The Metropolitan Borough of Holborn REPORT FOR THE YEAR 1903 OF THE MEDICAL OFFICER OF HEALTH WILLIAM ARTHUE 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 Medical Officers of Health; Fellow, and Member of Council, late Eon. Sec. of the Royal Institute of Public Health; Member, late Lecturer and Demonstrator, of the Sanitary Institute; late Medical Officer of Realth to the St. Olave District, Southwark, and the Holborn District Boards of Works. LONDON: DIPROSE, BATEMAN & CO., 9 & 10, SHEFFIELD STREET, LINCOLNS INN FIELDS. 1904. CONTENTS. PAGE Introduction 3 Death Statistics 3 Year 1903—Eecovds 3 Staff in Public Health Department 4 Prevention of Consumption 4 Small-pox 4 Vaccination and Re-vaccination 4 Scarlet fever 4 Ditto Stay of Patients in Hospital 4 Lodging House Bye-laws 5 Common Lodging Houses 5 Food Shops 5 Ice Cream 5 Underground Bakehouses 5 The New Education Act and the Prevention of Physical Deterioration 5 Area, Houses and Population 6 Number of Tenements 6 Estimated Population, 1903 7 Rateable Value, 1903 7 Births and Birth-rates 7 Mortality 7 „ Deaths registered in the Borough 7 Deaths in Public Instutitions etc., within the Borough 8 Deaths of Residents in Public Institutions outside the Borough 8 Corrected deaths and death-rates 9 Infantile Mortality 9 Ditto Deaths under one year per 1,000 births 9 Ditto Principal causes of Deaths of Children under one year 9 Senile Mortality 10 Infectious Diseases 10 Deaths from Zymotic Diseases 10 Ditto during the year 1903 and the preceding ten years 11 Notifications of Infectious Diseases in the Borough during 1903 and the preceding ten years 12 Small-pox 13 The great importance and value of successful Vaccination and Re-vaccination 13 The German method of dealing with Small-pox 13 Chicken-pox 14 Scarlet Fever 15 Ditto Secondary Cases 15 Ditto " Return" Cases 16 Ditto Reduction of Stay of Patients in Hospital 16 Diphtheria 18 Ditto Secondary and " Return" Cases 18 Enteric and Continued Fever 18 Ditto Outbreak in December, 1903 19 Ditto and Fried Fish 19 Ditto Infected Blankets from South Africa 19 Measles 20 Whooping Cough 20 Diarrhoea 20 English Cholera 21 Septic or Hospital Sore Throat 21 Plague and Cholera 22 Disinfections 22 Bacteriology 22 2 PAGE Prevention of Consumption 23 Ditto Voluntary Notification 23 Ditto Spitting 23 Ditto Disinfection 24 Ditto Sanatoria 24 Influenza 24 Alcoholism 24 Sudden and Violent Deaths 25 Inquests 25 The Public Mortuary 25 Housing of the Working Classes Act 25 Ditto Part I. Italian Colony 25 Ditto „ Union Buildings Area 26 Ditto Part 11. Representations 26 Ditto Part 111. Eeid's Brewery Site 26 Ditto ~ Herbrand Street Site 27 Houses Closed Voluntarily, Demolished, Rebuilt, etc. 27 Water Supply to New Buildings 29 Customs and Inland Revenue Acts 29 Sanitary Work 30 Ditto Changes in Staff 30 Ditto Appointment of Female Inspector 30 House to House Inspections 32 Bye-laws as to Houses let in Lodgings 33 Common Lodging Houses 34 Factories, Workshops and Workplaces 36 Bakehouses 37 Underground Bakehouses 37 Places where Food is prepared for Sale 38 Other Shops where Food is Sold 38 Slaughter Houses 38 Offensive Businesses 38 Dairies, Cowsheds and Milk Shops 39 Ice Creams 39 Unsound Food 39 Smoke Abatement 40 Meteorology 40 APPENDICES. PAGE Table I. Vital Statistics of whole Borough during 1903, and previous 10 years 41 Table 11. Vital Statistics of whole Borough and separate Localities in 1903 and previous 10 years 41 Table 111. Cases of Infectious Disease notified during the year 1903 42 Table IV. Causes of, and Ages at Death during the year 1903 42 Table V. Sanitary Inspectors' Work 43 Table VI. Proceedings during 1903 44 Table VII. Factories, Workshops and Workplaces—lnspections, etc. 45 Table VIII. Factories, Workshops and Workplaces—Matters dealt with 45 Table IX. Outworkers 46 Table X. Legal Proceedings under the Public Health (London) Act, 1891 46 Table XI. Legal Proceedings under the Sale of Food and Drugs Acts 47 Table XII. Legal Proceedings under the Dairies, Cowsheds and Milkshops Order 49 Table XIII. Meteorology 49 The Metropolitan Baraugh of Holborn REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1903. 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 1903, the various statistics for the year refer to the fiftytwo weeks ended Saturday, January 2nd, 1903, as adopted by the Registrar-General, and known as the registration year. The death statistics do not exactly correspond with those of the Registrar-General for the following reasons : —The Holborn Union includes the area of the old Holborn District Board of Works, Clerkenwell and St. Luke's. In many of the deaths registered in outlying public institutions the only address given is that of the Union, and from enquiries which I have made of the Authorities of the public institutions, I have ascertained that the previous addresses of the deceased before removal to the public institutions, were not in this Borough, and these deaths, although returned by the Registrars as belonging to this Borough, have been therefore excluded. The London birth-rate 28-4 per 1,000 is the lowest on record. The Holborn birth-rate was 28-1 in comparison with 27*7 in the previous year. The year has been a record one for this Borough and London in the following various ways:— The lowest general death-rate. The lowest death-rate from infantile mortality. The lowest death-rate from zymotic diseases. The lowest amount of notifiable diseases. The largest amount of rainfall. The largest amount of bright sunshine. The largest mean hourly horizontal movement of the air. 6 The death-rate in the Borough was only 18 - 3 per 1,000 ; the next lowest death-rate having been 20-0 per 1,000 in 1901, and 20-4 in each of the years, 1894 and 1897. The zymotic death-rate was only 1"21 per 1,000 in comparison with 2-29 for the preceding year. The sanitary and hygienic lessons to be learned from these records are the great importance of making use of all means that will ensure increased purity of the air we breathe such as can be obtained by the following measures. Good flushing of streets, gullies and drains; securing as much bright sunshine as possible, and reducing obstructions to the movement of the air in our large towns by the abatement of smoke nuisances, the demolition of narrow courts and allies, provision of parks and other open-air spaces, and securing as much ventilation and through ventilation as possible in dwellings and work-places. During the year changes have taken place in the staff of the Public Health Department, due to the resignations of Inspectors Freeman and Gregory, which took effect from the 30th September, 1903. The Public Health Committee and the Council agreed to my recommendation to appoint a female Inspector, and Miss F. N. F. Lovibond was appointed and began her duties on December 28th, 1903. The other vacancy was not then filled up for the following reasons: —At the time of the changes under the London Government Act, Inspector Freeman was engaged in the eastern part of the area of the Holborn District Board of Works, a large portion of which was then transferred to the Borough of Finsbury, and the Commissioners under the Act decided that Inspector Freeman should be transferred to this Borough. A large demolition of premises has taken place, or is about to take place, that has fortunately cleared away, or will shortly clear away, some of the most insanitary premises in the Borough. The prevention of consumption on various occasions during the year received the careful attention of the Council and of the Public Health Committee, and on the 9th December, the Council agreed that, during a period of twelve months to be computed from the Ist day of January next, any medical practitioner attending on or called in to visit any patient in the Borough who is suffering from consumption should be invited to send to the Medical Officer of Health a certificate in the same form as that prescribed by the Local Government Board for the notification of infectious diseases, and that in consideration of his doing so the Council should pay to him a similar fee to that to which he would have been entitled had he been notifying a case of infectious disease. In connection with the subject of Small-pox and the great importance and value of successful Vaccination and Re-vaccination and the necessity for a Re-vaccination Act, I have given extracts from the valuable report by Dr. R. Bruce Low, of the Local Government Board, on the arrangements made in Germany for dealing with Small-pox, in which he shows that compulsory Yaccination and Re-vaccination (and not isolation, as has been alleged) were Germany's great protectors against Small-pox. In his report he gives the number of recorded deaths from Small-pox in Germany and in England and Wales during the twelve years 1891-1902 inclusive, and from these statistics I have estimated that the Small-pox mortality in England and Wales was twenty times more than in Germany during that period. Under the heading Scarlet Fever I dealt with the question of the reduction of the stay of patients in hospital, and gave extracts from a paper of mine published in "Public Health," February, 1903, showing that there had been an average reduction of more than a week in the period of detention at the Metropolitan Asylums Board Hospitals which had been accomplished without any corresponding increase in " return" cases. I also emphasised the importance of every infectious hospital being well supplied with small isolation rooms or wards, and that ordinary wards for Scarlet Fever, Diphtheria, and Measles should, if possible, be small rather than large, so as to lessen the risk of spreading other infectious diseases accidentally introduced, and that patients at different ages should be equally distributed as far as possible through the wards. In fact, fever hospitals should be constructed so as to secure strict isolation as far as possible. This ideal system of hospital construction exists at the Pasteur Hospital, Paris, which is in connection with the Pasteur Institute. Some of the wards of the existing hospitals could with advantage and small outlay be converted into the cubicle system. In this way the stay of patients in hospital might be still further 7 reduced to the advantage of the patients, the parents, the public generally, and the ratepayers, and " return " cases would be abolished or reduced to a minimum. A week's reduction in the average stay possesses a very great economic value in tbat it saves the building of a new hospital and its administration. A new hospital costs at least £250,000, and its maintenance and administration about £35,000 a year. The new bye-laws as to houses let in lodgings were finally confirmed by the Local Government Board on the 21st August, 1903. During the year 296 bouses let in lodgings were added to the Register, and all the rooms, as far as practicable, were measured and the measurements also entered in the Register. The rooms of many other houses that were previously registered were also measured. On account of the increased powers respecting common lodging houses under the London County Council (General Powers) Act, 1902, I made a careful inspection and presented a detailed report of all the 47 common lodging bouses in the Borough. The sanitary condition of these houses has been much improved during the year, and in the great majority I found that sanitary works were already in progress at the times of my inspections. I advised the Council to oppose the renewal of the licenses for six of them, as I was of opinion that they were quite unfit for occupation. In several others I advised the renewal of the license to be opposed unless the requisite structural alterations were carried out, and in the remainder I was of opinion that the licenses might be renewed when the structural alterations were completed and minor sanitary defects were remedied. During the year there has been increased supervision of the premises in the Borough where food is sold, or prepared for sale, the number of such inspections having been 2,611 in comparison with 1,401 during the preceding year. The 32 underground bakehouses occupied a great deal of the time of the Public Health Committee, the Town Clerk and the Borough Surveyor, as well as this department; and the structural and sanitary conditions of all the bakehouses that have received the Council's certificate have been very much improved. On account of increased powers respecting the manufacture, sale and storage of ice-cream which have been conferred by the London County Council (General Powers) Act, 1902, many rooms and bedrooms which, before the Act came into force, were used in connection with this business, are no longer used, and many rooms or other places have been specially fitted up and prepared for this business. Under the new Education Act, this Council from the Ist May, 1904, has increased and great responsibilities in the care of the many children attending the provided and non-provided schools in the Borough. The late South African War has brought to light the large amount of physical deterioration that exists amongst the population of large towns, and it is to be hoped that the new Education Authorities will take a very broad, enlightened and public-spirited policy to assist in the prevention of this physical deterioration. The aim of education ought to be to produce healthy, useful, energetic and intelligent members of the community. It is therefore necessary that there should be increased medical inspection of children attending school. Physical deterioration and bad health not only lead to enormous mental and moral distress to the individuals afflicted and their relatives, but are an enormous cost to the community and the State, and help to undermine the strength of the Empire. Prevention is not only very much better, but from a material point of view, is also cheaper than cure even if this is possible, which generally on account of previous neglect is not the case. It is therefore necessary that increased attention should be paid to the hygienic details of school life, and that the elementary laws of health should be inculcated, and female children taught the essentials of domestic economy and infant rearing. Moreover the teachers themselves must be taught. The Society of Medical Officers of Health recently passed the follow ing resolutions: — (a) Domestic hygiene, personal hygiene, and physical training, to be a compulsory part of the training of all teachers. (b) The teaching of elementary domestic hygiene, personal hygiene, and physical training, to be compulsory subjects in all elementary schools. 8 AREA, HOUSES AND POPULATION. Area. From the report of the Census, 1901, the area of the Borough is 405T acres. Houses. The number of inhabited houses is 4,703 The number of houses occupied for business purposes only 989 The number of houses not in occupation 219 The number of houses building 29 Population. Males 29,489 Females 29,916 59,405 Total Density of population 147 persons per acre. „ „ for London 61 „ „ Details for the different parts of the Borough, and details of the changes in the population due to changes in the boundaries under the London Government Act, were given in the Annual Report for the year 1901. Details of the age and sex distribution of the population were given in the Annual Report for the year 1902. The number of persons of foreign nationality in the Borough at the last Census was 5,706 ; 3,978 males and 1,728 females. Of these 2,029 were Italians, 1,098 Germans and 660 French. In the County of Loudon the total number of foreigners was 135,377 ; 79,804 males and 55,573 females. Other details were given in the Annual Report for the year 1902. NUMBER OF TENEMENTS. At the Census of 1901, the total number of tenements in the Holborn Borough was 13,790 ; 3,725 one-room tenements, 3,834 two-room tenements. As large a proportion as 60 - l per cent, ot the population lived in tenements of only four rooms and 37*5 per cent, in tenements of one or two rooms. The following table gives details of tenements of 1, 2, 3 and 4 rooms : — Overcrowding. Tenements with No. of Tenements. Percentage of all Tenements. Total Occupants. Percentage of Population in each Group of Tenements. Average Occupants per room, No. of 1 to 4 roomed Tenements with more than 2 Occupants per room. No. of Occupants of Such Tenements Percentage of Population such Tenements. 1room 3,725 27.0 8,502 14.3 2.28 1,267 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 " overcrowding " is used in the sense that the tenements were occupied by 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 OO'l 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. 7 ESTIMATED POPULATION, 1903. The following are the estimated populations at the middle of the year 1903 :— Bloomsbury and St. Giles 30,644 Holborn Sub-District 27,217 Holborn Borough 57,861 London 4,613,812 England and Wales 33,378,338 United Kingdom 42,372,556 RATEABLE VALUE, 1903. Bloomsbury and St. Giles £491,862 Holborn £432,348 Holborn Borough £924,210 BIRTHS. During the 52 weeks ending Saturday, January 2nd, 1904, the number of births registered was: — Bloomsbury and St. Giles. Holborn. Total. Males *513 329 842 Females *478 301 779 Total *991 630 1,621 In London the number of births was 130,906 In England and Wales do. 947,949 BIRTH-RATES FOR THE YEAR. Bloomsbury and St. Giles *32.4 per thousand. Holborn Sub-Division 23.2 „ Holborn Borough *28.1 „ „ London 28.4 „ England and Wales 28.4 „ MORTALITY. The following deaths have been registered in the Borough (1903) : — Bloomsbury and St. Giles. Holborn. Total. Males 195 392 587 Females 172 501 329 Total 367 721 1,088 * 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 Begistrar-General, nor by the District Begistrar. 10 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. Holborn. St. Giles and Bloomsbury. St. Giles Workhouse 1 11 - 54 French Hospital 5 44 - 3 British Lying in Hospital 1 - 9 - Children's Hospital 10 - 315 5 National Hospital - - - 44 London Homœopathic Hospital 2 15 - 43 Italian Hospital 1 4 - 22 Alexandra Hospital - - - 1 Private - - 6 1 Total 66 35 70 426 The following deaths of Parishioners occurred in Public Institutions outside the Borough (1903): — INSTITUTION. Number. St. Giles and Bloomsbury. Holborn. Holborn Workhouse - 44 Holborn Workhouse, Mitcham - 12 Holborn Infirmary 1 121 Central London Sick Asylum 82 7 Islington Workhouse 1 - Camberwell Workhouse 1 - St. Marylebone Workhouse 1 - Westminster Workhouse 1 - Strand Union Infirmary 2 - St. Pancras Workhouse 1 - Banstead Asylum 4 - Caterham Asylum 3 4 Claybury Asylum - 1 Colney Hatch Asylum 6 5 Darenth Asylum 1 1 Hanwell Asylum 8 3 Horton Asylum, Epsom 2 - Hoxton House Asylum 1 - Leavesden Asylum 2 2 London County Asylum 1 1 Tooting-Bec Asylum 6 1 North Western Fever Hospital 4 - South Western Fever Hospital 6 2 Brompton Hospital for Diseases of the Chest 7 1 Charing Cross Hospital 7 1 Friedenheim Hospital 2 - German Hospital 1 _ 2 - Guy's Hospital 3 1 Home Hospital Hostel of God - 1 King's College Hospital 16 16 London Hospital 16 1 London Temperance Hospital 2 - Middlesex Hospital 2 16 Queen Charlotte Lying-in Hospital 1 - Royal Free Hospital 14 4 St. Bartholomew's Hospital 9 3 St. Mary's Hospital 1 - St. Thomas's Hospital 1 - University College Hospital 6 - St. Joseph's Home 1 - St. Peter's Home 2 - Home for Incurable Children - 1 - Clapham Maternity Home 1 River Thames 1 - H.M. Prison, Wormwood Scrubbs 1 1 Public Way 4 2 Private Nursing Homes, &c. 1 4 Total 190 272 9 CORRECTED DEATHS AND DEATH-RATES, 1903. 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 1903. Corresponding period 1902 (53 weeks). In Borough. Beyond Borough. 367 70 Bloomsbury and St. Giles 9 190 490 18.9 125 16.0 Holborn Sub-District 462 6 564 23.8 721 426 272 20.8 Whole Borough 1,088 587 496 r 1_ 462 1,054 18.3 21.2 Registration London Death-Rate 15.7 17.2 No. of Deaths. Death-Rate. Bloomsbury and St. Giles 490 16.0 Holborn Sub-District 564 20.8 Holborn Borough 1,054 18.3 London 72,109 15.7 England and Wales 514,450 15.4 The death-rate for the year 1903 was only 18.3 per 1,000 —the lowest death-rate recorded for Holborn—the average death-rate for the preceding decennium having been 22-0 per 1,000. The lowest death-rates in previous years having been 20-0 in 1901, and 20-4 in the years 1894 and 1897. INFANTILE MORTALITY. The number of deaths of children under five years of age was : — Bloomsbury and St. Giles 98 Holborn Sub-District 144 Holborn Borough 242 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. Bloomsbury and St. Giles 68 69 Holborn Sub-District 86 136 Holborn Borough 154 95 London 17,213 131 The principal causes of death of these 154 children under one year of age were:— Premature Birth 25 Malnutrition, debility, &c. 38 Bronchitis 11 Pneumonia and Pleurisy 17 Tubercular Diseases 14 Scarlet Fever 1 Measles 3 Whooping Cough 8 Diphtheria 1 Diarrhæa 18 Enteritis 5 Epidemic Influenza 1 Yenereal Diseases 4 Septic Disease 1 Heart Disease 2 Suffocation in bed and accidental 5 154 10 SENILE MORTALITY. The number of deaths of persons 65 years of age and upwards was in:— Bloomsbury and St. Giles 119 Holborn Sub-District 134 253 Holborn Borough Bloomsbury and St. Giles. Holborn Sub-District. Total. Of these the numbers were— 1 .. 65 years and under 70 36 43 79 70 „ „ 75 29 39 68 75 „ „ 80 26 25 51 80 „ „ 85 17 16 33 85 „ „ 90 9 9 18 190 years of age 1 2 1 94 „ „ 1 1 2 I 119 134 253 INFECTIOUS DISEASES. The number of notifications of infectious diseases in the Borough during 1902 was very small in comparison with any of the preceding ten years. The number of notifications being only 349 in comparison with a decennial average of 644. The number of deaths from the seven principal zymotic diseases, viz.:—Smallpox, Measles, Scarlet Fever, Diphtheria (including Membranous Croup) Whooping Cough, Fever (including Enteric or Typhoid, Typhus and Continued Fever), and Diarrhoea, was only 70 during the year in comparison with a decennial average of 160. The zymotic death-rate was also very low having been only 1-21 per 1,000 of the population in comparison with 2"39 for the year 1902. 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 Diarrhoea, and the deathrate from these diseases were: — I I Number. Zymotic Death-Rate. Bloomsbury and St. Giles 32 1.04 Holborn Sub-District 38 1.40 IHolborn Borough 70 1.21 And for Loudon 8,088 1.75 The following are the numbers of deaths from the separate diseases :— Bloomsbury and St. Giles. Holborn Sub-District. Holborn Borough. Small-pox - - - Measles 5 14 1 17 Scarlet Fever 3 1 4 Diphtheria and Membranous Croup 5 2 7 Whooping Cough 9 6 15 Typhoid Fever 4 1 5 Typhus - - - Diarrhæa 8 14 22 Total 32 38 70 11 DEATHS FROM ZYMOTIC DISEASES OCCURRING IN THE BOROUGH DURING THE YEAR 1903 AND DURING THE PRECEDING TEN YEARS. St. Giles and Bloomsbury. Year. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhæa. Total. 1893 4 15 12 21 18 25 101 6 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 9 5 22 70 6 1899 - 16 - 4 1 4 30 55 1900 - 11 4 9 13 6 20 63 1901 19 9 1 6 4 7 18 64 11 6 5 11 80 1902 37 5 5 Average for 10 years 1893-1902 6.2 16.6 4.6 8.8 12.9 5.6 19.3 74.0 1903 - 3 3 5 9 4 8 32 Holborn Sub-Division. Year. Small-pox. Measles. Scarlet Fever. Whooping Cough. Enteric Fever. Total. Diarrhæa. Diphtheria. 1893 22 4 54 11 131 15 25 - 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 1902 9 19 2 6 16 1 9 62 Average for 10 years 1893-1902. 2.1 22.7 2.6 16.8 14.6 4.5 22.9 86.2 1903 - 14 1 6 1 38 2 14 Whole Borough. Year. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhæa. Total. 1893 4 37 16 75 33 17 50 232 2 51 17 179 1894 1 36 50 22 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 1902 46 30 8 11 27 6 14 142 Average for 10 years 1893-1902. 8.3 39.3 7.2 25.6 27.5 10.1 42.2 160.2 1903 - 17 4 7 15 5 22 70 12 NOTIFICATIONS OF INFECTIOUS DISEASES IN THE BOROUGH DURING 1903, 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. 1893 72 81 34 - 91 2 _ 515 235 1894 7 40 84 33 - 63 - - 227 1895 13 63 147 24 - 63 1 311 1896 13 60 180 21 - 83 1 - - 345 1897 4 56 207 31 - 94 2 - 394 1898 - 39 65 23 - 72 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 1902 159 44 90 24 - 45 2 - 364 Average for 10 years 1893-1902. 132.2 26.1 - 67.4 .1 322.2 52.9 41.3 1.2 1903 1 22 55 36 2 65 - 182 1 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 notifications were received. Holborn Sub-District. Year. Small-pox. Diphtheria and Membranous Croup. Scarlet Fever. Enteric Fever. Continued Fever. Erysipelas. Puerperal Fever. Typhus Fever. Total. 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 2 - 339 1898 - 138 96 9 - 38 2 - 283 1899 - 63 117 32 2 43 1 - 258 1900 - 65 96 24 - 40 - - 225 1901 53 101 104 22 - 31 1 - 312 1902 58 69 112 15 - 40 4 - 298 Average for 10 years. 1893-1902. 18.5 91.5 130.5 .6 1.3 .3 322.1 24.6 54.9 1903 1 31 89 17 - 25 3 - 166 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. 1893 98 216 562 80 2 206 4 2 1,170 1894 23 99 149 57 - 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 1902 217 113 202 39 - 85 6 - 662 Average for 10 years, 1893-1902. 59.8 263.7 50.7 .5 122.3 2.5 .4 644.3 144.4 1903 2 53 144 53 2 90 4 - 348 Chicken-pox was notifiable from October 19th, 1901, to January 6th, 1903, inclusive, during which time 282 notifications were received. 13 SMALL-POX. During the year I received only two notifications of small-pox only one of which was a genuine case of small-pox, in comparison with 218 notified in 1902, and 211 in 1901. The first was that of a "tramp," a male 41 years of age, who stated that he had tramped from Manchester through the Midlands, and was removed from the Casual Ward in Little Grays Inn Lane. The other case notified was that of a male 6½ years of age. I was asked by the doctor to see the patient before removal, and on making a careful examination I found that the child was suffering from chicken-pox and not small-pox. I wrote to the doctor my opinion of the case and he afterwards wrote to me that he was then also of that opinion that it was chicken-pox. This doctor had had a fair experience of small-pox. I mention this as an illustration of the great difficulty there is in the diagnosis of many cases of small-pox and chicken-pox. I was also asked to examine various other doubtful cases of small-pox, but I was of the opinion that they were really cases of chicken-pox and they were not removed to hospital. The notifications in London were:—l9o3, 417 cases; 1902, 7,796 cases; 1901, 1,702 cases. THE GREAT IMPORTANCE AND VALUE OF SUCCESSFUL VACCINATION AND RE-VACCINATION. Necessity for a Re-vaccination Act. In my Annual Report last year I gave various facts and statistics showing the great importance and value of successful Yaccination and Re-vaccination, and also resolutions adopted by the Incorporated Society of Medical Officers of Health in connection with the proposed new Yaccination and Re-vaccination Act. Conflicting statements having been made from time to time in the Public Press as to the methods employed in Germany in dealing with small-pox patients, the President of the Local Government Board determined to obtain through his medical staff, information, collected personally in Germany, of a sort to enable him to contrast the actual methods employed there with those existing in England and' Wales. This mission was entrusted to Dr. R. Bruce Low, Medical Inspector of the Local Government Board, and he visited ten of the principal towns in Germany during the autumn of 1903, and conferred with the physicians of the hospitals, inspected the accommodation provided for small-pox patients and obtained also information from the Central Imperial Health Office, Berlin. In Germany all persons suffering from small-pox or suspected to be suffering from small-pox can be ordered to hospital for isolation, if, in the opinion of the medical adviser of the local authority the patient cannot he isolated at its home, and on the occurrence of a case of small-pox in a house "contacts" are immediately vaccinated or re-vaccinated. During the twelve years 1891 to 1902 inclusive, in Germany with a population in 1900 of 56,367,178, the number of recorded deaths from small-pox was 607; in England and Wales with a population in 1901 of 32,526,075, the number of registered deaths was 6,761; thus in the twelve years in Germany there were less than 11 deaths per million of the population in comparison with 208 in England and Wales, or in other words, the small-pox mortality was about twenty times more in England and Wales than in Germany. Dr. Bruce Low thus sums up his most valuable report:— " From the account above given of the methods employed in Germany for isolating small-pox it will be obvious that the general plan followed differs markedly from that employed in this country. Almost always in Germany small-pox cases are isolated on the site of the general hospital, and, as often happens, when the occurrence of small-pox in a given place is rare, the small-pox pavilion is not allowed to stand empty, but is used for the accommodation of other cases, infectious or non-infectious. 14 Untoward results to other persons, from bringing small-pox to the site of the general hospital for purposes of isolation and treatment have been seldom observed, and this, in Germany, is with one consent attributed to the protection which is conferred on the population by statutory vaccination and re-vaccination. Without these the German method, it is unanimously admitted, would break down. "It has been asserted in England, by persons who have little or no faith in the value of vaccination as a prophylactic against small-pox, that the comparative immunity of the German nation from that disease is due, not to statutory vaccination and re-vaccination, but to the strict system of isolation of Small-pox which is carried out in Germany. But the evidence given to me by the eminent medical men, with whom I personally conferred, entirely refutes this assertion; and one and all joined in the representation that compulsory vaccination and re-vaccination were Germany's great protectors against small-pox. " The description which I have given of the position of the small-pox pavilion at each of the hospitals visited in Germany shows conclusively that there is not in that country the strict system of isolation of small-pox in the sense as we in England understand it. With one or two exceptions the pavilion is shut off in no way from the rest of the hospital, and there is no limitation in the number of persons residing within the several zones around the hospital. Nor is the administration of the smallpox pavilion entirely separate from the general administration of the hospital establishment. The German nation, therefore, by the agency of compulsory vaccination and re-vaccination is able to dispense with separate small-pox hospitals altogether. It is not necessary there to provide for smallpox a separate site nor separate administration. Germany is in this way freed from great expense, not to speak of the suffering and inconvenience which fall upon the English nation.* But all this could not be achieved in Germany unless the law of Compulsory Vaccination and Re-Vaccination were thoroughly carried out. "Germany, indeed, would have less need even for small-pox pavilions on the sites of her general hospitals than she has at present, were it not for the continual importation of small-pox by foreigners, or by German subjects returning from foreign countries. " Should Germany's Vaccination Law at any future time be carried out less efficiently than at present, she may not only have to face the inconvenience of having to isolate more small-pox cases, but may also be driven to provide separate accommodation for small-pox eases at a distance from populous areas, and to endure the further expenses of separate administration and the like." CHICKEN-POX. The notification of chicken-pox which had been enforced during the greater part of the smallpox outbreak was continued until January 6th, 1903 inclusive. It was not then again renewed as the outbreak of small-pox in London was then practically at an end. In this Borough notification of chicken-pox began on the 19th October, 1901, and during the period to the 6th January, 1903 inclusive, 282 notifications were received, 114 belonging to St. Giles and Bloomsbury, and 168 to the Holborn District. Of these totals only three referred to the year 1903, one belonging to St. Giles and Bloomsbury, and two to Holborn. * " For the purpose of comparison I append a statement of the requirements of the Local Government Board as to small-pox hospital sites provided by means of loans sanctioned by them. The following is an extract from the Memorandum ' On the provision of Isolation Hospital accommodation by Local Authorities, 1902':— "' Hospitals for small-pox. In view of the frequently-demonstrated liability of small-pox hospitals to disseminate that disease to neighbouring communities, and in order to lessen the risk of such occurrence, the Board require the following conditions to be complied with in the case of small-pox hospitals provided by means of loans sanctioned by them. " ' Ist. The site must not have within a quarter of a mile of it either a hospital, whether for infectious diseases or not, or a workhouse, asylum, or any similar establishment, or a population of as many as 200 persons. " ' 2nd. The site must not have within half a mile of it a population of as many as GOO persons, whether in one or more institutions, or in dwelling houses. " ' 3rd. Even where the above conditions are fulfilled a hospital must not be used at one and the same time for the reception of cases of small-pox and of any other class of disease.' 15 SCARLET FEVER. During the 52 weeks ended Saturday, the 2nd January, 1904, the number of scarlet fever notifications, excluding duplicates was 144 : 55 in Bloomsbury and St. Giles, and 89 in the Holborn District. All except 10 were removed to hospital. In the preceding year the number of notifications excluding duplicates, was 202, and in the year 1901, 254. During the year 1903, there were only four deaths from this disease, 3 belonging to Bloomsbury and St. Giles and 1 to the Holborn District. There was no special outbreak of the disease during the year, and there was no special incidence of the disease in any one of the schools. Three cases occurred in three houses and two cases at eight houses, leaving 119 houses in which there was only one case during the year. The following table gives the details of the secondary cases. I have included the houses in which there was a secondary case within the previous twelve months in order to show that many of the so-called " return " cases are not really due to the discharge of the patient from hospital in an infectious state. SECONDARY CASES OF SCARLET FEVER. Houses. | Date of Notification of Primary Case. Date Returned from Hospital. Date of Notification of Secondary Case. Date Returned from Hospital. (1) Ist January, 1903 15th May, 1903 5th January, 1903 21st February, 1903 (2) 26th May, 1902 24th July, 1902 27th January, 1903 30th March, 1903 (3) 22nd August, 1902 16th October. 1902 2nd April, 1903 17th April, 1903 6th June, 1903 25th June, 1903 (1) 11th May, 1903 (peeling) 3rd July, 1903 17th April, 1903 18th May, 1903 20th julu, 1903 25th june, 1903 4th july, 1903 4th july, 1903 (5) 20th April, 1903 20th July, 1903 27th May, 1903 25th July, 1903 17th October, 1903 (6) 21st March, 1903 23rd May, 1903 7th July, 1903 14th July, 1903 (peeling) 14th October, 1903 14th October, 1903 (7) 16th July, 1903 19th November, 1903 7th August, 1903 2nd December, 1903 (8) 14th August, 1903 17th October, 1903 15th August, 1903 17th October, 1903 (9) 10th September, 1903 6th February, 1904 19th September, 1903 9th January, 1904 (10) 6th July, 1903 10th October, 1903 9th November, 1903 13th November, 1903 22nd March, 1904 9th March. 1904 (11) 2nd November. 1903 *8th December, 1903 10th November, 1903 *8th December, 1903 (12) 15th December, 1903 11th March. 1904 17th December, 1903 26th March, 1904. * Returned not Scarlet Fever. In house (1) the secondary case was probably contracted from the first before the patient was removed to hospital. In house (2) the secondary case occurred more than six months after the return of the first case from hospital, and was most probably contracted at school, and had nothing whatever to do with the first case. In house (3) the secondary case occurred about six months after the return of the first patient from hospital, and the infection was probably not caused by the first case. House (4). See below in "Return" cases. In house (5) the first patient was very ill, and was frequently visited by his mother, and did not return home until nearly five months after the second case had been removed to hospital. House (6). See below in " Return " cases. In house (7) the secondary case occurred on the 24th day after the rash in the first case, and may have been contracted from some article that was put away without being disinfected. In houses (8) and (9) each of the secondary cases was probably contracted from the first case before removal to hospital. In house (10) the two secondary cases were probably " Return " cases. See below. 16 In house (11) both cases were returned from hospital as not suffering from scarlet fever, and were probably cases of German measles. The first child had previously suffered from scarlet fever, and both of them had also had measles. In house (12) the secondary case was probably contracted from the first case before removal to hospital. "RETURN" CASES. The only secondary cases in the above list that could have been "return " cases were possibly at houses (4) (6) and (10). At house (4) the first patient was removed on the 11th May, in a desquamating condition, and was a young servant who had recently come from Gloucestershire, and her illness had begun and the rash appeared about three weeks previously. This patient returned on the 3rd July, and left in two days for another situation. The second patient was a boy aged 10 whose illness began and the rash appeared on the 18th May, seven days after the removal of the first patient. This patient returned home on the 4th July, the day after the young servant. The third case was a boy aged 5 years whose illness began and the rash appeared on the 10th July. It was a mild case, and it was thought the patient was suffering from German measles, and the case was not notified until the 20th July. On making enquiries respecting the so-called " return " case I found that the maid servant had left two days after her return from hospital, and that the boy who returned from hospital on the 4th July, was quite well, with no desquamation, and no discharge from nose or ears. At house (6) the first case, a boy aged 6, returned on the 23rd May, after staying in the hospital nine weeks. The second case, a girl, five years, became ill on the 6th July, and the rash appeared the following day, the 7th. The third case, a boy aged three years, was notified on the 14th July, because he was peeling. His illness had begun a fortnight previously, and was most probably the source of infection of the second case. The first patient on his return from hospital was quite well, had no desquamation, and no discharge from nose or ears. In house (10) the first patient, a boy 7 years old, was notified and removed on the 6th July, 1903, and returned from hospital on the 10th October. There was no peeling nor discharge from the nose or ears, and the patient slept alone for three weeks after his return from the fever hospital. The second patient, a boy 3 three years of age, began to be ill and the rash appeared on the 7th November, on the twenty-ninth day after the return of his brother from hospital, and he was notified and removed to hospital on the 9th November. The third case, a girl 9 years of age, was notified on the 13th November, and probably contracted her illness from the second case. In each of these three "return" cases there was nothing to indicate that the patients were not free from infection either at their return from hospital or afterwards, and it is very probable that the secondary cases at houses (6) and (10) were not really due to infection from the first case but from other causes. The cases at houses (2) and (3) show that secondary cases often occur many months after the return of a patient from, hospital, and the case at house (5) many months before the return of the first patient from hospital. REDUCTION OF THE STAY OF PATIENTS IN HOSPITAL. I read a paper at the meeting of the Metropolitan Branch of the Incorporated Society of Medical Officers of Health, which was published in " Public Health " in February, 1903, in which I prepared statistics of the average detention of scarlet fever patients in the hospitals of the Metropolitan Asylums Board, and showed 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. 17 It was generally considered that the conference with the Medical Superintendents 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. Since the reading of this paper, from the early part of March, 1903, Medical Officers of Health have received notification of the dates on which it is intended to discharge fever patients from hospital. Medical Officers of Health are also informed of errors of diagnosis which is very often of great assistance. I also gave statistics for the three years, 1899 to 1901, showing that since 1899 there had been an average reduction of rather more than a week in the period of detention at the Metropolitan Asylums Board hospitals ; this reduction having almost wholly taken place since 1900, and was of opinion that Dr. Simpson's valuable investigation and report to the Metropolitan Asylums Board respecting " return " cases was in no small measure responsible for this reduction, which had been accomplished without any corresponding increase in "return " cases. A week's reduction possesses a very great economical value in that it saves the building of a new hospital and its administration. A new hospital costs at least £250,000, and its maintenance and administration about £35,000 a year. In my paper I pointed out that many scarlet fever patients were also incubating other infectious diseases at the time of their admission to hospital, and that in the year 1898, as large a percentage as 12"57 of scarlet fever cases also suffered from other infectious diseases during their stay in hospital and that the average for the four years 1898-1901, was about 10 per cent. I therefore emphasized the importance of every infectious hospital being well supplied with small isolation rooms or wards and that ordinary wards for scarlet fever, diphtheria and measles should, if possible, be small rather than large, so as to lessen the risk of spreading other infectious diseases accidentally introduced, and that patients at different ages should be equally distributed as far as possible through the wards. In fact Fever hospitals should be constructed so as to secure strict isolation as far as possible. This ideal system of hospital construction exists at the Pasteur Hospital, Paris, which is in connection with the Pasteur Institute. This is a hospital built on the cubicle system except two wards which are found to be unsuitable, and will be subdivided. At this hospital different infectious diseases such as scarlet fever, diphtheria, measles and chicken-pox, are treated in different cubicles in the same ward. All these patients are attended by the same nurse, and yet it has never happened that the disease of one patient is conveyed to another patient. Full details of the construction and administration of this hospital were given by Professor Simpson in a paper, followed by a discussion, which I had the pleasure of hearing at the Liverpool Congress, and which was published in September, 1903, in the " Journal of State Medicine." The hospital is built on the ordinary pavilion plan with a small verandah on each side on each story, but instead of the long ward containing two rows of beds, ten or twelve in number on cach side, separated by the central portion of the ward, it contains the same number of cubicles, separated by a central passage. Each cubicle has its outside window opening into the verandah, and its outside well which is the wall of the block. Its other three walls, two of which separate it from the adjoining cubicles, and the third from the central passage, and so constructel that the masonry part is only 4 to 5 feet in height, and the rest, to the ceiling, consists of glass. The door leading into the passage has the lower portion of wood, and the upper of glass. The result is a series of well-lighted, selfcontained rooms, with a well-lighted central passage, and so arranged that while admitting of a certain amount of privacy, they are all under the direct supervision of the nurses on duty. Each cellule is provided with its own ventilation and warming, warm air being admitted near the flour, and the vitiated air being removed near the ceiling. It is also provided with hot and cold water arrangements. There is no furniture in the room except a small table, chair, and the bed and requisites for the patient. "When a bath is given, a bath on rollers is brought into the cellule and filled from the taps. In regard to existing hospitals, many wards could with advantage be converted into the cubicle system. Glass is now made as strong as ordinary walls, and there would be no difficulty in having the lower part opaque while the upper pare was transparent fir purposes of administration and light. One set of cubicles could be used for the admission of patients until it was determined whether two 18 diseases co-existed. In the event of co-existent diseases, they could be treated in the cubicle until well; while in the event of it turning out to be the disease for which it was sent to the hospital, the patient could be drafted after a certain time into a suitable common ward where the cases were classified. Another set of cubicles would provide isolation rooms for all patients suffering from discharges, thus preventing any possibility of spreading to other cases, and avoiding the danger of remaining in a ward in which infectious material could be engrafted on the discharges. In this manner some of the advantages of the cubicle system could be secured in hospitals already built. In this way the stay of patients in hospital could be still further reduced to the advantage of the patients, the parents, the public generally and the ratepayers, and " return" cases would be abolished or reduced to a minimum. DIPHTHERIA. The number of cases of diphtheria notified was only 53, of which 22 belonged to St. Giles and Bloomsbury and 31 to the Holborn Sub-district. All but 9 were removed to hospital. The decennial average for the Borough was 144 ; 53 for St. Giles and Bloomsbury and 91 for the Holborn district. The mortality in the two divisions was very different, viz., 22.7 in Bloomsbury and only 6'5 in the Holborn division. There was no special outbreak during the year, the largest number of cases notified in any one week having been only 4. Secondary and " Return " Cases. During the early part of January there were three nurses at the Children's Hospital attacked with diphtheria, and one nurse had also recently contracted enteric fever from nursing an enteric patient. I therefore saw the Resident Medical Officer and was glad to find that he was preparing a new set of rules and precautions for nurses who had to attend infections cases, and made some suggestions respecting the same. The only "return" cases occurred at one house in the Borough. The first patient, a male four and a-half years, was admitted to the North- Western Hospital on February 5th, suffering from scarlet fever. The patient suffered from post-scarlatinal diphtheria, and was notified on the 13th March and returned home on April 11th. On the 21st April, I had information that there was infectious disease at this house. On making inquiries I found that the mother and the aunt of the child who had returned from hospital had also suffered from sore throat, and each of them had some exudation of the fauces but no typical membrane. I saw the doctor who attended the cases, and took him two diphtheria outfits as I was of opinion that they were most probably suffering from diphtheria. On the 23rd the reports of the bacteriological examinations were received, and in each case the diphtheria bacilli were found, and the patients were notified and removed to hospital. The aunt returned to another house on the 15th May, and the mother returned home on the 19th May. On the 22nd May I had notification of the fourth case at the house, a male of six years; he, however, did not belong to the same family. In the remaining 45 houses there was only one case in each with no spread of infection. ENTERIC AND CONTINUED FEVER. Including two cases of continued fever, which were most probably enteric, as they were notified at the same time as a case of typhoid fever in the same house, apparently from the same source of infection, 56 cases were notified, of which 38 belonged to St. Giles and Bloomsbury, and 18 to the Holborn District. The decennial average being 51 for the Borough, and 26 and 25 respectively for the two divisions. 45 of the 56 cases were removed to hospital, and two of them were returned not enteric fever, also two other cases which were not removed to hospital, I was of opinion were not enteric fever. The notifications month by month were 3, 3, 1, 5, 2, 2, 1, 2, 5, 4, 4, 24. It is thus seen that only 16 of the cases occurred in the first six months of the year, and that there was rather a large outbreak of the disease in the month of December. 19 In four cases there was strong evidence that the disease was caused by eating shell-fish, and in several others there was a great probability that shell-fish was the cause of the disease. 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 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, it is desirable that an Act should be passed prohibiting the use for food of any shell-fish that have been laid or stored in places liable to sewage-contamination. Of the 24 cases notified in the month of December, 19 occurred in the vicinity of the Seven Dials, one of which I was of opinion was not a case of enteric fever, and the Widal re-action was not obtained. 15 of the 18 genuine cases were notified in the first fortnight of the month, and there were only two houses in which there was more than one case. Each of these having two cases. In one of these two houses the two cases were probably contracted from the same source of infection, and in the other house the second case was probably contracted from the first. I made very careful enquiry in each case and was able to exclude shell-fish, watercress, celery, milk and ice-cream as a common source of infection. On the other hand in twelve of the fifteen primary cases there was a history of the consumption of fried fish at a time corresponding to the period of infection. In one of the remaining three cases the patient (male 26) was very ill after eating fried fish seven weeks previously, and on account of that had not eaten any fried fish since. It is therefore probable that he may have been suffering from a mild attack of enteric fever for five weeks and that at the time of notification he was having a relapse. In the second of these three cases it is very probable that the woman had had fried fish as well as whelks, and in the other, although the patient had not had any fried fish, she very frequently had boiled fish, and it is possible that she may have contaminated her hands with the infected fish as she was in the habit of preparing and cooking it herself. I also had information of another case in the same neighbourhood, in which the Widal reaction was obtained, but the case was not notified as it bad been a mild case, and the patient was then convalescent. This patient had also often eaten fried fish from one of the two suspected shops. The only two cases which had been notified in the neighbourhood, in the City of Westminster, I was informed by the Medical Officer of Health of that City, had also eaten fried fish from one of these two sheps. I made enquiries respecting fried fish because I had read the detailed reports by Dr. Hamer, Assistant Medical Officer of Health, London County Council, of the outbreaks in Southwark, Lambeth and Kensal Town of enteric fever in September, 1900, which after a most careful enquiry he attributed to the consumption of fried fish. The Southwark outbreak consisted of more than 100 cases, and the evidence pointing to fried fish as the cause was exceedingly strong. I therefore had a consultation with Dr. Hamer and he made a large number of inspections with me, and also visited the fish shops at Billingsgate Market, and the South Western and North Western Fever Hospitals, to which the patients had been removed. INFECTED BLANKETS FROM SOUTH AFRICA. On the 21st May, I received information from the Medical Officer of Health of the City of London that a number of disused army blankets had been supplied to a large firm in this Borough. He informed me that blankets from the same source had been found to be soiled and infected with typhoid fever germs, and had given rise to an outbreak of typhoid fever. I at once proceeded to the factory, and with the manager inspected the premises, and saw that many of the blankets were already in use; I also saw the unused ones which were stored away. I was informed that no stains of any kind had been seen on the blankets, and that they had been sold to the firm as unused army 20 blankets which had been returned from South Africa. I also made inquiries respecting absence of employees on account of illness. No one had been away for more than a fortnight, and I saw and made personal inquiries of the only one who had been away so long, and be informed me that he had had no fever and no headache, and that his doct or had certified that he was suffering from acute indigestion. The manager rendered me every assistance, and was quite willing for the blankets to be removed for disinfection, and gave me the address of another branch of the firm to which a large number of blankets had also been sent. In all 338 blankets were removed and thoroughly disinfected by steam in the Council's apparatus, and returned at 1 p.m. the following day. All the blankets were carefully examined, and there was no evidence of any blood or faecal stains on any of them. I also at once communicated with the Medical Officer of Health of the district in which the branch of the firm was and the manager of the London firm also communicated with the branch. I visited the premises on four different occasions in order to make certain that no one connected with the firm was suffering from typhoid fever on account of these blankets. MEASLES Only 17 deaths from measles were registered during the year. Of these 15 were young children under 5 years of age. This is the smallest number of deaths from measles during the past decennium. In the year 1897, there were also only seventeen deaths. On the other hand, in the year 1892, there were as many as 101 deaths, and in 1896, there were 73 deaths from this disease, the decennial average being 39. Of the seventeen deaths only three belonged to Bloomsbury and St. Giles, and 14 to the Holborn Division. The decennial averages for these districts were 17 and 23 respectively. Measles was most prevalent in the Borough during the month of April, during which month six of the seventeen deaths occurred. Notwithstanding the prevalence of measles during that month, apart from the death returns, I had information of the occurrence of measles in only six other houses, in four of which I had the information from the doctors attending the cases, and no information at all from any of the schools. I therefore, reported to the Public Health Committee, that I thought it was desirable that the Town Clerk should be instructed to again communicate with the Managers of the Voluntary Schools, requesting them to kindly forward to me lists of children that are absent, or have been excluded on account of measles, and this recommendation was adopted by the Committee. Apart from the death returns during the whole year, I had information from all sources of only 31 cases of measles ;22 of which were received from the head teachers of schools. In no school had I information of sufficient prevalence of measles amongst the children attending, to close even the Infants' departments. During the year, disinfections were carried out in 30 houses after recovery or death from measles. 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 Ist April this year (1903). A brief summary of the Sections above referred to was given in last year's Annual Report so need not be repeated. WHOOPING COUGH. During the year there were only 15 deaths from whooping cough in comparison with an average for the previous decennium of 28. Of the 15 deaths 9 occurred in Bloomsbury and St. Giles, and 6in the Holborn Division. The decennial averages for these divisions were 13 and 15 respectively. DIARRHCEA. The number of deaths certified as Diarrhœa during the year was only 22, in comparison with an average of 42 during the previous decennium. The lowest being 14 in the year 1902 and the 21 highest 56 in the year 1899. Of the 22 deaths, 8 belonged to Bloomsbury and St. Giles, and 14 to the Holboro Division. The decennial averages for these divisions of the Borough were 19 and 23 respectively. All the 22 deaths were of young children under 5 years of age. In hot and dry summers there are many deaths from infantile Diarrhoea, but on account of the cool and wet summer last year there were only six deaths during the third or summer quarter. ENGLISH CHOLERA. On the 24th September, I had information from the Secretary of the British Lying-in Hospital that for some weeks there had been cases of English cholera at the hospital I therefore visited the premises and made a very careful enquiry. I found that from the 20th May to the 24th September, i.e. during a period of seventeen weeks, of the 51 nurses who had, during that time been engaged at the hospital, as many as 19 had suffered from severe diarrhoea or English cholera. The matron and two assistant-matrons were also attacked. During this period there were about 180 confinements, but only seven mothers were attacked. The domestic staff consists of a cook and five housemaids. Within the past six weeks there have been three new housemaids, so that of the nine members of the domestic staff only the cook was attacked. On the 8th June the new home for the nurses was opened. I found the drainage, sanitary conveniences and water supply satisfactory. On the other hand the larder is in a very unsatisfactory position. It is a basement room adjoining Short's Gardens, and is so placed that dust and dirt from the street can easily be blown on to any milk or other food that is placed there. Many outbreaks of diarrhœa in hospitals have been traced to the milk supply, and it has been shown that even milk that has been cooked, as in baked rice pudding, has not been raised to a sufficiently high temperature to destroy the spores of the germs (Bacilli enteriditis sporogenes) which will produce diarrhœa. The four last cases occurred on the 18th or 19th September. This was a very dry week, there having been no rainfall on six of the seven days, and no rain at all on the five days previous to this last outbreak. For about three weeks previously there had been no case of diarrhœa, and the outbreak preceding this occurred after an interval of dry weather. It is at such times that milk is specially liable to be contaminated by street dust, which generally contains some of the germs I have mentioned. After careful inspections and long interviews with the Matron on the 24th and 25th September, I saw the Secretary on the evening of the 25th, and informed him that from the peculiar nature of the outbreak I had formed the opinion that the milk supply was the most probable cause, and that it was desirable that all milk should be boiled, and that no food should be stored in the present larder or at least not without being kept in a refrigerator. SEPTIC OR HOSPITAL SORE THROAT. As there was this year a large increase in the number of cases of septic or hospital sore throat amongst the staff of the Alexandra Hospital, I was asked by the Secretary to examine the drainage of the hospital. I had made several inspections of the drainage of this hospital after its rebuilding about five years ago, and the work was then carried out in a first-class manner. On making a careful inspection of all the drainage, sanitary conveniences, and accessories in the hospital, I found that all were in very good order, and that the main drain and manholes were exceptionally clean. This is probably accounted for by the fact that the drains arc well flushed with an antiseptic solution every week. I afterwards made further inspections of the wards and the remainder of the premises with the Matron and the senior Surgeon, Mr. Bowlby, and after consideration of the matter, sent the following report:— Suggestions and Recommendations for the Prevention of Hospital Sore Throat. (1) The dressings to be well sprayed with water or a solution of disinfectant before being removed from the patients, and at once placed into water or a solution of disinfectant in order to prevent any contamination of the bed linen or the air of the wards. 22 (2) As the windows of the wards are generally closed during the dressing of the patient's wounds it is desirable that there should be more permanent ventilation to the wards especially those facing Queen Square. This could be done by ventilators in the chimney breasts and in the inner walls of the wards opposite the windows facing Queen Square. (3) The staff should thoroughly wash their hands before feeding. (4) When one of the staff is attacked (a) all food utensils used by the patient to be thoroughly scalded and washed separately. (b) All pillow cases, sheets, soiled linen, &c„ used by the patient to be put into a disinfectant solution or boiled before being sent to the laundry. PLAGUE OR 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 passengers and the addresses to which they are proceeding, to the respective Medical Officers of Health. Only four names and addresses of passengers respecting Plague, were received by me last year, and the usual enquiries were made. DISINFECTIONS During the 52 weeks ending January 2nd, 1904. DISTRICT. Rooms. Bedding, &c. No. of Articles. Number of Persons using Refuge. Persons Cleansed under the Cleansing of Persons Act. Bloomsbury and St Giles Holborn 5.662 4,639 12 4 178 223 Total 10,301 16 401 BACTERIOLOGY. DISTRICT. Diphtheria. Result of Examination. Enteric Fever. Result of Examination. Bloomsbury and St. Giles 2 bacilli not found. 3 positive. 3 8 1 bacilli found. 3 positive. 5 bacilli not found. Holborn 2 positive. 15 4 10 bacilli found. 2 negative. Total 11 bacilli found. 5 positive. 18 12 7 bacilli not found. 7 negative. PHTHISIS OR CONSUMPTION. The number of deaths from Phthisis during the year 1903, was 170, equivalent to a death-rate of 2.94 per 1,000. Of these, 96 belonged to Hloomsbury and St. Giles, or a death-rate of 3.13 per 1,000, and 74 to the Holborn District or a death-rate of 2.73 per 1,000. The corresponding rate for London was 1.55. The number of deaths from other tubercular diseases was 40. Of these, 10 belonged to Bloomsbury and St. Giles, and the rest to the Holborn Sub-district. The following table gives the number of deaths in the Holborn Borough, the rate per 1,000, and the correspondening rate for London for the 10 years, 1894 to 1903, inclusive. 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 1902 182 3.06 1.60 1903 170 2.94 1.55 23 PREVENTION OF CONSUMPTION. As the report on this subject which I prepared was included in my Annual Report for the year 1902, on pages 32 to 37 in order that each member of the Council might have a copy, there is no necessity to again include it in the report for this year. The subject received careful attention from the Public Health Committee and the Council on several occasions during the year, and the Public Health Committee at its meeting on the 30th November, 1903, recommended that the voluntary notification should in the first instance be put into force for a period of twelve months from the Ist January, 1904, the fees to be paid being the same as for the notifiable diseases. This recommendation was approved and adopted by the Council, and the Town Clerk was instructed to communicate it to the medical practitioners residing or practising in the Borough. The Town Clerk has also been making enquiries with a view to ascertaining on what terms arrangements could be made for the examination of sputum in doubtful cases. In New York after nearly three years of voluntary notification, the notification was made compulsory in January, 1897. It is also compulsory in Norway and Saxony, and is reported to be working satisfactorily. In Sheffield, the Corporation last year secured the sanction of Parliament for the compulsory notification of phthisis for a period of seven years. SPITTING. My recommendation that the Council should co-operate with other Metropolitan Borough Councils in order to secure the passing of a bye-law to prohibit spitting in all places of public resort fortunately became unnecessary before the report was finally considered by the Council; for on the 10th July, 1903, the London County Council in pursuance of powers under the Municipal Corporations Act, 1888 and the Local Government Act, 1888, made the following bye-law:— " No person shall 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. " Any person who shall offend against this bye-law shall be liable for each offence to a fine not exceeding Forty shillings." In my report I also advised that the Council should draw attention of owners of common lodging houses, public houses, restaurants and workshops, to the danger which is known to arise from indiscriminate spitting, and that an offer he made to supply cards of warning. I am glad that this recommendation was adopted by the Council, and the Town Clerk was instructed to have the same printed and distributed throughout the Borough. The following is a copy of the card:— The Metropolitan Borough of Holborn. SPITTING. YOU ARE EARNESTLY REQUESTED TO ABSTAIN FROM THE DANGEROUS AND OBJECTIONABLE HABIT OF SPITTING. 26 DISINFECTION. Of the 170 deaths from phthisis during the year 1903, 108 took place at infirmaries or hospitals, and of the remaining 62 who died at home the rooms occupied by the deceased were disinfected in 45 cases. In the majority of the remaining cases it was found that the bedding, &c., had been thoroughly cleansed, and that the rooms were also very clean. When any patient is removed to infirmary from the St. Giles Workhouse the bed and bedding on which the patient slept are thoroughly disinfected. SANATORIA. At the recent Annual General Meeting of the National Association for the Prevention of Consumption it was reported that considerable progress in the promotion of Sanatoria had been made during the year, there now being more than 70 institutions in the United Kingdom, making a total of 2,760 beds; an increase of 18 institutions with 375 beds over the return in October, 1902. The majority of these institutions were, however, for paying guests, and, as I pointed out in my last report, 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 sending 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. The subject was further considered by the Metropolitan Asylums Board last November, and the following resolution was agreed to: — " That the Managers having duly considered the question of the proposed establishment of sanatoria for consumptive patients and the letters received from the Local Government Board and the various Metropolitan Local Authorities and Medical Officers of Health in regard thereto, are of opinion that the matter is one of such vital and far-reaching importance to the community at large, and one which, if adopted by the managers, would entail so considerable extension of their duties and responsibilities, and so large an increase in their expenditure, as to call for some authoritative expression of opinion by the Chief Health Authority of the country, viz., the Local Government Board, before the managers are asked to take any definite action in the matter or to make any further inquiries in regard thereto, and that the Local Government Board, the several Boards of Guardians, the Borough Councils and the Medical Officers of Health bo so informed." INFLUENZA. Only 11 deaths last year were assigned to influenza, 7 in Bloomsbury and St. Giles, and 4 in the Holborn Division. ALCOHOLISM. Thirty-two deaths were assigned to alcoholism or cirrhosis of liver; 15 in Bloomsbury and St. Giles, and 17 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 4 of the Appendix. 25 SUDDEN AND VIOLENT DEATHS. Inquests. The following inquests on the bodies of Parishioners were held : — Coroner: Dr. G. P. Danford Thomas, 20, Brunswick Square. Inquiry Officer: Mr. Richard Powell, 58, Hemingford Road, Barnsbury, N. Total Number. Cause of Death. Natural. Accidents. Suicide. Manslaughter. Bloomsbury and St. Giles 25 9 11 5 - 58 26 29 2 1 Holborn .. Total 83 35 40 7 1 THE PUBLIC MORTUARY, GOLDSMITH STREET. 133 bodies were received (21 being non-parishioners), and on these 70 inquests were held, and 39 post-mortems made. District. Bodies received. Inquests held. Post-mortems. Non.Parishioners. Bloomsbury and St. Giles Holborn.. 52 81 26 44 15 24 11 10 Total 133 70 39 21 HOUSING OF THE WORKING CLASSES ACT. Under Part I. of the Act. Italian Colony. Details of this 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 Council, urging that Council to proceed with this area. Since the representation was made, Nos. 27 to 31 inclusive, Eyre Street Hill, have been demolished and rebuilt as warehouses, and Nos. 1 and 2, Eyre Court, and 4½ Little Bath Street have been closed as inhabited houses, and are now used entirely for the manufacture and storage of ice cream. On the 4th January, 1904, the Housing of the Working Classes Committee reported as follows:— " In our Report of the 7th December last, we stated that we were considering a letter which had been received from the Secretary of State for the Home Department, enquiring the Council's views as to the proposal of the London County Council not to make a Scheme under Part I. of the Housing of the Working Classes Act, 1890, for the improvement of this area, as it appears to be the intention of the freeholders to develop the property for commercial purposes. The enquiries which the Town Clerk has been making with a view of ascertaining the accuracy of this allegation are almost completed, and we hope to bo in a position to definitely report to the Council on the subject shortly. In the meanwhile, bearing in mind the fact that if the area were to be redeveloped by the owners for commercial purposes, that a very large population of the working classes would be displaced, we felt that it was desirable that we should ascertain whether, in the event of such a 26 state of affairs arising, the County Council would be able to earmark any housing accommodation they might be authorised to provide, and which had not been set apart for other purposes with a view of rehousing the population to be displaced from the Warner Street area. We accordingly appointed a deputation, consisting of our Chairman and Vice-Chairman and Councillor Hazell, J.P., and the Medical Officer of Health to wait upon the Housing of the Working Classes Committee of the London County Council upon the subject; we have to-day received from the deputation a report of what took place at the interview, from which we gather that the deputation, who were most courteously received, had a sympathetic hearing and were promised that their representations should receive most serious consideration, and that a reply would be sent as soon as any decision had been arrived at." 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. In January, 1903, the Council agreed to the registration of the houses let in lodgings in the area under Section 94 of the Public Health (London) Act, 1891. UNION BUILDINGS AREA. 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 1903, Nos. 18, 19, 20 and 21, Yerulam Street, were closed after representation under Part 11. of the Act; Nos. 15, 16and 17, which had been demolished were rebuilt; Nos 5, 6, 7 and 8, Providence Place were closed; Nos. 1, 3, 5, 7 and 13, Portpool Lane, were closed; No. 6, Half Moon Court, was closed, and Nos. 3, 6, 7, and the Cow Shed, Union Buildings, were closed. Under Part 11. of the Act. Under Part 11. of the Act, Section 30, the following were represented as unhealthy dwelling houses: — 11, verulam Street. 20 and 21, Great Queen Street. 1, 2 and 3, Queen's Place. 9, Betterton Street. Closing orders were obtained for Nos., 20 and 21, Great Queen Street, and Nos. 1, 2 and 3, Queen's Place. No. 9, Betterton Street was closed, demolished and rebuilt without further action being necessary, and No. 11, verulam Street, was renovated and made fit for human habitation, and the summons after being adjourned on two occasions was then withdrawn. Under Part 111. of the Act, REID'S BREWERY SITE. The Reid's Brewery site was purchased by the London County Council for the erection of working-class lodging houses for 1,681 of the 3,700 persons of the working classes that will be displaced by the new Holborn to the Strand street (Kingsway). During 1903, Ledam and Bourne Buildings, blocks B and A, were completed, and the erection of buildings on the Clerkenwell Road and Leather Lane frontages of the area was begun. 27 From the following report of the Housing of the Working Classes Committee of the 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 : — "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 Grays 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 Grays 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 Grays 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 Grays Inn Road will contain another short block of five-story dwellings, and the remainder of the site between this block and Grays Inn Road frontages will be laid out as a playground and garden. An estate office and 23 shops will be provided on the ground floor of the dwellings facing Clerkenwell Road and Leather Lane. The accommodation will consist of 551 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 361 two-roomed tenements, 136 three-roomed tenements, and 41 four-roomed tenements. Accommodation will be provided in all for 2,614 persons exclusive of shops." HERBRAND STREET SITE. In 1901 this site was acquired for the purpose of providing for 680 of the 3,700 persons of the working classes displaced by the new Holborn to the Strand street (Kingsway), and building operations were begun about August, 1902. During last year three blocks, Coram, Dickens, and Thackeray Buildings, were being erected. HOUSES CLOSED VOLUNTARILY, DEMOLISHED, REBUILT, ETC. Bloomsbury and St. Giles. Alfred Place, Nos. 1, 2, 3, 4, 5, 6, 7. Rebuilding. " " 8, 9, 10, 11, 12, 13, 14, 15, 16, 18, 19. Demolished and rebuilding. Bernard Street and Herbrand Street (corner of). Flats erected. Bloomsbury Street, Nos. 9, 11, 19. Remain closed. „ „ No. 13. Closed. „ „ Nos. 14, 16. Rebuilt. No. 18. Demolished and rebuilt. Nos. 21 and 23, and Nos. 94, 95, 96 and 97, Great Russell Street. Rebuilt as the Kenilworth and Waverley Hotel (completed). Chenies Street, Nos. 8 and 10. Rebuilding. Coptic Street, Nos. 26, 27, 28 and 29, with 1 and 2 Little Russell Street. Rebuilt (Mudie's). Cosmo Place, Nos. 2, 4, 6. Demolished. Being rebuilt as the Cosmo Hotel. Coram Street, No. 23, with 27, Kenton Street. Demolished. Flats being erected. Drury Lane, No. 175. Closed. „ „ „ 176. Closed. Endell Street, Nos. 33 and 35. Rebuilding. Francis Street, No. 18. Site still vacant. „ „ Nos. 5, 6, 7, and 37 and 39, Huntley Street. Rebuilding as üblic house, shops and flats, (completed). Gate Street, Nos. 1, 22, 24. Demolished. 30 Great Queen Street, No. 1. In course of demolition. „ „ „ No. 81. Demolished. „ „ „ Nos. 19, 20 and 21. Closed under the Housing of the Working Classes Act. Great Russell Street, Nos. 29, 30, 31, 32, 33, 34. Demolished. „ „ „ „ 94, 95, 96 and 97, and Nos. 21 and 23, Bloomsbury Street. Rebuilding as Kenilworth and Waverley Hotel. Completed. Great White Lion Street, No. 3. Remains closed. Great Wild Street, Nos. 31, 32, 33, 34, 35, 36, 37, 38, 39, 40. Demolished. Gower Mews, Nos. 18, 19, 20. Closed, undergoing repair and renovation. Herbrand Street. Erection of new houses for the Working Classes by the London County Council, nearly completed. Herbrand and Bernard Streets (corner of). New flats, nearly completed. High Holborn, Nos. 111, 114 and 115. Rebuilding. „ „ „ 112 and 113. Closed. „ „ „ 127, 128 and 129. Demolished. „ 223, 224, 225, 226, 227 and 228. Kenton Street, No. 27 and 23, Coram Street. Demolished. Flats being erected. Little Queen Street, Nos. 9, 12, 13, 14, 15, 16, 17, 18, 19, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40. Demolished. Little Russell Street, Nos. 1 and 2. Little Wild Street, Nos. 19, 20, 21, 24, 25, 26. Demolished. Neal Street, Nos. 25, 27, 29, 26, 28, 30, 32. Rebuilt as warehouses. „ „ No. 24. Closed. Nottingham Court, Nos. 8, 9, 10, 11, 12. Rebuilt as warehouses. Newton Street and Parker Street. New premises for Pall Mall Gazette. Building completed. Queen's Place, Nos. 1, 2, 3. Closed under the Housing of the Working Classes Act. Queen Street. No. 14. Rebuilding. Red Car Yard. Nos. 1 and 2. Partly demolished. Sardinia Street, Nos. 34, 36, 38 and 40. Demolition completed. Short's Gardens, Nos. 11, 12 and 13. Demolished. „ „ „ 20, 21 and 22. Closed. Southampton Row, Nos. 14,16, 18,20, 22,24,26, 28, 30, 32, 34, 36, 38,40,42. Demolished. „ „ „ 67, 69, 71, Rebuilding completed. „ „ Walduck's Bedford Hotel Extension. Erection completed. „ „ Nos. 126 and 128. Rebuilding as the Cosmo Hotel. Southampton Street, No. 13. Demolished. Theobald's Road, No. 91. Demolished. Tottenham Court Road, Nos. 209, 210, 216, 217, 218, 219, 220, 221, 222, 223, 224, 225, 226. Rebuilding. Twyford's Buildings. Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9. Demolished. Holborn Sub-District. Bedford Row, No. 44. Rebuilding completed. Charles Street, No. 3. Demolished and being rebuilt. „ „ Nos. 8 and 9. Rebuilding, completed. Eagle Street, No. 59. Demolished and rebuilt as workshops. „ „ No. 60. Rebuilt. „ „ Nos. 43, 44,45, 46. Demolished. „ „ No. 47. Closed. Emerald Street, No. 1. Rebuilt. „ „ Nos. 13, 15. Demolished and rebuilding. „ „ Nos. 17, 19, 21. Rebuilt. Ely Place, Nos. 15, 16, 17, 18, 19, 20. Being rebuilt. 29 Ely Buildings (15 tenements). Being rebuilt. Fisher Street, Nos. 2, 3, 4, 5, 6. Demolished. „ „ No. 13. Remains closed. „ „ no. 14. Demolished. Fullwood's Rents, Nos. 1 and 2. Demolished. Half-Moon Court, No. 6. Closed. Hatton Garden, No. 109. Being demolished. High Holborn, Nos. 79 and 80, 82 and 83. Rebuilt. „ „ No. 35. Rebuilt. Jockey's Fields, No. 13. Demolished and rebuilt as offices. Kingsgate Street, Nos. 30, 32, 34, 36. Demolished. Lamb's Conduit Street, Nos. 14, 16, 18. Rebuilt. Nos. 25,27. Rebuilt. Nos. 24, 26, 28. Rebuilt. Laystall Street, Nos. 17, 19, 21, 23, 25. Demolished and being rebuilt. Leather Lane, Nos. 1 to 9a. Rebuilt. „ „ „ 56, 57, 58. Being demolished. „ „ „ 64, 66. Closed. Little Grays Inn Lane. Workhouse. Demolished. Mount Pleasant, No. 69. Being rebuilt. Orange Street, No. 11. Demolished. Portpool Lane, Nos. 1, 3, 5. Closed. „ „ Nos. 7, 13. Closed. Providence Place, Nos. 5, 6, 7, 8. Closed. Red Lion Street, No. 61. Closed. Robin Hood Yard, No. 2 (with No. 3, Charles Street). Demolished and being rebuilt. Reid's Brewery site, Clerkenwell Road and Portpool Lane. L.C.C. houses for the working classes, viz.:—Ledam Buildings and Bourne Buildings completed. Sandland Street, Nos. 17, 18, 19, 20, 21 (with No. 44, Bedford Row). Rebuilt. Theobald's Road, Nos. 66 and 68 (with 1, Emerald Street). Rebuilt. verulam Street, Nos. 15, 16, 17. Rebuilt. „ 18, 19, 20, 21. Closed. Union Buildings. Cowshed. Closed. „ „ Nos. 3, 6, 7. Closed. WATER SUPPLY TO NEW BUILDINGS. During the year I have given certificates that the following premises which have been newly erected or rebuilt have a proper and sufficient supply of water: — Block B, Bourne Estate. Dwellings for the Working Class. Messrs. Wolff's premises west side of Alfred Place. 120, High Holborn. Block A, Bourne Estate. Kenilworth and Waverley Hotel, Nos. 94, 95, 96, and 97, Great Russell Street and Nos. 21, and 22, Bloomsbury Street. Blenheim Mansions, Francis Street. The " Marlborough Arms," Public House, No. 39, Huntley Street and No. 5, Francis Street. The Bedford Hotel Extension, Nos. 83, 85 and 87, Southampton Row. For many new premises, such as factories, workshops, offices, &c., a certificate is not required. CUSTOMS AND INLAND REVENUE ACTS. During the year certificates have been granted under the Customs and Inland Revenue Act, 1890, that the following premises are so constructed as to afford suitable accommodation for each of the 30 families or persons inhabiting them, and that due provision is made for their sanitary requirement, viz.:— Block C, Bourne Estate, 55 tenements. Block D, Bourne Estate, 55 tenements. Block E, Bourne Estate, 55 tenements. Block F, Bourne Estate, 55 tenements. 18, Coram Street, 5 tenements. 19, Coram Street, 5 tenements. 20, Coram Street, 5 tenements. 21, Coram Street, 5 tenements. 22, Coram Street, 5 tenements. St. George's Mansions, Coptic Street, 16 tenements. Dalmeny Mansions, Theobald's Road, 16 tenements. At 18, Coram Street, St. George's Mansions, and Dalmeny Mansions works were required to remedy sanitary defects before the certificates were granted. A certificate was also requested for Leather Lane Buildings, but was refused. SANITARY WORK. During the year several changes have taken place in the staff of the Public Health Department. On account of the resignations of Inspectors Freeman and Gregory which took effect on the 29th September, there were only three Inspectors until the female Inspector (Miss F. N. F. Lovibond) was appointed, and began her duties on the 28th December. The districts were re-arranged in the following way:—lnspector Bennett took Wards A., B. and D.; Inspector Clark took Wards E., F. and G., and Inspector Larard took Wards C., H. and I. In connection with the new appointment I suggested that it would be more advantageous to the public health interests of the Borough, that instead of appointing two new male Inspectors, one should be a female inspector, and I gave the following reasons. The tendency of all sanitary legislation is to increase the duties in the Public Health Department. During the existence of the present Council there have been many such additions made. Under the provisions of the London Government Act, 1899, varions powers have been transferred from the London County Council to the Borough Councils. These include the registration of dairymen, and the duty of enforcing the bye-laws and regulations with respect to dairies and milk shops, and with respect to slaughter-houses and offensive businesses. Under the Factory and Workshops Act, 1901, which came into force on the Ist day of January, 1902, the Council is made the Authority responsible for the sanitary condition of the workshops and workplaces in the Borough, and while the Factory Inspector is responsible for the sanitary condition of factories, any sanitary defects reported by him 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. In the memorandum issued by the Home Office respecting the duties of Sanitary Authorities under this Act, it was pointed out that the word " workplace" has a very extended meaning, and is not to be limited to places where something is being manufactured or made, but includes any place where work is done permanently, and where people assemble together to do work permanently of some kind or other. From the Ist April this year, the provisions of Sections 60 to 65, Sections 68 and 69 and 70 to 74 inclusive, of the Public Health (London) Act, 1891, with respect to dangerous infectious diseases have also applied to measles. Under the London County Council (General Powers) Act, 1902, Part 8, increased powers and duties were given to this Council respecting the manufacture, sale and storage of ice cream; and in the same Act, Part 9, increased powers were given to the London County Council respecting common lodging houses, and I am now required to inspect them and report whether it is necessary for any objections to be offered to the applications for licenses Over 60 per cent, of the population of this Borough live in tenements of under five rooms, and as the new bye-laws as to houses let in lodgings were confirmed by the Local Government Board in August last, there will be much increased work, especially in the Holborn Sub-district, in enforcing these bye-laws. 31 There are also many other matters of great public health importance which I should advise, and which I should like to see undertaken by this Council in the carrying out of which the services of a female inspector would be specially appropriate. As you are aware the death-rate from consumption is very high in this Borough, in fact, last year the death-rate from this disease was in this Borough, the highest of the Metropolitan Boroughs. In a special report on the subject presented to the Public Health Committee, on the 4th May last, I advised that this Council should undertake further duties for the prevention of this disease ; but as the time of the Public Health Committee has been very much occupied with many other urgent matters, and especially with the consideration of underground bakehouses, it has not yet been practicable for the Committee to consider this report. I should also like to see much more work done in connection with the prevention of measles, whooping cough, infantile diarrhoea, and the proper feeding of children. The following duties could very appropriately be undertaken by a female inspector ; inspection of outworkers' homes, domestic workshops, and workshops where females are employed, laundries, day schools, and restaurants ; also in assisting in the inspection of tenement houses, for which the services of the fifth inspector, have in the past been very useful. Also work in connection with the prevention of consumption, measles, whooping cough and infantile diarrhœa. I think it is also desirable that the female inspector should be appointed an inspector under the Sale of Food and Drugs Acts, in order that samples of food and drugs could sometimes be taken by her. She might also sometimes be usefully employed in the inspection of milkshops. From a report of the Medical Officer of Health of the London County Council giving particulars as to the sanitary inspectors employed in various districts of London, dated March, 1903, the following fifteen of the Metropolitan cities and boroughs had already appointed female inspectors: —Battersea, Camberwell, Chelsea, Hackney, Hampstead, Islington, Kensington, Lambeth, Paddington, Poplar, St. Marylebone, St. Pancras, Southwark, Wandsworth and the City of London. Of these, Kensington and Paddington have appointed two, Southwark four, and the remainder one each. Although a large demolition of property has taken or is about to take place in the Borough, and has fortunately cleared away some of the most insanitary property in the Borough, many of the new buildings will increase the number of workshops, and the number of outworkers. Also all new premises will have to be inspected to see that they have a proper and sufficient water supply, and suitable and sufficient watercloset accommodation. Although there has been much demolition, there has also been much reconstruction. Six blocks of the Bourne Estate on the Reid's Brewery site are already completed and occupied, and the houses for the working classes on the Herbrand Street site are nearing completion. "When all have been completed and occupied, there will be an increased population of 3,294, and will mean increased work, especial])' for the female inspector, respecting the non-notifiable infectious diseases and outworkers. Moreover, it is in such dwellings that a more immediate and greater success might be expected to attend our efforts for the prevention of disease. I have very carefully considered the question of whether I could advise the Council to appoint only one additional inspector, male or female ; for the reasons mentioned above I regret that I really cannot do this, and advise the appointment of both a male and female inspector. Metropolitan Boroughs. Number of Sanitary Inspectors. Average per Sanitary Inspector. Inhabited Houses. Tenements. Tenements under 5 rooms. Overcrowded Tenements. Population. Population in tenements under 5 rooms. Population in overcrowded tenements. Males. Females. Holborn If 4 Sanitary Inspectors - 1 3,448 2,693 696 8,931 3,719 4 3 1,176 14,851 If 5 Sanitary Inspectors 5 4 1 941 2,758 2,154 557 11,881 7,145 2,975 City of London 16 1 227 314 195 30 1,584 625 172 Excluding 7 Meat Inspectors 9 1 386 534 331 50 2,692 1.062 292 Finsbury* 9 1,031 2,677 *2,279 708 11,274 8,705 3,969 - Excluding Meat Inspector 8 1,160 3,012 2,564 797 12,683 9,793 4,465 - St. Pancras 15 1 1,482 3,565 2,814 635 14,707 9,737 3,526 St. Marylebone 7 1 1,692 3,953 2,868 647 16,663 9,269 3,518 Paddington 10 2 1,474 2,805 1,818 284 11,998 6,103 1,628 Kensington 11 2 1,702 2,950 1,624 354 13,587 5,648 2,016 Hampstead 6 1 1,613 2,428 1,025 123 11,706 3.459 745 Southwark 13 4 1,228 2,812 2330 478 12,128 8,701 2,710 *Female Lnspector since appointed. 32 HOUSE TO HOUSE INSPECTION, 1903. Alfred Mews. Aldwych Buildings. Arthur Street. Betterton Street. Bucknall Street. Castle Street. Charing Cross Road. Clark's Buildings. Coram Street (part of). Denmark Place. Denmark Street. Drury Lane. Endell Street. Gate Street. Goldsmith Street. Great Queen Street. Great St. Andrew Street. Great Turnstile. Great White Lion Street. Great Wild Street. Herbrand Street. High Street. Holborn Place. Kennedy Court. St. Giles and Bloomsbury. Kenton Street. Lawrence Street. Lindsey Buildings. Little Denmark Street. Little Earl Street. Little St. Andrew Street. Little Wild Street. Lumber Court. Macklin Street. Marchmont Street (part of). Maynard Street. Middle Yard. Museum Street. Neal Street. Neal's Yard. New Compton Street. New Oxford Street. Newton Street. New Turnstile. New Yard. Nottingham Court. Parker Street. Phœnix Street. Phœnix Yard. I Queen's Place. Queen Street. Red Lion Yard. St. George's Buildings. Sardinia Place. Sardinia Street. Shaftesbury Avenue (part of). Short's Gardens. Smart's Buildings. Southampton Row. Stacey Street. Store Street. Torrington Mews. Torrington Mews East. Tower Street. Twyford Buildings. Upper Montague Mews. West Street. Whetstone Park. Wild Court. Woburn Mews West. Woburn Place. Albion Buildings. Baldwin's Gardens. Baldwin's Place, Beauchamp Street. Bishop's Head Court. Bleeding Heart Yard. Boswell Court (South side). Brooke's Market. Castle Court. Chapel Street. Clerkenwell Road. Devonshire Street. Dove Court. Dunstable Court. Eagle Street. East Street. Emerald Street. Evelyn Buildings. 1 I Holborn. Eyre Court. Eyre Place. Eyre Street Hill. Eyre Terrace. Farringdon Road. Fleet row. Fox Court. Fulwood's Rents. Gloucester Street. Grays Inn Passage. Great Saffron Hill. Half Moon Court. Hand Court. Henry Street. High Holborn. John's Mews. Lamb's Conduit Passage. Leather Lane Buildings. Leigh Street. Little Bath Street. Little James Street. Millman Place. Mount Pleasant. New North Street. North Mews. Old North Street. Poole's Buildings. Providence Place. Red Lion Passage. Summer Court. Summer Street. Verulam Street. Vine Street. Warner Street. 33 BYE-LAWS AS TO HOUSES LET IN LODGINGS. At the end of the year the following 775 houses were registered under these bye-laws. Of these 439 are in Bloomsbury and St. Giles, and 336 are in the Holborn Sub-district. All have been inspected from time to time during the year, and the bye-laws enforced. Bloomsbury and St. Giles. Locality and Numbers of Houses. Arthur Street, Nos. 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 Betterton Street, Nos. 1, 4. 7, 8, 9, 10, 11, 14, 15, 16, 17, 18, 19, 21, 22, 23, 24, 25,26, 27, 29,30, 31, 33, 34 Castle Street, Nos. 4, 6, 8, 12, 18, 20, 22, 24, 28, 32, 40, 48, 50, 52, 60, 62, 64, 70 Clark's Buildings, Nos. 1, 2, 3, 4, 5, 6, 7, 8 Denmark Place, Nos. 1, 2, 3, 4, 5, 6 Drury Lane, Nos. 13, 14, 17, 18, 19, 22, 23, 24, 162, 163, 164, 169, 170, 171, 175, 176, 178, 180, 184 & 185, 186, 188, 192 Dyott Street, Nos. 2, 3, 4, 5, 6, 10, 16, 17, 18, 19, 20, 21 Goldsmith Street, Nos. 9, 11, 13, 15, 17, 25, 29, 31 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 Great Queen Street, Nos. 12, 23,24, 26,28, 34, 39, 43, 44, 48, 49, 50, 52, 54, 66, 69, 69a Great White Lion Street, Nos. 1, 2, 3, 4, 12, 13, 14, 15, 16, 17 Great Wild Street, Nos. 41, 45, 51, 52, 53, 54, 55, 56, 57 Kenton Street, Nos. 1, 3, 5, 7, 9, 13, 15. 17, 19, 21, 23, 25 Little Earl Street, Nos, 8, 10, 11, 13, 15, 25, 26, 27, 28 Little St. Andrew Street, Nos. 1, 3, 4, 7, 11, 14. 15, 21, 25, 27, 28, 28A Little Wild Street, Nos. 11, 12, 13, 15 Total Number of Houses Registered. 21 25 18 8 6 22 12 8 28 17 10 9 12 9 12 4 11 Neal Street, Nos. 11, 13, 15, 17, 19, 20, 21, 22, 25, 34, 37, 38, 39, 40, 42, 44, 47, 50, 52, 54, 58, 60, 62, 66, 70, 72, 74, 76, 80, 82 New Compton Street, Nos. 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, 37, 38,39, 42, 43, 44, 45, 46, 47, 48, 49, 51, 52. 53, 54,55, 56, 59, 60, 61, 63, 64, 65, 66, 67, 68, 69, 70, 71 New Turnstile, Nos. 2, 3, 4, 5, 6, 7, 8, 10 Nottingham Court, Nos. 1, 2, 3,13,13½, 15,16 Parker Street, Nos. 2, 4, 6 Phœnix Street, Nos. 3, 4, 5, 6, 7, 8, 11, 12, 13,14, 15, 16, 17 Queen Street, Nos. 2, 3, 14, 17, 18, 19, 26 Sardinia Place, Nos. 7, 9, 11, 12, 13, 15, 17 Sardinia Street, No. 6 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, 181, 183, 185, 187 Short's Gardens, Nos. 1, 2, 4, 5, 6, 7, 37, 38, 39 Smart's Buildings, Nos. 1, 2, 4, 5, 7 Stacey Street, Nos. 1, 2, 3, 4, 5, 6, 7, 13, 14, 15, 16, 17, 18, 19, 20 Tower Street, Nos. 11, 12, 15, 16, 17 19 20, 21 West Street, Nos. 4, 12, 14, 16, 18, 22 30 55 8 7 3 13 7 7 1 28 9 5 15 8 6 Wild Court, Nos. 1, 2, 3, 4, 5 5 Lumber Court, Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 Holborn Sub-Division. Locality and Numbers of Houses. Total Number of Houses Registered. Back Hill, Nos. 1, 2, 3, 4, 5 5 Castle Court, Nos. 5, 6 2 Baldwin's Place, Nos. 1, 2, 3, 4, 5, 6, 7, 8 8 Charles Street, No. 4 1 Beauchamp Street, Nos. 1, 2, 3, 3a, 4, 5, 6, 7,8,9 10 Chapel Street, Nos. 3, 5, 9,10,11,12,13,15,18 9 Bishop's Head Court, Nos. 1, 3,4, 6, 7, 10,11 7 Devonshire Street, Nos. 2, 3, 4, 5, 6. 8, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 21a, 23, 24, 25, 26, 27, 30, 31, 33, 34, 37, 38, 39, 40, 41, 42, 43, 44, 46, 47, 48, 49, 50, 52 40 Boswell Court, Nos. 8, 9, 10, 11, 12, 13 6 34 Locality and Numbers of Houses. Total Number of Houses Registered. Dove Court, Nos. 1, 2, 3, 4 4 Leigh Street, Nos. 2, 3, 4, 8, 9, 10, 11, 12 8 Drake Street, Nos. 9, 10 2 Little Bath Street, Nos. 1, 2, 3, 4, 5, 7, 9 7 Dunstable Court, Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 11, 12 11 Little Grays Inn Lane, Nos. 10, 11, 12, 13, 14, 15, 16, 17 8 Eagle Street, Nos. 9, 10, 11, 12, 13, 18, 19, 20, 22 and 23, 28, 31, 32, 35. 36, 37, 39, 41, 42, 48, 49, 50, 51, 53, 58 24 Little Saffron Hill, No. 13 1 Mount Pleasant, Nos. 47, 49, 63 3 Eyre Court, Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 12 New North Street, Nos. 1, 2, 3, 4, 5, 6. 7, 8, 9, 10,11,12,13, 14,14a, 19, 20, 21, 22, 23, 24 25, 26, 27, 28, 29, 30, 31, 33, 34, 35, 36 32 Eyre Place, Nos. 1, 2 2 Old North Street, Nos. 1, 2, 3, 4, 9, 10 6 Eyre Street Hill, Nos. 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18,19. 20, 21. 22, 23, 24, 25, 25A 21 Portpool Lane, Nos. 19 and 21 1 Eyre Terrace, Nos. 3, 4, 5 Poole's Buildings. Nos. 8, 9, 10, 11 4 3 Red Lion Street, Nos. 26, 58 2 Emerald Street, Nos. 14, 16, 18, 22, 24 5 Red Lion Passage, Nos. 2, 3, 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 16,17 14 Evelyn Buildings (47 tenements) 1 Fleet Row. Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 15 16 Summer Street, Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 11, 12 and 13, 14, 15, 16 and 17, 18 and 19, 20 Fox Court, Nos. 6, 7, 8, 9 11, 12 6 9 Verulam Street, Nos. 8, 9, 10, 11, 27, 28, 38, 39, 40 Fulwood's Rents, No. 21 1 Half Moon Court, Nos. 6, 7, 8, 9 4 2 Vine Street, Nos. 6, 25 Lamb's Conduit Passage, Nos. 1, 2, 3, 4, 5, 7, 8, 8A, 14, 15, 16, 17, 18, 19, 20 15 8 Warner Street, Nos. 32 and 34, 38, 40, 42, 44, 48, 50, 52 Leather Lane Buildings (48 tenements) 1 During the year 296 houses let in lodgings, all in the Holborn Division, have been added to the Register. Other houses formerly on the Register have been closed for demolition during the year, and some are now occupied by members of only one family. The new bye-laws as to houses let in lodgings were finally confirmed by the Local Government Board on the 21st August, 1903. lam very glad that the Local Government Board ultimately assented to the omission of the exemption clause. In my Annual Report last year, I gave full details respecting the correspondence and interview with the Local Government Board. COMMON LODGING-HOUSES ACTS, 1851 & 1853. The Secretary of State, by a Provisional Order which came into operation on the Ist November, 1 894, 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. „ 4 „ Holborn Sub-district for 1,062 „ 2858 „ Total 47 in the Borough 35 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 16, Castle Street 33 M 9, Dyott Street 29 M *12, ditto 62 M *13, ditto 20 M 14, Lumber Court 73 M 3, Neal's Yard 44 M †20, ditto 34 M †21, ditto M 22 to 25, Queen Street 151 M 46 †22, ditto 36 M 20 to 21, ditto 134 M 2, Kennedy Court 10 M 6, Betterton Street 95 M 6, Wild Court 30 M 3, ditto 12 M 4, ditto 24 M 7, ditto 35 M 1 to 7, Macklin Street 96 M 5, ditto 10 W 19, ditto 45 M 6, ditto 8 w 21, ditto 23 W 7, ditto 11 W Parker Street, Municipal Buildings 324 M 8, ditto 38 w 25, Drury Lane W 8, Parker Street 33 W 34 13, Sardinia Street 54 M 10, Parker Street (back addition) 50 W 36, Parker Street 115 M 15, ditto ‡ M 25, Great Queen Street 50 M I I * Closed and demolished during year. †Closed during year. ‡Part of a Common Lodging-house in the City of Westminster. A total of 33 Common Lodging-houses registered for 1,796 Lodgers. 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. 50 W 65, Mount Pleasant 9 M 18, Fulwood's Rents 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 I A total of 14 Common Lodging-houses registered for 1,062 Lodgers. During the month of June, I made a careful inspection of all the common lodging houses in the Borough, and presented a detailed report respecting them, a copy of which was sent to the London County Council. I advised the Council to oppose the renewal of the licenses for 11, 12 and 13, Short's Gardens, and for Nos. 20, 21 and 22, Short's Gardens, as I was of opinion they were quite unfit for occupation as common lodging houses. Also for 13 and 15, Sardinia Street, which are occupied with Nos. 27, 28, 29 and 30, vere Street, in the City of Westminster, and for 3, Neal's Yard, which forms part of a large common lodging house, Nos. 20 to 25, Queen Street, inclusive. Nos. 11, 12 and 13, Short's Gardens, have since been closed and demolished. Nos. 20, 21 and 22, Short's Gardens, have been closed. Nos. 13 and 15, Sardinia Street, will probably soon be demolished in connection with the new street leading to the new Kingsway. Many alterations were carried out at 20 to 25, Queen Street, and 3 Neal's Yard, and the premises were made suitable for occupation as a common lodging house. In the great majority of the remaining common lodging houses many alterations had already taken place or were in progress in order to obtain a renewal of licenses and in the remainder there were only a few defects which were easily remedied. 36 Under the London County Council General Powers Act, 1902, the London County Council has obtained increased powers respecting common lodging houses. Under this new Act, the license is only valid for the period of one year, but the license may be renewed from year to year. The license can only be refused upon the ground (a) that the person applying to be licensed is not a fit and proper person to be licensed as a common lodging house keeper; or (b) that the premises are not suitable or suitably equipped for the purposes of a common lodging house. Respecting the premises it is further stated that they must be structurally and otherwise suitable for use and occupation as a common lodging house, having regard to the number, health, safety and convenience of the persons occupying or intended to occupy the same. Under this section of the Act (Section 47), the London County Council have been making many further requirements in all the common lodging houses of the Borough before the license will be renewed. All the rooms of the common lodging houses have been measured, and in most of the common lodging houses the number of beds will have to be reduced. In many cases the drainage will have to be reconstructed, and in many the waterclosets and lavatory accommodation also. The County Council has also required separate accommodation for the washing of clothes and feet of the inmates. In cases where the passages and staircases are not made of fire-resisting material, adequate means for escape in case of fire have to be provided. Section 53 of the London County Council (General Powers) Act, 1902, is as follows:— (1.) From and after the passing of this Act, Section 9of the Common Lodging Houses Act, 1851, shall cease to be operative or to have effect in the county. FACTORIES, WORKSHOPS AND WORKPLACES. During the year the inspection of factories, workshops and workplaces in the Borough has been continued, and as, under the new Factory and Workshop Act of 1901, a register of all the workshops in the Borough must be kept, all the 360 workshops (including 12 workshop laundries) which were inspected during the year have been placed on the register. In all, 704 workshops (including 13 workshop laundries, and excluding bakehouses which are kept in a separate register), were on the register at the end of the year and consisted of 1,100 rooms; and 3,484 men, 1,349 women and 384 young persons were employed. Our list gives details of these workshops under more than 200 different trades, and these have been abridged into the following 14 principal divisions:- Trade. No. of Workshops. Males. Females. Young Persons. Total. Tailors 126 353 301 24 678 Dressmakers 26 5 102 17 124 Other Makers of Wearing Apparel 40 100 110 8 218 Laundries 13 1 70 - 71 Scientific Instrument Makers 21 139 26 10 175 Musical and other Instrument Makers 6 58 17 3 78 Electrical Apparatus and Appliances 8 25 7 16 48 Jewellers, Diamond Mounters, etc. 42 324 131 70 525 Blacksmiths and other Workers in Metal 99 379 16 21 416 Carpenters, Cabinet Makers and other Workers in Wood 107 698 18 32 748 Portmanteau Makers and other Workers in Leather 28 184 16 19 219 Glass Blowers and other Workers in Glass 22 110 1 5 116 Bookfolders and Stationers 17 79 36 9 124 Miscellaneous 149 1,035 461 150 1,646 Total 704 3490 1,312 384 5,186 37 Further details are given in the Appendix, Tables 7, 8 and 9, which are in the form suggested by the Medical Officer of Health for the County of London, with a view to securing uniformity of statistics in the Metropolis, and have been approved by the Chief Inspector of Factories. Table VII. gives further details of inspections of factories, workshops and workplaces. Table VIII. gives details of matters dealt with. Table IX. gives details respecting outworkers. BAKEHOUSES. At the beginning of the year 1903, there were 38 bakehouses in the Borough, of which 19 were in Bloomsbury and St. Giles, and 19 in Holborn. The following is a list of bakehouses in the Borough. Bloomsbury and St. Giles, 2 Bloomsbury Court. 21 Marchmont Street. 77 Marchmont Street. 10 Bury Street. 8 Museum Street. 166 Drury Lane. 60 Neal Street. 155 High Holborn. 24, 26 and 28 New Oxford Street. 162 High Holborn. 217 and 218 High Holborn (Holborn Restaurant). 21 Sardinia Street. 200 Shaftesbury Avenue. 63 High Street. 88 Southampton Row. 33 Tottenham Court Road. 19 Little Earl Street. 5 Little St. Andrew Street. 6 Torrington Place. Holbobn. 50 Lamb's Conduit Street. 172 Clerkenwell Road. 9 Cosmo Place. 13 Leigh Street. 49-57 Farringdon Road (factory). 19 Red Lion Street. 33 Great Ormond Street. 50 Red Lion Street. 1 Greville Street. 74 Red Lion Street. 8 High Holborn. 92 Theobald's Road. 58 Leather Lane (now being rebuilt). 124 Theobald's Road. 70 Leather Lane. 136 Theobald's Road. 6 Lamb's Conduit Street. 36 Warner Street. 28 Lamb's Conduit Street. All are underground bakehouses, with the exception of 2, Bloomsbury Court, 162, High Holborn, 88, Southampton Row, 74, Red Lion Street, 28, Lamb's Conduit Street, one of the two at 6, Lamb's Conduit Street, and 58, Leather Lane. These bakehouses, especially the 32 underground ones, occupied a great deal of the time of the Public Health Committee, the Town Clerk and the Borough Surveyor, as well as this Department. In addition to my inspections and detailed reports on various occasions, and inspections and detailed reports by the Borough Surveyor, 69 inspections were made by the Sanitary Inspectors, and 5 notices for minor defects were served during the year. In addition, many 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. In December, 1902, the Council informed the occupiers of all underground bakehouses in the Borough that after the Ist day of January, 1904, an underground bakehouse shall not be used unless certified by the Council to be suitable for that purpose, and requesting occupiers to inform the Council whether they wished to make application for such certificate. 38 Applications for certificates were received from the occupiers of all the underground bakehouses with the exception of No. 8, High Holborn. At No. 233, Tottenham Court Road, the application was refused. The premises are about to be demolished, and have not been used as an underground bakehouse since December 31st, 1903. No. 8, High Holborn also is no longer used as an underground bakehouse. The application for the certificate for the underground bakehouse at No. 6, Lamb's Conduit Street was refused, and it has not been used as such since the end of the year. No. 70, Leather Lane is included in the Union Buildings area, and a new bakehouse is being built for this occupier by the London County Council at No. 58, Leather Lane. The Council refused the application for the certificate as the bakehouse did not comply with the Council's requirements, but, at the request of the London County Council, has allowed the occupation of the underground bakehouse to be temporarily continued. No. 21, Sardinia Street will also be demolished in connection with the new Kingsway, and for this reason the Council has allowed the occupation of the same to be temporarily continued. In all other cases certificates have either been granted or are about to be granted. In my Annual Report for the year 1902, I included a long report on the minimum requirements which I suggested for the great majority of the underground bakehouses, and mentioned that the Town Clerk and I reported that we considered it undesirable for the Council to lay down any hard and fast rules that could be applied equally to all. PLACES WHERE FOOD IS PREPARED FOR SALE. Under this head are included kitchens of hotels, restaurants and eating-houses of all sorts, tripe, offal and other meat shops, fried fish, eel and other fish shops, and other places where food is prepared for sale, excluding bakehouses, which are given above. The number of these places on the register at the end of 1903 was 313. 770 inspections were made and 70 notices were served during the year for sanitary defects where found. OTHER SHOPS WHERE FOOD IS SOLD. The inspection of other food shops includes 718 inspections of market streets, 54 provision merchants and cheesemongers, 82 fruiterers and greengrocers, 38 grocers and general shops, and 52 confectioners. The inspections of dairies, cowsheds and milkshops, and ice cream premises are dealt with under separate headings. SLAUGHTER-HOUSES. The two slaughter-houses in the Borough :— 29, Red Lion Street, and Yorkshire Grey Yard, Eagle Street, were inspected on 28 occasions during the year, and no breach of the regulations was found. OFFENSIVE BUSINESSES. The only other offensive business in the Borough is that of a tripe dresser and boiler, of Nos. 67 and 68, Leather Lane. These premises are inspected weekly, and no breach of regulations was found. These premises are also included in the Union Buildings area, and will be demolished in accordance with the scheme for improving the area. 39 DAIRIES, COWSHEDS AND MILKSHOPS. The number of registered dairies and milk shops in the Borough at the end of the year was 167 of which 70 were in Bloomsbury and St. Giles, and 97 in the Holborn District. During the year 23 dairies and milkshops were newly registered, 10 belonging to St. Giles and Bloomsbury, and 13 to Holborn 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. The Sanitary Inspectors made 812 inspections of these premises; 5 notices were served for breaches of regulations, and there was one prosecution for selling milk on unregistered premises, the defendant being convicted and ordered to pay 2s. costs. Last year we had not so much difficulty in enforcing the covering of milk for preserving its purity, and for protecting it against infection or contamination; in several cases however, the occupiers had to be cautioned. Of the two cow sheds in the Borough, viz :— 4 Goldsmith Street, and Union Buildings, Leather Lane, the latter is included in the Union Buildings area, and was closed at the latter part of the year. ICE CREAM. On account of the increased powers which we have by the London County Council (General Powers) Act, 1902, for regulating the manufacture and sale of ice cream, much attention has been given during the year by this Department to premises where ice creams are manufactured, stored or sold. At the end of the year there were 32 premises where ice cream was manufactured or sold, and 179 inspections of these premises, including 28 early morning inspections between 6 and 7 a.m. were made. 15 notices for sanitary defects were served. In one case legal proceedings were taken for manufacturing ice cream in a sleeping apartment, and the defendant was convicted and fined 10s. 6d., and 9s. 6d. costs. Many rooms and bedrooms which before the Act came into force were used for the manufacture, sale or storage of ice cream are no longer used for the purpose, and many rooms or other places have been specially fitted up and prepared for this business. UNSOUND FOOD. On the 26th February, an oxtail which was exposed for sale and was unsound, unwholesome and unfit for the food of man, was seized and condemned at the Bow Street Police Court. Having regard, however, to all the circumstances of the case, no proceedings were taken beyond a caution sent to the vendor by the Town Clerk. Applications were received for the removal and destruction as trade refuse, of the following articles of food, all of which were unsound and unfit for the food of man :— 1 cwt. anchovies. 24 fowls. 70 baskets beans. 6 sacks onions. 5 carcasses of fawns. 8 lbs. onions. 5 baskets plums. I also received application for the removal and destruction of 28 quarter boxes of tomatoes, but on inspection I found that many of the tomatoes were quite fit for food. I therefore gave instructions for all the sound ones to be separated from the unsound ones, when this was done I found about onequarter of them were good and fit for food, and the remaining three-quarters (21 cases) were removed for destruction. 40 I also received application for the removal and destruction of 7 boxes of white grapes, but on examination I found that only 5 boxes were unfit for food, and this number was subsequently removed and destroyed as trade refuse. SMOKE ABATEMENT. Much attention was given to the abatement of smoke in the Borough. The smoke shafts were frequently kept under observation, and in 107 instances the inspections were recorded; 17 intimation notices and 3 statutory notices were served for the abatement of smoke nuisances. METEOROLOGY. The mean temperature for the year was 50°.1 or about 1°, higher than for the years 1901 and 1902, when the mean temperatures for each year was 49°.2. The rainfall was 35.54 inches, being as much as 11.0 inches above the average for the preceding 50 years. The total amount of bright sunshine was 1,445 hours out of a total possible 4,458 hours, and was 127 hours above the average for the preceding 16 years. The mean hourly horizontal movement of the air was 13.2 miles per hour which was the highest recorded during the past 50 years. In each of the years 1901 and 1902, this mean hourly movement was 11.5 miles per hour. The lowest mean recorded during the past 50 years being 9.3 miles per hour. Further details are given in Table 13. 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. I have the honour to be, Gentlemen, Your obedient Servant, W. A. BOND. 41 APPENDIX. TABLE I. Vital Statistics of Whole District during 1903 and Previous Years. Name of District—The Metropolitan Bobough of Holborn. Year. Population estimated to Middle of each Year. 2 Births. Total Deaths Registered in the District. Total Deaths in Public Institutions In the District. 9 Deaths of Nonresidents registered in Public Institutions in the District. 10 Deaths of Residents registered in Public Institutions beyond the District. 11 Nett Deaths at All ages belonging to the District. Under 1 Year of Age. (Nett.) At all Ages. Number. 3 Rate.* 4 Number. 5 Rate per 1,000 Births registered 6 Number. 7 Rate.* 8 Number. 12 Rate.* 13 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) U l,IUV IjtfUU I 1 «->/•/• 1897 67,074 1,772 26.5 289 163 1,335 20.0 568 447 478 1,366 20.4 1898 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 1902 58,542 1,646 27.7 213 129 1,283 21.9 627 517 494 1,260 21.2 (53 weeks) — — — — — — i — Averages for years 1893-1902 65,693 1,829 27.8 297 161 1,403 21.4 571 438 484 1,450 22.0 1903 57,861 1,621 28.1 154 1,088 18.8 587 496 462 1,054 18.3 95 * 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 1893 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 1903 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. 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 31,820 660 150 832 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 1902 58,542 1,646 1,260 213 31,020 994 594 86 27,522 652 666 127 Averages of Years 1893 to 1902 65,693 1,829 1,450 297 35,477 1,054 727 139 30,215 722 157 775 1903 57,861 1,621 1,054 154 30,644 991 490 68 27,217 630 564 86 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. (6) 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 1893 to 1900 refer to the old areas of the St. Giles and Holborn District Boards of Works. 42 TABLE III. Cases of Infectious Disease notified during the year 1903. 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. Small-pox 2 - - 1 - 1 - 1 1 - 1 Cholera - - - - - - - - - - - Diphtheria and Membranous Croup 53 1 13 13 11 11 4 22 31 18 26 Erysipelas 90 - 1 2 7 66 14 65 25 38 8 Scarlet Fever 144 2 47 72 13 10 - 55 89 48 86 Typhus Fever - - - - - - - - - - - Enteric Fever 54 - 2 15 12 24 1 36 18 32 13 Relapsing Fever - - - - - - _ - _ _ - Continued Fever 2 - - - 1 1 - - - - 2 Puerperal Fever 4 - - - 1 3 - 1 3 1 1 Plague - - - - - - - - - - - Chickenpox 3 - - 3 - - - - 2 - - Totals 352 3 63 106 45 116 19 183 169 135 137 Note.—The Isolation Hospitals are those of the Metropolitan Asylums Board. TABLE IV. Causes of, and Ages at, Death during Year, 1903. Causes of Death. Deaths in or belonging to whole District at Subjoined Ages. Deaths in or belonging to Localities at all Ages. Total Deaths in Public Institutions in The District. All Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Bloomsbury and St. Giles. Holborn. Small-pox - - - - - - - - - - Measles 17 3 12 2 - - - 3 14 2 Scarlet Fever 1 3 1 - - - 5 - 3 2 Whooping Cough 16 8 8 - - - - 9 7 24 Diphtheria and Membranous Croup 7 1 6 - - - - 5 1 11 Croup - - - - - - - - - - Fever Typhus - - - - - - - - - - Enteric 5 - - - 3 - 4 1 4 2 Other Continued - - - - - - - - - - Epidemic Influenza 11 1 - - - 5 5 7 4 1 Cholera - - - - - - - - - - Plague - - - - - - - - - - Diarrhæa 22 18 4 - - _ _ 8 14 14 Enteritis 9 5 4 - - 3 1 4 5 10 Puerperal Fever 3 - - - 3 - - 3 10 - Erysipelas 3 - - - 2 1 2 1 3 - Other Septic Diseases 18 1 1 1 1 11 3 8 10 18 Phthisis 170 - 1 2 8 151 8 96 74 39 Other Tubercular Diseases 40 14 10 7 2 5 2 10 30 84 Cancer, Malignant Disease 49 - 1 - - 3 17 28 21 17 Bronchitis 116 11 7 - 46 52 40 76 22 - Pneumonia 93 17 17 - 2 39 18 50 43 75 Pleurisy 11 - - - 1 9 1 4 7 1 Other Diseases of Respiratory Organs 8 - 1 - - 6 1 5 3 11 Alcoholism Cirrhosis of Liver} 32 - - - 29 3 17 - 15 Venereal Diseases 5 - 1 - - 3 4 4 2 - Premature Birth 25 25 - - 1 - 14 11 15 - Diseases and Accidents of Parturition 1 - - - - 1 - - 1 1 Heart Diseases 71 2 1 5 4 31 28 33 38 33 Accidents 42 5 6 4 2 18 7 12 30 5 Suicides 11 - 1 10 - 7 4 1 - - All other causes 264 38 10 3 11 96 106 121 143 192 All causes 1054 154 88 26 34 499 253 490 564 587 43 TABLE V- Sanitary Inspectors' Work. Inspector Bennett. Inspector Clark. Inspector Gregory. Inspector Larard. Inspector Freeman. Inspector Lovibond (1 week). Whole Borough. Complaints 50 47 48 3 71 219 - Infectious Diseases 109 114 62 77 16 1 379 1,322 Dwelling Houses 273 512 133 383 21 - 75 143 1,068 Lodging Houses 440 178 232 143 - Common Lodging Houses 25 5 9 47 - - Dairies, Cowsheds and Milkshops 153 212 96 316 35 812 - Ice Creams— Manufacture or Storage 27 14 14 124 179 - - Slaughter-houses 28 28 - - - - - 272 37 Market Streets 150 45 214 718 - 142 45 9 539 Butchers' Shops 174 169 - Inspections. 22 17 12 15 1 67 Bakehouses - Other Food Shops 69 73 46 94 22 304 - 103 111 206 218 39 802 Other Workshops 125 21 59 107 Out-Workers' Rooms and Registers 9 18 - - Workplaces - - - 1 - - - - 3 9 Schools 3 2 - - Smoke shafts 51 15 30 107 11 - - Urinals 3 109 18 57 187 - - 183 7 366 Miscellaneous 88 48 40 - 361 448 695 1,647 Periodical Inspections 143 - - 2,669 2,072 2,029 8,688 1,280 Total Inspections 598 40 1,463 998 1,568 7,296 No. of Re-Inspections 2,178 1,089 - 598 Visits other than Inspections and Re-Inspections 1,050 354 957 495 41 3,495 4,133 5,257 2,723 4,624 2,661 19,479 81 Total 181 131 1,350 Intimation Notices Served 385 193 460 - 164 403 56 1,173 Houses 368 182 - Waterclosets defective or dirty 71 154 173 18 485 69 - 71 9 insufficient 12 14 87 44 - 22 12 9 88 Drains defective 18 27 - 19 28 26 7 104 Soil pipes or waste pipes defective 24 - 8 33 Gullies defective 2 13 6 4 - Ash-bins defective 4 8 4 11 1 28 - 2 7 3 38 „ absence of 7 19 - 1 8 Water supply defective 6 1 - - - „cistern dirty or defective 10 19 18 14 6 67 - 14 „ fittings defective - 14 - - - - 7 31 11 7 77 Yard or area paving defective 21 - Roof or guttering defective 12 40 26 46 6 130 - 16 26 Accumulations 10 39 2 - 93 137 113 20 381 Premises dirty 44 67 - 34 overcrowded 8 35 6 83 92 - - 4 146 other defects 9 31 10 - 1 15 3 2 21 Underground rooms - 4 - 1 3 1 9 Animals improperly kept - - 9 17 Smoke nuisances 4 1 3 - - 1 7 3 19 Urinals 8 - 1 3 - 4 Other nuisances - - - - 22 7 14 - 1 Manure receptacles, absence of - - 17 17 11 57 † Factories and Workshops 75 177 - 17 8 7 18 33 83 Di rt y 4 - 2 7 32 41 86 Waterclosets, defective or dirty - 4 2 3 - 1 „ insufficient - - 8 „ absence of separate accommodation for sexes 1 1 4 2 - - 2 5 1 16 24 Drains, soil pipes, &c., defective - - - Improperly ventilated - - - - - - 4 1 1 6 Overcrowded - - - 3 35 Other nuisances 32 - - - - 206 4 24 45 29 104 Breach of Bye-laws or Regulations— ‡ Lodging houses - 2 Dairies, cowsheds, milkshops and slaughter-houses 2 - 160 - - - 42 74 147 15 338 Statutory Notices Served 160 - * The majority of these are weekly inspections of Registered Lodging Houses. † Many nuisances at workshops, that are parts of dwelling houses, are included in the Intimation Notices served under " Houses." ‡ Many breaches of bye-laws are included in Intimation Notices served under " Houses." 44 The following Tables VI. VII. VIII. and IX. are in the form suggested by the Medical Officer of Health for the London County Council with a view to securing uniformity of Statistics in the Metropolis. TABLE VI. Proceedings during 1903. NUMBER OF PLACES- Number of Inspections 1903. PREMISES. Number of Notices 1903. Number of Prosecutions 1903. On register at end of 1902. Removed in 1903. On register at end of 1903. Added in 1903. Milk premises 157 23 13 167 2 812 5 1 0 Cowsheds 2 0 28 - Slaughter-houses - 2 - 2 Other offensive trade premises 2 1 weekly 1 - - - 21 - 11 32 Ice Cream premises 179 15 1 594 115 Registered houses let in lodgings 1,068 206 296 775 6 (a)* (b)* (a)* (b)* * (a) For overcrowding. * (b) For other conditions. Overcrowding, 1903— Number of Dwelling Rooms overcrowded 83 Number remedied 83 Number of notices issued 83 Number of prosecutions 1 Underground Rooms— Number closed during year 21 Insanitary Houses— Number closed under the Public Health (London) Act, 1891 - „ „ „ „ Housing of the Working Classes Act 7 Shelters provided under Scction 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year - Customs and Inland Revenue Acts— 13 Number of houses for which applications were received during the year Number of dwellings comprised therein 332 Number of certificates granted 13 Number of prosecutions under Bye-laws under Public Health (London) Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, etc. - (b) For prevention of nuisance arising from offensive matter running out of any manufactory, etc. - (c) For the prevention of keeping of animals in such a manner as to be injurious to health 8 (d) As to paving of yards, etc., of dwelling houses - (e) In connection with the removal of offensive matter, etc - (f) As to cesspools and privies, removal and disposal of refuse etc. - (g) For securing the cleanliness of tanks, cisterns, etc - (h) With respect to water closets, earth closets, etc. 3 (i) With respect to sufficiency of water supply to water closets - (j) With respect to drainage, etc. (Metropolis Management Act, Section 202) - (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Act, Section 202) - Mortuaries— Total number of bodies removed 130 Total number of infectious bodies removed 18 45 TABLE VII. Inspection of Factories, Workshops, and Workplaces. Class of Work Number of Places ‡ Number of Inspections. 1903. Number of Notices. 1903. Number of Prosecutions. 1903. On Register at end of 1902. Added in 1903. Removed in 1903. On Register at end of 1903. Premises. Rooms. 1 - - 1 - 2 - - Factories + Factory Laundries 1 - 2 - - Factory Bakehouses 1 - - ‡ Included under Worksh ops and Work places. Other Factories 7 Included under other Workshops. 13 26 Workshop Laundries 12 6 67§ 42 5 37 - 5 - Workshops Workshop Bakehouses - 791 - 343 348 - 691 1,074 177 Other Workshops 148 177* 7 - 89 - 237 - Outworkers' Premises* Places where Food is prepared for Sale + - 770 - Not on Register. 70 313 Workplaces Workplaces other than the above I I I I I I I 11 1,749 1,293 - 259 Total 449 - 542 * There were in addition, many inspections of Outworkers' Premises made during the house-to-house inspections of Lodging Houses and other Dwelling Houses. + Under this head are included the Kitchens of Hotels, Restaurants and Eating-houses of all sorts. Tripe, Offal, and other Meat Shops. Fried Fish, Eel, and other fish Shops, and other places where food is prepared for sale, excluding Bakehouses which are given above. ‡Registration of Factories is not required by the Factory and Workshop Act, 1901, but most of them were inspected during 1903, and notices served where necessary. § Many Inspections of Underground Bakehouses were also made by the Borough Surveyor and the Medical Officer of Health in connection with the requirements for the Council's Certificate. There is a very large number of "workplaces other than the above, the registration of which is not required, and many of them were inspected and notices served where necessary. TABLE VIII. Matters Dealt with. Number of Defects. Notices Issued. Prosecutions PARTICULARS. Found Notified by Home Office. Remedied. Notified to Home Office. - Matters under the Public Health (London) Act, 1891. I I 78 5 78 78 Want of Cleanliness 1 1 1 1 1 - Want of Ventilation - 6 1 Want of Air Space; Overcrowding 6 - 6 - 3 1 3 - 3 Insufficient - Sanitary Accommodation (s.38). 86 5 86 - 86 Unsuitable - 8 8 Not Separate for Sexes 2 - 8 - - - - Want of Drainage of Floors - - - 59 - 59 - Other Nuisances 59 - Contraventions of Factory and Workshop Act, 1901. I Occupying Underground Bakehouse without Certificate ... Not in force until 1904 5 Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) - 5 - - 5 Failure as regards Lists of Outworkers (s. 107) 115 - 115 115 - - Giving out work to be done in premises which are Unwholesome (s. 108) - - - - - - - infected (s. 110) - 11 - - 11 Allowing Wearing Apparel to be made in Premises infected by Scarlet Fever or Small Pox (s. 109) - - 8 - - 8 ? 75 Other contraventions 75 - ? ? 361 - 76 380 Total 455 15 Cases reported to H.M. Inspector:— Abstract not affixed, 74. As to action taken in cases notified by H.M. Inspector. Other cases, 2. Number of Underground Bakehouses in use at the end of 1903, 29. Certificates granted (s. 101), 23. Number of workshop rooms measured, 587. 46 TABLE IX. List of Outworkers (s. 107). Class of Homework. Number of Lists Received. Number of Addresses of Outworkers. Due Feb. 1st. Due Aug. 1st. Received from Other Authorities Forwarded to other Authorities. - — No. of Lists. No. of Outworkers. No. of Lists. No. of Outworkers. Wearing Apparel:— — — — —■~ 188 127 Tailors 54 322 54 386 5 12 4 11 Shirt and Collar Makers 11 2 1 3 1 1 2 5 Dress-makers Lace - - - - - - - - Cabinet making - - - - - 77 Fur pulling - - - 2 Electro Platers 2 13 1 15 16 4 1 Other 1 - - 3 - Total 350 143 60 413 217 62 Number of Notices prohibiting homework in unwholesome premises (s. 108), Nil. Number of Orders prohibiting homework in infected premises (s. 110,), Nil. TABLE X. Legal Proceedings under the Public Health (London) Act, 1891. Date. Premises. Offence. Result. 20, New North Street 1903. January 8 Breach of lodging-house regulations Breach abated; summons withdrawn „ „ 21, Do. Do. do. Do. do. 18, Eagle Street February 6 Nuisance: W.C.s defective and very foul. (Recurring nuisance) Prohibition order, with 27s. costs „ „ 20, Torrington Mews Nuisance: premises dirty; insufficient external light and ventilation to W.C.; drain defective ; rainwater pipe defective; roof defective Summons adjourned April 17 10, Great Russell Street Nuisance: drain defective, and basement yard and areas dirty Order to abate in 21 days; £1. 1s. costs „ „ 1, Lumber Court Breach of regulations as to lodging-houses Defendant convicted and fined £2 and 2s. costs 2, Do. „ „ Do. do. Defendant convicted and fined £1 and 2s. costs „ „ 3, Do. Do. do. Do. do. „ „ 4, Do. Do. do. Do. do. May 22 9, Goldsmith Street Nuisance: W.C. stopped and in filthy condition. (Recurring nuisance) Order to abate forthwith; £1. 7s. costs February 6 to June 19 20, Torrington Mews Nuisance: premises dirty; insufficient external light and ventilation to W.C.; drain defective; rainwater pipe defective; roof defective Work done; costs paid, £1. 1s.; summons withdrawn April 17 to June 19 7, New North Street Breach of London County Council bye-laws. (Insufficient W.C. accommodation) Numbers reduced. Summons withdrawn July 17 25, Eyre Street Hill Manufacturing ice cream in sleeping apartment Defendant convicted and fined 10s. 6d. and 9s. 6d. costs. 47 TABLE X.— continued. Result. Date. Premises. Offence. July 23 2, Ormond Yard Breach of bye-laws. (Absence of manure receptacle) Breach abated. Costs paid (10s. 6d.) Summons withdrawn do. do. 6, do. „ „ 13, do. do. do. „ „ do. 34, do do. „ „ 35, do. do. do. „ „ 36, do. do. do. „ „ 20, Torrington Mews do. Summons withdrawn on death of Owner „ „ 13, do. do. Summons withdrawn. Change of ownership „ „ 10, Great. Russell Street Nuisance:drain defective, and basement, yard and area, dirty Order to abate in fourteen days August 10 Defendant convicted and fined £2, and £5. 5s. costs Breach of London County Council bye-laws 35, New North Street „ 14 10, Great Russell Street Recovery of costs of work executed under Magistrate's order Judgment order and 20s. costs October 23 and 30 1, Great White Lion Street Prohibition order and 23s. costs Nuisance. W.C. foul November 12 2, do do. do. do. „ „ 14, Red Lion Passage Breach of London County Council bye-laws Defendant convicted and fined £3 and 2s. costs December 1 do Order to abate. Defendant convicted and fined 40s. and £2. 4s. costs Nuisance. Premises dirty throughout, W.C. foul, staircase defective, yard paving defective, accumulation of refuse, third floor back overcrowded „ „ 8, Lamb's Conduit Passage Order to abate. Fined £2 and 6s. costs Nuisance. Ceilings and walls of premises dirty throughout, accumulation of rubbish, absence of proper ash-bin, washhouse paving defective „ „ Order to abate. 6s. costs do Overcrowding 8 38, Short's Gardens Prohibition order and 6s. costs Nuisance. W.C. stopped and foul „ „ TABLE XI. Proceedings under the Sale of Food and Drugs Act during the year 1903. Address. Offence. Result. Date. Name. 1903. January 23 8, Beauchamp Street Selling milk adulterated with 8.7 per cent, of added water Defendant convicted and ordered to pay 12s 6d. costs Kershaw, Mrs., or Gerlock, William March 3 Selling milk containing 97.34 grains per gallon of boric acid Defendant convicted and fined 20s. and 12s. 6d. costs Otterbein, Sarah 166, Drury Lane Defendant convicted and fined 20s. and 12s. 6d. costs „ 2, Queen Street Selling milk containing 41.91 grains per gallon of boric acid Davis, Hannah Selling milk at least 13.3 per cent, deficient in fat " Defendant convicted and fined £5 and 12s. 6d. costs Municipal Lodging- House, Parker Street Longby, Charles J. Selling butter containing 83 per cent, of foreign fat 51, Eagle Street Defendant convicted and fined £5 and 12s. 6d costs „ Wastell, William 50 TABLE XI. —continued. Date. Name. Address. Offence. Result. March 5 Morgan, Alfred 37, Great Wild Street Selling milk containing 23.31 grains per gallon of boric acid Defendant convicted and fined 20s. and 12s. 6d. costs 29, Lamb's Conduit Street Davis, Mrs. April 9 Selling milk adulterated with 6.8 per cent, of added water Defendant convicted and fined 40s. and 12s. 6d. costs Wilson, W. 43, Endell Street Selling margarine unlabelled Defendant convicted and fined 20s. and 12s. 6d. costs „ Callan, John 11, Lumber Court Selling milk at least 8 per cent, deficient in fat Defendant convicted and fined 20s. and 12s. 6d. costs „ 15, Denzell Street Lott, David Selling milk from which 24.6 per cent, of the fat had been removed. Warranty produced, summons withdrawn May 6 Moor, Charles 12, Great Russell Street . Selling milk from which 16 per cent, of the fat had been removed Defendant convicted and fined 40s. and 12s. 6d. costs „ Jenkins, Richard Union Buildings Selling milk adulterated with 11-1 per cent, of added water Defendant convicted and fined 40s. and 12s. 6d. costs „ 73, Mount Pleasant Lloyd, David June 2 Selling milk from which 19-3 per cent, of the fat had been abstracted. Defendant convicted and fined 40s. and 12s. 6d. costs Saggers, F. 33, Mortimer Market „ 8 and July 7 Selling milk deficient in fat to the extent of 25 per cent. Warranty proved, summons withdrawn Chiappa, Joseph 24, Eyre Street Hill Selling milk from which 14.3 per cent, of the fat had been abstracted. July 3 Defendant convicted and fined 20s. and 12s. 6d. costs Elliott, Jane 134, Clerkenwell Road Selling milk adulterated with 11.1 per cent, of added water Defendant convicted and ordered to pay 12s. 6d. costs „ „ Padroni, Biaccio 40, Warner Street Selling milk adulterated with 6.4 per cent, of added water Defendant convicted and fined 20s. and 12s. 6d. costs „ „ Do. Do. Selling milk deficient in fat to the extent of 11 - 6 per cent. Defendant convicted and fined Is. and 2s. costs „ „ 1, Clark's Buildings Lauterwasser, Jack J „ 6 Selling milk from which 10.3 per cent, of the fat had been abstracted Defendant convicted and fined £5 and 12s. 6d. costs Lloyd, John 14, Francis Street Selling milk from which 7.0 per cent, of its fat had been abstracted Warranty proved ; summons withdrawn „ „ Busse, Miss 27, Millman Street August 18 Selling butter containing 84 per cent, of foreign fat Defendant convicted and fined £5 and 12s. 6d, costs, or 1 month's imprisonment 24, Store Street Bliss, John and Collins, William „ 24 Selling milk deficient in fat to the extent of 7.6 per cent. Warranty proved ; summons dismissed Wakelin, R. 15, Beauchamp Street „ 26 Selling milk containing at least 70 per cent, of added water Defendant convicted and fined 4s. and 12s. 6d. costs Lord Rayleigh's Dairy (Franklin Robert) 12, Great Russell Street „ 18 Selling milk deficient in fat to the extent of 18.6 per cent. Defendant convicted and ordered to pay 12s. 6d. costs 12, Great Russell Street Lord Rayleigh's Dairy (O'Brieu, Mr.) Selling milk deficient in fat to the extent of 18.6 per cent. Defendant dead, summons withdrawn „ „ 172, Wardour Street Billings, Frederick (Sudbury Dairy Company) Selling milk deficient in fat to the extent of 7.6 per cent. Third portion of sample submitted to Government Laboratory, butbottle burst before analysis. Summons withdrawn. „ „ 51 TABLE XII. Proceedings under the Dairies, Cowsheds and Milkshops Order. Date, Premises. Offence. Result. 1903. January 23 8, Beauchamp Street Selling milk on unregistered premises Defendant convicted, and ordered to pay 2s. costs TABLE XIII. Meteorology of London, 1903. (Deduced from observations at Greenwich under the superintendence of the Astronomer Royal.) 1903. Air Temperature. Bright Sunshine. Rain and other forms of Precipitation. Mean of— Mean of A. and B. Difference from Average. + Total possible. Total observed, Difference from ; Average. + Number of days. Total fall. Difference from Average. + Minimum. A Maximum, B r 0 0 0 0 hrs. hrs. hrs. m ins. ins. January 36.8 44.6 40.7 +2.2 259 57.2 + 27.9 18 2.13 +. 0.14 February 39.3 50.7 45.0 +5.5 276 73.3 + 20.5 10 1.37 - 0.11 March 38.7 53.4 46.0 + 4.3 365 132.6 + 42.7 18 2.20 + 0.74 April 36.7 52.0 44.3 - 2.9 413 128.9 - 8.5 11 1.85 + 0.19 May 44.3 63.0 53.6 + 0.5 481 182.9 + 1.1 15 1.95 - 0.05 June 47.0 64.6 55.8 - 3.6 494 187.9 + 5.0 10 6.07 + 4.05 July 52.6 71.5 62.0 - 0.4 498 184.1 - 1.3 13 5.27 + 2.80 August 51.4 69.2 60.3 - 0.4 451 188.0 + 15.9 17 4.82 + 2.47 September 49.3 66.0 57.6 + 0.4 380 169.3 + 34.6 15 2.24 - 0.01 October 46.6 58.7 52.7 + 2.7 331 84.3 - 0.3 24 4.44 + 1.63 November 39.1 49.8 44.5 + 1.3 266 35.4 - 7.2 16 1.93 - 0.34 December 34.5 42.0 38.3 - 1.4 244 21.4 - 3.6 12 1.27 - 0.50 Year 43.0 57.1 50.1 + 0.6 4,458 1445.3 + 126.8 179 35.54 + 11.01 + The averages used are obtained from observations extending over 50 years for Eain and Temperature, and 16 years for Sunshine.