 Central— H olborn - — 18 198 186 29 3 1 216 3.64 219 3.74 435 7.38 Finsbury — 14 79 131 31 46 3 93 0.91 211 2.09 304 3.00 City of London - — 2 6 19 11 9 — 8 0.30 39 1.52 47 1.82 East— Shoreditch - — 2 1 313 118 7 4 18 0.15 442 3.74 460 3.89 Bethnal Green - 1 3 28 276 199 39 1 32 0.24 515 3.96 547 4.20 Stepney 1 1 4 155 929 417 38 3 161 0.53 1387 4-61 1549 5-14 Poplar 1 — 2 6? 332 282 15 1 71 0'.2 630 3-71 700 4-13 South— Southwark 7 82 251 260 7 89 0-.48 518 2-50 607 2-93 Bermondsey... — — 107 101 107 15 1 107 0.81 224 1-72 331 2-53 Lambeth — 3 48 189 151 23 -— 51 0.16 363 1-18 414 1 34 Battersea ... — 53 99 66 23 1 53 0.31 189 1-10 242 1-41 Wandsworth 1 — 8 23 70 54 7 32 0.13 131 0'54 163 0-67 Camberwell — — 54 147 190 17 2 54 0.20 356 1-35 410 1-55 Deptford — — 4 71 62 10 2 4 0.03 145 1-29 149 1-32 Greenwich ... — — 11 58 34 9 1 11 0.11 101 l-0i 112 1-14 Lewisham — 2 10 50 33 5 — 12 0 09 S8 0-66 100 0-75 Woolwich — 1 22 111 116 7 2 23 0-.9 236 1-97 259 2-16 Port of Loudon— — — — 1 9 4 1 9 1 — 14 — — — London— 7 7 272 1416 4475 2928 352 43 1702 0.37 7798 1.70 9500 2.07 * Annual rates per 1,000 of estimated population. It is thus seen that the incidence of the disease was greatest in the Holborn Borough, having been 7.38 per 1,000 of estimated population, and least in Hampstead, where it was only 031. The maximum number of cases, 1,549, was in Stepney, and the minimum, 27, in Hampstead. 17 Deaths from Small-pox in the Metropolitan Cities and Boroughs during 1901 and 1902 and Death-rates for each year, after Distribution of Deaths in Public Institutions. The figures for each quarter have been taken from the Quarterly Reports of the Registrar-General. 1901. 1902. 1901. 1902. Outbreak 1901-02. Quarters. Quarters. Year. Rate. * Year. Rate* Total Deaths, Total Rate. 1 2 4 1 2 3 4 WEST— Paddington — — — — 9 11 — — — — 20 0.13 20 0.13 Kensington — — — 1 6 5 — — 1 0.11 11 0.06 12 0.07 Hammersmith — — 2 13 8 — 5 — 15 0.13 13 0.11 28 0.24 Fnlham — — — 3 8 4 1 — 3 0.02 13 0.09 16 0.11 Chelsea — — — 1 1 5 1 — 1 0.01 7 0.09 8 0.10 Westminster — — 1 15 33 6 — — 16 0.09 39 0.21 55 0.30 NORTH— St. Marylebone — 1 4 2 17 7 — — 7 0.05 24 0.18 31 0.23 Hampstead — — 1 1 2 1 — — 2 0.02 3 0.03 5 0.05 St. Pancras — — 20 21 41 31 9 — 41 0.17 81 0.34 122 0.51 Islington — — 2 6 17 30 7 — 8 0.02 54 0.16 62 0.18 Stoke Newington — — 1 2 5 3 — — 3 0.06 8 0.15 11 0.21 Hackney — — 1 4 25 44 1 — 5 0.02 70 0.31 75 0.33 CENTRAL— Holborn — — 1 29 43 3 — — 30 0.51 46 0.78 76 1.29 Finsburv — — — 7 26 1 9 — 7 0.07 36 0.35 43 0.12 City of London — — — 2 3 4 — — 2 0.08 7 0.27 9 0.35 EAST— Shoreditch — — — 5 61 14 1 — 5 0.04 76 0.64 81 0.68 Betbnal Green — 1 — 1 33 27 4 — 2 0.02 64 0.49 66 0.51 Stepney — — — 22 172 77 11 — 22 0.07 260 0.86 282 0.93 Poplar — — — 10 50 40 3 — 10 0.06 93 0.54 103 0.60 SOUTH— Southwark — — 1 13 39 36 3 — 14 0.07 78 0.37 92 0.44 Bermondsey — — — 14 7 22 2 — 14 0.11 31 0.23 45 0.34 Lambeth — — 1 3 35 23 2 — 4 0.01 60 0.19 64 0.20 Batt ersea — — — 2 14 11 2 — 2 0.01 27 0.15 29 0.16 Wandsworth — — — 3 16 7 2 — 3 0.01 25 0.10 28 0.11 Camberwel — — — 7 17 42 3 1 7 0.03 63 0.23 70 0.26 Deptford — — — 1 18 15 — — 0.01 33 0.29 34 0.30 Greenwich — — — 3 9 12 1 — 3 0.03 22 0.22 25 0.25 Lewisham — — — — 5 3 4 — — — 12 0.09 12 0.09 Woolwich — — — 1 14 22 2 — 1 0.01 38 0.31 39 0.32 London Deaths — 2 35 192 734 506 73 1 229 0.05 1314 0.28 1543 0 ..33 Do. Death Rates*... — 0.00 0.03 0.17 0.64 0.44 0.06 0.00 0.05 — 0.28 — — — * Annual rates per 1,000 of estimated population. It is thus seen that the maximum death-rate during the outbreak was 1.29 in Holborn and the least 0.05 in Hampstead. The maximum number of deaths was 282 in Stepney, and the least, 5, in Hampstead. The first notification was received on the 4th June. I visited the case with the Doctor, and was of the opinion that it was a severe case of Chicken-pox. As another Doctor also considered it was Small-pox, I advised that a Consultant should be called in. He also thought it was Small-pox, and the patient was removed to the South Wharf at Rotherhithe, but returned the same day certified not to be suffering from Small-pox The patient's brother, a, medical student who visited him during his illness, also contracted Chicken-pox. The first case of Small-pox was C. S., male, 50 years of age, a rent collector, of 21, Portpool Lane, a registered tenement house. He probably contracted the disease at a working man's club near the Holborn Town Hall. He was taken ill on the 9th August, the rash appeared on the 11th, notified on the l3th, and removed to hospital the same evening. The rooms and their contents were thoroughly disinfected, the patient's wife and family 18 were re-vaccinated and were removed to 191, High Holborn, a vacant house the property of the Council, some of the rooms of which were prepared and furnished for the occasion. Only 20 of the 56 inhabitants of the house could be persuaded to be re-vaccinated. A second case (an Italian woman) occurred in the same house (not the same family) about a fortnight later, but was not notified until the sixth day of the rash. No other case was notified from this house. After the first case and prior to the second case at 21, Portpool Lane, the five successive cases notified all occurred at a distance from this house, and in the western half of the Borough, and were all scattered cases, and probably contracted from persons living outside the Borough. A cause of much of the spread of the disease in the Borough was a woman of the unfortunate class who slept at common lodging houses, and was visiting public houses in the Borough for about a week with the eruption on her. I saw her in the street with another woman of the same clays near the Relief Offices, Endell Street, and prevailed upon her to see a doctor there. She was notified and detained, but unfortunately escaped before the ambulance arrived, and was not again found and removed to hospital until after midnight more than two days after her escape. Delay in notification either on account of neglect in calling in a Doctor, or on account of difficulty of diagnosis, has been another great cause of spread of the disease. In one house, 43, Great Wild Street, a tenement house which contained 28 persons, 12 contracted Small-pox, and of these ten most probably contracted it from a youth who had not been attended by a Doctor, and a younger brother who had the eruption out for six or seven days before a Doctor was called in. The eleven persons had all refused re-vaccination after the first case. These two youths also infected at least 8 or 9 relatives and friends who lived in the neighbourhood and had visited them at this house. In another house, 15, Nottingham Court, a small tenement house of only 6 rooms, and which contained 16 persons, 9 contracted small-pox. The first was a man aged 30 who had been visiting at a common lodging-house in Queen Street where there had been many cases of small-pox. The case was notified on the 30th December, 1901, as soon as the rash appeared, and the patient was at once removed to hospital. The patient's wife was at once re-vaccinated and a child aged 3¼ had already been vaccinated, and an unvaccinated daughter aged 2 years was then, fortunately, living with her grandmother. Many others in the house promised to be re-vaccinated, but afterwards refused. No further case was notified until the 15th February, 1902, an infant 10 months old, who had not been vaccinated. This child became ill on the 9th February, and the rash appeared on the llth, but the child was not seen by a doctor until it was taken to King's College Hospital on the 15th February, from which place it was removed to the hospital ships, and soon afterwards died there. On the 25th February, 10 days afterwards, four other cases were notified from this house, viz., the mother of the child, a brother aged 8 years, who was unvaccinated at the time of infection, having been vaccinated for the first time on February 16th and two friends of the family, a female aged 28 and a male aged 25. On the following day, February 26th, three other patients were notified and removed; the father (aged 35) of the infant removed on the 15th February, and two friends of the family, a female aged 24, and a female aged 18. Three of these patients were removed from our shelter, No. 191, High Holborn, where they had been kept under observation during the disinfection of the house. One patient (female, 24) was removed as soon as she became ill before the rash appeared, and was re-vaccinated the same day just prior to her removal. Several other patients who lived in the neighbourhood were known to have been infected from the infant mentioned above. One, a boy 7 years old, who lived in the adjoining house, No. 14, who was unvaccinated, although a sister one year old who had been vaccinated did not contract small-pox. Another case was an unvaccinated infant 7 months old. 19 In another tenement house, No. 2, Clark's Buildings, which contained at the time of the receipt of the first notification 25 persons, there were seven cases of small-pox. These arose through a child who had the disease. The father and mother stated they thought it was chickenpox and did not call in a doctor. On the 2lst February two cases were notified, viz., a male aged 18 years, not vaccinated, and a male aged 33 years, who had been vaccinated only in infancy. The father and mother and a brother and sister of the former had fortunately been vaccinated or re-vaccinated about a month previously, the wife of the latter had been vaccinated recently, and a child of the latter was also vaccinated, so that the disease did not spread in these families. On making room to room enquiries throughout the house some children of another family were found concealed in one of the basement rooms with well marked scabs of small-pox. This family consisted of father, mother, and eight children, the ages of the children varying from 19 years to 10 months. The first child that had been attacked with small-pox was a girl 12 years of age who was unvaccinated, Her rash first appeared about the 1st February. The father had been re-vaccinated six years previously, and the three elder girls, aged 19, 17 and 14 respectively had been re-vaccinated about a month previously, and they all remained well. All the younger children, aged 10 months, 2½ 5 and 7 years respectively, were all unvaccinated at the time of nfection. The two former had not been vaccinated at all, and the two latter were not vaccinated until after infection, a few days before the discovery of the cases. In the four younger children the rash appeared about the 13th and 14th February. With the exception of those who contracted small-pox, there was no unvaccinated person in the house. The promises were thoroughly disinfected, ana there was no further case of small-pox. At No. 24a, High Street, on the ground floor of which was a stationer's shop, the remainder of the house being let in tenements, there were six cases of small-pox out of 18 persons who occupied the house. My attention was first called to this house on the 24th December, 1901, by an undertaker, who informed me that he had been requested to bury the body of a person that he thought might have died from small-pox. On visiting the premises 1 found that the body was that of a man aged 39 years, who had died from hæmorrhagic small-pox. This person's illness began on the 18th December, and the rash appeared on the 20th; he had been attended by a doctor, but the case was not notified until after I saw the doctor respecting the same. The wife of the deceased had only been vaccinated in infancy, and was re-vaccinated the following day, December 25th. The two children, boys aged 6 and 1 year 4 mouths, had fortunately been vaccinated in infancy, and did not contract small-pox. The deceased's wife was removed on the 2nd January, 1902, as soon as the rash appeared, she unfortunately not having been re-vaccinated until some days after infection. The next case was that of a girl 7 years old, the daughter of an anti-vaccinator, who had refused re-vaccination for himself and children on the 24th December when I had the information of the first case in the house. This patient was removed on Monday the 6th January, 1902, and had not been vaccinated at all until two days previously, i.e., not until eleven or twelve days after infection. The other children of the family were vaccinated for the first time on Sunday the 5th January, 1902. Two other cases were also removed from this house on this day, the sister-in-law of the first case (deceased), this patient at first refused re-vaccination on December 24th, but was re-vaccinated on January 2nd, the date on which her sister was removed, and the wife of the anti-vaccinator, the mother of the child before mentioned, she was 42 years of age, and had only been vaccinated in infancy. On the 9th January, the husband, age 46, a well-known anti-vaccinator, was removed. He had previously informed me that he had had small-pox when a child. Eighteen cases of small-pox were traced to have had their origin from the first case which had not been diagnosed and notified by the doctor in attendance until after I had made enquiries of him respecting the case. The deceased's wife and her two children instead of coming to our shelter during the disinfection of her rooms, as promised, went to sleep with some friends in a small tenement house in Denmark Place, and two cases of small-pox were removed from this family about a fortnight later. One of the undertaker's men who, notwithstanding my advice, 20 neglected to be re-vaccinated, contracted small-pox, also the daughter of the housekeeper at the doctor's residence contracted small-pox and died. On account of evidence that the Council obtained, that the doctor, before the death of his patient, knew that he was suffering from small-pox, the Council took proceedings against him for failure to notify the case; but the magistrate gave the doctor the benefit of the doubt, and acquitted him. Many eminent medical men gave evidence as to the great difficulty of diagnosis in such cases. In many other cases the spread of the disease was due either to neglect in calling in a doctor or on account of the difficulty of diagnosis. In all houses in which a case was notified on the first day of the rash and all the people in the house were vaccinated or re-vaccinated who had not been vaccinated within five years, no further case of small-pox arose. I think, however, I need not give further details to show the very great value of prompt notification and efficient vaccination and re-vaccination. cases in common lodging-houses. Of the 397 genuine cases during the outbreak 73 occurred at the following Common Lodging Houses:— Cases. No. of Beds. 22-25, Queen Street (men) 21 285 8-10, Parker Street (women) 12 83 4, Greville Street (men) 12 55 Salvation Army Shelter, Charles Street (men) 8 333 Fulwood's Rents (men) 6 114 „ „ (women) 4 82 16, Castle Street (men) 3 33 Kennedy Court (women) 2 113 Parker Street Municipal (men) 3 324 11, Short's Gardens (men) 1 36 6, Betterton Street (men) 1 95 73 1,553 preventive measures. The preventive measures which were adopted may be arranged under the following headings:— 1. Vaccination and re-Vaccination. 2. Early diagnosis of the disease. 3. Prompt removal of the patient to Small-pox Hospital. 4. Disinfection. 5. Temporary shelter or house accommodation for persons during the disinfection of their rooms. 6. Visits to infected houses day by day for a fortnight, so that any person who is ill can be medically examined, in order to ascertain whether the person has contracted Small-pox. 7. Information to the respective Medical Officers of Health of the districts in which contacts with the patient reside or work, and to Schools, Libraries, Workplaces, &c. 1.—Vaccination and Re-Vaccination. The most effective measure for the prevention of Small-pox is Vaccination and Re-Vaccination. It is most anomalous that the control of Vaccination should be in the hands of Boards of Guardians, and this Council agreed that this control should be transferred to the Sanitary Authorities. 21 I at once advised that prompt measures should be taken to secure efficient vaccination and re-vaccination throughout the Borough. I wrote to the Boards of Guardians of St. Giles and Bloomsbury and of Holborn, suggesting that they should give directions for a house-tohouse visitation in order to endeavour to secure this. I also saw the clerks and vaccination officers of these Boards. I alluded to the results of the inspection of the arms of children attending Voluntary Schools in the Borough of Marylebone, and suggested that the Council should endeavour to secure this in tha Board and Voluntary Schools throughout the Borough. The Board of Guardians of St. Giles and Bloomsbury very promptly took action. The Board had placards respecting Small-pox and Vaccination posted throughout the Parishes, and similar handbills distributed in the house-to-house visitation ; also the leaflets of the Jenner Society on the subject of Vaccination and Sanitation. An assistant Vaccination Officer was also appointed to assist in the house-to-house visitation. By the 24th December, 1901, every house, tenement, common lodging-house, factory, laundry, &c., had been visited, 13,000 hand-bills and 3,000 Jenner leaflets had been distributed. The number of Vaccinations performed by the Public Vaccinator, Dr. Hallen, up to the 30tli December, 1901, was:— Primary Vaccinations 469 Re-Vaccinations 1,714 Total 2,183 Including these the totals to the 30th June, 1902, were:— Primary Vaccinations 692 Re-Vaccinations 5,132 Total 5,824 The numbers diminished very much during the second quarter of the year, as the outbreak was then abating. The following are the details of the examination of the arms of children attending schools in the Parishes of St. Giles and Bloomsbury:- SCHOOL. Number in Attendance. Number of Objectors. Number Examined. Number Vaccinated. Number Doubtful. Number Unvaccinated. Endell Street National 529 — 529 433 — 96 Christ Church do 295 87 208 173 9 26 Drury Lane Industrial 129 21 108 83 — 25 Tower Street Board 351 94 257 191 — 66 Great Wild Street Board 751 61 690 542 41 107 Galen Place National 354 — 354 302 — 52 Macklin Streer. Catholic 239 — 239 134 — ' 105 Gate Street Catholic 272 — 272 181 — 91* Total 2,920 263 2,657 2,039 50 568 * Including 46 who had been only recently vaccinated through house-to-house visitation. At the last school in the list, the examination was not made until the 9th January, 1902, as the Managers of the School at first refused to allow this to be done. The percentage of children found to be unvaccinated was 21.4. Of the 568 children found unvaccinated, 398 have been successfully vaccinated. 22 155 reside in other parishes, and notices were posted to the Vaccination Officer of the district in which they resided. 4 have died. 8 have gone away. 2 have been postponed by Medical Certificate. 1 is insusceptible. In the Holborn Sub-Division of the Holborn Union much vaccination and re-vaccination was also carried out. House-to-Housa visitation, in proximity to the cases of Small-pox notified, was made by the Vaccination Officer. Prom August, 1901, to the end of June, 1902, the numbers of vaccinations by the Public Vaccinator, Dr. Gabe, was as follows :— Primary Vaccinations 2,340 Re-Vaccinations 5,610 Total 7,956 In addition to these, many large firms have had their employees vaccinated at private expense, and many of the residents have been vaccinated or re-vaccinated by their own doctors during the present outbreak, so that a large proportion of the population is fully protected against Small-pox, and thus prevents spread of the disease. The Vaccination Officer of this Division of the Borough also informs me that, as a result of the examination of the arms of children at the Board and Voluntary Schools, about one-third refused examination; about one-third were vaccinated; about one-third were not vaccinated. He found that most of the children who were not examined had been vaccinated, the parents objecting to the examination on the ground of a false idea of re-vaccination being made compulsory. As a result of this examination fully 1,000 children were primarily vaccinated and more than 1,000 were re-vaccinated. conscientious objectors. From the 12th August, 1898, when the Conscientious Objectors Clause of the Vaccination Act, 1898, came into operation, until the end of the year 1902, there have been only 46 Certificates of Conscientious Objections of the parents of children born and resident in the Borough, viz.:— Year. St. Giles and Bloomsbury. Holborn. Total. 1898 8 4 12 1899 6 4 10 1900 4 5 9 1901 3 7 10 1902 2 3 5 1898—1902 23 23 46 re-vaccination of the councils employees. At the beginning of the outbreak I was again re-vaccinated, and advised the staff of the Public Health Department to be re-vaccinated, pointing out that cases of small-pox had occurred amongst the Sanitary Inspectors and Disinfecting Staff of other Boroughs. All the Sanitary Inspectors were re-vaccinated (except the one who had been successfully re-vaccinated 18 months previously) also the two Clerks of this department, and all have escaped small pox. 23 On account of the great increase of disinfections required, fresh men were employed who had not been re-vaccinated, and six of these men contracted small-pox, one of whom was re-vaccinated too late, five days after he had begun this work, and after he had contracted small-pox. No case occurred amongst any of the Disinfecting Staff after having been re-vaccinated twelve days, nor has any other employee of the Council contracted small-pox. The Town Clerk was also re-vaccinated, and the majority of the staff of his and of the other departments. the great importance and value of successful vaccination and re-vaccination. The present outbreak of Small-pox has again demonstrated the very great importance and. value of successful vaccination and re-vaccination. The Registrar-General has published statistics of the 1,015 deaths from Small-pox of London residents which have been registered from the beginning of the outbreak to the 5th of April, 1902. Of these there has been no death of a person who had been re-vaccinated within the previous ten years, and but one death of a vaccinated child under ten years of age, and this child was certified to have been but imperfectly vaccinated. On the other hand, there were 264 deaths of im-vaccinated children under ten years of age, including 38 deaths of children under ten who were not vaccinated until after they had contracted Small -pox. In the Holborn Borough, I estimate that about 20,000 persons were vaccinated or revaccinated during the present outbreak, and allowing the usual twelve days for protective incubation, not one of them has contracted Small-pox. I have also mentioned that there was no death of a person under 15 years of age who was vaccinated at the time of infection. The special report dated the 10th January, 1902, of the Metropolitan Asylums Board, stated that during the past year a very large number of new staff have joined the Ships and the Gore Farm Hospital, but not one cane of Small-po.e has occurred. Not one of the staff of the Hospital Ships has ever died of Small-pox. Similar evidence was afforded by the severe epidemic of small-pox in 1870-1872. The Special Committee appointed by the Managers to collate statistics of this epidemic resorted as follows:— "The necessity of re-vaccination, when the protective power of the primary vaccination has to a great extent passed away, cannot be too strongly urged. No greater argument to prove the efficacy of this precaution can be adduced than the fact that out of upwards of 14,800 cases received at the hospitals only four well-authenticated cases were treated in which re-vaccination had been properly performed, and these were light attacks. Further conclusive evidence is afforded by the facts that all the nurses and servants of the hospitals, to the number at one time of' upwards of over 300, who are hourly brought into intimate contact with the disease, who constantly breathe its atmosphere, and than whom none can be more exposed to its contagion, have with but few exceptions, enjoyed complete immunity from its attacks. These exceptions were cases of nurses or servants, whose re-vaccination in the pressure of the epidemic was overlooked, and who speedily took the disease, and one case was that of a nurse who, having had small-pox previously, was not re-vaccinated, and took the disease a second time." From the Report and voluminous Appendices of the Report of the Royal Commission on Vaccination I prepared the following table, giving statistics of the incidence, number of deaths and death-rates amongst the vaccinated and unvaccinated under ten years of age in the largetowns in which detailed enquiry was made. The figures for London are obtained from the Annual Reports of the Metropolitan Asylums Board for the ten years 1891 to 1900. 24 statistics of the following large towns:- Total number of cases of Small-pox. Under Ten years of Age. Vaccinated. Unvaccinated. No. N umber of Deaths. Death Rate. No. Number of Deaths. Death Rate. London,1891-1900 5,166 125 - - 672 153 22.8 Leicester. 1892-1893 357 2 - — 167 15 140 Sheffield, 1887-1888 4,703 353 6 1.7 228 100 43.9 D'ewsburv Union, 1891-1892 1,029 44 1 2.2 174 56 32.1 Warrington, 1892-1893 667 33 2 6.0 32 12 37.5 Gløucester, 1895-1896 1,979 26 1 3.8 680 279 41.0 Manchester. 1892-1893 805 11 — — 36 7 19.4 Oldham, 1892-1893 121 3 — — 15 5 33 3 Leeds, 1892-1893 200 4 — — 8 3 37.5 Halifax, 1892-1893 330 4 — — 38 15 39.5 Bradford, 1893 658 17 — — 57 23 40.3 Total 16,018 662 10 1.6 2,047 668 32.6 Note.—The vaccinated include all cases that had any evidence of vaccination, however imperfect. A further conclusive proof of the life-saving power of vaccination is the great change in the age incidence of the disease. Before vaccination was introduced, the number of deaths of children under 10 years of age was enormous, and greater than the total number of deaths of persons of all other ages. Now the deaths of children under 10 years of age is but a small percentage of the total deaths from small-pox, and practically include only children that had not been vaccinated. (2) Early Diagnosis of the Disease. The early diagnosis of the disease is of great importance, as if the patient is removed to Hospital the first day of the rash, and all contacts at once re-vaccinated and disinfection carried out, the disease will not spread. It is well known that there is great difficulty in the diagnosis of many cases of Small-pox. I was asked by Medical Practitioners to see very many cases of Small-pox, Chicken-pox and suspicious cases before the notifications were made. The Council adopted the notification of Chicken-pox, and several of the cases notified, I found on examination, were cases of Small-pox. Also several notified as Small-pox, I found to be really suffering from Chicken-pox. The Metropolitan Asylum Board kindly made arrangements for Metropolitan Medical Officers of Health to visit the South Wharf and Small-pox Ships. I gladly availed myself of the opportunity. Arrangements ought to be made for all medical students to see cases of Small-pox. (3) Prompt Removal of the Patient to Hospital. This service is admirably carried out by the Metropolitan Asylums Board. On receipt of a message by telephone or telegram, an ambulance with a driver, porter, and nurse, is at once despatched at any time during the day or night. I was generally on duty long after office hours; and at the beginning of the present year the Public Health Committee consented to an Inspector being on duty till 10 p.m., and on Sundays till 1 p.m., and Dr. Watkins-Pitchford was appointed to assist me. He was on duty sifter office hours, from January 15th until the end of April, 1902, and he and I took Saturday evening and Sunday duty alternately. 25 (4) Disinfection. All infected rooms and articles were thoroughly disinfected, all bedding, clothings linen, etc., being removed from the house and disinfected in the Council's steam disinfector. Additional men were furnished by the Borough Surveyor as the outbreak increased. Shafts were added to the disinfecting trucks, and a pony was employed to draw them. A new Defries Steam Disinfecting Apparatus was provided. All rooms were also stripped and limewashed by the Surveyor's Department. In common lodging houses this was done the same day that the patient was removed, even if this took place after office hours, the men being at work sometimes till after midnight. (5) Temporary Shelter or House Accommodation for Persons during the Disinfection of their Rooms. As soon as the first case of Small-pox was notified an empty house, 191, High Holborn, belonging to the Council was prepared and furnished as a shelter for persons during the disinfection of their rooms. The family of the first case remained there for a fortnight, but the families generally only remained at the shelter until the disinfection and stripping of the rooms was completed. At first, food for the families was supplied by the St. Giles and Bloomsbury Guardian Board. As soon as the Council had the opinion of the Local Government Board, dated the 22nd February, 1902, that it is competent to a Metropolitan Borough Council to supply the necessary food to any inmate of a temporary shelter provided by them, the Council did this instead of the Guardian Board. During the outbreak the number of inmates was 240, of these 187 belonged to Bloomsbury and St. Giles, aud 53 to the Holborn Sub-Division. (6) Visits to Infected Houses Day by Day for a Fortnight so that any Person who is ill can be medically examined in order to ascertain whether the person has contracted small-pox. (7) Information to the respective Medical Officers of Health of the Districts in which Contacts with the Patient reside or work, and to Schools, Libraries, Workplaces, &c. During the last three months of the year (1901 and the first five months of 1902) the work of carrying out these various preventative measures occupied much of the time of the Public Health Department. Visits were also made on the 17th day after the removal of a patient suffering from Small-pox as an additional precaution. conference on small-fox. A Conference of Representatives of the Sanitary Authorities of the Metropolis, convened by the Metropolitan Borough of Holborn, was held on the 7th February, at the offices of the Metropolitan Asylums Board, on the embankment, for the purpose of considering whether the measures at present adopted in dealing with outbreaks of Small-pox can be in any way improved. Mr. R. M. Hensley, Chairman of the Metropolitan Asylums Board, welcomed the delegates. He reminded them of some of the figures contained in the report presented at a recent meeting of the Metropolitan Asylums Board as proving the value of vaccination and re-vaccination. Professor W. R. Smith was elected to the chair, and Mr. Henry C. Jones, Town Clerk of the Metropolitan Borough of Holborn, was appointed Clerk to the Conference, and various resolutions were afterwards proposed. 26 After considerable discussion, the following resolutions, submitted on behalf of the Borough of Holborn, were agreed to :— (a) That, in the opinion of the Conference, the powers and duties at present vested in Guardians of the Poor, with regard to vaccination and re-vaccination, should be transferred to, and enforced by, Borough Councils. (b) That in the opinion of the Conference, an amendment of the law is necessary, to ensure compulsory vaccination and rs-vaccination of all persons (who have not been vaccinated within five years) in a dwelling house wherein small-pox has broken out. (c) That, in the opinion of the Conference, it should be declared an offence, under the Public Health (London) Act, 1891, to refuse or withhold information, or give false information, with respect to persons living in a house in which small-pox has broken out, with regard to (a) their names, (b) employment or occupation, (c) schools attended by their children, or (d) as to any persons not living in such house, bat employed therein. (d) That, in the opinion of the Conference, the provisions of the Public Health (London) Act, 1891, with regard to the prevention of infectious diseases, require amendment by (a) shortening the period of twenty-four hours, allowed by Section 60, for the master of a house to decide whether he will undertake the disinfection or allow the Sanitary Authority to do so; and (b) extending the provisions of Section 64 to the taking of any house, or part of a house, by a person suffering from an infectious disease, or who has been exposed to infection. (e) That, in the opinion of the Conference, all disinfections should be carried out by the Sanitary Authority. It was further resolved :— (/) That, in the opinion of the Conference, it is advisable that application be made to the Metropolitan Asylums Board to send out, to every Medical Officer of Health in London, daily lists of small-pox cases only, with age and addresses of patients, as is done weekly in the case of all infectious diseases. Upon consideration of a letter addressed by the Council of tlie Metropolitan Borough of St. Pancras to the President of the Local Government Board, with regard to the steps to be taken to prevent the spread of small-pox by contact, the following resolution was passed :— (g) That, in the opinion of the Conference, it is desirable to amend the law by providing that when a person inhabits any part of a house in which there have been cases of small-pox, and knowingly associates with other persons without having his own person and clothes disinfected and cleansed to the satisfaction of the Local Sanitary Authority, he should be liable to a penalty not exceeding £20. On consideration of a communication addressed by the Town Clerk of the Royal Borough of Kensington to the Local Government Board, requesting them to undertake the supply of lymph to any registered Medical Practitioner who may apply for the same, instead of to Public Vaccinators only, the Conference unanimously approved the suggestion. resolutions as to vaccination adopted by the incorporated society op medical officers of health. In view of a new Vaccination Act, suggested amendments were the subject of much consideration and discussion by the Society of Medical Officers of Health and its various Branches, and the following were the resolutions adopted by the Society :— " 1. It is expedient, in the interests of children as well as of the ommunity at large, that 27 the present statutory enactments requiring the vaccination of children in infancy should be maintained." [Note.—Section 1 of tlie Vaccination Act, 1898: "(1) The period within which the parent or other person having the custody of a child shall cause the child to be vaccinated shall be six months from the birth of the child."] "2. That any relief from these requirements which Parliament, when considei'ing the Vaccination Act, 1898, may see fit to give should be given by an extention of the existing provisions of the law empowering magistrates to suspend vaccination for a definite period, and not by unlimited exemption, as at present." [Note.—Section 2 of the Vaccination Act, 1898: "(1) No parent or other person shall be liable to any penalty under Section 29 or Section 31 of the Vaccination Act of 1867, if within four months from the birth of the child he satisfies two Justices or a Stipendiary or a Metropolitan Police Magistrate in Petty Sessions that he conscientiously believes that vaccination would be prejudicial to the health of the child, and within seven days thereafter delivers to the Vaccination Officer for the district a certificate by such Justices or Magistrate of such conscientious objection."] "3. That such postponement should not be for a longer period than four years, when the requirements of the law should automatically revive, subject to further postponement to the age of twelve years (or to an earlier age in case of prevalence in the neighbourhood of the child of epidemic small-pox) in case of the renewed objection of the parent, and that at this latter age all children who have not been vaccinated efficiently within five years shall be required to be vaccinated or re-vaccinated as the case may be. "4. That the Local Government Board should have the power, on the occurrence of small-pox in any locality to make an order requiring the children residing therein to be re-vaccinated at an earlier age than the twelfth year during such period as the Board may deem neccessary. "5. That all persons who have been in contact with a case of small-pox should be required to be vaccinated or re-vaccinated forthwith, if in the opinion of the Medical Officer of Health such vaccination or re-vaccination is neccessary. "Persons occupying the same ward in a workhouse or lodging in a common lodging-house in which a case of small-pox occurs should be deemed to be in contact. "6. That the administration of the Vaccination Acts should be transferred from the Poor Law Authorities to Sanitary Authorities and be administered— "(a) As regards the Metropolis, by the Councils of the Metropolitan Cities and Boroughs; "(b) As regards County Boroughs, by the Councils of such Boroughs; and "(c) As regards the rest of Lngland and Wales, by the Councils of Administrative Counties, provided that the Council of an Administrative County should be empowered to delegate any or all of the duties under the Acts to any or all of the Councils of the Sanitary Authorities within such Administrative County, with power to revoke such delegation at any time. "7. That, in the event of any of the aforesaid Councils failing to carry out the duties imposed upon them by the Acts, the Local Government Board should undertake the duties, and recover any expenses incurred from the Council making such default. "8. That Sanitary Authorities should be empowered to expend public funds in promoting vaccination and re-vaccination whenever their districts are visited by or threatened with small-pox. 28 "9. That a minimum standard of vaccination and of re-vaccination should be prescribed by the Local Government Board, such standard to state the number, area, and description of marks to be produced. "10. That the Local Government Board should prescribe forms of certificate for vaccination and re-vaccination, which, when filled up, should state the results obtained as to the number, area, and description of marks produced. "11. That every registered medical practitioner giving a certificate of vaccination or re-vaccination should do so by properly filling up the form prescribed. "12. That calf lymph, guaranteed by the Local Government Board, should be supplied on demand to every registered medical practitioner. "13. That stations for the preparation of vaccine should be established under Government supervision in the large provincial centres. "14. That the tenure of office of all officials under the Vaccination Act should be on similar lines to those conditions under which Poor Law Medical Officers are appointed." Note.—Poor Law Medical Officers are appointed under an Order of the Poor Law Board (now the Local Government Board), dated May 25th, 1857, Article 2 of which is substantially as follows :—" Every District Medical Officer duly qualifie at the time of his appointment, and then being, or within two months after his appointment becoming, resident within the district for which he shall be appointed to act, shall hold his office until he shall die or resign, or be proved to be insane (by evidence which the Poor Law Board shall deem sufficient), or become legally disqualified to hold soch office, or be removed by the said Board, or cease to reside within such district." "15. That a Medical Officer of Health should be given power to detain contacts under observation. "16. That Medical Officers of Health should have power to cause to be vaccinated or re-vaccinated contacts at the expense of the Sanitary Authority, or, in emergency, himself to vaccinate such contacts. "17. That a penalty should be provided against false information being given by any person in connection with an outbreak of small-pox—e.g., false names and incorrect addresses. "18. That in the opinion of this Society all vagrants should be required to be vaccinated, unless they can show the marks of recent vaccination, or produce a certificate of re-vaccination." chicken-pox. In my Annual Report for 1901 I included my report on the notification of chicken-pox, and on the 9th October, 1901, the Council unanimously agreed to the notification of chicken-pox, which came into force one week after the advertisement on the 12th October. During the year 1902, 226 cases of chicken-pox were notified, 90 belonging to Bloomsbury and St. Giles, and 136 to the Holborn Sub-District. The notification of chicken-pox was continued until January 6th, 1903, inclusive, and during the whole period that the notification was in force 282 notifications were received, 114 belonging to St. Giles and Bloomsbury, and 168 to the Holborn Sub-District. I was called in consultation by many medical practitioners before many doubtful cases of chicken-pox or small-pox were notified. All the eases of chicken-pox notified were also visited, and in a few cases it was found that the patients were really suffering from small-pox, and they were removed to the hospital ships. 29 scarlet fever. Daring the 53 weeks ended Saturday the 3rd January, 1903, the number of scarlet fever notifications, excluding duplicates, was 202; 90 in Bloomsbury and St. Giles, and 112 in the Holborn Sub-District. All except three were removed to Hospital. The decennial average for St. Giles and Bloomsbury was 141, and for the Holborn Sub-District 151. There were 8 deathsregistered as due to this disease, 6 belonging to Bloomsbury and St. Giles, and 2 to the Holbora Sub-District. The disease was not very prevalent in the Borough last year, and the weekly fluctuations in the two divisions of the Borough were more marked than usual. Reduction of the Stay of Patients in Hospital. I read a Paper at the meeting of the Metropolitan Branch of the Society of Medical Officers of Health, on December 19th, 1902, in which I prepared statistics of the average detention of scarlet fever patients in the hospitals of the Metropolitan Asylums Board, and shewed that this period was longer than in most of the Provincial hospitals, and in hospitals in America and on the Continent. I then gave reasons and evidence for the adoption of measures that in the opinion of many experts, would reduce the average period of detention of patients in hospital, not only to the advantage of the patients but also of the parents, the public, and the ratepayers. It was generally considered that the conference with the Medical Supeintendents of the hospitals of the Metropolitan Asylums Board, at the reading of the Paper and at the adjourned discussion thereon, would result in increased co-operation, and a reduction in the average period of detention of patients in hospital. The Paper was published in " Public Health," February, 1903. diphtheria. The number of cases of diphtheria notified was 113, of which 44 belonged to Bloomsbury and St. Giles, and 69 to the Holborn Sub-District. All but 6 were removed to hospital. The decennial average for the two divisions being 55 and 92 respectively. There were 11 deaths from this disease, 5 belonging to Bloomsbury and St. Giles and 6 to the Holborn Sub-Division. The mortality was only 9.7 per cent. The disease was not very prevalent during the year, and as in scarlet fever the weekly fluctuations of the disease were more marked than usual. enteric fever. 39 cases were notified, the same as last year, of which 24 belonged to St. Giles and Bloomsbury and 15 to the Holborn Sub-District, the decennial average being 26 for each division34 of the 39 cases were removed to hospital, and two of them were returned as not enteric fever. The number of deaths was 6,5 belonging to St. Giles and Bloomsbury and 1 to the Holborn Sub-District. In four of these cases there was strong evidence that the disease was caused by eating shell-fish. One of them was a boy aged 13, who had been at a school outing at Southwick for a fortnight, and had also visited Southend-on-Sea. Of the boys who went to this outing 18 were attacked with enteric fever, and all of them had eaten cockles, or mussels, or both. Many outbreaks of enteric fever have been proved to be due to sewage contaminated shell-fish. In many cases oysters and other shell-fish which have been laying in beds where there was a probability of sewage contamination have been proved on bacteriological examination to have been so contaminated. During December, 1902, and January, 1903, oysters from various 30 sources were submitted by the Worshipful Company of Fishmongers for bacteriological examination, and the majority of them were found to have sewage contamination. In order to prevent outbreaks of this disease due to the eating of contaminated shell-fish, an Act ought to be passed prohibiting the use for food of any shell fish that have been laid or stored in places liable to sewage contamination. measles. All the 30 deaths from measles during the year were of voung children under five years of age. Eleven of the deaths belonged to Bloomsbury and St. Giles, and 19 to the Holborn Sub-Division. The decennial averages for these districts of the Borough were 20 and 26 respectively. In no school had I intimation of the sufficient prevalence of measles amongst children attending them to close even one of the infant departments. During the year the Council made a recommendation to the London County Council that the provisions of Sections 60 to 65 inclusive, Sections 68 and 69, and 70 to 74 inclusive of the Public Health (London) Act, 1891, with respect to dangerous infectious diseases should also apply to measles in the administrative County of London. This order was made by the London County Council and duly approved by the Local Government Board, and came into force from and including the 1st April this year (1903). The following is a brief summary of the Sections above referred to :— Section 60 gives power to sanitary authorities to require the cleansing and disinfection of infected houses or parts of houses and the disinfection or destruction of infected articles, and requires them to pay compensation for articles destroyed or for unnecessary damage caused by disinfection, and to provide, free of charge, temporary accommodation for the shelter of persons during the disinfection of the dwellings. Section 61 enables sanitary authorities to require infected bedding, clothing or other articles to be delivered up to them for disinfection or destruction, and provides that they shall pay compensation for any unnecessary damage or for any articles destroyed. Any person failing to comply with a notice by the sanitary authority under this section is liable to a fine not exceeding Ten Pounds. Section 62 prohibits persons from knowingly casting, or causiug or permitting to be cast, infectious rubbish into ashpits without previous disinfection. Any person infringing the provisions of this section is liable to a fine not exceeding Five Pounds, and to a further fine of Forty Shillings for every day during which the offence continues after notice of such provisions has been served on the master of the house by the sanitary authority, which shall on his request provide for the removal and disinfection or destruction of the aforesaid rubbish. Section 63 prohibits persons, under a penalty not exceeding Twenty Pounds, from knowingly letting houses or parts of houses in which infected persons have been lodging until such premises have been disinfected, and until all infected articles therein have been disirfected or destroyed. For the purposes of this section the keeper of an inn shall be deemed to let for hire part of a house to any person admitted as a guest into such inn. Section 64 provides that any person letting, or showing for the purpose of letting, a house or part of a house, who knowingly makes a false statement as to a case of infectious disease being, or having within six weeks previously been, therein, shall be liable to a fine not exceeding Twenty Pounds, or to a months's imprisonment with or without hard labour. 31 Section 65 provides for a penalty not exceeding Ten Pounds, on persons ceasing to occupy infected houses or parts of houses without disinfection or notice to the previous existence of the disease to the owner or master of the house or part of the house, or knowingly making a false answer to questions on the subject. Section 68 prohibits, under a penalty not exceeding Five Pounds, the exposure of infected persons and articles without proper precautions against spreading the disease. Section 69 prohibits, under a penalty not exceeding Ten Pounds, infected persons from carrying on any occupation in such a manner as to be likely to spread disease. Section 70 prohibits the conveyance of infected persons in public conveyances. The person responsible for such an offence is liable to a fine not exceeding Ten Pounds and the driver of the conveyance is further liable to a fine not exceeding Five Pounds, if after conveying any such person, he fails to give notice to the sanitary authority and to have the conveyance disinfected. Section 72 prohibits, under a penalty not exceeding Five Pounds, the retention for more than 48 hours in a dwelling room, sleeping room or work room, of the body of any person who has died of any infectious disease, unless such body is retained with the sanction in writing of a doctor. Section 73 requires that, in certain cases, the body of a person who has died in hospital of an infectious disease shall be removed only for burial. Any person wilfully offending against this section is liable to a fine not exceeding Ten Pounds. Section 74 prohibits, without previous notice to the owner or driver, the use of a public conveyance for carrying the body of a person who has died of an infectious disease, and requires the disinfection of the conveyance if so used. Any person offending against this section is liable to a fine not exceeding Five Pounds, and to a further fine not exceeding Forty Shillings for every day during which the offence continues. whooping cough. The number of deaths from whooping cough was much greater than last year, there having been 11 deaths in Bloomsbury and St. Giles and 16 in the Holborn Sub-Division in comparison with only 4 and 8 in the preceding year. The decennial average for these divisions was 13 and 18 respectively. diarrhŒa. The number of deaths assigned to diarrhoea (including deaths from epidemic diarrhoea, epidemic enteritis and deaths of young children in the summer months certified as deaths from enteritis) was much less than in the preceding year, being only 14 in comparison with 42 last year. Of these 5 belonged to Bloomsbury and St. Giles and 9 to the Holborn Sub-Division The decennial average for these divisions was 21 and 24 respectively. plague and cholera. No notification of Plague or Cholera was received. If any case of Plague, Cholera or Small-pox occurs on a vessel, the Port Medical Officer of Health, on its arrival, sends the names of the passengers and the address to which they are proceeding to the respective Medical Officers of Health. Only 2 names of passengers respecting Plague and 6 respecting Small-pox were sent to me during the year. The usual enquiries were made, no one of the passengers afterwards suffering from plague or small-pox. 32 disinfections During the 53 weeks ending January 3rd, 1903. district. Rooms. Bedding, &c. No. of Articles. Number of Persons using Refuge. Persons Cleansed under the Cleansing of Persons Act. Bloomsbury and St. Giles 337 14,053 91 21 Holborn 275 6,435 38 1 Total 612 20,488 129 22 bacteriology. ict. Diphtheria. Result of Examination. Enteric Fever. Result of Examination. Bloomsbury and St. Giles 1 1 bacilli not found. 4 3 positive. Holborn 16 8 bacilli found. 1 1 negative. 8 bacilli not found. 1 positive. Total 17 8 bacilli found. 5 4 positive. 9 bacilli not found. 1 negative. phthisis or consumption. The number of deaths from Phthisis daring the year 1902 was 182, equivalent to a death-rate of 3.06 per 1,000. Of these 93 belonged to Bloomsbury and St. Giles, or a death rate of 2.92 per 1,000, and 89 to the Holborn Sub-district, or a rate of 3.19 per 1,000. The corresponding rate for London was 1.60. The number of deaths from other tubercular diseases was 31; of these, 11 belonged to Bloomsbury and St. Giles, and 20 to the Holborn Sub-district. prevention of consumption. In March, 1901, in a Report on this subject I advised the voluntary notification of the disease, disinfection of rooms, provision of sanatoria for the open air treatment of consumption, bacteriological examination of sputum in doubtful cases, and the instruction of the public in precautions to be taken. At the same time a leaflet, which was approved by the Public Health Committee, was distributed in the Borough. This Report was again considered after the meetings of the British Congress on Tuberculosis in July, 1901, but no further action was taken. The subject was again carefully considered by the Public Health Committee and the Council this March (1903) and has been postponed for further consideration. I will therefore include the further Report on the subject in this Annual Report in order that every Member of the Council may have a printed copy. It is now well-known that consumption is an infectious disease and that the terrible waste of life caused by it and the distress, moral and material, which, it involves is preventable. In the Holborn Borough, as in other districts of a similar character, the death-rate from consumption is very high. I have obtained from the Registrar-General's Department the following statistics for the eight years 1894 to 1901 inclusive. I tried to get them for the ten years, but was informed that the Holborn figures for the years 1892 and 1893 were not available. Prior to 1901 the figures are for the combined areas of the St. Giles and Holborn District 33 Boards, and the rates have been calculated on the estimated populations as revised by thepublished Census Returns, 1901:— Year. Holborn Borough. London. Rate per 1,000. Deaths. Rate per 1,000. 1894 196 2·75 1·69 1895 225 3·19 1·77 1896 215 3·03 1·68 1897 197 2·87 1·72 1898 220 3·26 1·74 1899 207 3·12 1·85 1900 193 2·96 1·74 1901 166 2·81 1·66 The Registrar-General has published the death-rates in the old London Districts from the year 1896 to the year 1900 inclusive and since then for the areas of the new Boroughs. I have also included the figures for 1901 and 1902 as obtained from the Returns sent to me:— Year. St. Giles and Bloomsbury. Holborn. 1896 2·91 3·24 1897 2·99 2·76 1898 3·34 3·17 1899 3·13 3·08 1900 2·99 2·85 1901 3·07 2·62 1902 2·92 3·19 Although from the Registrar-General's return for the year 1901 the phthisis death-rate in this Borough (2.81) was the highest of all the London Boroughs, the following table shows that in districts of other Boroughs in which there is great density of population the death-rates from consumption are also very high and in some of them even higher than in the sub-divisions of this borough:— Death-rates from Consumption in Sanitary Areas for the Years 1899, 1900, and 1901. 1899. 1900. 1901. Holborn— St. Giles and Bloomsbury 3·13 2·99 2·81 Holborn Sub-Division 3·08 2·85 City of London 2·19 2·50 2·29 Finsbuby— St. Luke's 3·53 3·16 2·19 Clerkenwell 2·32 2·57 South wark - St. George-the-Martyr 3·53 3·66 2·51 Newington 2·62 2·21 St. Saviour's 3·44 3·11 Westminster — St. Margaret and St. John 3·31 2·41 1·89 St. George, Hanover Square 1·36 1·36 St James 2·11 1·64 St. Martir-in-the-Fields 1·82 2·37 Strand 2·70 3·26 In the eight years 1894 to 1901 inclusive the number of deaths from consumption in this Borough was 1,619. On the other hand the total number of deaths in the same years from the six principal epidemic or zymotic diseases, viz., small-pox, measles, scarlet-fever, diphtheria whooping-cough and enteric fever was only 870, or in other words for every 100 deaths from the six principal epidemic diseases in Holborn there were 186 deaths from consumption. 34 These statistics show the great importance of farther steps being taken for the prevention of consumption in this Borough. In London in the ten years 1892 to 1901 inclusive the total number of deaths from phthisis was 79,615, and if deaths from the other forms of tuberculosis are included the number of deaths attributable to tuberculosis was 111,761; on the other hand the number of deaths from the six principal epidemic or zymotic diseases was 83,133. It is also important to bear in mind that about 90 per cent. of tho deaths from consumption occur between the ages of 15 and 65, or the period when life is most valuable to the community. On the other hand over 75 per cent. of the deaths from the six principal epidemic or zymotic diseases are of very young children under five years of age. Moreover consumption is generally a very lingering chronic disease lasting for several years, and a large number of the patients have to be maintained in Poor Law Infirmaries or other similar institutions at the public expense, and as the patients are very often the bread-winners of the families, the families also often be comes destitute. In the Holborn Borough last year of the 182 deaths, 103 were in Poor Law or other institutions at the time of their death. Statistics have recently been published in. Prussia showing that the tuberculosis death-rate in that country has dropped from 31 per 10,000 in 1886 to 21 per 10,000 in 1900. During the same period the English tuberculosis death-rate has only fallen from 24- to 19 per 10,000. In the opinion of the Council of the National Association for the Prevention of Consumption the causes of this phenomenal drop in the Prussian tuberculosis death-rate are:—(a) the widespread knowledge as to the infectious character of tuberculosis, which has led to precautions being taken amongst the working classes ; (b) the provision of a large number of sanatoria for the working classes; (c) the early and systematic resort to sanatoria which the Workmen's State Insurance Department in Germany encourages and assists. voluntary notification. In order that preventible measures may be carried out by this Council in individual cases the Council must have information of their existence. Since my Report of March, 1901, the feeling in favour of voluntary notification in England and other countries has very much increased, and it has now been adopted in the following eleven of the London Cities and Boroughs:— City of London, Hammersmith, Southwark, City of Westminster, Hampstead, Stoke Newingtoa, Einsbury, Kensington, and Greenwich, Lambeth, Woolwich. In the provinces about forty Urban Authorities have adopted this form of notification .Among the more important of these districts may be mentioned :— Blackburn, Hnddersfield, Plymouth, Bolton, Leeds, Salf'ord, Brighton, Leicestei-, Sheffield, Cardiff, Liverpool, Southampton, Derby, Manchester, and Edinburgh, Nottingham, Sunderland. As I mentioned in a former Report, voluntary notification was begun in the City of New York on March 1st, 1894, and in January, 1897, the notification was made compulsory. In New York the following cases of consumption were notified voluntarily:—In 1694, 4,166; in 1895, 5,824; in 1896, 8,334; so that the system cannot be said to be impracticable or unsuccessful. 35 As I have just mentioned, the notification of consumption is now compulsory in New York, and it is also compulsory in Norway and Saxony, and is reported to be working satisfactorily. A Bill asking for compulsory notification is about to be brought before the Prussian Diet. The principal advantages to be gained from notification are :— 1. To advise the patient as to the conditions which would tend to promote recovery. 2. To see that the patient's home and workplace are in a satisfactory sanitary condition. 3. To advise other occupants of the house or workshop as to the precautions they should take to prevent their becoming tuberculous. 4. To disinfect the room and clothing of the patient when necessary. 5. To give special warning respecting spitting and the disinfection of sputum. As the question has been raised whether this Council has the power to pay fees for the voluntary notification of consumption, I may inform the Council that the question was raised by the Borough of Southwark, and that the Town Clerk of that Council received a reply from the Local Government Board, dated the 31st October, ] 901, stating " that the Council of the Borough "of Southwark have power, without any sanction on the part of the Board, to pay a reasonable "fee to Medical Practitioners for the voluntary notification of phthisis occurring in their respective " practices." In view of this statement by the Local Government Board it would appear that the Council would be justified in paying reasonable fees to medical practitioners for the voluntary notification of cases of phthisis occurring in the Borough. If the Council agree to pay such fees it would be safe to prescribe the same fee as that prescribed by the Public Health (London) Act, 1891, Section 55 (3), for each certificate of a notifiable infectious disease—viz., half-a-crown if the case occurs in the medical practitioner's private practice, and one shilling if the case occurs in his practice as Medical Officer of any public body or institution. disinfection. Many experiments have proved that the dust of rooms in which a consumptive patient has been living is generally infected with the germs of tuberculosis; hence the necessity for the periodical disinfection of the rooms occupied by the patient and his clothing and other articles. When a consumptive removes to a Sanatorium, hospital, or other premises, or dies, the room ought to be thoroughly disinfected as after other infectious diseases. On the receipt of information in the death returns of a death from consumption, the premises are visited and disinfected if the consent for this can be obtained. This Council recently made arrangements with the district Registrars for a copy of the return of the death of a consumptive to be sent to me as soon as the death has been registered. bacteriological examination of sputum. As the sputum or expectoration of a consumptive often contains large numbers of the germs of tuberculosis before a certain diagnosis can be made by other methods and measures for prevention and cure can be more successfully carried out in the early stages ol the disease it is advisable that medical practitioners attending patients in the Borough should have facilities for this bacteriological examination given them by the Council, as is already done for doubtful cases of diphtheria and typhoid fever. 36 SANATORIA. Since my last report on this subject, much progress has been made in the provision of Sanatoria for consumptives, and there are now over 50 of these institutions in the United Kingdom, containing a total of about 2,500 beds. Sanatoria for the early cases and homes for the advanced cases amongst the poorest classes are a pressing necessity. The early cases may then be restored to health and activity. The advanced consumptive left to die in a small tenement of only one or two rooms is the most common cause of spreading the infection. Many Boards of Guardians are of opinion that they should erect proper sanatoria for the open-air treatment of their consumptive patients instead of sendiug them, as at present, to the general infirmaries. This, of course, would be a great improvement, but public opinion is now so rapidly advancing that I think the best course would be for these Sanatoria to be provided by the Metropolitan Asylums Board, as that is the authority in London for the isolation and treatment of infectious diseases. spitting. I am of opinion that this Council ought to co-operate with the other Metropolitan Borough Councils in oi'der to secure the passing of a bye-law to prohibit spitting in all places of public resort. In Liverpool there is already a bye-law against spitting in tramcars or tramway stations or in premises connected therewith. Manchester and Glasgow have bye-laws against spitting in the Corporation tramcars. In Glamorganshire the following bye-law is in force:—"A person shall not spit on the floor, side, or wall of any public carriage or of any public hall, public waiting room or place of public entertainment, whether admission thereto be obtained upon payment or not." The Council of the National Association for the prevention of consumption has recently passed the following resolution:—"That spitting on the floors of public buildings, on platforms, corridors, staircases, and in public carriages or passenger boats, or in any covered place of public resort should be forbidden by law." A copy of this resolution has been forwarded to the Presidents of the Local Government Board and the Board of Trade, and has been circulated widely in the Press. In Boston, U.S.A., the Board of Health on the 23rd March, 1899, issued the following regulations:-"The Board of Health hereby adjudges that the deposit of sputum in public places is a nuisance, source of filth, and cause of sickness, and hereby orders that spitting upon the floor, platform, or steps of any railroad or railway station, car, public building, hall, church, theatre, market, or any side walk immediately connected with the said public places be and hereby is prohibited." In many other towns of the United States and Canada similar bye-laws have been passed; also in France, Germany, Austria, Belgium, Denmark, and Hungary various laws prohibiting spitting have been passed. In the City of London and in many other towns a circular letter drawing attention to the filthy and dangerous habit of indiscriminate spitting has been addressed to all Railway, Omnibus and Tramway Companies, Markets, Public Offices, Restaurants, Licensed Victuallers, Common Lodging Houses and Public Libraries, and a suitable notice for hanging up has been issued. I would therefore advise that this Council should draw the attention of Owners of Common Lodging Houses, Public Houses, Restaurants, and Workshops to the danger which is known to 37 arise from indiscriminate spitting, and that an offer be made to supply cards of warning to hang up if they so desire. An appropriate form of wording for the card would be as follows :— SPITTING EXCEPT INTO PROPER RECEPTACLES IS STRICTLY FORBIDDEN. Indoor Expectoration on Floors is a Main Source of Spread of Consumption. education or the public. As I have already mentioned, in 1901 a leaflet on the Prevention of Consumption was approved by the Public Health Committee and distributed in the Borough. The National Association for the Prevention of Consumption and other forms of tuberculosis has been doing exeellent work for the promotion of the education of the public, and it has now many local branches in various parts of the Kingdom. During the past year this Association has been successful in securing the co-operation of the Friendly Societies. This co-operation is very valuable as it will bring to the whole movement for the prevention of tuberculosis a wide-spread public interest among the working classes of the country as the Friendly Societies represent some 3,000,000 adult and 600,000 child members. The Council of the National Association has recently forwarded 500 copies of their leaflets to the National Conference of Friendly Societies, and arrangements for keeping the Friendly Societies supplied with leaflets from time to time at a minimum cost will be entered into. An elementary course on matters relating to Public Health ought to form part of the curriculum of all schools. 38 influenza. Only 15 deaths were last year assigned to Influenza, 6 in Blooinsbury and St. Giles, and 9 in the Holborn Sub-division. alcoholism. Twenty-nine deaths, the same number as last year, were assigned to alcoholism or cirrhosis of liver, but the numbers iu the Divisions of the Borough were reversed. In 1902, 10 were in Bloomsbury and St. Giles, and 19 in the Holborn Sub-division. These represent only a small proportion of the deaths that are really caused by alcoholism, as they are frequently registered under the headings of other secondary causes. Further details of the causes of and ages at death are given in Table IV of the Appendix sudden and violent deaths. Inquests. The following inquests on the bodies of Parishioners were held :— Coroner : Dr. (x. P. Danford Thomas, 20, Brunswick Square. Inquiry Officer: Mr. J. Bryant, 7, Cobden Buildings, King's Cross Road. Total Number. Cause of Death. Natural. Accidents. Suicide. Manslaughter. Bloomsbury and St. Giles 60 38 17 4 1 Holborn 59 32 23 4 -- Total 119 70 49 8 1 the public mortuary, goldsmith street. 200 bodies were received (38 being non-parishioners), and on these 110 inquests were held, and 62 post-mortems made. District. Bodies received. Inquests held. Postmortems. Non-Parishioners. Bloomstury and St. Giles 88 51 30 17 Holborn 112 59 32 21 Total 200 110 62 38 HOUSING or the WORKING classes act, 1890. Under Part T. of the Act. Italian Colony. Details of thip area which was represented by me in 1901, were given in my Annual Report for that year. This Council has sent several communications to the London County 39 Council urging that Council to proceed with this area. Since the representation was made, Nos. 27 to 31 (inclusive), Byre Street Hill, have been demolished and rebuilt as warehouses, and Nos. 1 and 2, Eyre Court, and 4|, Little Bath Street, have been closed as inhabited houses, and are now used entirely for the manufacture and storage of ice cream, and I have received information that other parts of the area have been let on building leases. The area has received much attention from this Department during the year in the endeavour to maintain it in as sanitary condition as is possible without altering the structural defects and bad arrangement of the houses, which could only be done by an improvement scheme or by rebuilding. Union Buildings Akea. Aylesbury Place, Clerkenwell, and Union Buildings, Holborn, Improvement Scheme, 1899. After local enquiry in the year 1900 a Provisional Order was made by one of Her Majesty's Principal Secretaries of State, and an Act confirming the Provisional Order was afterwards passed. During the year 1902 Nos. 15, 16, and 17, Yerulam Street, were being rebuilt, and in the latter part of the year Nos. 18 to 21 (inclusive), Verulam Street, were represented under Part II of the Act, and were afterwards closed. Under Part II. of the Act. Under Part II. of the Act, Section 30, the following were represented as unhealthy dwelling houses:—Nos. 4 and £>, Fisher Street, Nos. 41, Kingsgate Street, and Nos. 18, 19, 20 and 21, Verulam Street. Closing Orders were obtained for Nos. 4 and 5, Fisher Street, and the London County Council, after notices were served for the other houses, agreed to close the premises without further action being taken. Under 1'ait 111. of the Act. Keid's Bbeweey Site. The Peid's Brewery site was purchased by the London County Council for the erection of working class lodging houses for 1,681 of the 3,7(j0 persons of the working classes that will be displaced by the new Holborn to the Strand Street (Kingsway). During 1902 the erection of these houses was continued and Skipwith Buildings, Denys Buildings, Freewell Buildings and Scrope Buildings, Blocks C, D, E and F respectively were completed, and Ledham Buildings, Block B and Block A were nearly completed. From the following Report of the Housing of the Working Classes Committee of tin London County Council it appears that the general scheme will be extended so as to include accommodation in all for 2,614 persons exclusive of shops. 40 "We have had under consideration plans for the development of the Reid's Brewery site, " Clerkenwell, which was acquired by the Council for the provision of accommodation for persons " to be displaced by the formation of the new street from Holborn to the Strand. The site has " frontages to Clerkenwell Road, Leather Lane, Portpool Lane, and Gray's Inn Road. The plan " which we have approved and which has also received the approval of the Secretary of State " provides for the erection of five-story block dwellings all round the site except on the frontage to " Gray's Inn Road, where the existing buildings will remain for the present. These dwellings " will be pierced with six archways up to the second floor, giving access to the interior of the " site. There are also two existing archways from Gray's Inn Road. The main interior of the " site will be occupied by five five-story transverse blocks of dwellings divided by yards and gardens. " The narrow end of the site next Gray's Inn Road will contain another short block of five-story " dwellings, and the remainder of the site between this block and Gray's Inn Road frontages will " be laid out as a playground and garden. An estate office and twenty-three shops will be pro" vided on the ground floor of the dwellings facing Clerkenweli Road and Leather Lane. The " accommodation will consist of 5-51 tenements, of which only 13 will be associated and the "remainder self-contained. The 13 associated tenements will consist of one room; there " will be 301 two-roomed tenements, 136 three-roomed tenements, and JI four-roomed tenements. " Accommodation will be provided in all for 2,614 persons, exclusive of the shops." herbrand street site. In 1901 this site was acquired for the purpose of providing for 080 of the 3,700 persons of the working classes displaced by the new Holborn to the Strand street, and building operations were begun about August, 1902. houses closed voluntarily, demolished, rebuilt, &c. Bloomsbury and St. Giles. Alfred Place, Nos. 1, 2, 3, 4, 5, 6, 7. Demolished. Alfred Place, Nos. 8, 9, 10, 12, 13, 14, 15, 16, 17, 18. Closed. Betterton Street, No. 28. Demolished and Extension of the British Lying-in Hospital built. Bernard Street and Herbrand Street (corner of). New Flats being erected. Bloomsbury Street, Nos. 9, 11, 19. Closed. ,, „ Nos. 14, 16. Demolished. ,, ,, No. 20. Rebuilt. „ „ Nos. 21 and 23, and Nos. 94, 95, 96, and 97, Great Russell Street, Partly rebuilt as the Kenilworth and Waverley Hotel. Chenies Sti-eet, Nos. 8 and 10. Closed. Coptic Street, Nos. 26, 27, 28 and 29. Demolished. Cof.mo Place, No. 4. Remains closed. Francis Street, No. 18. Demolished. Francis Street, Nos. 5, 6 and 7, and 37 and 39, Huntley Street. Rebuilding as Public House, Shops and Flats (Blenheim Mansions). Nearly completed. Great Russell Street, No. 29. Closed. Great Russell Street, Nos. 94, 95, 96, and 97, and Nos. 21, and 23, Bloomsbury Street. Partly rebuilt as the Kenilworth and Waverley Hotel. Great White Lion Street, No. 3. Closed. Great Wild Street, Nos. 31, 32, 33, 34 and 3o. Closed. Herbrand Street. New Houses for the Working Classes being erected for the L.C.C, ,, „ and Bernard Street (corner of). New Flats being erected, High Street, No, 47. Demolished and New Warehouse built. 41 High Holborn, Nos. 109 and 110 (with-No, 108, Holborn Sub-division). Rebuilding completed. Huntley Street, Nos. 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 29, 31, 33, 35. Demolished. Kingsgate Street, Nos. 11, 13, 15, 17, 25, .27, 29, 35, 39, 41, 43. Demolished. Keppel Mews North, Nos. 6 and 10. Demolished. „ ,, No. 13. Rebuilt. „ South, Nos. 14, 16, and 17. Demolished. Lawrence Street, Nos. 1, 2, 0, and 4. Warehouses and Workshops. Rebuilding completed. Little Queen Street, Nos. 24, 25, 26, 27, 34, 35, 37, 38, 39, 40. Closed. Little Russell Street, Nos. 1 and 2. Demolished. Little Wild Street, Nos. 22 and 23. Demolished. Neal Street, Nos. 25, 27, 29, 26, 28, 30, and 32. Demolished. Newton Street and Parker Street. New Premises for the "Pall Mall Gazette" being erected. Nottingham Court, Nos. 8, 9, 10, 11, 12. Demolished. Queen Street, No. 14. Demolished. Plummer's Court, Nos. 1, 2, 3, 4. Demolished. Red Car Yard, Nos. 1 and 2. Closed. Sardinia Street, Nos. 30, 32, 42, and 44. Demolished. ,, „ Nos. 34, 36, 38, and 40. Being demolished. Southampton Row widening— Nos. 2 and 4, Baptist Church House. Rebuilt. Nos. 116 and 118, High Holborn, and Nos. 1 and 2, Eagle Street. Rebuilt. Nos. 14, 22, 24, 26, 28, 30, 34, and 38, Southampton Row. Closed. Southampton Row, Nos. 11 and 13. Rebuilt. ,, ,, Nos. 67, 69, and 71. Demolished, and being rebuilt. „ „ Walduck's Bedford Hotel Extension being erected. „ ,, Nos. 126 and 128. Closed for rebuilding. Theobald's Road, No. 91. Demolished. Torrington Mews East, No. 10. Demolished. Tottenham Court Road, Nos. 216, 217, 218, 220, 221, 223, 224, 225, and 226. Demolished. holborn sub-division. Bedford Row, No. 24. Rebuilt. „ ,, No. 44. Demolished. Rebuilding. Charles Street, Nos. 8 and 9. Rebuilding. Cockpit Yard. Back part of 21, Little James Street. Rebuilt. Eagle Street, No. 59. Closed. ,, „ No. 60. Demolished. „ „ Nos. 33 and 34. Rebuilt. Emerald Street, No. 1. Demolished. „ „ Nos. 6, 8, and 12. Rebuilt. Eyre Street Hill, Nos. 27 to 31. Rebuilt. Ely Place, Nos. 15, 16, 17, 18, 19, and 20. Being demolished. Ely Buildings (15 tenements). Being demolished. Eisher Street, No. 13. Closed and being demolished. „ „ No. 14. Demolished. Fulwood's Rents, Nos. 1 and 2. Demolished and being rebuilt. Great Saffron Hill, Nos. 68, 70, and 72. Rebuilt. High Holborn, Nos. 79 and 80, 82 and 8-3, and Prudential Assurance Company's Buildings. Being rebuilt. High Holborn, No. 35. Demolished and being rebuilt. „ „ No. 84. Rebuilt. 42 John's Mews, No. 14|. Demolished and rebuilt. Kingsgate Street, Nos. 30, 32, 34, and 36. Closed .for demolition. Lamb's Conduit Street, Nos. 14, 16, and 18. Being rebuilt. „ ,, No. 24. Closed. Leather Lane, Nos. 1 to 9a. Being rebuilt. Little Gray's Inn Lane. Workhouse. Being demolished. ,, „ Casual Ward. Rebuilt. Little James Street. Premises at back of 28, John Street. Rebuilding completed. Orange Street, No. 11. Closed for demolition. Portpool Lane. Washhouses, Thanksgiving Buildings. Closed. Reid Brewery Site, Clerkenwell Road and Portpool Lane. L.C.C. Houses for the Working "Classes—viz., Ledam Buildings, Skipwith Buildings, Denys Buildings, Freewell Buildings, Scrope Buildings, and one other block. Nearly completed. Sandland Street, Nos. 17, 18, 19, 20, and 21, with No. 44, Bedford Row. Demolished, and being rebuilt. Theobald's Road, Nos. 66 and 68, with No. 1, Emerald Street. Demolished, and being rebuilt. Verulam Street, Nos. 15, 16, and 17. Being rebuilt. sanitary work. During the year ending the 3rd January, 1903:— The number of inspections and visits made was 17,685 ,, „ „ intimation notices served was 1,854 „ „ „ statutory „ „ „ 642 „ „ „ summonses under the Public Health Act 67 „ ,, ,, ,, under the Food and Drugs Acts 24 Further details of the Sanitary Inspectors' work are given in the Appendix, Table V. legal proceedings. Further details of the Legal Proceedings are given in the Appendix, Tables VI. and VII. HOUSE TO HOUSE INSPECTIONS. The Following House to house Inspections were made during the year:-  St. Giles and Bloomsbury.  Arthur Street. Little Earl Street. Queen's Place. Barter Street. Little Russell Street. Red Car Yard. Betterton Street. Little St. Andrew Street. Ridgmount Street. Bloomsbury Court. Little White Lion Street. Sardinia Place. Castle Street. Luraber Court. Shaftesbury Avenue. Clark's Buildings. Marchmont Street. Short's Gardens. Dyott Street. Model Buildings, Streatham Street. Silver Street (North side) Great Earl Street. Smart's Buildings Great Queen Street. Neal Street. Southampton Row (West side). Great St. Andrew Street. New Compton Street. Great White Lion Street. New Oxford Street. Stacey Street. Great W ild Street. North Crescent. Stedham Chambers, Coptic Street. Goldsmith Street. Nottingham Court. Gower Mews. Phœnix Street. Torrington Mews. Herbrand Street. Plummer's Court. Tower Street. Huntley Street. Queen Street. Twyford's Buildings. 43 holborn sub-division. Back Hill. Featherstone Buildings. Millman Mews. Baldwin's Gardens. Fleet Row. Millman Street. Beauchamp Street. Fox Court. Mount Pleasant. Bishop's Head Court. Fulwood's Rents. New North Street. Brownlow Street. Gray's Inn Road. Old North Street. Boswell Court. Greville Street. Ormond Yard. Castle Street. Hatton Yard. Portpool Buildings. Devonshire Street (Eastside). Hatton Garden. Portpool Lane. Dove Court. Half Moon Court. Providence Place. Dunstable Court. Jockey's Fields. Red Lion Passage. Eagle Street. John's Mews. St. Alban's Buildings. Evelyn Buildings. Kirby Street. Summer Court. Eyre Court. Lamb's Conduit Passage. Summer Street. Eyre Place. Laystall Street. Verulam Street. Eyre Street Hill. Leather Lane Buildings. Vine Street. Eyre Terrace. Little Gray's Inn Lane. Warner Street. regulations as to houses let in lodgings. In this Borough the following houses are registered under these Regulations. Of these 522 are in Bloomsbury and St. Giles, and 72 are in the Holborn Sub-District. All have been inspected from time to time during the year, and the regulations enforced. Bloomsbury and St. Giles. Locality and Numbers of Houses. Total Number of Houses Registered. Locality and Numbers of Houses. Total Number of Houses Registered. Arthur Street, Nos. 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 21 Denmark Place, Nos. 1, 2, 3, 4, 5, 6 6 Drury Lane, Nos. 13, 14, 17, 18, 19, 22, 23 24, 162, 163, 164, 166, 169, 170, 171, 175, 176, 178, 180, 186, 187, 188, 192 23 Betterton Street, Nos. 1, 4, 5, 7, 8, 9, 10, 11, 12, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 29, 30, 31, 32, 33, 34 29 Dyott Street, Nos. 2, 3, 4, 5, 6, 10, 16, 17,18, 19. 20, 21 12 Castle Street, Nos. 4, 6, 8, 12, 18, 20, 22, 24 28, 32, 40, 48, 50, 52, 60, 62, 64, 70 18 New Compton Street, Nos. 7, 8, 9, 10, 11,12, 13, 14, 15, 17, 18, 19, 20, 21, 22,23, 24, 25, 26, 27, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 42, 43, 44, 45, 46. 47. 48, 49, 51. 52, 53, 54, 55, 56, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71 59 Eagle Street, No. 3 1 Goldsmith Street, Nos, 9, 11, 13, 15, 17, 25, 29, 31 8 Great St. Andrew Street, Nos. 2, 3, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 19, 20, 21, 32, 37, 38, 40, 41, 42, 43, 44, 45, 46, 47 28 New Turnstile, Nos. 2, 3, 4, 5, 6, 7, 8, 10 8 Great Queen Street, Nos. 12, 19, 20, 21, 23, 24, 26, 28, 34, 38, 39, 43, 44, 48, 49, 50, 52, 54, 66, 69, 69A 21 Nottingham Court, Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 13½,14, 15, 16 17 Parker Street, Nos. 2, 4, 6 ... 3 Great White Lion Street, Nos. 1, 2, 3, 4, 12, ] 3, 14, 15, 16, 17 10 Phœnix Street, Nos. 3, 4, 5, 6, 7, 8, 11,12, 13, 14, 15, 16, 17 13 Great Wild Street, Nos. 31, 32, 33, 34, 35, 36. 37, 38, 39, 40, 41, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58 25 Queen Street, Nos. 2, 3, 14, 17, 18, 19, 26, 27 8 Sardinia Street, Nos. 6, 12, 34, 36, 38, 40 6 Kenton Street, Nos. 1, 3, 5, 7, 9, 13, 15, 17, 19, 21, 23, 25, 27 13 Sardinia Place, Nos. 7, 9, 11, 12, 13, 15,17 7 Shaftesbury Avenue (formerly Dudley Street) Nos. 131, 133, 135, 137, 139, 141, 143, 145, 147, 149, 151, 153, 155, 157, 159, 161, 163, 165, 167, 169, 173, 175, 177. 179, l8l, 183, 185, 187 28 Kingsgate Street, Nos. 17, 29, 33, 37, 41 5 Little Earl Street, Nos. 8, 10, 11, 13, 15, 25, 26, 27, 28 9 Little St. Andrew Street, Nos. 1, 3, 4, 7, 11, 14, 15, 21, 24, 25, 27, 28, 28a 13 Short's Gardens, Nos. 1, 2, 4, 5, 6, 7, 23, 36, 37, 38, 39, 40 12 Little Wild Street, Nos. 11, 12, 13, 14, 15, 19, 20, 21, 22, 23, 25, 26 12 Smart's Buildings, Nos. 1, 2, 3. 4, 5, 7, 10 7 Stacey Street, Nos. 1, 2, 3, 4, 5, 6, 7, 13, 14, 15, 16, 17, 18, 19, 20 15 Lumber Court. Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 13, 14 13 Tower Street, Nos. 11, 12, 15, 16, 17, 19, 20, 21 8 Neal Street, Nos. 11, 13, 15, 17, 19, 20, 21, 22, 25, 27, 29, 31, 34, 37, 38, 39, 40, 41, 42, 43, 44, 47, 49, 50, 52, 54, 55, 58, 60, 62, 66, 68, 70, 72, 74, 76, 78, 80, 82 39 Twyford Buildings, Nos. 3, 4, 5, 6, 7, 8 6 West Street, Nos. 4, 12, 14, 16, 18, 22 6 Clark's Buildings, Nos. 1, 2, 3, 4, 5, 6, 7, 8 8 Wild Court, Nos. 1, 2, 3, 4, 5 5 44 Holborn Sub-Division. Locality and Numbers of Houses. Total Number of Houses. Registered. Locality and Numbers of Houses. Total Number of Houses Registered. Baldwin's Place, Nos. 1, 2, 3, 4, 5, 6, 7, 8 8 Leigh Street, Nos. 4, 8 2 Castle Court, Nos. 5, 6 2 Little Bath Street, No. 9 1 Cbarles Street, No. 4a 1 Little Saffron Hill, No. 13 1 Devonshire Street, Nos. 4, 52 2 Mount Pleasant, Nos. 47, 49, 63 3 Dove Court, Nos. 1, 2, 3, 4 4 New North Street, Nos. 2, 20, 21, 22 4 Drake Street, Nos. 9, 10 2 Portpool Lane, Nos. 19 and 21 1 Eagle Street, Nos. 9, 20, 28, 45, 46, 53 6 Princeton Street, Nos. 22, 24 2 Emerald Street, Nos. 14, 16, 18, 20, 22, 24 6 Red Lion Screet, Nos. 26, 58 2 Evelyn Buildings (47 tenements) 1 Red Lion Passage, No. 5 1 Fulwood's Rents, No. 21 1 Verulam Street, Nos. 11, 15, 16, 17, 18, 19, 20, 21 8 Half Moon Court. Nos. 6, 7, 8, 9 4 Lamb's Condnit Passage, No. 17 1 Warner Street, Nos. 32 and 34, 38, 40, 42, 44, 48, 50, 52 8 Leather Lane Buildings (48 tenements) 1 Some of these houses have been closed for demolition during the year. The following' is the Report of the Public Health Committee, after the interview of the Chairman (C. Fitz-Roy Doll, Esq.) and the Town Clerk, with the Local Government Board repecting the proposed new Bye-Laws as to Houses let in Lodgings :— It will be within the recollection of Members of the Council that some time since, at the request of the Local Government Board, we prepared a set of Bye-Laws as to houses let in lodgings or occupied by members of more than one family with the view to the code of bye-law, being similar over the whole of the Borough. At the present time the registration of tenement lodging-houses is effected under bye-laws made respectively by the Board of Works for the St. Giles and Holborn Districts, which bye-laws the Town Clerk points out to us still remain in force by virtue of the London (Miscellaneous) Scheme, 1900. When the draft bye-laws approved by the Council were submitted to the Local Government Board for their consideration, a number of amendments were made, to many of which we saw no reason to raise any objection, but there were two points which we regarded as of considerable importance, and on which we did not see our way to fall in with the views of the Local Government Board. These were, firstly, the insertion of a bye-law which would in effect make it compulsory on the Council to register all houses, or parts of houses, let in lodgings, or occupied by members of more than one family, the rental of the tenements of which were below a certain minimum, and, secondly, the omission of a proposal that a card to be supplied by the Council, fixing the number of persons who might lawfully occupy any room in a registered lodging house, should be placed in that room, and produced whenever demanded by any duly authorised officer of the Council. The Local Government Board having intimated their willingness to receive a deputation upon the subject, our Chairman and the Town Clerk attended at the offices of the Board on the 23rd January, 1903, when they were received by Dr. Parsons, the Assistant Medical Officer, and a member of the legal staff. We have now received a report as to what took place at the interview in the course of which the difficulty of the question raised was frankly admitted by the officers of the Local Government Board, who stated that if they could be satisfied that every Authority would enforce the bye-laws within its area, no difficulty need arise, but they stated that there were cases in which, under the pretence of exercising their discretion, authorities had resolved not to place any of the tenement lodging-houses within their district under the scope of the byelaws. The Town Clerk pointed out that the proposal of the Local Government Board in framing the bye-law in the manner proposed, would have the effect of depriving the Council of the power of exercising its discretion, as he claimed it had a right to do, and moreover would be contrary to the terms of an opinion which had been obtained by the London County Council from Mr. C. A. Cripps, K.C. 45 With regard to the second point, it is suggested that possibly the words of the 94th Section of the Public Health (London) Act, 1891, while they authorise the making and enforcement of a bye-law for fixing the number of persons who may occupy a house, or part of a house, do not appear to the Local Government Board to impose upon the occupier of a lodging house the obligation to produce a card as suggested. It was however pointed out by our Chairman and the Town Clerk, that there could be no hardship imposed upon the landlord or occupier of a lodging house, by merely being required to produce the card provided by the authority. At the conclusion of the interview, Dr. Parsons stated that he was afraid the Local Government Board would not see their way to alter their views upon the subject; the Town Clerk, therefore, intimated that if this were so, it would be necessary for the Council to consider whether they should not instead of repealing the existing bye-laws, retain and enforce them. An examination of the bye-laws shows that with the exception of a difference in the amount of cubic space required in the case of a room used both as a sitting room and a bedroom, the bye-laws are almost identical in their terms. In the St. Giles District they have been in force for very many years, and have been found to work satisfactorily without causing hardship to the owners or occupiers of tenement lodging houses. We have given the matter most careful consideration, we see no reason to advise the Council to alter their previous decision, and if the Local Government Board still deline to sanction the bye-laws in the form proposed, we think that the application for confirmation had better be withdrawn and the existing bye-laws continued in force. We recommend :— "That the Town Clerk be instructed to address a communication to the Secretary of the "Local Government Board, and point out that for the reasons stated, the Council cannot see their "way to depart from their previous decision on the subject of the proposed bye-laws, and intimate "that in the event of the Local Government Board still feeling themselves unable to confirm the "bye-laws in the form proposed, that the Council will not proceed further with its application for "confirmation, but will continue to enforce the existing bye-laws." Many houses let in lodgings in the Holborn Sub-division have been ordered by the Council to be registered, but the Council is waiting for the reply from the Local Government Board to the above Report before having them placed on the Register. common lodging houses acts, 1851 & 1853. The Secretary of State, by a Provisional Order which came into operation on the 1st November, 1894, transferred to the London County Council the powers of the Commissioner of Metropolitan Police in respect of Common Lodging-houses. The following is a list of the Common Lodging-houses registered in this Borough:— Of these 33 are in Bloomsbury and St. Giles for 1,796 lodgers. „ 14 „ Holborn Sub-District for 1,062 „ Total 47 in the Borough 2,858 „ Bloomsbury and St. Giles. Situation of Common Lodging-House. Authorised. No. of Lodgers. Sex of Lodgers. Situation of Common Lodging-House. Authorised. No. of Lodgers. Sex of Lodgers. 11, Short's Gardens 36 M 25, Great Queen Street 50 M 12, ditto 62 M 16, Castle Street 33 M 13, ditio 20 M 9, Dyott Street 29 M 20, ditto 34 M 14, Lumber Court 73 M 21, ditto 46 M 3, Neal's Yard 44 M 22, ditto 36 M 22 to 25. Queen Street 151 M 6, Betterton Street 95 M 20 and 21, ditto 134 M 6, Wild Court 30 M 2, Kennedy Court 10 M 7, diito 35 M 3, ditto 12 M 1 to 7, Macklin Street 96 M 4, ditto 21 M 19, ditto 45 M 5, ditto 10 W 21, ditto 23 W 6, ditto 8 W Parker Street Municipal Buildings 324 M 7, ditto 11 W 8, Parker Street 33 W 8, ditto 38 W 10, Parker Street (back addition) 50 W 25, Drury Lane 34 W 36, Parker Street 115 M 13, Sardinia Street 54 M 15, ditto * M A total of 33 Common Lodgmg-houses registered lor 1,796 Lodgers. * Part of a Common Lodging-house in the City of Westminster. 40 Holborn Sub-District. Situation of Common Lodging-House. Authorised No. of Lodgers. Sex of Lodgers. Situation of Common Lodging-House Authorised No. of Lodgers. Sex of Lodgers. 18, Fulwood s Rents 50 W 65, Mount Pleasent 9 M 19, ditto 32 w 39, Hatton Wall 101 M 20, ditto 114 M 28, Red Lion Square 72 M 7, Castle Court 57 M 39, Queen Square 52 M 40, Eagle Street 50 m 28,Orde Hall Street 22 m 12, Took's Court 63 M 25, Charles Street, Salvation Army Shelter 333 M 13, Took's Court 52 M 4, Greville Street 55 M A total of 14 Common Lodging-houses registered for 1,002 Lodgers. common lodging-houses. According to the Report of the Medical Officer of Health for the administrative County of London for the year 1901, the number of Common Lodging-Houses on the Register was at the end of that year 514 (or fourteen less than the preceding year), providing accommodation for 28,037 persons. 35,225 visits were paid by day and 2,133 night visits. In addition to these there were 4,241 day visits and 55 night visits to unregistered houses, including 3,185 visits to seamen's lodging-bouses. The number of new houses placed on the Register in 1901 was nine, and the number of cases of infectious disease reported from Common Lodging-Houses was as follows:—Small-pox, 135; Erysipelas, 17; Diphtheria, 6; Enteric fever, 5; Scarlet fever, 2; and Measles, 1; a total of 166. A marked improvement in the standard of cleanliness maintained in Common LodgingHouses in London is observable. Much attention has been devoted by the Council's officers to the maintenance of these houses in a condition free from noxious insects. Particularly may be mentioned the use of the plumber's blowpipe, the flame of which is able to penetrate the interstices of iron bedsteads and of woodwork. dairies, cowsheds and milk shops, slaughter-houses and offensive businesses. Under the London Government Act, 1899, it became the duty of the Borough Councils to enforce the bye-laws and regulations for the time being in force with respect to dairies and milk shops, and with respect to slaughter-houses, knackers' yards, and offensive businesses. All these premises have been inspected from time to time, and all nuisances or breaches of regulations abated. dairies, cow sheds and milk shops. The number of registered dairies and milk shops in the borough is 157, of which 66 are in Bloomsbury and St. Giles, and 91 are in the Holborn Sub-District. During the year, 7 were newly registered in Bloomsbury aud St. Giles, and 12 in the Holborn Sub-District. On application for registration under the Dairies, Cowsheds and Milk Shops Order of 1885, the premises were also carefully inspected by me, and notices served to remedy any sanitary defects. There are only two cow sheds in the Borough, viz :— No. 4, Goldsmith Street, and Union Buildings, Leather Lane. 47 The latter is included in the Union Buildings area, for which after a local enquiry, a Provisional Order was made in 1900 for improving the area, and which was subsequently confirmed by Act of Parliament. The London County Council did not insist on the covering of milk for preserving its purity and for protecting it against infection or contamination. We have, therefore, had much difficulty in enforcing this. In many cases we cautioned the occupiers, and when the milk was dirty on account of neglect of this covering I had the milk filtered, or if very dirty had it thrown away down a gully. slaughter-houses. There are now only two slaughter-houses in the Borough, as the Licence for No. 23, Store Street, was not renewed last October, viz:— No. 29, Bed Lion Street, Yorkshire Grey Yard, Eagle Street. offensive businesses. The only offensive business in the Borough, is that of a tripe dresser and boiler at Nos. 67 and 68, Leather Lane. These premises are also included in the Union Buildings area, and will he demolished as provided by the scheme for improving the area. factories and workshops. The Factory and Workshop Act of 1901, which came into force on the 1st .January, 1902, has much increased the work of the Public Health Department. Under this Act the Council is made the Authority responsible for the sanitary condition of workshops and workplaces in the Borough, while the Factory Inspector is responsible for the sanitary condition of factories, although any sanitary defects reported by the Factory Inspector have to be attended to and remedied under the supervision of this department. The Council is also responsible for the provision of suitable aud sufficient sanitary conveniences in factories as well as in workshops and workplaces. The Secretary of State for the Home Office has been advised that the word "workplace" is not to be limited to a place where something is being manufactured or made but is of a very wide signification and includes such premises as stables and stable yards, kitchens of restaurants, &c. Under the new Act the Council must keep a Register of all the workshops in the Brough, and the Medical Officer of Health is required in his Annual Report to the Council to report specifically on the administration of the Act in workshops aud workplaces, aud to send a copy of the same to the Secretary of State. Very important powers of controlling the conditions under which certain classes of work are done in the homes of the workers were for the first time given to District Councils by the Act of 1901. These powers aim at the prevention of homework being done (1) in premises which are injurious or dangerous to the health of the workers themselves, e.g., overcrowding, 48 want of ventilation, or other insanitary conditions, (2) any premises where there is any dangerous infectious disease. In accordance with section 107 of the Act lists of outworkers have to be kept in certain specified trades, and copies of this list have to be sent to the District Council on or before the 1st day of February and the 1st day of August in each year. The details of all outworkers who do not reside iu the Borough have to be sent to the Councils of the district in which they work. Under section 101 new duties of great importance are placed on the Council in regard to underground bakehouses. The Act provides generally that no underground bakehouse whether factory or workshop shall be used as such unless it was so used on the 17th August, 1901, (passing of the Act). Moreover, after the 1st January, 1904, it will not be lawful to use any underground bakehouse wherever established unless the Council are satisfied that it is suitable for the purpose with regard to construction, light, ventilation, and in all other respects and have given a certificate of suitability. Under section 98 of the Act increased power is given for dealing with any bakehouse (whether underground or not) which is unfit on sanitary grounds for use or occupation. Summary of Sanitary work done during 1902 under the Factory and Workshops Act, 1901: Workshops placed on the Register 350 Workshops Improperly ventilated 20 „ (No. of rooms) ,, 540 „ Overcrowded 27 Outworkers residing in the District, placed on the Register 148 „ Other nuisances 8 „ Notices sent to H. M. I. of Factories, women, young persons or children employed, in which no abstract of the Act is posted 94 Outworkers residing in other Districts placed on the Register 122 Workshops inspected 750 ,, Notices served 162 „ Dirty 65 ,, Waterclosets, defective or dirty 63 Factories and Workshops. Sanitary defects reported by H. M. I. of Factories 52 „ Waterclosets, insufficient 19 „ Drains, soil pipes, &c., defective 17 bakehouses. There are 41 bakehouses in the Borough, of which 23 are in Bloomsbury and St. Giles, and 18 are in the Holborn Sub-Division. The following is a list of bakehouses in the Borough :— Bloomsbury and St. Giles. 160 Drury Lane (closed during the year). 166 do. 200 Shaftesbury Avenue. 63 High Street. 19 Little Earl Street. 5 Little St. Andrew Street. 6 Torrington Place. 233 Tottenham Court Road. 33 Great Wild Street (closed during the year). 60 Neal Street. 21 Sardinia Street. 26 Little Queen Street (now closed). 2 Bloomsbury Court. 10 Bury Street. 155 High Holborn. 162 High Holborn. 217,218 „ (Holborn Restaurant). 21 Marchmont Street. 77 Marchmont Street. 8 Museum Street. 24, 26, 28 New Oxford Street. 88 Southampton Row. 34 do. (closed during the year). 49 Holborn Sub-District. 92 Theobald's Road. 124 do. 136 do. 19 Red Lion Street. 50 do. 74 do. 6 Lamb's Conduit Street (two). 28 do. 50 do. 8 High Holborn. 9 Cosmo Place. 33 Great Ormond Street. 13 Leigh Street. 58 Leather Lane. 70 do. 172 Clerkenwell Road. 1 Greville Street. 36 Warner Street. 49-57 Farringdon Road (Factory). All are underground bakehouses with the exception of Nos. 162, High Holborn, 88, Southampton Row, 74, Red Lion Street, and one of the two at No. 6, Lamb's Conduit Street. They were all inspected from time to time during the year, and notices served where necessary. In addition, very detailed reports, with plans and sections, and the measurements of the various dimensions, and the areas of the windows and other openings for light and ventilation of all the underground bakehouses were prepared. The following was my Report to the Public Health Committee respecting Underground Bakehouses:— I have bad consultations with the Town Clerk respecting Underground Bakehouses, and we have agreed that it is desirable that the Council should at once inform the occupiers of all underground bakehouses in the Borough that, after the 1st day of January, 1904, an underground bakehouse shall not be used unless certified by the District Council to be suitable for that purpose, and request the occupiers to inform the Council whether they wish to make application for such certificate. We also think it is undesirable for the Council to lay down any hard-andfast rules that could be applied equally to all. I think, however, that the following minimum requirements might be applied to the great majority of the underground bakehouses. The Council has to be satisfied that the underground bakehouse is suitable as regards construction, light, ventilation, and in all other respects. A.—Construction. 1. The bakehouse shall be of a minimum capacity of 1,000 cubic feet, and shall be in every part thereof at least 8 feet high, measured from floor to ceiling. 2. The walls shall be smooth throughout and impermeable to damp. 3. The ceiling shall be properly ceiled with smooth and impervious material. 4. The floors shall be of smooth and impervious material throughout. 5. Any drain or sewer under the bakehouse shall be constructed of gas and watertight pipes. No gully shall be within the bakehouse, unless the drain connected therewith be made to discharge into a trapped inlet outside the bakehouse. 6. The drainage and sanitary conveniences must comply with the present requirements for new houses, unless the Council is satisfied that there is no nuisance from the existing arrangements. 7. Provision shall be made for safe and suitable means of access to the bakehouse. B.—Light. 1. The bakehouse shall be sufficiently lighted by daylight by means which shall exclude the entrance of street dust or dirt. 50 As so many points have to be taken into consideration in connection with the suitable fighting of a bakehouse, I think it is undesirable that any hard-and-fast rule should be agreed to. For example, an underground bakehouse might be provided with an external area, the walls of which might be covered with white glazed bricks. In accordance with the London Building Acts, 1894, Section 70 (1) (c), "Every habitable "room shall have one or more windows opening directly into the external air, or into a con"servatory with a total superficies clear of the light equal to at least one-tenth of the floor area "of the room." I think this standard might be generally adopted for underground bakehouses. C.—Ventilation. The bakehouse shall be properly and effectually ventilated by permanent inlets and outlets communicating directly with the open air, in such a way and at such a height above its street level as to prevent the entrance into the bakehouse of street dust or dirt. Where natural ventilation is not effective or in the opinion of the Medical Officer insufficient, ventilation by fans or other artificial means shall be provided. D.—All other Respects. Dough troughs and other furniture or fittings (if any) shall be mounted on strong castors, or wheels, so as to be readily movable for cleansing purposes, or where fixed, shall be raised atleast 1 foot from the floor, and set sufficiently away from all walls so as to allow of access to all parts. There shall not be in direct communication with the bakehouse any coal or other cellar, room, unpaved yard or area which may be a nuisance, or cause contamination by foul air, dust or dirt. Provision shall be made for the proper storage of flour elsewhere than in the bakehouse itself. Sufficient and suitable lavatory accommodation, including clean towels, soap and water, shall be provided outside the bakehouse for the persons employed therein. General Requirements for all Bakehouses. A.—Structural. 1. Every room or place used as a bakehouse to be in such a state as to be on sanitary grounds fit for use in occupation as a bakehouse. 2. No water-closet, earth closet, privy or ashpit to be within, or communicate directly with the bakehouse. 3. Every cistern for supplying water to the bakehouse to be separate and distinct from any cistern for supplying water to a water-closet. 4. No drain or pipe for carrying off fcœal or sewage matter to have an opening within the bakehouse. 5. All the inside walls of the rooms of a bakehouse, and all the ceilings or tops of the rooms (whether those walls, ceilings, or tops are plastered or not), and all the passages and staircase of a bakehouse, to be either painted with oil or varnished, or be lime-whited, or be partly painted or varnished and partly limewaslied; and 51 (a) Where the bakehouse is painted with oil or varnished there must be three coats of paint or varnish, and the paint or varnish must be renewed once at least in every seven years, and must be washed with hot water and soap once at least in every six months; and (b) Where the bakehouse is limewashed, the limewashing must be renewed once at least in every six months. 6. No place on the same level with a bakehouse, and forming part of the same building,, be used as a sleeping place unless it is constructed as follows, that is to say :— (a) Is effectually separated from the bakehouse by a partition extending from the floor to the ceiling ; and (b) Has an external glazed window of at least nine superficial feet in area, of which at the least four and a half superficial feet are made to open for ventilation; and unless such sleeping room (if separately occupied) comply with the requirements as to underground rooms (so occupied) laid down in the Public Health Acts. B.—Administrative. 1. The bakehouse to be kept at all times periodically cleansed and in a cleanly state, and free from offensive effluvia arising from drains, w.c.s, urinals or other nuisance. 2. Nothing to be stored within the underground bakehouse itself, and no sweepings, ashes, or other refuse matters to be allowed to remain and accumulate, but to be removed from such underground bakehouse immediately after the day's work be concluded or shift changed. 3. All utensils, troughs, &c., to be kept at all times scrupulously clean. 4. No animal to be kept in a bakehouse on any pretence whatever. 5. No overcrowding to be allowed at any time within a bakehouse, a minimum 250 cubic feet of space being allowed for each person employed therein during ordinary work, and 400 cubic feet of space during overtime. 6. The bakehouse is never to be used for any other purpose except that for which it is intended. No laundry or other work is to be carried on in the bakehouse. (7) In the part of a bakehouse in which the process of baking bread is carried on, the period of employment for any male young person above the age of sixteen years may be between five o'clock in the morning and nine o'clock in the evening if he is employed in accordance with the following conditions, viz. :— (a) Where he is employed on any day before the beginning or after the end of the ordinary period of employment there must be allowed him for meals and absence from work between the above mentioned hours of five in the morning and nine in the evening not less than seven hours ; and (b) Where he is employed on any day before the beginning of the ordinary period of employment he must not be employed on the same day after the end of that period ; and (c) Where he is employed on any day after the end of the ordinary period of employment he must not be employed next morning before the beginning of the ordinary period of employment. (d) For the purpose of this exception the ordinary period of employment means the period of employment for women or young persons under the age of sixteen years in the bakehouse, or, if none are employed, means such period as can under this Act be fixed for the employment of women and young persons under the age of sixteen years in the bakehouse, and notice of that period shall be affixed in the bakehouse. 52 As suggested by the Town Clerk and myself, he was instructed to draw the attention of the owners or occupiers of underground bakehouses within the Borough to the terms of the Act, and furnish them with forms on which applications for certificates should be made. ICE CREAMS. This Council suggested to the London County Council that the following notice should be also printed in Italian, and copies of it in English and Italian were posted and circulated throughout the Borough:— The London County Council hereby gives notice that Part VIII. of the London County 'Council (General Powers) Act, 1902, which will come into operation on 1st November, 1902, provides as follows :— Any person being a manufacturer of or merchant or dealer in ice creams or other similar commodity who within the County— (a) Causes or permits ice creams or any similar commodity to he manufactured sold or stored in any cellar shed or room in which there is any inlet or opening to a drain or which is used as a living room or sleeping room ; (b) In the manufacture sale or storage of any such commodity does any act or thing likely to expose such commodity to infection or contamination or omits to take any proper precaution for the due protection of such commodity from infection or contamination ; or (c) Omits on the outbreak of any infectious disease amongst the persons employed in his business or living or working in on or about the premises in or on any part of which any such commodity as aforesaid is manufactured sold or stored to give notice thereof forthwith to the Medical Officer of the Sanitary District in which such business is carried on or such premises are situate ; shall be liable for every such offence on conviction in a Court of Summary Jurisdiction to a penalty not exceeding Forty Shillings. Every itinerant vendor of any such commodity as aforesaid shall if not himself the manufacturer thereof exhibit in a legible manner on a conspicuous part of his barrow a notice stating the name and address of the person from whom he obtains such commodity and if such vendor is himself the manufacturer of such commodity he shall in the same manner exhibit his own name and address. Every such itinerant vendor who shall fail to comply with the provisions of this Section shall be liable for each offence on conviction as aforesaid to a penalty not exceeding Forty Shillings. Proceedings for the recovery of the penalties shall be instituted by the Sanitary Authority for the District in which the offence was committed or of the District to the Medical Officer of which such notification as aforesaid ought to have been made or in which such itinerant vendor as aforesaid shall offer any such commodity as aforesaid for sale as the case may be. G. L. Gomme, Clerk of the Council. Spring Gardens, S.W., 11 th September, 1902. Much attention was given to the area known as the Italian Colony during the year, and many notices for the abatement of nuisances were served. All premises in which ice cream was manufactured, sold, or stored were carefully inspected and the new Act enforced. Many premises which before the Act were used for the manufacture, selling, or storage of ice cream will no longer be used for this purpose, and many other changes will be effected by the new Act. 53 KITCHENS OF RESTAURANTS. During the year 1901, 67 kitchens of restaurants were inspected and 17 notices served. During the year 1902, the kitchens of hotels and public houses that had restaurants were also inspected and in all, 122 kitchens were inspected and the 40 notices that were served included the following nuisances:— Kitchens dirty 16 Drains defective 9 Soil pipe defective 1 W. C. in improper position 6 W. C. defective 5 Additional W. C. required 2 Gully choked 1 Paving defective 12 Dustbin, defective or absent 2 Insufficient ventilation 6 OTHER FOOD SHOPS. During the year other food shops were from time to time inspected, such as butchers, poulterers, fishmongers and fried fish shops, greengrocers and fruiterers, and much tinned food was also inspected. UNSOUND TOOD. Applications were received for the removal as trade refuse of the following articles of food, all of which were unsound:— 5 cases of tinned salmon. 8 rabbits. 4. l1/4 cwt. apples. 70 lbs. rabbits. 43 cases and 4 drums bananas. 19 rabbits. 18 „ bananas. Application was also made for the removal of 20 cases of unsound apples, but on inspection a large portion was found to be sound, and only those that were unfit for food were removed and destroyed. The whole of this unsound food was seen by me prior to its removal and destruction by the Council's contractor. SMOKE ABATEMENT. Much attention was given to the abatement of smoke from boilers and furnaces. The chimney shafts of the Borough were frequently kept under observation, and 27 notices were served to abate smoke nuisances. METEOROLOGY. The mean temperature for the year was 49°.2—the same as for the year 1901. The rainfall was 19.34 inches, being 5.46 inches below the average of the preceding 86 years. Further details are given in Table VIII. I desire to express my appreciation of the excellent assistance and hearty co-operation that I have received from the Staff of the Public Health Department during the year, and the readiness with which they have taken their turns for work after office hours and on Sundays, during the outbreak of small-pox and for the inspection of the market streets. I have the honour to be, Gentlemen, Your obedient Servant, W. A. BOND. 54 TABLE I. Vital Statistics of Whole District during 1902 and Previous Years. Name OF District—The Metropolitan Borough OF Holborn. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Nonresidents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyondthe District. Nett Deaths at all Ages belonging to the District. Under 1 Year of Age. (Nett.) At all Ages. Number Rate.* Number. Rate per 1,0011 Births registered Number. Rate.* Number. Hate* 1 2 3 4 5 6 7 8 9 10 11 12 13 1892 70,570 2,014 28.6 367 182 1,634 23.2 526 363 545 1,816 25.8 1893 69,827 1,958 28.1 340 174 1,678 24.5 600 431 565 1,812 26.0 1894 69,088 1,902 27.6 294 155 1,384 20.1 568 426 447 1,405 20.4 1895 68,349 1,941 28.5 .359 185 1,546 22.7 526 355 470 1,661 24.4 1896 67,785 1,959 28.5 331 169 1,366 19.8 509 380 457 1,443 21.0 (53 weeks) 1897 67,074 1,772 26.5 289 163 1,335 20.0 568 447 478 1,366 20.4 189X 66,371 1,840 27.8 336 183 1,467 22.2 605 461 477 1,483 22.4 1899 65,677 1,857 28.4 298 161 1,439 22.0 628 471 496 1,464 22.4 1900 64.990 1,762 27.2 311 177 1,326 20.5 516 412 514 1,428 22.1 1901 59,232 1,660 28.4 203 122 1,214 20.5 572 481 448 1,181 20.0 Averages for years 1891-1900 66,896 1,866 28.0 312 167 1,438 21.5 561 422 489 1,505 22.4 1902 53 weeks 58,542 1,646 27.7 213 129 1,283 21.9 627 517 494 1,260 21.2 * Rates in columns 4, 8, and 13 calculated per 1,000 of estimated population. Note—The deaths included in Column 7 of this table are the whole of those registered during the year as having actually occurred within the district or division. The deaths included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non-residents" is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there; and by the term "Residents" is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. N.B.—The years 1891 to 1900 refer to the old areas of the St. Giles and Holborn District Boards of Works. Area of District in acres (exclusive of area covered by water) 405.1 Total population at all ages 59.405 at Census of 1901. Number of inhabited houses 4.703 ,, Average number of persons per house 12.6 „ „ TABLE II. Vital Statistics of separate Localities in 1902 and previous years. Names of Localities. Holborn Borough. Bloomsbury and St. Giles. Holborn Sub-District. Year. Population estimated to middle of each year. Births Registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births Registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births Registered. Deaths at all Ages. Deaths under 1 year. a. b. c. d. a. b. c. d. a. b. c. d. 1892 70,570 2,014 1,816 367 37,861 1,129 919 180 32,709 885 897 187 1893 69,827 1,958 1,812 340 37,563 1,094 926 155 32,264 864 886 185 1894 69,088 1,902 1,405 294 37,268 1,070 745 144 31,820 832 660 150 1895 68,349 1,941 1,661 359 36,974 1,120 851 185 31,375 821 810 174 1896 67,785 1,959 1,443 331 36,683 1,064 734 162 31.102 895 709 169 1897 67,074 1,772 1,366 289 36,394 981 676 146 30,680 791 690 143 1898 66,371 1,840 1,483 336 36,108 1,027 746 158 30,263 813 737 178 1899 65,677 1,857 1,464 298 35,824 1,132 748 136 29,853 725 716 162 1900 64,990 1,762 1,428 311 35,542 1,018 679 137 29,448 744 749 174 1901 59,232 1,660 1,181 203 31,401 1,040 575 88 27,831 620 606 115 Averages of Years 1892 to 1901 66,896 1,866 1,505 312 36,161 1,067 759 149 30,734 799 746 163 1902 58,542 1,646 1,260 213 31,020 994 594 86 27,522 652 666 127 Notes.—(a) The separate localities adopted for this table should be areas of which the populations are obtainable from the census returns, such as wards, parishes or groups of parishes, or registration sub-districts. Block 1 may, if desired, be used for the whole district; and blocks 2, 3, &c., for the several localities. In small districts without recognised divisions of known population this Table need not be filled up. (b) Deaths of residents occurring in public institutions beyond the district are to be included in sub-columns c of this Table, and those of non-residents registered in public institutions in the district excluded. (See note on Table I. as to meaning of terms " resident " and " non-resident.") (c) Deaths of residents occurring in public institutions, whether within or without the district, are to be allotted to the respective localities according to the addresses of the deceased. N.B.—The years 1892 to 1900 refer to the old areas of the St. Giles and Holborn District Boards of Works. 55 TABLE III. Cases of Infectious Disease notified during the year 1902. Notifiable Disease. Cases notified in whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from each locality. At all Ages. At Ages—Years. Bloomsbury and St. Giles. Holborn. Bloomsbury and St. Giles. Holborn. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Smallpox 218 4 8 20 59 123 4 160 58 156 57 Cholera — — — — — — — — — — — Diphtheria and Membranous Croup 113 7 38 42 13 13 — 44 69 44 65 Erysipelas 85 2 3 9 5 50 16 45 40 7 5 Scarlet Fever 202 4 62 101 29 6 — 90 112 88 108 Typhus Fever — — — — — — — — — — — Enteric Fever 39 — 1 8 15 15 — 24 15 20 14 Relapsing Fever — — — — — — — — — — — Continued Fever — — — — — — — — — — — Puerperal Fever 6 — — — 3 3 — — 4 1 1 Plague — — — — — — — — — — — Chickenpox 226 19 103 88 13 3 — 90 136 1 7 Totals 889 30 215 268 137 213 20 455 434 317 257 Note.—The Isolation Hospitals are those of the Metropolitan Asylums Board. TABLE IV. Causes of, and Ages at, Death during Year 1002. Causes of Death. Deaths in or belonging to whole District at Subjoined Ages. deaths in or belonging to Localities (at all ages). Total Deaths in Public Institutions in the District. All Ages. Under 1. 1 and under 6. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Bloomsbury and St. Giles. Holborn. Small-pox 46 3 7 3 9 19 5 37 9 1 Measles 30 6 24 — — — — 11 19 5 Scarlet Fever 8 — 5 3 — — — 6 2 1 Whooping Cough 27 7 20 — — — — 11 16 31 Diphtheria and Membranous Croup 11 5 3 3 — — — 5 6 19 Croup — — — — — — — — — — Fever Typhus — — — — — — — — — Enteric 6 — — — 2 4 — 5 1 3 Other Continued — — — — — — — — — — Epidemic Influenza 15 1 1 — — 9 4 6 9 — Cholera — — — — — — — — — — Plague — — — — — — — — — — Diarrhoea 14 11 2 — — — 1 5 9 37 Enteritis 7 3 3 — — — 1 5 2 6 Puerperal Fever 4 — — — — 4 — 1 3 1 Erysipelas — — — — — — — — — 1 Other Septic Diseases 11 2 2 — 2 4 1 3 8 14 Phthisis 182 1 2 3 13 153 10 93 89 54 Other Tubercular Diseases 31 9 11 3 2 6 — 11 20 71 Cancer, Malignant Disease 55 — — — — 35 20 22 33 29 Bronchitis 144 20 7 — — 58 59 49 95 16 Pneumonia 134 27 26 4 2 61 14 69 65 85 Pleurisy 11 — — — — 9 2 5 6 4 Other Diseases of Respiratory Organs 2 — 1 — — 1 — 2 — 4 Alcoholism Cirrhosis of Liver 29 — — — — 24 5 10 19 5 Venereal Diseases 8 5 — — — 3 — 4 4 9 Premature Birth 28 28 — — — — — 12 8 Diseases and Accidents of Parturition 3 — — — 1 2 — 1 2 1 Heart Diseases 91 3 — — 1 60 27 48 43 31 Accidents 42 17 4 2 1 14 4 17 25 9 Suicides 9 — — — 1 7 1 4 5 — All other causes 312 65 7 2 4 122 112 152 160 182 All causes 1260 213 125 23 38 595 266 594 666 627 56 TABLE V. SANITARY INSPECTORS' WORK. Inspector Bennett. Inspector Clark. Inspector Gregory. Inspector Larard. Inspector Freeman. Whol‡ Borough. Complaints 48 63 45 138 33 327 inspections. Infectious Diseases 158 198 146 173 116 791 Dwelling Houses 94 459 389 448 54 1,444 Lodging Houses 485 69 75 163 406 1,198 Dairies, Cowsheds and Milkshops 46 47 43 49 23 208 Slaughter-houses — 26 17 1 — 44 Market Streets 144 9 21 239 73 486 Butchers' Shops 2 10 14 1 3 30 Bakehouses 1 28 36 9 29 103 Other Food Shops 6 13 13 21 161 214 Other Workshops 41 179 195 200 32 647 Smoke Shafts 13 33 24 69 2 136 Urinals 7 99 16 11 — 133 Miscellaneous 44 127 57 234 20 500 Total Inspections 1,041 1.297 1,046 1,618 919 5,921 No. of Re-inspections 986 1,677 2,000 1,105 1,397 7,165 Visits other than Inspections and Re-inspections 605 978 552 1,733 731 4,599 Total 2,632 3,752 3,598 4 456 3,047 17,685 Intimation Notices Served: 257 436 380 513 268 1,854 Houses:- 238 378 359 475 215 1.665 Waterclosets defective or dirty 116 164 172 200 80 732 ,, insufficient 18 24 5 15 16 78 Drains defective 54 34 182 51 47 368 Soil pipes or waste pipes defective 31 53 102 71 26 283 Gullies defective 2 13 6 28 12 61 Ash-bins defective 7 14 10 13 19 63 „ absence of 5 14 37 9 5 70 Water supply defective — 3 1 2 6 12 „ cistern dirty or defective 13 21 25 21 20 100 „ fittings defective 1 6 — __ 1 8 Yard or area paving defective 10 29 24 13 20 96 Roof or guttering defective 8 25 39 26 27 125 Accumulations 19 38 14 34 10 115 Premises dirty 115 109 141 150 100 615 „ overcrowded 7 20 2 40 18 87 „ other defects 8 24 15 35 17 99 Underground rooms 2 13 6 1 3 25 Animals improperly kept —- 1 2 1 2 6 Smoke nuisances 4 8 6 14 — 27 Urinals 3 4 2 7 — 16 Other nuisances 8 14 25 10 6 63 Manure Receptacles, absence of — 37 15 — — 52 *Workshops:— 19 31 21 38 53 162 Dirty 9 14 9 10 23 65 Waterclosets defective or dirty 8 7 8 26 14 63 „ insufficient 4 5 3 5 2 19 Drains, soil-pipes, &c., defective 2 — 1 4 10 17 Improperly ventilated — 2 3 7 8 20 Overcrowded 1 5 3 2 16 27 Other nuisances 2 2 2 2 — 8 Breach of Regulations:- Dodging Houses 6 29 9 1 — 45 Dairies, Cowsheds, Milkshops, and Slaughterhouses — — — — — — Statutory Notices Served 62 155 174 149 102 642 57 TABLE VI. Legal Proceedings under the Public Health (London) Act, 1891. Date. Name. Address of Premises. Offence. Result. 1902. January 17 Walter Hill and Co. Limited. Workshop situated in Gilbert Street A chimney sending forth black smoke Defendants convicted and fined £10 and 10s. 6d. costs „ 31 February 9 J. Colin Matheson Failure to notify case of small-pox Summons dismissed with costs February 5 Percy Osborne 33 Kingsgate Street Drain defective and unventilated Order for abatement in 28 days; defendant to pay 6s. costs " Shaftesbury Avenue, Freehold Land Syndicate 11 Broad Street Yard paving defective; roof defective; sink waste pipe on top floor defective; premises, ceilings, and walls dirty; improper position of W.C. in basement; drain not ventilated; defective traps Order for abatement in 28 days; defendant to pay 6s. costs " The Owner 30 Upper Bedford Place Soil pipe not ventilated; rain water pipe and scullery waste pipe connected to drain; long hopper pan in basement W.C.; pan closet on top floor water cistern dirty; premises dirty; sash line broken; drain not ventilated Order for abatement in 28 days; defendant to pay 6s. costs April 16 Henry Hanson No 9 Sardinia Place Defective traps to drain; drain not ventilated; no door to W.C. and improper pan and dirty; dustbin dilapidated; basement dirty Order for abatement in 14 days; defendant to pay 6s. costs " Henry Hanson 11 Sardinia Place Basement dirty and not paved; improper dustbin; W.C. improper pan and dirty flooring and stairs broken; accumulation of rubbish in area and area not drained; drain not ventilated Order for abatement in 14 days; defendant to pay 6s. costs " Do. 41, Great Wild Street Soil pipe defective; W.C. dirty: accumulation in basement; no traps to drain Do. May 2 Do. 13, Sardinia Place Improper pan and no water supply to same; yard paving defective and walls dirty; first floor back room overcrowded; top floor duty; accumulation in area; area not drained; drain not ventilated Summons dismissed " William Wells 49, Red Lion Street Soil pipe of W.C.s on ground floor and basement unventilated; sink wastes in front basement directly connected to drain; cistern in front basement not covered; W.C.s in basement badly lighted Summons withdrawn; work done „ Messrs. Johnson and Masters 8, Beauchamp Street Flushing pipe defective; connections to W.C. pan Order for abatement in 14 days; defendant to pay 6s. costs „ Do. Do. do. Insufficient W.C. accommodation Number of inhabitants reduced; £2 2s. costs paid; summons withdrawn „ The Owner 6. Herbrand Street Drain not ventilated; foul long hopper pan to W.C.; back yard, walls and ceilings of basement and staircase require cleansing and distempering Order to abate within 7 days ; defendant to pay 6s. costs 58 TABLE VI.—continued.  Date. Name. Address of Premises. Offence. Result. May 21 Mrs. Howell 50, Great Wild Street Defective paving in yard; improper pan to W.C. premises dirty and first floor front room overcrowded Order to abate within 14 days ; defendant to pay 6s. costs „ Do. Do. do. Insufficient W.C. accommodation Summons withdrawn „ 27 Frank Rippingille Stove Co. Ltd. 69, Hatton Garden W.C. on ground floor stopped up; ceiling walls and flooring of same dirty and defective; flushing apparatus defective: rainwater pipe defective Order to abate forthwith; defendants to pay 6s., costs. „ 23 Meux Brewery Ltd The Brewery, Tottenham Court Road Emission of Black Smoke Costs paid; summons withdrawn „ 27 Hazell, Watson, and Viney 5 & 8, Kirby Street and, 26, Charles Street Emission of Black Smoke Defendants convicted and fined 40s. and 2s. costs June 24 Mrs. Rhimes 24, Little Russell Street Drain unventilated soil pipe in house, not ventilated; Insufficient flush of water to W.C.; Premises require limewhining throughout Order to abate in 7 days 6s. costs July 1 The Owner 17, Little James Street Drain defective and not properly ventilated; Bell traps in front and back areas; Sink waste in back kitchen direct communication to drain W.C. and flushing tern Order to abate in 21 days. 6s. costs July 1 The Owner 19, Little James Street Drain defective and not properly ventilated; rain water pipes directly connected to drain; bell traps in front and back areas; walls and ceiling of passage and basement defective and dirty Order to abate in 21 days. 6s. costs „ Do. 21, Do. do. Drain defective and not properly ventilated; sink waste in wash house directly connected to drain, walls and ceiling of rooms and passages defective and dirty Order to abate in 21 days. 6s. costs „ Mr. Child 31, Great Ormond Street W.C. in basement in improper position; Rain water pipe in front of house and pipe taking sink waste from first floor directly connected to drain; soil pipe unventilated Order to abate in 14 days. 6s. costs „ H. Goldstein 9, Leigh Street Accumulation in back basement cistern of W.C. defective Work done; costs paid; summons withdrawn June 3 to August 19 Messrs. Thomas Wolfe and Sons 9, Upper Montague Mews Drain badly trapped and unventilated; W.C. badly situated; foul long hopper pan; roof leaky; scullery waste pipe untrapped; stable and coach house dirty Work done; costs paid; summons withdrawn »» ••• Do. 10, Do. do. Drain badly trapped and unventilated; W.C. badly situated; foul long hopper pan; insufficient flush of water to same; stable and coach house dirty Do. do. 59 TABLE VI.—continued.  Date. Name. Address of Premises. Offence. Result. June 3 to August 19 Messrs. Thos. Wolfe & Sons 16, Upper Montague Mews Drain badly trapped and unventilated; W. C. badly situated; foul long hopper pan; roof leaky ; walls and ceilings of coach house and stable dirty Order to abate in 14 days; defendants to pay 27s. costs. „ Do. 12, Do. Drain defective and unventilated; W.C. badly situated; pan foul; no flush of water; walls and ceilings of rooms and the stable and coach house dirty Do. „ Do. 13, Do. Drain badly trapped and unventilated; W.C. badly situated foul long hopper pan; insufficient flush of water to same; stable and coach house dirty Do. „ Do. 14, Do. Drain defective; W.C. badly situated and drain unventilated; Sink waste untrapped; walls and ceilings of stables and coach house broken and dirty Do. „ Do. 15, Do. Drain badly trapped; soil pipe unventilated; W.C. dark and unventilated; pan dirty; roof defective; stables dirty Do. „ Do. 11, Do. W.C. badly situated; drain badly trapped and unventilated; roof leaky; back walls damp; walls and ceilings of stable and coach house broken and dirty Do. „ Do. 17, Do. Drain badly trapped and coach house dirty Do. „ Do. 18, Do. Drain badly trapped; soil pipe unventilated; stable and coach house dirty Do. „ Do. 19, Do. Drain badly trapped; soil unventilated; sink waste pipe untrapped; stable dirty Work done, costs paid. Summons withdrawn. „ Do. 20, Do. Drain badly trapped; soil pipe unventilated; stable and coach house dirty Do. „ Do. 22, Do. Drain defective; W.C. badly situated; long hopper pan Do. „ Do. 23, Do. Drain defective; soil pipe unventilated; sink waste pipe untrapped Do. „ Do. 21, Do. Drain defective; soil pipe unventilated; W.C. pin foul; sink waste pipe untrapped; coach house dirty. Do. „ Do. 25, Do. W.C. badly situated; drain defective; foul long hopper pin; stable and coach house dirty. Do. „ Do. 26, Do. Drain defective and unventilated; long hopper pan badly connected to trap; paying of coach house defective. Do. 60 TABLE VI.—continued.  Date. Name. Address of Premises. Offence. Result. June 3 to August 19 Messrs. Thos. Wolfe & Sons 27, Upper Montague Mews Scullery waste pipe untrapped; foul long hopper pan to W.C., and rain water pipe in front insufficient length. Work done, costs paid, Summons withdrawn. Do. Do. 28, do. W.C. badly situated, foul long hopper pan, ventilating shaft defective Do. July 28 Mr. Harris 4, Woburn Street Drain not intercepted, defective traps to W.C.'s on ground, first, and second floors Order to abate in 7 days, defendants to pay 6s. costs. „ 28 Mr. Harvey 53, Southampton Row Soil pipe unventilated Order to abate in 7 days, defendant to pay 6s. costs. July 28 to September 2 Mr. de Matteo 2, Torrington Street Drain not intercepted, defective trans to W.C on ground floor, improper W.C. on top floor, defective roof, stack pipe defective Summons withdrawn. July 18 Mrs. Lawlor 5, Gt. White Lion Street Rooms, staircase, watercloset, yard, and basement dirty (breach of Lodging-house Regulations) Defendant convicted and fined 1s. and 20s. continuing penalty and 2s. costs. „ 29 Alex. Hayman Wilson 21, New North Street Ashbin uncovered, premises dirty, no water supply to w.c.,yard paving defective (breach of lodging - house regulations) Defendant convicted and fined 40s. and 23s. costs. „ 29 Alex. Hayman Wilson 22, New North Street Premises dirty (breach of the lodging house tegulations) Defendant convicted and fined 40s. and 12s. 6d. costs. „ 29 Mrs. MacAnnaly 26, Red Lion Street Premises dirty (breach of the lodging house regulations) Defendant convicted and fined 1s. and 21s. costs October 7 The Owner 7, Great Russell Street Drain unventilated, soil pipe unventilated Order to abate in 7 days, and 6s. costs. October 7 E. H. Chalmers, trading as The Scottish Press, Ltd. 12, Verulam Street W.-C. in basement improperly situated, and in direct communication with workroom, also insufficient w.c. accommodation to premises Order to abate in 21 days and 6s. costs. „ 13 Mr. Smith 6, Twyfords Buildings Yard drain choked, defective wooden ashbin Do. „ 13 Do. 7, do. Drain in basement choked and accumulation of refuse Do. „ 13 The Owner 37, Neal Street Breach of L.C.C. by-laws. Insufficient w.c. accomodation Numbers reduced, summons withdrawn. „ 13 Do. Do. Drain not intercepted or ventilated, and defective soil pipe Order to abate in 21 days and 6s. costs. „ 20 Rees Jones 13, Stacey Street Breach of L.C.C. by-laws. Insufficient w.c. accommodation Numbers reduced, summons withdrawn „ 20 Do. 5, do. Do. Do. „ 20 Do. 11, Phoenix Street Do. Adjourned 3 weeks. November 3 E. La Hooke 33, Gower Street Drain defective and improperly ventilated, w.c. on ground floor badly trapped Order to abate in 14 days, and 6s. costs. „ 21 Mr. Hornsey 174, Shaftesbury Avenue The w.c. stopped and foul Order to close premises, with 6s. costs 61 TABLE VI.—continued.  Date. Name. Address of Premises. Offence. Result. November 21 The Manager Bedford Head Hotel Smoke nuisance Fined £10 and 2s. costs. December 9 The Owner 50, Ormond Yard Walls and ceilings of rooms occupied by Mrs. Mayhew require cleansing: w.c. choked: improper pan to same: no external light and ventilation to w.c. Summons withdrawn, premises to be demolished and reconstructed. „ 9 Messrs. Barry and Barry 50, Dev. nshire Street No water supply to w.c.: underground room occupied contrary to the provisions of the Act. Order to abate in 10 days, 6s. costs. „ 9 Do. 4, Devonshire Street Paving back area defective and dirty walls of front basement damp: staircase to basement defective. Work done, costs paid, summons withdrawn. „ 15 Mr. Jones 15, Little Earl Street Walls and ceilings throughout the house require cleansing: no dust bin : no supply of water to w.c. Order to abate in 21 days. „ 15 Messrs. J. C.& W. W. Isaacson Vacant land in West Street Accumulation of offensive refuse. Accumulation removed, summons withdrawn. 62 TABLE VII. Proceedings under the Sale of Pood and Drugs Acts.  Date. Name. Address. Offence. Result. January 16 Sarah Garrett 53, Gloucester Road Selling butter adulterated with 75 per cent, of foreign fat Defendant convicted and fined £5 and 2s. costs. „ 24 Henry Jenkins 73, Red Lion Street Selling camphorated oil deficient in camphor to the extent of 76 per cent. Defendant convicted and lined £3 and 12s. 6d. costs. „ 24 Arthur Spinks 134, Theobald's Road Selling paregoric elixir deficient inalcobol to the extent of 18.10 per cent Summons dismissed, application for costs refused. „ 4 Do. Do. Selling soap linimen: adulterated with 40 p.c. of methylated spirit Summons dismissed. March 18 Margaret Clif on 8a, Fisher Street Selling milk without being registered Defendant convicted and fined 20s. and 2s. costs. „ 18 Do. Do. Keeping milk in a sleeping apartment Defendant convicted and fined 40s. and 2s. costs. May 2 J. Mayhew 20, Bell Court Selling batter containing 87 per cent, of foreign fat Defendant convicted and fined £5 and 12s. 6d. costs. „ 2, 9, 16 Padroni 40, Warner Street Selling milk from which 9.3 of fat had been abstracted Defendant convicted and fined 20s. and 12s. 6d. costs. „ 28 C.Keele 3, Gt. Russell Street Selling sweet spirits of bitre deficient in ethyl bitrite to the extent of at least 52.5 per cent. Defendant convicted and fined 40s. and 12s. 6d. costs. „ 28 Thomas Williams trading as Messrs. Pryce & Co. 98, Gray's Inn Road Selling Gregory's powder prepared with magnesium carbonate, and not in accordance with the British Pharmacopœia Defendant convicted and fined £4 and 12s. 6d. costs. „ 28 E. P. Boutall 239, High Holborn Selling sweet spirits of nitre deficient in ethyl nitrate to the extent of at least 58.2 per cent. Defendant convicted and fined £3 and 12s. 6d. costs. July 8 Henry Hanson 61, Marchmont Street Selling milk from which at least 6.0 per cent. of fat had been abstracted Warranty produced, summons not properly served, withdrawn. „ 8 Liugi Cosavella 233, Tottenham Court Road Selling milk from which at least 6.6 of fat had been abstracted Defendant convicted and fined £2 and 12s. 6d. costs. „ 8 David Lloyd 73, Mount Pleasant Selling milk from which 46 per cent. of its fat had been abstracted. Defendant convicted and fined £1 and 12s, 6d. costs. ,, The Belgrave Bakery Co., Ltd. 8, High Holborn Selling milk containing 9.8 per cent. added water. Defendant convicted and fined £3, 12s. 6d. costs. ,, J. S. Hubert 65, Red Lion Street Selling butter containing 1.20 per cent. excess of water. Defendant convictedatd fined £1 and 12s. 6d. costs. „ George W. Gadsden 29, Doughty Mews Selling butter adulterated with 82 per cent. foreign fat. Defendant convicted and fined £5 and 12s. '6d costs. „ 28 David R. Evans 23, Windmill Street Selling milk from which 5.3 per cent. of the fat had been abstracted. Wananty proved, summons dismissed. „ Do. Do. Selling milk adulterated by the addition of 4.3 per cent. of water Warranty proved, summons dismissed. „ Express Dairy Company, Limited 40, New Oxford Street Selling milk from which 18 per cent, of the fat had been abstracted Warranty pleaded, summons dismissed. December 3 John Stormont 30, Devonshire Street Selling butter containing 72 per cent. of foreign fat Defendant convicted and fined £2 and 12s. 6d. costs. „ 3 Jack John Lauterwasser 1, Clark's Buildings Selling milk containing .038 per cent, of boric anhydride (B203) equal to 47.08 grains per gall. of boric acid Defendant convicted and fined 40s. and 12s. 6d. costs. 63 TABLE VII.—continued.  Date. Name. Address. Offence. Result. December 2 O. Milordini 1, Little Bath Street Selling milk from which 18.0 per cent, of fat had been abstracted. Defendant convicted and fined 10s. and 12s. 6d. costs. „ 2 Antonio Perella 13, Eyre Street Hill Selling milk from which 32.6 per cent. of its fat had been abstracted. Defendant convicted and ordered to pay 12s. 6d. costs. TABLE VIII. 1902. months. Mean Heading of the Barometer. Temperature of the Air. Rain. Highest Day. Lowest by Night. Range in Month. Mean of all Highest. Mean of all Lowest. Mean Daily Range. Mean for the Month. Departure from Average of 131 Years, 1771—1901. Number of Days it Fell. Amount Collected. January in. 29.985 52˚.7 24˚.7 28˚.0 45˚.7 37˚.2 8˚.5 41˚.8 + 5˚.0 9 in. 0.64 February 29.691 541 14.3 39.8 40.2 30.6 9.6 35.2 —3.6 13 0.79 March 29.683 60.5 26.6 33.9 51.9 37.4 14.5 44.4 + 3.3 15 1.36 April 29.775 68.2 30.9 37.3 55.6 38.9 16.7 46.9 + 0.7 7 0.42 May 29.794 71.0 29.8 41.2 57.3 41.2 16.1 48.4 —4.2 22 3.33 June 29.743 80.7 41.1 39.6 66.9 49.6 17.3 57.6 —0.8 15 3.10 July 29.853 86.1 42.4 43.7 71.7 51.6 20.1 61.7 —0.1 12 1.09 August 29.753 79.0 42.8 36.2 69.5 51.7 17.8 00.6 —0-4 19 2.93 September 29.891 75.1 30.8 38.3 65.6 47.5 18.1 56.6 0.0 8 1.65 October 29.808 67.1 32.6 34.5 55.9 43.7 12.2 49.8 + 0.3 14 1.24 November 29.710 57.9 27.2 30.7 49.5 39.8 9.7 44.7 + 2.1 12 1.29 December 29.881 56.7 24.5 32.2 44.9 37.5 7.4 41.2 + 2.1 13 1.50 Year 29.797 86.l 14.3 71.8 56.2 42.2 14.0 49.2 + 0.5 159 sum. 19.34 sum.