HOL 13 The Metropolitan Borough of Holborn. Report for the Year 1911 OF The medical Officer of health, WILLIAM ARTHUR BOND, M.A., M D„ D.P.H. Camb, Bach. Surgery Camb., M.R.C.P.Lond. Fellow, Member of Council and late President of Metropolitan Branch, oj the Society of Medical Officers of Health; Fellow, and Member of Council, late Hon. Sec., of the Royal Institute of Public Health; Member, late Lecturer and Demonstrator, of the Royal Sanitary Institute; ate Medical Officer of Health of the St. Olave District, Southwarlc, and the Holborn District Boards of Works. London : D1PROSE, BATEMAN & CO., SHEFFIELD STREET, LINCOLN'S INN FIELDS, W.C. 1912. CONTENTS. Page. Introduction 5 Population and Houses 7 Estimated Population, 1911 7 Number of Tenements 8 Births aud Birth-rates 8 Ditto ditto corrected 9 Mortality 9 Deaths Registered 9 Deaths in Public Institutions within the Borough 10 Ditto ditto outside the Borough 10 Corrected deaths and death-rates 10 Infantile Mortality 10 Prevention of Infantile Mortality 12 Care and Feeding of Infants 12 Notification of Births Act, 1907 12 Modified Milk lor Infants 13 Senile Mortality 14 Deaths from Epidemic Diseases 14 Ditto ditto during 1911 and ten preceding years 15 Ditto Measles 15 Ditto Whooping Cough 16 Ditto Diarrhœa 16 Ditto Phthisis 16 Ditto Influenza 16 Ditto Alcoholism 16 Ditto Cancer 16 Sudden and Violent Deaths 17 Inquests 17 The Public Mortuary 17 Infectious Diseases 17 Notification of Infectious Diseases during 1911 and ten preceding years 18 Small Pox 19 Chicken Pox 19 Scarlet Fever 19 Ditto Errors in Diagnosis 19 Ditto Secondary Cases 20 Ditto Return Cases 20 Diphtheria 20 Ditto Errors in Diagnosis 20 Ditto Secondary and Return Cases 20 Enteric Fever 20 Cerebro-spinal Fever 21 Ophthalmia Neonatorum 21 Polio-myelitis and Encephalitis 21 Phthisis or Consumption 21 Ditto ditto Voluntary Notification 22 Ditto ditto Public Health (Tuberculosis) Regulations, 1911 23 Ditto ditto Final Report, Royal Commission 24 Glanders, Anthrax and Hydrophobia in Man 26 Bacteriology 26 Disinfections 26 Shelter 27 Cleansing of Persons Act, 1897 27 Housing, Town Planning, &c., Act, 1909 27 Premises Closed Voluntarily, Demolished, Rebuilt, etc. 29 Sanitary Work 32 House to House Inspections 32 A 2 4 Page. Water Supply to New Buildings 33 Ditto to Tenement Houses 33 By-laws as to Houses let in Lodgings 33 Revenue Acts 34 Overcrowding 34 Removal of House Refuse 34 Removal of Manure 34 Common Lodging Houses 35 Factories, Workshops and Workplaces 35 Bakehouses 36 "Standard" Bread and Flour 37 Home Work 38 Places where Food is prepared for Sale 38 Slaughter House 39 Dairies, Cowsheds and Milkshops 39 Ice Cream 39 Unsound Food 39 Offensive fumes from factories 40 Smoke Abatement 40 Great Queen Street Wesleyan Chapel—Removal of Human Remains 40 APPENDICES. Table I. Vital Statistics of whole Borough during 1911 and previous 10 years 43 Table II. Cases of InfeciiousDisease notified during the year 1911 44 Table III. Causes of, and Ages at Death during the year 1911 45 Table IV. Infantile Mortality during the year 1911 46 Table V. Sanitary Inspectors' Work—Inspections, &c. 47 Table VI. Ditto Notices, &c. 48 Table VII. Proceedings during 1911 50 Table VIII. Factories, Workshops. Workplaces and Homework 51 (1) Inspections 51 (2) Defects found 51 (3) Homework 52 (4) Registered Workshops 53 (5) Other matters 53 Table IX. Legal Proceedings 54 The Metropolitan Borough of Holborn. REPORT of the Medical Officer of Health For the Year 1911. 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 1911, the various statistics of the year refer to the fifty-two weeks ended Saturday, December 30th, 1911, as adopted by the Registrar-General, and known as the Registration year. The Census of the Population which was taken on Sunday, April 2nd, 1911, gave an enumerated population in the Borough of 49,357, a reduction of 10,048 on the previous census of 1901, or 169 per cent. During the previous decennium 1891-1901 there was a reduction of 7,376, or 11*0 per cent. The Borough is becoming less and less residential and more and more important as a business centre. The number of factories, workshops and workplaces keeps increasing so that we have now a very large day population. The density of population is 122 persons per acre in comparison with 61 for London. All the birth-rates and the various death-rates for the years 1901-1911 have been re-estimated on the census populations 1901 and 1911 instead of as given in previous Annual Reports on the census populations 1891 and 1901. 6 The following statistics for the year 1911 in comparison with the previous census year 1901 indicate the very great improvement that has taken place in the sanitary and hygienic condition of the Borough during the past decennium:— 1911. 1901. Death-rate per 1,000 15.2 20.0 Death-rate from the seven principal epidemic diseases 1.21 2.25 Death-rate from Phthisis 1.72 2.47 Number of notifications of Infectious disease 259 757 Notification-rate per 1,000 5.29 12.79 Infantile Mortality per 1,000 births 113 126 (1905)* Much work has been done during the year under the Housing, Town Planning, etc., Act, 1909, and the Housing Regulations of September, 1910. 129 of the worst houses in the Borough were reported on in detail, and of these I represented 31 as being unfit for human habitation. Of these 24 were made fit for human habitation and 6 were closed voluntarily. 22 other houses were closed voluntarily without the necessity for any representation being made. The defects in the remaining houses were dealt with under the Public Health (London) Act, 1891. I desire to express my high appreciation of the 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. * Details of births, names and addresses of mothers etc , were not supplied until the latter part of 1904. 7 POPULATION AND HOUSES. A Census of the Population was taken on Sunday, April 2nd, 1911. Although the report has not yet been published the Registrar-General has favoured me with some detailed information which is given in the following tables. It will be seen that the enumerated population was 49,357, a reduction of 10,048 on the previous census of 1901 or 16.9 per cent. During the previous decennium 1891-1901 there was a reduction of 7,376 or 11.0 per cent. The Borough is becoming less and less residential and more and more important as a business centre. The number of factories, workshops, workplaces and offices keeps increasing so that we have now a very large day population. The density of the population was 122 persons per acre in comparison with 61 for London. The number of inhabited buildings was 7,985 and uninhabited 1,393, and 38 were in course of erection. POPULATION. Persons. Males. Females. 1901. 1911. 1901. 1911. 1901. 1911. St. Giles and St. George, Bloomsbury 31,406 25,088 15,370 12,036 16,066 13,052 Lincoln's Inn 61 69 41 44 20 25 St. Giles and Bloomsbury 31,497 25,157 15,411 12,080 16,086 18,077 St. Andrew and St. George-the-Martyr 25,103 22,283 12,441 10,912 12,622 11,371 Liberty of Saffron Hill, Hatton Garden, Ely Rents, and Ely Place 2,561 1,733 1,488 992 1,073 741 Grays Inn 232 173 140 96 92 77 Furnivals Inn — — - - - — Staple Inn 12 11 9 9 3 2 Holborn Sub-Division 27,908 24,200 14,078 12,009 13,830 12,191 Holborn Branch 59,504 49,357 29,858 24,089 29,916 25,268 Wards— Bloomsbury, North 5,204 5,144 2,411 2,341 2,793 2,803 Bloomsbury, South 7,194 5,851 3,219 2,624 3,975 3,227 Lincoln's Inn 5,605 3,430 2,974 1,921 2,631 1,509 Saffron Hill 2,565 1,733 1,488 992 1,073 741 St. Andrew, North 4,518 3,946 2,142 1,948 2,376 1,998 St. Andrew, South-East 10,549 10,038 5,506 5,006 5,043 5,032 St. George-the-Martyr 10,280 8,483 4,942 4,063 5,338 4,420 St. Giles, Central 9,622 7,657 5,196 4,173 4,426 3 484 St. Giles, North 3,372 3,075 1,611 1,021 2,261 2,054 8 buildings. Kind of Building. Total Population. Inhab. Total Buildings. Uninhab Building. Ordinary dwelling houses 18,122 1,696 74 10 Flats and Maisonettes 16,283 4,854 427 2 Shops 4,767 653 61 16 Hotels, Inns and Public Houses 3,478 191 6 1 Offices, Warehouses, Workshops, Factories, etc,. with sleeping accommodation 1,229 364 29 8 Do. without sleeping accommodation - - 774 - Institutions 4,253 56 — - Other Buildings 925 171 22 1 Totals 49,367 7,986 1,393 38 ESTIMATED POPULATION, 1911. The following are the estimated populations at the middle of the year 1911:— St. Giles and Bloomsbury 24,990 Holborn Sub-District 24,102 Holborn Borough 49,092 London 4,521,301 NUMBER OF TENEMENTS. At the Census of 1901, the total number of tenements in the Holborn Borough was 13,790. As large a proportion as 37'5 per cent. of tbe population lived in tenements of one or two rooms, and 60.1 per cent. of the population lived in tenements of one to four rooms. REGISTERED BIRTHS AND BIRTH-RATES. District. Males. Females. Both Sexes. Birth rata per 1,000 Legitimate. Illegitimate. Total. St. Giles and Bloomsbury 386 405 719 72 791 31.8 Holborn 236 216 471 11 482 20.1 Whole Borough 622 661 1,190 83 1,273 26.0 9 CORRECTED BIRTHS AND BIRTH-RATES. Of the 791 registered births in St. Giles and Bloomsbury, a large proportion of which took place at the British Lying-in Hospital, Endell Street, as many as 416 were of infants whose mothers were non-residents in the Borough. In addition I received information of the births in outlying Institutions of 61 infants whose mothers were residents of the Borough, 20 of St. Giles and Bloomsbury and 41 of the Holborn Division, and of 4 births that were notified but not registered, 1 of St. Giles and Bloomsbury and 3 of the Holborn Division. The corrected numbers are as follows:— District. Corrected number of Births of Residents. Corrected Birth-rate per 1000. Legitimate. IUegitimate. TotaL 1911. 1810. St. Giles and Bloomsbury 339 28 367 147 14.2 Holborn 526 27 553 23.0 24.7 Whole Borough 865 55 920 18.8 19.1 In London the corrected number of births was 111,738, or a rate of 24.8 per 1,000, in comparison with 254 for 1910. MORTALITY The following deaths have been registered in the Borough (1911):— St. Giles and Bloomsbury. Holborn. Total. Males 127 381 508 Females 93 322 415 Total 220 703 923 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. St. Giles and Bloomsbury. Holborn. St. Giles Workhouse 22 - 7 - French Hospital 4 2 22 — British Lying-in Hospital 1 1 11 - Children's Hospital 3 10 — 372 National Hospital 2 - - 57 London Homoeopathic Hospital - 10 - 61 Italian Hospital 1 3 - 18 Alexandra Hospital - - - 4 Private — — 29 7 Total 33 26 69 519 There were 407 deaths of "Residents" in various Workhouses, Infirmaries, Asylums, Hospitals, &c., outside the Borough, 105 of whom were removed from Common Lodging Houses in the Borough. Of the total, 200 formerly resided in St. Giles and Bloomsbury, and 207 in the Holborn District. CORRECTED DEATHS AND DEATH-RATES, 1911. 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, 1911. Death Rate for 1911. Corresponding period 1910. In Borough. Beyond Borough. St. Giles and Bloomsbury 220 70 69 5 200 352 14.1 13.8 Holborn Sub-District 703 541 519 4 207 390 16.2 17.0 Whole Borough 923 611 588 — 407 741 15.2 15.4 Registration London 67,826 15.0 13.7 INFANTILE MORTALITY. The number of deaths of children under one year of age, and the number of deaths of children under one year of age per 1,000 total registered births and per 1,000 corrected birtlis, were the following for:— Deaths under 1 year of age. Deaths under 1 year per 1,000 registered births. Deaths under 1 year per 1,000 corrected legitimate births. Deaths under 1 year per 1,000 corrected illegitimate bii-ths. Deaths under 1 year per 1.000 corrected births. St. Giles and Bloomsbury 36 46 86 250 98 Holborn Sub-District 68 141 116 259 123 Holborn Borough 104 82 104 254 113 London 14,440 - - - 129 11 Death-rate per 1,000 corrected births in 1911 and in six preceding years. 1905. 1906. 1907. 1908. 1909. 1910. 1911. St. Giles and Bloomsbury 121 130 122 116 100 91 98 Holborn Sub-District 131 126 138 107 103 106 123 Whole Borough 126 128 131 111 101 100 113 London 129 131 116 113 108 103 129 From the above table it will be seen that since the adoption of the notification of Births Act in March, 1908, the infantile mortality of the Borough has been less than that for London. The increase in this rate last year was more than wholly accounted for by the large number of deaths from diarrhoeal diseases due to the exceptional hot and dry summer, there having been 26 deaths from diarrhoeal diseases in comparison with only 9 in 1910. Fourteen at least of the 104 deaths of infants under one year of age were of illegitimate children. Of the 104 deaths of infants during the year the Lady Sanitary Inspector was able to obtain further details respecting 96. Of the remaining 8 cases, 2 had removed and 2 died in the Workhouse. Of the 96 deaths respecting which further details were obtained, 17, principally cases of premature birth, died before taking food; only 38 were breast fed, 1 was partly, and 40 artificially fed. In 8 of these the mothers worked in factory or workshop, 14 were engaged in charing or other work outside the home, 2 were engaged in home work (tailoring), and 7 were in domestic service. There was the large number of 26 deaths of infants from diarrhoeal diseases, 16 being artificially fed, 3 partly so, and 2 unascertained. Of the 104 deaths 42 were from prenatal causes and 62 from postnatal causes. The principal causes of death of these 104 children under one year of age are given in Table V. of the Appendix. G 12 PREVENTION OF INFANTILE MORTALITY. (1) Care and Feeding of Infants. In previous Annual Reports I have given details respecting visits and inquiries made by the Lady Sanitary Inspector, with a view to improving the health of infants and diminishing the infantile mortality in the Borough. If thought desirable, instructions are given respecting the care and feeding of the child and a leaflet left. Babies that are not thriving are periodically weighed. Notices are also served for any sanitary defects found. During the year 666 first visits were made. In 51 cases the mothers could not be traced, most of these being Workhouse cases. In the remaining 615 cases) 8 children did not live long enough to take any food, 13 were partly and 14 entirely artificially fed, and 553 were breast fed at the time of the first visit, about a fortnight after birth. A large number of revisits were made, particularly in the cases of children who were not breast fed, and especially those who were feeding on modified milk. (2) Notification of Births Act, 1907. The total number of births notified in the Borough during the registration year 1911, was as follows:— Notified once only (a) By Doctors 966 (b) „ Midwives 219 (c) „ Parents and others 30 Notified twice (a) By Doctors and Parents 2 (b) „ Midwives and Parents — Total 1,217 During the same period 1,273 births were registered. During the year, Miss Orange made 666 primary visits respecting newlyborn children. She found that in 642 cases the births had been notified and in only 24 cases not notified. Of the 24 cases not notified, 11 were attended by doctors, 2 .by midwives, 10 by students, and in 1 case the person in attendance on the mother at the time of the birth could not be ascertained. I wrote in most cases requesting the reasons for non-notification. From the doctors I had replies giving reasonable grounds for their not having done so. In 13 the cases of midwives and students of hospitals, the reasons generally given were that the students or midwives, had only been recently appointed, and were not aware of the Act, or that the notification had accidently been omitted. In all cases where the births had not been notified, Miss Orange informed the mothers that it was the duty of the father, and of any person in attendance on the mother at the time of, or within six hours after the birth, to notify the same. The mothers always replied that their husbands were ignorant of the Act. (3) Modified Milk for Infants. In my Annual Report for 1906 I gave a detailed report respecting this matter and the arrangements made with the Express Dairy Company, who have various depots in and near the Borough to supply modified milk for infants of the working classes at the reduced rate of 4d. per day on production of a certificate from me. During the year 52 new certificates were issued, of which 1 was not used. Including 18 children who were taking the milk at the beginning of the year 1911, the milk was used by 69 children during the year, in comparison with 59 during the previous year. In the majority of cases the infants thrived well on the milk, in 3 cases however the milk was not suitable. In a number of cases the use of the milk was after various periods and for various reasons discontinued; in 9 cases on account of the mothers leaving the Borough. There were 5 deaths of infants who had been taking prepared milk during the year. One died from broncho-pneumonia, aged 8 months. This child had taken the milk from two months old and made good progress until it had measles followed by pneumonia. One was much wasted when it began the milk at three months old, but died at six months from gangrene of the back and toxtemia. 3 died from diarrhoea, 2 of them being twins. In each of the cases of the twins, 1 was brought up on the breast and the other twin on prepared milk, and in both cases although the parents were very poor and the homes were in a very dirty and neglected state, the twins that were fed on the breast survived. In both cases the other twins improved very much on the prepared milk. The twin of one mother died at six months old after having left off prepared milk for about a month before that. The twin of the other mother had reached the age of 11 m nths when it also died from diarrhoea and neglect. The Mayor, Councillor Walter Hazell, J.P., has for a number of years very kindly assisted poor parents who cannot afford to pay the whole amount. Of the 69 children who were taking prepared milk during the year, the parents of as many as 53 children were so assisted. In the great majority of cases, viz., 42, half the amount, 2d. per day was paid by the Mayor; in 1 case 3d., and in 10 cases Id. per day was paid. c 2 14 SENILE MORTALITY. The number of deaths of persons 65 years of age and upwards was in:— St. Giles and Bloomsbury 101 Holborn Sub-District 92 Holborn Borough 193 St Giles and Bloomsbury. Holborn Sub-District. Total. Of those the numbers were— 65 years and under 70 33 27 60 70 „ „ 75 30 25 55 75 „ „ 80 17 20 37 80 „ „ 85 10 16 26 85 „ „ 90 10 1 11 90 years of age - 1 1 91 „ - 1 1 92 „ - 1 1 95 „ 1 — 1 101 92 193 DEATHS FROM EPIDEMIC DISEASES. The following tables give details respecting the number of deaths, and the deathrates, from the seven principal epidemic diseases, viz.:—Small-pox, Measles, Scarlet Fever, Diphtheria (including Membranous Croup), Whooping Cough, Fever (including Enteric or Typhoid, Typhus and Continued), and Diarrhoea. It will be seen that the number was only 59 in comparison with a decennial average of 80. The death-rate for the Borough was only 1-21 in comparison with 219 for London. Number. Epidemic Death-Rate. St. Giles and Bloomsbury 17 0.68 Holborn Sub-District 42 1.75 Holborn Borough 59 1.21 And for London 9.858 2.19 The following are the number of deaths from the separate diseases:— St. Giles and Bloomsbury. Holborn Sub-District. Holborn Borough. London. Small-pox - - - 9 Measles 7 8 15 2,570 Scarlet Fever 2 1 3 172 Diphtheria and Membranous Croup — 3 3 612 Whooping Cough 1 2 3 1,038 Typhoid Fever 1 1 2 144 Typhus — — — — Diarrhœa (under 2 } ears of age) 6 27 33 5,313 Total 17 42 59 9,658 15 DEATHS FROM EPIDEMIC DISEASES OCCURRING IN THE BOROUGH DURING THE YEAR 1911 AND DURING THE PRECEDING TEN YEARS. Year. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhœa. Total. Number. Rate per 1000. Number. Rate per 1000. Number. Rate per 1000. Num. ber. Rate per 1000. Number. Rate per 1000. Number. Rate per 1000. Number. Rate per 1000. Number. Rate per 1000. 1901 30 0.51 22 0.37 3 0.05 14 0.24 10 0.17 12 0.20 42 0.71 133 2.25 1902 46 0.79 30 0.52 8 0.14 11 0.19 27 0.46 6 0.10 14 0.24 142 2.44 1903 - - 17 0.30 4 0.07 7 0.12 15 0.26 5 0.09 22 0.38 70 1.22 1904 2 0.04 43 0.76 - - 7 0.12 8 0.14 4 0.07 35 0.62 99 1.75 1905 — — 11 0.20 3 0.05 4 0.07 15 0.27 4 0.07 22 0.40 59 1.07 1906 — — 25 0.46 2 0.04 7 0.13 10 0.18 1 0.02 39 0.72 84 1.55 1907 - - 13 0.34 3 0.06 10 0.19 27 0.51 2 0.04 16 0.30 71 1.34 1908 - - 10 0.18 6 0.11 5 0.09 7 0.13 4 0.08 26 0.49 58 1.09 1909 - - 14 0.27 3 0.08 3 0.06 15 0.29 1 0.02 7 0.14 43 0.84 1910 — — 13 0.26 - - 4 0.08 16 0.32 4 0.08 6 0.12 43 0.86 Average for 10 years 19011910. 7.8 0.13 19.8 0.36 3.2 0.06 7.2 0.13 15.0 0.27 4.3 0.08 22.9 0.41 80.2 1.44 1911 — — 15 0.31 3 0.06 3 0.06 3 0.06 2 0.04 33* 0.67* 59 1.21 London, 1911. 9 0.00 2,570 0.57 172 0.04 612 0.14 1,038 0.23 144 0.03 5313* 1.18* 9,858 2.19 * The Registrar General now (1911) takes the deaths from Diarrhoea and Enteritis under two years of ago. MEASLES. Measles, although apparently less prevalent than in the year 1910, was more fatal, and was again much less prevalent than in the year 1906. We received information of 101 cases in comparison with 231 in 1910, 139 in 1909, 86 in 1908, and 370 in 1906. Most of the cases and deaths occurred in February and March. There were 15 deaths or a rate of 0'31 per thousand in comparison with a decennial rate of 0.36. Of these 7 belonged to St. Giles and Bloomsbury and 8 to the Holborn District. During the year the Education Department of the London County Council excluded all the unprotected children from certain classes, in the Infants Department, of the undermentioned schools from and up to the dates specified :— St. John-the-Evangelist, Class C—22nd February to 10th March, and 8th to 29th June. Wild Street, Room A—24th February to 3rd March. St Andrew, Holborn, under 5—1st to 17th March. St. Peter's (Italian), under 5—13th to 31st March. Christ Church, Classes B & C—19th June to 7th July. 16 Cases that cannot be satisfactorily isolated and nursed at home can now be removed to hospitals of the Metropolitan Asylums Board, on the recommendation of the Medical Officer of Health, provided accommodation is available. WHOOPING COUGH Whooping cough was returned as the cause of 3 deaths during the year, in comparison with 16 in the preceding year. Two of the deaths were in St. Giles and Bloomsbury and 1 in the Holborn District. All were children under 2 years of age. The death rate was 0 06 per 1,000 in comparison with the decennial average of 0.27. diarrhœa and enteritis. The number of deaths from diarrhoea and enteritis was 39. Ten belonged to St. Giles and Bloomsbury and 29 to the Holborn District. 33 were children under 2 years of age, 26 being under 1 year of age. The Registrar-General has introduced a change in the method of classification of diarrhœal deaths. He now takes the deaths from diarrhoea and enteritis under two years of age, instead of deaths at all ages from cholera, dysentery and diarrhoea. In the Borough there were 33 deaths, or a rate of only 0 67 per 1,000, in comparison with 1.18 for London with 5,313 deaths under two years of age. 29 of our deaths and 4,310 London deaths occurred during the exceptionally hot summer quarter. PHTHISIS. For details see pages 22-24. INFLUENZA. During the year there was only 1 death registered as due to influenza. ALCOHOLISM. Only 16 deaths were assigned to alcoholism or cirrhosis of liver, 7 in St. Giles and Bloomsbury. and 9 in the Holborn District. These represent only a portion of the deaths really caused by alcoholism, as they are frequently registered under the headings of other secondary causes. CANCER. Fifty-four deaths were registered as due to cancer or malignant disease, 29 belonging to St. Giles and Bloomsbury and 25 to the Holborn District. 17 SUDDEN AND VIOLENT DEATHS. Inquests. The following inquests on the bodies of Parishioners were held:— Coroner: Mr. Walter Schroder, Office, Manor Place, Paddington Green, W. Inquiry Officer: Mr. Richard Powell 58, Hemingford Road, Barnsbury, N. District. Total Number. Cause of Death. Natural. Accidents. Suicide. Murder. St. Giles and Bloomsbury 39 19 14 6 — Holborn 37 16 18 3 — Total 76 35 32 9 — THE PUBLIC MORTUARY, GOLDSMITH STREET. 107 bodies were received (38 being non-parishioners), and on these 66 inquests were held, and 63 post-mortems made. District. Bodies Received. Inquests held. Post-mortems. Non-Parishioner St. Giles and Bloomsbury 50 35 27 17 Holborn 57 31 26 21 Total 107 66 53 38 Further details as to the causes of and ages at death are given in Table III. of the Appendix. NOTIFICATIONS OF INFECTIOUS DISEASES. The number of notifications of infectious diseases in the Borough during 1911 was 259 in comparison with a decennial average of 356. During the past eight years the notifications per 1,000 of the population have been less than for London, and last year were 5.29 per 1,000 in comparison with 5.57 for London. For further details, see Table II. NOTIFICATIONS OF INFECTIOUS DISEASES IN THE BOROUGH DURING 1911, AND DURING THE PRECEDING TEN YEARS, AND RATES PER 1,000. Year. Small-pox. Diphtheria and Membranous Croup. Scarlet Fever. Enteric Fever. Continued Fever. Erysipelas. Puerperal Fever. Typhus Fever. Ophthalmia Neonatorum. Cerebrospinal Fever Acute Polio-myelitis. Total. No. Rate per 1000. No. Rate per 1000. No. Rate per 1000. No. Rate per 1000. No Rate per 1000. No. Rate per 1000. No. Rate per 1000. No. Rate per 1000. No. Rate per 1000. No. Rate per 1000. No. Rate per 1000. No. Rate per 1000. 1901 211 3.57 161 2.72 254 4.29 39 0.66 0 0.00 89 1.50 2 0.03 1 0.02 - - - - - - 757 12.79 1902 217 3.73 113 1.94 202 3.47 39 0.67 0 0.00 85 1.46 6 0.10 0 0.00 — — — — - — 662 11.37 1903 2 0.03 53 0.93 144 2.52 53 0.93 2 0.03 90 1.57 4 0.07 0 0.00 - - - - - — 348 6.08 1904 6 0.11 46 0.82 99 1.76 41 0.73 0 0.00 77 1.37 7 0.12 0 0.00 — — — — - — 276 4.91 1905 1 0.02 47 0.85 156 2.82 21 0.38 1 0.02 35 0.63 2 0.03 0 0.00 — — — — — — 263 4.76 1906 0 0.00 66 1.22 137 2.53 15 0.28 0 0.00 56 1.03 2 0.03 0 0.00 - - - - - — 276 5.10 1907 0 0.00 64 1.21 156 2.94 14 0.26 0 0.00 40 0.75 1 0.02 1 0.02 - — 2 0.03 - - 278 5.24 1908 0 0.00 50 0.94 193 3.64 25 0.47 0 0.00 46 0.87 2 0.03 0 0.00 - — 0 0.00 - - 316 5.96 1909 1 0.02 47 0.92 98 1.92 16 0.31 1 0.02 41 0.80 3 0.06 0 0.00 - - 0 0.00 - - 207 4.06 1910 0 0.00 45 0.90 68 1.36 25 0.50 0 0.00 42 0.84 0 0.00 0 0.00 - — 1 0.02 - - 181 3.62 Average for 10 years 1901-1910. 43.8 0.75 69.2 1.25 150.7 2.73 28.8 0.52 0.4 0.01 60.1 1.08 2.9 0.05 0.2 0.00 — — — — — — 356.4 6.39 1911 0 0.00 85 1.74 120 2.45 10 0.20 0 0.00 37 0.76 2 0.04 0 0.00 5 0.10 0 0.00 0 0.00 259 5.29 London,1911 72 0.02 7,404 1.64 10,500 2.33 1,024 0.23 23 0.01 4,904 1.09 303 0.07 1 0.00 674 0.15 100 0.02 69 0.02 25,074 5.56 Chicken-pox was notifiable from October 19th, 1901. to January 6th, 1908. inclusive, during which time 282 notifications were received, and from April 8th to November 6th, 1904, inclusive, during which time 61 notifications were received; and in 1911, from 22nd March to 21st June, during which period 101 notifications were received. Anthrax, nil; Glanders, nil; Hydrophobia, nil; Acute Polio-myelitis, nil; Acute Encephalitis, nil. There were also the following voluntary notifications of Phthisis:- 1904 344 1908 162 1911 Voluntary 3 1905 208 1909 Voluntary 16 „ Hospital 81 1906 191 „ Poor Law 326 „ Poor Law 104 1907 171 342 188 1910 Voluntary 16 „ Poor Law 154 170 19 SMALL POX. There was no notification of small pox in the Borough during the year. There was a small outbreak of small-pox, principally confined to the Eastend of London of 70 cases, 28 of which occurred at the Mile End Infirmary. Of the 70 cases 17 were children under 10 years of age, only three of whom had been vaccinated. The three vaccinated all recovered. Of the 14 unvaccinated eight died, a death rate of 57.1 per cent. This outbreak, in accordance with all experience of epidemic small-pox, shows the great advantage of vaccination and revaccination. CHICKEN POX. On account of the above outbreak of small-pox, chicken-pox was notifiable for three months from the 22nd March, 1911, during which period 101 notifications were received. There was an outbreak of chicken-pox at the St. Giles' Workhouse, at which nine cases occurred. SCARLET FEVER. Excluding duplicates, the number of notifications of scarlet fever was 120 in comparison with only 68 in the year 1910. Of these 80 belonged to St. Giles and Bloomsbury and 40 to the Holborn District. In the St. Giles District all the cases were removed to hospital, and in the Holborn District all but one. The number of notifications was equal to 2.45 per 1,000 in comparison with 233 for London. The average for the preceding decennium in the Borough was 2.73 per 1.000. There was rather a large outbreak, especially in the St. Giles and Bloomsbury District, during the months of June and July, when 53 of the 120 cases were notified. In this division of the Borough for a number of years there had been but little scarlet fever. There was therefore a large number of unprotected children. For instance in one of the streets, Betterton Street, which has a large number of children, 16 cases were notified, while in the preceding six years the total was only six cases. Two of the "return" cases were not only the probable source of two other cases in the respective houses in which they resided, but they both attended the St. Giles, Endell Street School, at which there were 16 cases before the summer holidays. Errors in Diagnosis. During the year only seven cases were returned as not suffering from scarlet fever, or only 5.8 per cent. of the notifications. d 20 Secondary Cases of Scarlet Fever. Exclusive of the above seven cases, and two nurses at a hospital, of the remaining 111 notifications 83 occurred in houses in which there was no secondary case. In two houses there were four cases and in four houses three cases, and in four houses two cases occurred. "Return" Cases of Scarlet Fever. Two patients after their return home each led to two return cases, i.e., cases which occurred in the house soon after the return home of a patient from hospital. Both of these attended the same school as mentioned above. DIPHTHERIA. The number of cases of diphtheria notified was 85 of which 33 belonged to St. Giles and Bloomsbury and 52 to the Holborn District. All but one were removed to Hospital. The notification rate was 1.74 per 1,000 in comparison with 1.64 per 1,000 for London. The average for the preceding decennium for the Borough was 1.25 per 1,000. Errors in Diagnosis. Four patients were returned from the Hospital of the Metropolitan Asylums Board not suffering from diphtheria, or only 4.7 per cent. of the cases notified. Secondary and Return Cases. Excluding the above four cases and three nurses at a hospital, of the remaining 78 cases 61 occurred in houses in which there was no secondary case. In three houses there were three cases notified, and in four houses two cases each. One patient apparently caused two "return" cases which were notified 10 days after the return home of the patient from hospital. Diphtheria Anti-toxin was supplied free of charge in 10 cases. ENTERIC FEVER. Excluding duplicates there were 10 notifications in comparison with 25 for the preceding year. Six belonged to the St. Giles and Bloomsbury District and four to the Holborn District. These notifications corresponded to a rate of 0.20 per 1,000 in comparison with 0.23 for London. Of these ten cases four were not contracted in the Borough, and of the remaining six three were probably contracted from eating infected shell fish. 21 CEREBRO SPINAL FEVER. (Epidemic Cerebro-Spinal Meningitis). No case was notified during the year. OPHTHALMIA NEONATORUM. Ophthalmia Neonatorum is an infectious inflammation of the eyes in newlyborn children, and is the most common cause of blindness beginning in infancy. It became compulsorily notifiable on the 13th March, 1911. Arrangements were made by the London County Council for cases of inflammation of the eyes in newly-born which are notified to the Medical Officer of Health of the County Council by midwives to be visited in the first instance by an Inspector under the Midwives Act, when, if hospital treatment is urgently necessary, immediate steps should be taken to obtain it and information sent to the Medical Officer of Health. Five cases were notified in the Borough during the year. These cases were visited by the Lady Sanitary Inspector. Two of the infants were attended at Ophthalmic Hospitals and three by their own doctors. POLIO-MYELITIS AND ENCEPHALITIS. Acute Polio-myelitis and Encephalitis, or inflammation of the grey matter of the spinal cord and brain, commonly known as infantile paralysis, was made notifiable on the 1st September, 1911. No notification was received during the year. There were sixty-nine notifications in London. PHTHISIS OR CONSUMPTION. The number of deaths from phthisis during the year was 96, or a death-rate of 196 per 1,000, or 1.72 if corrected for sex and age. distribution. Of these 44 belonged to St. Giles and Bloomsbury, a death-rate of 1.77, and 52 to the Holborn District or a death-rate of 2.16 per 1,000. Although the death-rate from phthisis is still high in the Borough there has been a satisfactory reduction in the death-rates during the past ten years, as is shown in the table given below, and last year was as in 1910 the lowest recorded. It must also be remembered that in Holborn there is a much larger proportion of persons living in common lodging houses than in any other London Borough. In Holborn the rate is as many as 355 beds per 10,000 of the population; whereas in Hampstead there are no common lodging houses, and 12 Boroughs have less than one-tenth the proportion of Holborn. D 2 22 During the seven years 1904-1910 the average death-rate in common lodging houses in Holborn per 1,000 beds was about 20. Also during the past eight years more than 30 per cent. of the deaths from phthisis in Holborn had been residents in common lodging houses in the Borough. During the past year of the 96 deaths, 31 had been removed to infirmaries from common lodging houses in the Borough, 16 from St. Giles and Bloomsbury, and 15 from the Holborn District. The corrected number of deaths in London was 6,084, equal to a rate of l-35 per 1,000, in comparison with 1.23 for 1910. The following table gives the number of deaths in the Holborn Borough and the death-rates per 1,000 (crude and corrected for sex and age distribution of the Holborn population in comparison with London) and the corresponding rates for London, for the 11 years 1901-1911. Year. Holborn Borough. London. Rate per 1,000 Deaths. Death-Rate per 1,000. Crude. Corrected. 1901 166 2.81 2.47 1.66 1902 182 3.08 2.71 1.61 1903 170 2.98 2.62 1.57 1904 157 2.80 2.46 1.65 1905 149 2.71 2.38 1.46 1906 118 2.18 1.92 1.49 1907 125 2.36 2.07 1.46 1908 105 1.97 1.73 1.39 1909 108 2.11 1.85 1.40 1910 98 1.96 1.72 1.23 1911 96 1.96 1.72 1.35 VOLUNTARY NOTIFICATION OF CONSUMPTION. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1908. The Voluntary Notification of Consumption was in the first instance put into force for a period of 12 months from the 1st January, 1904, the fees to be paid being the same as for the notifiable diseases; it has been extended from time to time, on the last occasion for three years 1909-11 inclusive. As a large proportion of the voluntary notifications formerly received were Poor Law cases, the great majority are now compulsory notifications under the Public Health (Tuberculosis) Regulations, 1908. Excluding many duplicate notifications, there were 187 cases notified; 68 belonging to St. Giles and Bloomsbury and 119 to the Holborn District. The corresponding numbers for the year 1910 were respectively 170, 61 and 119. 23 Of the total number 187 notifications received, 68, or 36 per cent. were residents of common lodging houses, and were all but 4 at once or soon afterwards removed to workhouse infirmaries. With few exceptions the remaining 119 lived in tenement houses. 58 of these were soon removed to infirmaries or hospitals so that 61 remained at home, and some of these had previously been in sanatoria or infirmaries. In previous Annual Reports I gave details as to the action that is taken and the various results that were obtained from the enquiries made. I may, however, remind the Council that a printed leaflet on the Prevention of Consumption, giving instructions for measures to be taken to prevent the spread of the disease, is left in all cases occurring in tenement houses, and spitting flasks are supplied free of charge where required. After death, or removal to infirmary or hospital, disinfection is advised. Consent for this was obtained in 56 cases. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1911. The Local Government Board issued an Order, which came into operation on the 1st May, 1911, embodying further Regulations to provide for the notification of cases of pulmonary tuberculosis occurring amongst the in-patients or out-patients at hospitals, or other similar institutions for the treatment of the sick, which are supported wholly or partially otherwise than by the contributions of the patients (or of their relatives or guardians) and otherwise than from rates and taxes. By a subsequent Order of the 15th November, 1911, which came into force on the 1st January, 1912, the system of notification was completed by extension to all medical practitioners including school medical inspectors. For the purposes of these Regulations, and of the Poor Law Regulations, and of the Hospital Regulations, a Council on the advice of their Medical Officer of Health may supply all such medical or other assistance, and all such facilities and articles as may reasonably be required for the detection of pulmonary tuberculosis, and for preventing the spread of infection and for removing conditions favourable to infection, and for that purpose may appoint such officers, do such acts and make such arrangements as may be necessary. A Council on the advice of their Medical Officer of Health may provide and publish or distribute in the form of placards, handbills or leaflets suitable summaries of information or instruction respecting pulmonary tuberculosis, and the precautions to be taken against the spread of infection from that disease. 24 Final report of the Royal Commission on Tuberculosis, The Royal Commission appointed to inquire into the relations of human and animal tuberculosis has now made its final report, and we consider it desirable that the attention of the Council should be directed to its main conclusions. The Commissioners were appointed to inquire and report with respect to tuber culosis:— (1) Whether the disease in animals and man is one and the same; (2) Whether animals and man can be reciprocally infected with it. (3) Under what conditions if at all, the transmission of the disease from animals to man takes place, and what are the circumstances favourable or unfavourable to such transmission. In answer to the first question the conclusion arrived at is that "man must therefore be added to the list of animals notably susceptible to bovine tubercle bacilli," and that "whether one prefers to regard bovine tuberculosis and the cases of tuberculosis in man which are caused by the human type of bacilli as varieties of the same disease or as independent diseases, there can be no question that human tuberculosis is in part identical with bovine tuberculosis." As regards the second term of the reference the report states that mammals and men can be reciprocally infected with tuberculosis, that bovine animals are not completely immune to the human tubercle bacillus and adult human beings can be infected with the bevine type, even the pulmonary form of this disease in man being sometimes caused by the bovine tubercle bacillus. In answer to the third question, viz., under what conditions, if at all, the transmission of tuberculosis from animals to man takes place, and what are the circumstances favourable or unfavourable to such transmission, the report states that, as regards human tuberculosis, "animals, domestic and other, which have been found capable of suffering from severe generalised tuberculosis of the human type are comparatively few," and that "probably only where the cow or goat has received a large dose of tuberculous material derived from man does the human tubercle bacillus escape into the blood stream of the animal, reach her milk sinusos and become eliminated with her milk." It cannot, however, the report goes on to say, be confidently affirmed that man is wholly free from risk through animal food, although the degree of danger cannot at present be determined. Turning to bovine tuberculosis, the report shows that as regards the individual cases under observation of persons suffering from tuberculosis, the lesions of the disease (especially pulmonary tuberculosis) when fatal have been referable, with few exceptions, to human bacilli. On the other hand, the report states that "there can be no doubt that a considerable proportion of the tuberculosis affecting children is of bovine origin, and particularly that which effects primarily the 25 abdominal organs and the cervical glands." The report goes on to say that "judging by our feeding experiments there would appear to be strong presumption that as regards most animals comparatively large doses given either singly or by frequent repetition are necessary to produce by ingestion acute progressive generalised tuberculosis, though we have recorded instances in which a very small dose administered but once has produced this result. Applying a like presumption to man (and our observations on the monkey and chimpanzee in this connection afford warrant for so doing) it may be asked in what way are children, the members of the human family who are especially liable to exhibit acute fatal tuberculosis commencing as an abdominal affection, most likely to obtain a large and fatally infective dose of tubercle bacilli ? As already indicated by us, to this question there can be but one answer—namely, that the evidence which we have accumulated goes to demonstrate that a considerable amount of the tuberculosis of childhood is to be ascribed to infection with bacilli of the bovine type transmitted to children in meals consisting largely of the milk of the cow." In conclusion the report refers in the following terms to the steps that should, in the opinion of the Commissioners, be taken to prevent the spread of bovine tuberculosis—"Meanwhile we, in view of the evidence adduced by us, regard ourselves as called upon to pronounce on administrative measures required in the present for obtaining security against transmission of bovine tubercle bacilli by means of food. In the interests therefore of infants and children, the members of the population whom we have proved to be especially endangered, and for the reasonable safeguarding of the public health generally, we would urge that existing regulations and supervision of milk production and meat preparation be not relaxed; that on the contrary, Government should cause to be enforced throughout the kingdom food regulations planned to afford better security against the infection of human beings through the medium of articles of diet derived from tuberculous animals. "More particularly we would urge action in this sense in order to avert or minimise the present danger arising from the consumption of infected milk. And in this connection it may be convenient for us to repeat certain facts observed by us in reference to the conditions tending to the elimination by the cow of bovine tubercle bacilli in her milk; facts in our opinion of such importance that they formed the subject of our third interim report. Bovine tubercle bacilli are apt to be abundantly present in milk as sold to the public when there is tuberculous disease of the udder of the cow from which it was obtained. The fact is, we believe, generally recognised though not adequately guarded against. But these bacilli may also be present in the milk of tuberculous cows presenting no evidence whatever of disease of the udder even when examined post-mortem. Further, the milk of tuberculous cows not containing bacilli as it leaves the udder may, and frequently does, become infective by being contaminated with 26 the faeces or uterine discharges of such diseased animal. We are convinced that measures for securing the prevention of ingestion of living bovine tubercle bacilli with milk would greatly reduce the number of cases of abdominal and cervical gland tuberculosis in children, and that such measures should include the exclusion from the food supply of the milk of the recognisably tuberculous cow, irrespective of the site of the disease, whether in the udder or in the internal organs." The report of the Royal Commission indicates the need for more ample powers than are now possessed for the exclusion of tuberculous milk from London, and the desirableness of the continual exercise of existing powers until the subject can be dealt with in a comprehensive manner by Parliament. GLANDERS, ANTHRAX AND HYDROPHOBIA IN MAN. No notifications were received. BACTERIOLOGY. The following table gives details of the examinations made by the Lister Institute of Preventive Medicine and the Royal Institute of Public Health during the year District. Diphtheria. Enteric Fever. Consumption. Number Submitted. Result of Examination. Number Submitted. Result of Examination. Number Submitted. Result of Examination. St. Giles and Bloomsbury 15 7 bacilli not found 2 2 Negative 33 8 bacilli not found 8 bacilli found 25 bacilli found Holborn 56 35 bacilli not found 1 0 Positive 21 9 bacilli not found 21 bacilli found 1 Negative 12 bacilli found Whole Borough 71 42 bacilli not found 3 3 Negative 54 17 bacilli not found 29 bacilli found 0 Positive 37 bacilli found DISINFECTIONS. During the 52 weeks ended December 30th, 1911. District. Rooms. Bedding, &c. Number of Articles. Number of Persons using Shelter. St. Giles and Bloomsbury 223 3,358 - Holborn 225 2,256 3 Whole Borough 448 5,614 3 27 SHELTER DURING DISINFECTION OF HOUSES. As the Council's Shelter for the accommodation of persons during the disinfection of their houses at No. 191, High Holborn, was demolished in July, 1906, the Council made arrangements with the adjoining Borough of Finsbury for the use of their shelter. As the disinfectors work very early and very late, if required, it was only necessary to use the shelter during the year for the accommodation of 3 persons. CLEANSING OF PERSONS ACT. During the year 133 persons (130 men and 3 women) infested with vermin had their bodies and clothing disinfected free of charge. All had their bodies cleansed in the baths of the St. Giles and Bloomsbury Casual Wards in Goldsmith Street, and 940 articles were disinfected in the Council's steam apparatus. Under the London County Council (General Powers) Act, 1907, powers are given to that Council for the compulsory cleansing of verminous children attending any of the Council's schools, and verminous inmates of any common lodging house. HOUSING TOWN PLANNING &c. ACT 1909. Proceeding Under Section 17. Houses Inspected. Represented by Medical Officer of Health. Defects Remedied without Closing Orders. Closed Voluntarily. General Character of Defects. Remarks. Short's Gardens, No. 17 Yes - - Insufficient light and ventilation of rooms, staircase and W.C.'s. Defective roofs and dampness and dilapidations Closing Order made, premises made fit and Closing Order determined. Lamb's Conduit Passage, Nos, 1 to 20 - - - ditto Adjourned by Committee. The worst houses Nos. 14 to 20 were for sale, for rebuilding, and now demolished. Goldsmith Street, Nos. 25, 27, 29, 31,33 — — Nos. 25, 27, 29, and 31 ditto Since demolished. Ormond Yard, Nos. 2, 3, 4, 5, 6, 8, 9, 10, 12, 14, 15, 16, 17, 18, 19, 20, 21, 23, 25, 26, 27, 28, 32, 37, 38, 40, 41, 42, 50, 51, 53, 54, and 56 Nos. 3, 8, 14, 15, 19, 21, 25, 26, 28, 32, 37. 40, 41, and 42 In all cases - ditto Defects of other houses remedied under Public Health (London) Act, 1891. Short's Gardens, No. 19 Yes. — — ditto Work in progress, but unsatisfactory; so Closing Order made April, 1912. Torrington Mews, Nos. 11 to 23 - - Nos. 11, 13, 14, 15, 16, 18, and 19 ditto Negotiations in progress for surrender of leases. Adjourned. Nos. 11 to 19 now demolished. E 28 Housing, Town Planning, &c., Act, 1909—continued. Houses Inspected. Represented by Medical Officer of Health. Defects Remedied without Closing Orders. Closed Voluntarily. General Character of Defects. Remarks. Emerald Street, Nos. 4, 14, 16, 18, 22, 24, 30, 36, and 38 Nos. 4, 14, 16, 18, 22, and 24 No. 4 Nos. 14, 16, 18, 22, and 24 Insufficient light and ventilation of rooms, staircase and W.C.'s. Defective roofs and dampness and dilapidations No. 30 dealt with under Sec. 15. Housing, Town Planning, etc., Act, 1909, and now closed. Nos. 36 and 38 under Public Health (London) Act, 1891 Woburn Mews, Nos. 1 to 14 Nos. 1, 2, 4, 5, 6, 7, 8, 12, and 13 Nos. 1, 4, 5, 6, 7, 8, 12 and 13 No. 2 ditto Others dealt with under Public Health (London) Act, 1891. Bishop's Head Court, Nos. 1 to 11 — — Nos. 1 to 11 ditto — Nottingham Court, Nos. 1, 2, 3, 13, 14, 15, and 16 — — — ditto Consideration adjourned. For sale for rebuilding. Neal Street, Nos. 34, 36, 38, 40, 42, 44, and 46 — — — ditto ditto. Short's Gardens, Nos. 30, 32, 34, 36, and 38 — — — ditto ditto. 5, Hand Court — — — Dilapidations Dealt with under Public Health (London), Act, 1891. Total Nos., 129* 31 23 28 — One Closing Order. Defects remedied and Closing Order determined. * A number of other inspections made toward the end of the year and dealt with in 1912 will be included in Report for that year. It will be seen from the above that a Closing Order last year was made only for No. 17, Short's Gardens, the first house represented under the above Act. A large amount of work which included the demolition of the four upper stories of the back addition was carried out and the Closing Order was afterwards determined. In all the other cases the owners either closed the houses voluntarily, or agreed to carry out the works required to render the premises fit for human habitation, and the Committee therefore decided in those cases not to recommend the Council to make any formal Closing Order. I made an inspection of a large number of houses in the Borough, and made lists of dwelling-houses, including the above 129, the early inspection of which was in my opinion desirable, and keep adding to these lists from time to time. Underground Rooms habitually used as Sleeping Places. In accordance with the Sub-Section 7 of the same Section (17) of the Act, "A room habitually used as a sleeping place, the surface of the floor of which "is more than three feet below the surface of the part of the street adjoining 29 "or nearest to the room, shall for the purpose of this section be deemed to be "a dwelling house so dangerous or injurious to health as to be unfit for human "habitation, if the room either— (a.) is not on an average at least seven feet in height from floor to ceiling; or (b.) "Does not comply with such regulations as the Local "Authority with the consent of the Local Government Board may "prescribe for securing the proper ventilation and lighting of such rooms, and the protection thereof against dampness, effluvia, or ex"halation: Provided that if the Local Authority, after being required "to do so by the Local Government Board, fail to make such regula"tions, or such regulations as the Board approve, the Board may "themselves make them, and the regulations so made shall have effect "as if they had been made by the Local Authority with the consent "of the Board. "Provided that a Closing Order made in respect of a room to which this ''sub-section applies shall not prevent the room being used for purposes ''other than those of a sleeping place; and that, if the occupier of the room "after notice of an order has been served upon him fails to comply with the "order, an order to comply therewith may, on summary conviction, be made "against him. A Closing Order made in respect of any room to which this "sub-section applies shall not be treated as a Closing Order in respect of a "dwelling house for the purposes of Section 18 of the Act which deals with "Demolition Orders." I prepared suggested regulations in accordance with the above, and after careful consideration by the Committee the matter was adjourned for the present. LIST OF PREMISES CLOSED, DEMOLISHED OR REBUILT DURING 1910. St. Giles and Bloomsbuhy. Alfred Mews, No. 18. Premises closed for demolition. Alfred Place, Nos. 28 to 31. Site still vacant. Betterton Street, Nos. 15 and 16. Site still vacant. Broad Street, Nos. 13 to 17. New Prince's Theatre built. Chenies Street, No. 7. Closed. Drury Lane, Nos. 166 to 171. Middlesex Music Hall rebuilt. Do. Nos. 190 and 191. Rebuilt. Francis Street, Nob. 14 to 18. Site still vacant. Goldsmith Street, Nos. 3, 5 and 7. Site still vacant. E 2 30 Gower Street, Nos. 22 to 42. Demolished. Do. Nos. 44 to 54 (inclusive) and Malet Street. New residential chambers being built for Bourne and Hollingworth's staff. Great Queen Street, Nos. 65 to 69a. Being rebuilt. Great St. Andrew Street, Nos. 43 to 47 and New hotel being built. Great White Lion Street, Nos. 1, 2, 3 and 4. High Holborn, Nos. 162, 163, 164, and 168. New Post Office being rebuilt. Do. Nos. 249, 250, 251, 252, 253, 254 and 255. Being demolished. Keppel Mews (North). Nos. 43 and 44. Site still vacant. Do. Nos. 49 and 58 do. Keppel Street (South Side). Site still vacant. Kingsway. Corner of Keeley Street to No. 1, Wild Court. New premises built. Do. Holy Trinity Church. Rebuilt. Lincoln's Inn Fields, Nos. 52, 53 and 54. Being demolished. Middle Yard, Wild Court (adjoining Connaught Rooms.) Rebuilt. Montague Place (North side). Site still vacant. Do. (South side). Rebuilding. (British Museum extension). Museum Street, No. 60. Rebuilding. North Crescent, Nos. 1 to 13. Closed to be demolished. Red Lion Yard. Workshops. Being demolished. Russell Mews. Site still vacant. Russell Square, Nos. 9, 65 and 66. Rebuilding. Shaftesbury Avenue, No. 206. New Princes Theatre built. Shelton Street, Nos. 1 and 2. Middlesex Music Hall rebuilt. South Crescent, Nos. 1 to 5. Front portion still vacant. Southampton Row, Nos. 88 to 98. Rebuilt. Torrington Place, Nos. 9 and 10. New shop and house built. Torrington Mews, Nos. 11 to 19. Closed. Do. (East), Nos. 7 and 8. Closed. Tottenham Court Road. New premises built for Y.M.C.A., also fronting to Gt. Russell Street, Bedford Avenue and Caroline Street. Do. Nos. 205 and 206. Closed to be demolished. Do. No. 268. New Electric Theatre built. Do. Nos. 193 and 195. Site still vacant. West Street, Nos. 2, 4, 6 and 8. Partly demolished. Whetstone Park, Nos. 36, 37, 38 and 39, and Carter's Seed Warehouse. Being demolished. Wild Court, rear of International Buildings. New premises built. Woburn Mews, Nos. 10 and 38. Closed. Do. Nos. 15-34. Site still vacant. Woburn Place, Nos. 42-53 do. 31 Holborn. Beauchamp Street, Nos. 6, 7 and 8. Eebuilt. Bell Court, No. 20. Rebuilding. Bishop's Head Court, Nos. 4 and 5. Demolished. Do. Nos. 6, 7, 8 and 9. Site still vacant Boswell Court, Nos. 10 to 13. Site still vacant. Devonshire Street, Nos. 30 and 31. Rebuilt. Do. Nos. 44, 45, 46 and 47. Demolished. Dunstable Court. Site still vacant. Eagle Street, Nos. 9, 10 and 11. Site still vacant. Do. No. 42. Site still vacant. Do. No. 43. Rebuilding. Do. Nos. 53, 56 and 58. Closed. Gloucester Street, No. 6. Site still vacant. Great Ormond Street, No. 58. Rebuilt. Do. Nos. 63, 65, 67, 69. Rebuilding. Hattou Garden, No. 94. Rebuilt. Do. No. 102. Rebuilding. Kirby Street, Nos. 2 and 21. Rebuilding. Leather Lane, Nos. 6 to 8. Rebuilding. Do. Nos. 9 to 11. Demolished. Do. Nos. 13 to 15. Rebuilt. Do. No. 48. Demolished. New North Street, Nos. 20 to 28. Site still vacant. Ormond Yard, Nos. 30, 31, 44 to 48. Rebuilt. Queen Square, Nos 8 to 11. Rebuilding. Do. Nos. 34, 35 and 36. Rebuilt. Queen Square Place, Nos. 3 and 4. Rebuilding. Red Lion Street, No. 47. Rebuilt. Do. No. 48. Site still vacant. Do. No. 70. Rebuilt. Robin Hood Yard, Nos. 1, 2 and 3. Rebuilding. Do. No. 15. Rebuilt. Southampton Buildings, Nos. 43, 44, 45 and 46. Site still vacant. Verulam Street, Nos. 17 and 18. Rebuilt. White Hart Yard, Nos. 1, 2, 3 and 4. Rebuilding. 32 SANITARY WORK. HOUSE TO HOUSE INSPECTIONS, 1911. St. Giles and Bloomsbury. Alfred Place. Arthur Street. Bainbridge Street. Betterton Street. Broad Street (part of). Bucknall Street. Castle Street. Charing Cross Road. Church Passage. Clark's Buildings. Clark's Mews. Denmark Place. Denmark Street. Drury Lane (part of). Dyott Street. Endell Street. Gilbert Street. Goldsmith Buildings. Goldsmith Street. Great Earl Street. Great St. Andrew Street Great Turnstile. Great White Lion Street Herbrand Street. Kenton Street. Lawrence Street. Little Earl Street. Little Russell Street. Little St. Andrew Street. Little White Lion Street. Lumber Court. Neal Street. New Compton Street. New Oxford Street (part of). New Turnstile. Nottingham Court. Phœnix Street. Shaftesbury Avenue (part of). Short's Gardens. Smart's Buildings. Stacey Street. Store Street. Torrington Mews. Torrington Mews East. Tottenham Court Road (part of). Tower Street. Upper Bedford Place. West Street. Wild Court. Wild Street. Woburn Mews. Holborn. Back Hill. Beauchamp Street. Bishop's Head Court. Chapel Street. Clerkenwell Road (part of). Dane Street. Devonshire Street. Dorrington Street. Eagle Street. East Street. Emerald Street. Evelyn Buildings. Eyre Street Hill. Farringdon Road. Featherstone Buildings. Fox Court. Gloucester Street. Greville Street. Hand Court. Hatton Wall. 33 Lamb's Conduit Passage. Leather Lane. Leather Lane Buildings. Little Bath Street. Little Gray's Inn Lane. Millman Street. Mount Pleasant. New North Street. Old North Street. Ormond Yard. Portpool Lane. Princeton Street. Quality Court. Red Lion Passage. Red Lion Street. Robert Street. Summer Street. Yerulam Street. Warner Street. WATER SUPPLY TO NEW BUILDINGS. During the year I inspected and gave certificates for the following premises:— 1, Greville Street. 1 and 3, Leather Lane. 1, 2 and 3, Greville Chambers. 210 and 211, High Holborn. 4, Beauchamp Street. 167—177, Shaftesbury Avenue. 26—36, New Compton Street. Bonnington Hotel. 9 and 10, Torrington Place. 191, Drury Lane. 36 and 38, Kingsway. and 61 and 62, Lincoln's Inn Fields (Kings House). Kings way Hall. WATER SUPPLY TO TENEMENT HOUSES. In accordance with Section 78 of the London County Council (General Powers) Act, 1907, 14 notices were served for the provision of additional water supply in tenement houses, and in the majority of cases the work required was completed during the year. In cases where the lease of the premises expired within twelve months the notices were allowed to stand over. In the year 1908, when the above section first came into operation 403 such notices were served. BY-LAWS AS TO HOUSES LET IN LODGINGS. At the end of the year, 633 houses were registered under these By-laws, of these, 336 are in St. Giles and Bloomsbury, and 297 in the Holborn District, 12 such houses were removed from the Register principally on account of the 34 closing or demolition of the houses, and in some cases because the houses are now occupied only by members of one family, and 4 were added to the Register. During the year, there were 1,002 inspections of these premises, excluding a very large number of periodical inspections and re-inspections. 15 notices were served for 32 overcrowded rooms, and 173 notices for other breaches of the By-laws, exclusive of 638 notices that were served for annual cleansing as required by the By-laws. REVENUE ACTS. Four applications were received during the year for Certificates from me under the above Acts. One comprising two tenements was granted, and three comprising seven tenements were refused. OVERCROWDING. The number of dwelling rooms found to be overcrowded was 64, in comparison with 49 in the previous year. 32 of these were dealt with as breaches of the By-laws as to houses let in lodgings. REMOVAL OF HOUSE REFUSE. In accordance with the Contract, all house refuse has to be removed at least twice a week, and oftener if required by the Medical Officer of Health. In the main thoroughfares there is a daily collection before 10 a.m. As usual, much attention was given to securing the regular removal of house refuse. A large number of inspections were made by me, and the inspectors, including early morning inspections, of the streets in which there is a daily removal. Only 20 genuine complaints respecting non-removal of house refuse were received from householders. 133 notices were served for the provision of proper dust receptacles. During the year a number of applications were received for the removal of trade refuse for which the Contractor is paid by the owners in accordance with Section 33 of the Public Health (London) Act, 1891. REMOVAL OF MANURE. The removal of manure was again carried out satisfactorily. No complaint was received. Posters requiring the periodical removal of manure and other refuse matter from all stables or other premises in the Borough not less frequently than every 48 hours were again posted in the various mews in the Borough. 35 COMMON LODGING HOUSES ACTS. 1851 and 1853 The Secretary of State, by a Provisional Order which came into operation on the 1st November, 1894, transferred to the London County Council the powers of the Commissioner of Metropolitan Police in respect of common lodging houses. The following is a list of the Common Lodging Houses registered in this Borough at the end of the year 1911:— Of these 14 are in St. Giles and Bloomsbury for 1,060 lodgers. „ 7 „ Holborn District for 622 „ Total 21 in the Borough for 1,682 „ St. Giles and Bloomsbury. Situation of Common Lodging House. Authorised No. of Lodgers. Sex of Lodgers. Situation of Common Lodging House. Authorised No. of Lodgers. Sex of Lodgen. 6, Betterton Street 83 M 1-7, Macklin Street 96 M 2, Kennedy Court 8 W 19, do. 40 W 3, do. 10 w 21, do. 26 W 4, do. 19 W Parker Street Municipal 345 M 5, do. 8 W 7, 9, and 11, Short's Gardens, and 3, Neal's Yard 311 M 6, do. 8 W 7, do. 9 W 8, do. 34 W 6 and 7, Wild Court 63 M Holborn 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. 25, Charles Street 241 M 28, Orde Hall Street 22 M 40, Eagle Street 50 M 39, Queen Square 52 M 4, Greville Street 53 M 12 and 13, Took's Court 110 M 29, Hatton Wall 94 M FACTORIES, WORKSHOPS AND WORKPLACES. During the year there were 148 inspections of factories, 746 inspections of workshops and 2,486 of workplaces. 264 Intimation Notices for sanitary defects were served and 41 Statutory Notices. F 36 The following table gives the changes that have taken place during the year, details of the number of premises on the Register at the end of the year, number of inspections, etc. Inspections of Factories, Workshops and Workplaces. Class of Work. Number of Places. Number of Inspections. 1911. Number of Notices 1911. Number of Prosecution 1911 On Register at end of 1910. Added in 1911. Removed in 1911. On Register at end of 1911. Intimations. Statutory. Premises. Rooms. Factories.‡ Factory Laundries 3 — — 3 — 3 — — — Factory Bakehouses 1 3 - 4 - 47 1 - - Other Factories - - — - — 98 17 1 — Workshops. Workshop Laundries 9 - - 9 28 9 - - - Workshop Bakehouses 30 1 3 28 - 167 9 1 - Other Workshops 1,092 47 10 1,129 1,799 570 112 17 - Workplaces. Home workers' Premises* 188 39 10 217 230 170 3 1 — Places where Food is prepared for Sale † 387 5 7 385 - 2,067 52 3 - Workplaces other than the the above§ — — — — — 249 70 18 — Total 1,710 94 30 1,775 2,057 3,380 264 41 - * There were in addition, many inspections of Homeworkers' Premises made during the house-to-house and periodical inspections of Lodging Houses and other Dwelling Houses. † Under this head are included the Kitchens of Hotels, Restaurants and Eating-houses of all sorts, Slaughter Houses, Tripe, Offal, and other Meat Shops, Fried Fish, Eel, and other Fish Ships, Ice Cream 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 1911, and notices served where necessary. § 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. BAKEHOUSES. At the end of the year 1911, there were 32 bakehouses in the Borough, of which 13 were in St. Giles and Bloomsbury and 19 in the Holborn District. The Bakehouse at 29, Lamb's Conduit Street, was newly occupied during the year. The following is a list of the bakehouses in the Borough all of which are underground except those marked *:— 37 St. Giles and Bloomsbury. *2 Bloomsbury Court. 10 Bury Street. 164 Drury Lane. 155 High Holborn. 217 & 218 High Holborn (Holborn Restaurant). 63 High Street. 19 Little Earl Street. 5 Little St. Andrew Street. 21 Marchmont Street. 77 Marchmont Street. 8 Museum Street. 200 Shaftesbury Avenue. *15 Torrington Place. Holborn. 158 Clerkenwell Road. *9 Cosmo Place. 13 Dane Street. *4a East Street (Factory). *51 Farringdon Road (Factory). 33 Great Ormond Street. 1 Greville Street. *91 Leather Lane (Factory). *6 Lamb's Conduit Street. 50 Lamb's Conduit Street. *29 Lamb's Conduit Street. *55 Mount Pleasant. 19 Red Lion Street. 50 Red Lion Street. *74 Red Lion Street 92 Theobald's Road. 124 Theobald's Road *Viaduct Buildings, also 17 Charterhouse Street (Factory). 36 Warner Street. During the year, in addition to my inspections, there were 214 inspections of bakehouses, including 47 inspections of the factory bakehouses. Ten notices were served for various sanitary defects. STANDARD BREAD AND FLOUR. Bleached and so-called "Improved" Bread and Flour. In my Annual Report for last year I gave details which indicate the superior food value of " standard" bread and flour. Researches by numerous scientists have shown that the germ and inner layer of the husks or bran of all cereals such as wheat, oats, rice and maize contain important substances (vitamines) which are essential to the nutritive value of the grain and that if these are eliminated in the milling or preparation of the grain a staple diet composed of cereals thus peeled not only fails adequately to nourish the consumers but tends to set up active disease. In a large number of instances, as recorded by various observers in the East, where rice forms the staple article of diet, the disease beri beri has been exterminated by the use of unpeeled rice instead of white polished rice in which the inner layer of the husk has been removed during the preparation. F 2 38 I also indicated a method that might be adopted for the standardisation of flour and bread. I also gave some abstracts from recent reports to the Local Government Board on the subject of the bleaching of flour and the addition of so-called "improvers" to flour and the presence of calcium sulphate in baking powder and self-raising flour Of 70 samples of imported flour, 57 or more than 80 per cent. were bleached, and of 157 samples purchased in different parts of England 117 or about 75 per cent. The Report of the Chief Medical Officer of the Board of Education shows that 63 per cent. or nearly two-thirds of the six million school children in England and Wales suffer from various defects, and that a considerable per centage of them suffer from a greater or less degree of malnutrition. He emphasises the absolute necessity of the people understanding something of the comparative values of food if we are to have a healthy and vigorous nation in future. Dr. R. Hutchison also states that " there are few subjects on which popular instruction is more urgently needed than on the relative value of foods. Much of the malnutrition and chronic ill-health which are unfortunately so rife amongst the poorer classes of the community are due not so much to inabili ty to provide the necessaries of life as to ignorance as to what it is best to buy." In order to build up a strong healthy race to carry on the imperial work of our great Empire it is essential that the women of the industrial and poorer classes should know how to buy and cook in a wholesome way the foods which nourish best at the least cost. HOME WORK. Details are given in the preceding Table, and in Table VIII. 3 of the Appendix. Many inspections of home-workers' premises are also made during house to house and periodical inspections of lodging houses and dwelling houses in which home-workers reside. Further details respecting factories, workshops, laundries, workplaces and home work are given in Table VIII. (1, 2, 3, 4 and 5) of the Appendix. PLACES WHERE FOOD IS PREPARED FOR SALE. Under this head are included kitchens of hotels, restaurants and eatinghouses of all sorts, slaughter-houses, tripe, offal and other meat shops, fried fish, eel and other fish shops, premises where ice cream is made, and other places where food is prepared for sale, excluding bakehouses which are given on a previous page. 39 The number of these places on the register at the end of 1911 was 385 ; 2,067 inspections were made, and 55 notices were served during the year for sanitary defects found. In addition to the above inspections of places where food is prepared for sale, there were also 811 inspections of market streets, each of which includes a number of stalls at which meat, fish, fruit and vegetables are sold. These streets are also regularly inspected on Saturday evenings and Sunday mornings. SLAUGHTER HOUSE. There is now only one slaughter-house in the Borough, viz., No. 29, Red Lion Street, which, in addition to my inspections, was inspected on 12 occasions during the year. Only sheep are killed. DAIRIES, COWSHEDS AND MILKSHOPS. The number of registered dairies and milkshops in the Borough at the end of the year was 177, of which 73 were in St. Giles and Bloomsbury, and 104 in the Holborn District. In all 14 dairies and milk shops were newly registered, 6 belonging to St. Giles and Bloomsbury, and 8 to the Holborn District. In addition to my inspections the Sanitary Inspectors made 658 inspections of these premises, and 3 notices were served for sanitary defects or breaches of regulations, and in some cases alterations were carried out without the service of notices. ICE CREAM. During the year there were 40 premises in the Borough where ice cream was manufactured or sold, and in addition to my inspections, 140 inspections of these premises were made. One notice was served for sanitary defects. As ice cream is often made in the early morning, inspections between 6 and 9 a.m. were also occasionally made in order to ascertain whether there were any infringements of the London County Council (General Powers) Act, 1902. No such infringement was found. UNSOUND FOOD. Applications were received for removal and destruction as trade refuse of the following articles of food, all of which were unsound and unfit for the food of man:— 40 394 crates Bananas. 1 pot Jam. 51 bundles Tomatoes. 1 bottle Calf's Feet Jelly. 383 tins Preserved Fruits (assorted). 1 glass Herring Eoes. 34 bottles Do. 3 tins Tinned Fish. 2 sacks Potatoes. 1 case Herrings. 158 cases Apples. 1 trunk Flat Fish. Part box Raisins 14 Rabbits. 10 boxes Turkish Delight. 11 Pork Pies. 32 lbs. Pork (2 fore quarters). OFFENSIVE FUMES FROM FACTORIES. During the year 1909 four new oil engines were provided by an Electric Supply Company; much nuisance was caused by offensive fumes emitted from the chimney shaft receiving the exhaust pipes from these engines, and many complaints were received. The matter received much careful consideration, and various alterations were carried out by the Company, and the exhaust pipes were carried up more than 20 feet above the top of the chimney shaft. As further complaints were received, the Company in 1910, carried up these exhaust pipes an additional 15 feet. Notwithstanding this, the nuisance continued from time to time. Plans for the construction of a chimney stack of ferro-concrete, about 150 feet high, were submitted to the London County Council. Since the completion of the work no complaints have been received. Complaints are occasionally received of nuisances from offensive fumes from other premises which have been dealt with in former years. These are now only due to some accident or temporary defect, and the nuisances are soon abated. SMOKE ABATEMENT. The smoke shafts in the Borough were frequently kept under observation, and in 117 cases the inspections were recorded. 8 intimation notices and 1 statutory notice were served. GREAT QUEEN STRTET WESLEYAN CHAPEL (Now West London Mission). Removal of Human Remains. I received information that in the course of the demolition of the Great Queen Street Wesleyan Chapel, certain coffins containing human remains had been discovered. I was also requested by the Secretary of State for the Home Department to investigate the matter and forward details of the same. 41 I found that 44 coffins had been re-interred in vaults by an Order in Council dated 7th May, 1858, and that no burials had taken place there since. On the 8th October, 1911, I received a licence signed by the Secretary of State for the Home Department, for the removal of the human remains under certain conditions. The work was at once put in hand. All the old coffins were sprinkled with freshly made ground lime and put into new coffins. These coffins were removed in two batches early in the mornings of the 13th and 14th October, between 3.30 a.m. and 7 a.m., and re-interred at the Hendon Park Cemetery. At my suggestion the men engaged in the work wore leather gloves to prevent the grazing of their hands while handling the heavy and more or less damaged lead coffins. I inspected the operations at least twice daily while the work was going on, and Inspector Larard was present while the work was being carried out, and also accompanied the coffins and saw the re-interment at the cemetery. The work was carried out to my satisfaction and strictly in accordance with the provisions of the license. For further details of Sanitary Work and Legal Proceedings see Tables V., VI., VII., VIII., IX. and X. 43 APPENDIX. TABLE I. Vital Statistics of Whole District during 1911 and Previous Years. Name of District—The Metropolitan Borough of Holborn. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Under 1 Year of Age At all Ages. Uncorrected Number. Nett. Number. Rate. of Nonresidents registered in the District. of Residents not registered in the District. Number. Rate per 1.000 births. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1906 54,260 1,640 1,149 21.3 1,212 22. 4 673 410 147 128 949 17.6 1907 53,247 1,570 1,008 19.0 1,131 21.3 606 387 132 116 912 17.2 1908 52,224 1,543 1,066 20.1 1,064 20.1 599 403 118 111 868 16.4 1909 51,191 1,436 986 19.3 1,067 20.9 637 377 100 101 807 15.8 1910 50,148 1,352 1,017 20.3 943 18.9 567 392 102 100 768 15.4 1911 49,092 1,273 920 18.8 923 18.9 588 407 104 113 742 15.2 Area of District in acres (exclusive of area covered by water) 405.l Total population at all ages 49,357 at Census of 1911. Number of inhabited houses 7,895 „ „ Average number of persons per house 6.2 „ ,, N.B.—In previous Annual Reports the populations, birth-rates and death-rates have been estimated from the Census Populations of 189 I and 1901. In the above Table these have all been re-estimated from the Census Populations of 1901 and 1911. 44 TABLE II. Cases of Infectious Disease notified during the year 1911. Name of District—Holborn. Notifiable Disease. Number of Cases Notified. TotalCases notified in each Locality (e.g. Parish or Ward) of the District. Total Cases Removed to Hospitals. At all Ages. At Ages—Years. St. Giles and Bloomsbury. Holborn. Under 1. 1 to 5 6 to 15. 15 to 25. 25 to 45 45 to 65. 66 and upwards. Small-pox - - - - - - - - - - - Cholera — — — — - — — - - - - Diphtheria (including Membranous Croup 85 1 28 37 15 4 — — 33 52 84 Erysipelas 37 1 1 3 8 8 10 6 18 19 9 Scarlet Fever 120 — 39 68 7 6 — — 80 40 119 Typhus Fever — — — — — — — — — — — Enteric Fever 10 — 1 1 1 5 2 — 6 4 7 Relapsing Fever — — — — — — — — — — Continued Fever — — — — — — — — — — Puerperal Fever 2 — — — 1 1 — — 1 1 1 Plague — — — — — — — — — — — Phthisis Under Tuberculosis Regulations, 1908 104 — — 2 6 38 48 10 36 68 101 Under Tuberculosis Regulations, 1911 81 — 3 5 7 47 19 — 29 52 23 Others 2 — — — 1 1 — — 1 1 — Ophthalmia neonatorum 5 6 - - - - - - 2 3 — Cerebro spinal fever - - - - - - - - - - - Polio-myelitis - - - - - - - - - - - Glanders - - - - - - - - - - - Anthrax - - - - - - - - - - - Hydrophobia - - - - - - - - - - - Totals 446 7 72 116 46 110 79 16 206 240 344 Chicken Pox was also notifiable for three months from the 22nd March, during which period 101 notifications were received. 45 TABLE III. Causes of, and Ages at, Death. Causes of Death. Net Deaths at the Subjoined Ages of "Residents" whether occurring within or without the district. Deaths in Localities (At all ages). Total Deaths whether of "Residents" or "Non- Residents" in Institutions in the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. St. Giles and Bloomsbury. Holborn. All causes Certified 742 104 39 16 20 31 126 213 193 352 390 611 Uncertified - - - - - - - - - - - - Fever Enteric 2 - - - - - 1 1 - 1 1 - Small-pox - - - - - - - - - - - - Measles 15 2 7 6 - — — — — 7 8 — Scarlet Fever 3 - - - 2 - 1 - — 2 1 — Whooping Cough 3 1 2 - - - - - - 1 2 30 Diphtheria and Croup 3 - 1 2 — - - - - - 3 10 Influenza 1 - - - - - - - 1 1 — — Erysipelas 1 - - — — — — — 1 — 1 — Cerebro-Spinal Fever - - - - - - - - — — — 8 Phthisis (Pulmonary Tuberculosis) 96 - - 1 - 7 49 31 8 44 52 14 Tuberculous Meningitis 8 2 3 1 2 - — — — 4 4 32 Other Tuberculous Diseases 12 - 1 - 1 2 3 4 1 5 7 44 Rheumatic Fever 1 - - — — 1 — — — — 1 — Cancer, Malignant Disease 54 - - - - - 5 27 22 29 25 21 Bronchitis 71 7 1 1 - - 3 22 37 35 36 10 Broncho-Pneumonia 30 12 12 — 1 — — 3 2 9 21 37 Pneumonia (all other forms) 43 1 - 3 - 1 9 18 11 13 30 24 Other Diseases of Respiratory Organs 5 - - - - 1 - 4 - 1 4 11 Diarrhœa and Enteritis 39 26 7 — — — 1 2 3 10 29 92 Appendicitis & Enteritis 1 - - - - - - 1 — — 1 — Alcoholism 5 - - - - - 2 3 — 2 3 1 Cirrhosis of Liver 11 - — — — — 4 5 2 5 6 4 Nephritis and Bright's Disease 23 1 - - - 2 4 7 9 12 11 11 Puerperal Fever 1 — — — — 1 — — — 1 — — Other accidents and diseases of Pregnancy and Parturition - - - - - - - - - - - - Congenital Debility and Malformation, including Premature Birth.. 29 29 - - - - - - - 14 15 61 Violent Deaths, excluding Suicides 34 4 1 1 5 3 6 10 4 16 18 3 Suicides 7 - - - 1 3 3 — — 6 1 — Other Defined Diseases 243 19 3 1 8 10 35 75 92 133 110 196 Diseases, III-Defined or Unknown 1 — 1 — — — — — — 1 — 1 All causes 742 104 39 16 20 31 126 213 193 352 390 611 G 2 46 TABLE IV. Infantile Mortality during the Year 1911. Nett Deaths from stated causes at various Ages under One Year of Age. Cause of Death. Under 1 Week 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. All Causes. Certified 19 5 1 3 28 14 20 22 20 104 Uncertifid — — — — — — — — — — Small Pox — — — — — — — — — — Chicken Pox — — — — — — — — — — Measles — — — — — — — — 2 2 Scarlet Fever — — — — — — — — — — Diphtheria and Croup — — — — — — — — — — Whooping Cough — — — 1 1 — — — — 1 Diarrhœa — 1 — — 1 1 8 7 4 21 Enteritis 1 1 — — 2 2 — — 1 5 Tuberculous Meningitis — — — — — — — — 2 2 Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — Congenital Malformations — — — — — — 1 — — 1 Premature Birth 15 1 — — 16 3 1 — — 20 Atrophy, Debility, Marasmus 1 1 — 1 3 3 2 — — 8 Atelectasis 1 — — — 1 — — — — 1 Injury at birth — — — — — — — — — — Erysipelas — — — — — — — — — — Syphilis — — — — — 2 — — — 2 Rickets — — — — — — — — — — Meningitis (not Tuberculous) — — — 1 1 — — — 2 3 Convulsions — — — — — 1 1 2 3 7 Gastritis — — — — — — — — — — Laryngitis — — — — — — — — — — Bronchitis — 1 1 — 2 — 3 1 1 7 Pneumonia (all forms) — — — — — — 1 7 5 13 Suffocation, overlying — — — — — 2 1 — — 3 Other causes 1 — — — 1 — 2 5 — 8 19 5 1 3 28 14 20 22 20 104 Nett Births in the year Iegitimate, 86.1 illegitimate 55 Nett Deaths in the year of Iegitimate infants 90. illegitimate „ 14. 47 TABLE V. Sanitary Inspectors' Work.—Inspections, &c. Inspector Bennett. Inspector Clark. Inspector Larard. Inspector Orange. Whole Borough. Inspections. Infectious Diseases 109 129 96 156 490 Dwelling Houses 224 286 140 96 746 Lodging Houses 358 245 221 178 1,002 Common Lodging Houses — 25 64 — 89 Dairies, Cowsheds and Milkshops 162 212 281 — 658 Ice Cream—Manufacture or Storage 23 19 98 — 140 Slaughter-house — 12 — — 12 Market Streets 345 70 395 1 811 Butchers' Shops 570 184 197 — 951 Bakehouses 60 92 62 — 214 Other Food Shops 363 141 363 106 973 Laundries 1 — 2 6 9 Other Workshops 153 161 90 166 570 Out-Workers' Rooms and Registers 15 32 32 170 249 Workplaces 108 55 83 3 249 Factories (excluding Bakehouses and Laundries) 41 8 36 13 98 Schools — — 4 — 4 Smoke shafts 4 8 105 — 117 Urinals 1 93 15 — 109 Miscellaneous 173 27 112 2 314 Periodical Inspections* 1,708 2,250 1,852 55 5,865 Dust † 50 116 81 — 247 Mews 5 144 8 — 157 Maternity — — — 600 600 Total Inspections 4,473 4,309 4,340 1,552 14,674 No. of Re-Inspections 1,012 1,536 770 684 5,065 Do. do. Maternity — — — 1,063 Visits other than Inspections and Re-Inspections 501 932 906 286 2,814 Do. do. Maternity — — — 189 Total 5,986 6,777 6,016 3,774 22,553 * The majority of these are weekly inspections of Registered Lodging Houses. † A large number of inspections respecting the removal of Refuse is also made during General and Periodical Inspections of houses. 48 TABLE VI. Sanitary Inspectors' Work.—Notices served. Inspector Bennett. Inspector Clark. Inspector Larard. Inspector Orange. Total. Intimation Notices—Total served 211 387 310 146 1,054 Houses 166 312 267 104 789 The house or part of the house in a dirty condition 56 40 35 28 159 The house or part of the house in a damp condition 1 7 9 3 20 The house in a dilapidated condition 8 40 15 5 68 The watercloset so foul as to he a nuisance 4 11 14 7 36 Do. without a water supply 10 19 23 — 52 Do. with a deficient supply of water 8 27 2 — 37 Do. improperly constructed 1 — — — 1 Do. so defective as to be a nuisance 17 29 20 16 82 Do. stopped 10 54 41 6 111 Do placed in an improper position 1 — 1 — 2 Insufficient external ventilation to watercloset 1 13 3 1 28 Insufficient watercloset accommodation — 9 — 23 32 Absence of watercloset accommodation — — — — — Absence of proper watercloset accommodation for persons of each sex See under Workshops &c. The soil pipe defective 3 2 1 — 6 Do. unventilated 2 — — — 2 Do. improperly ventilated — — — — — The yard paving defective 10 8 2 — 20 Do. dirty — 15 10 — 25 Do. undrained — — — — — The area improperly paved — — — — — Do. dirty — 22 5 — 27 Do. undrained — — — — — The inlet of surface drain improperly trapped — — — — — A gully trap improperly placed within the house — — — — — The waste pipe of sink improperly connected with the drain - - 8 1 9 Do. do. improperly trapped — 3 — — 3 Do. do. untrapped 10 23 4 — 37 Do. of lavatory improperly connected with the drain - - - - - Do. do. improperly trapped — — — — — Do. do. untrapped — — — — — Do. of bath directly connected with the drain - - - - - Do. do. improperly trapped — — — — — Do. do. untrapped — — — — — The water cistern so foul as to be a nuisance 22 9 7 11 49 Do. being without a close fitting cover 2 8 7 3 20 Do. being placed in an improper position - - - - - Do. defective — 10 — — 10 An accumulation or deposit of refuse 6 25 28 6 65 The absence of proper ashbin 52 32 7 2 93 The ashbin defective 11 23 3 3 40 The drain foul - 1 — — 1 Do. defective 5 11 12 1 29 Do. choked or stopped 7 42 16 3 68 Do. unventilated — — — — — 49 TABLE VI.—continued. Sanitary Inspectors' Work.—Notices served.—continued. Inspector Bennett. Inspector Clark. Inspector Larard. Inspector Orange. Total. Houses- continued. The rainwater pipe in direct communication with the drain - - - - - Do. do. do. with the soil pipe — — — — — Do. do. defective 4 19 1 — 24 The water supply used for domestic purposes connected with the cistern which is used for flushing the watercloset - - - - - The absence of proper water supply 2 10 2 — 14 The roof defective 18 18 20 4 60 The guttering defective — 3 5 — 8 The paving of wash-house defective — 2 2 2 6 The want of proper manure receptacle — 5 1 — 6 An animal kept in such place or manner as to be a nuisance 1 1 1 - 3 The house or part of the house overcrowded 3 12 8 9 32 An underground room occupied as a dwelling contrary to the provisions of the Act 4 9 2 9 24 The space below floor in the basement or ground floor being unventilated - 2 - - 2 Do. improperly or insufficiently ventilated - - - - - A chimney sending forth black smoke in such quantity as to be a nuisance See under Workshops A urinal improperly constructed, drained or offensive - 1 - - 1 Do. with no supply of water — — 1 - 1 Other nuisances 6 29 9 11 55 * Factories, Workshops and Work Places 45 73 103 42 265 Dirty 19 14 13 19 65 Waterclosets, defective or dirty 5 22 18 8 53 Do. insufficient 1 — — 1 2 Do. absence of separate accommodation for sexes 2 6 1 6 15 Drains, soil pipes, &c., defective 3 8 9 1 21 Improperly ventilated - — 3 3 6 Overcrowded 1 3 1 1 6 Chimney sending forth black smoke — 3 5 - 8 Other nuisances 2 11 11 6 30 Ashbins 2 15 34 — 51 Breach of Bye-laws or Regulations— † Lodging-houses 23 103 21 41 188 Dairies,cowsheds, milkshops and slaughterhouses — — — - — Keeping of animals 1 1 1 — 3 London County Council (General Powers) Acts Urinals - - - - - Verminous Rooms 7 13 20 29 69 Ashpits — 1 - - 1 Foodshops — — 1 — 1 Statutory Notices 28 64 43 26 161 * 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." 50 TABLE VII. Proceedings during 1911. PREMISES. NUMBER OF PLACES— Number of Inspections 1911. Number of Notices 1911. Number of Prosecutions 1911. On register at end of 1910. Added in 1911. Removed in 1911. On register at end of 1911. Milk premises 172 14 9 177 658 3 0 Cowsheds 0 0 0 0 0 0 0 Slaughter-houses 1 0 0 1 12 0 0 Other offensive trade premises 0 0 0 0 0 0 0 Ice Cream premises 40 0 5 35 0 1 0 Registered houses let in lodgings 641 4 12 633 1,002 (a)* 15 (a)* nil (a)* 173 (b)* nil * (a) For overcrowding. * (b) For other conditions. Total number of Intimation notices served for all purposes 1,054 Overcrowding, 1911— Number of Dwelling Rooms overcrowded 64 Number remedied 64 Number of prosecutions 0 Underground Rooms — Illegal occupation dealt with during year 24 Number of rooms closed 24 Insanitary Houses— Number closed under the Public Health (London) Act, 1891 0 „ „ ,, ,, Housing of the Working Classes Act 1 Ice Cream— Proceedings under London County Council (General Powers) Act, 1902 0 Verminous Rooms— Numbers of premises cleansed under Section 20 of the London County Council (General Powers) Act, 1904 67 Shelters provided under Section 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year 3 Revenue Acts— Number of houses for which applications were received during the year 4 Number of dwellings comprised therein 9 Number of tenements for which ceitificates were (a) granted 2 ; (4) refused 7 ; (c) deferred 0 Housing. Town Planning, etc., Act, 1909. Section 35— Number of applications for certificates 0 „ „ beds comprised therein 0 „ ,, certificates granted, 0; refused, 0; deferred 0 Number of prosecutions under Bye-laws under Public Health (London) Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, etc 0 (b) For prevention of nuisance arising from offensive matter running out of any manufactory, etc. 0 (c) For the prevention of keeping of animals in such a manner as to be injurious to health 0 (d) As to paving of yards, etc., of dwelling houses 0 (e) In connection with the removal of offensive matter, etc. 0 (f) As to cesspools and privies, removal and disposal of refuse, etc 0 ( g) For securing the cleanliness of tanks, cisterns, etc 0 (h) With respect to water closets, earth closets, etc. 0 (i) With respect to sufficiency of water supply to water closets 0 (j) With respect to drainage, etc. (Metropolis Management Act, Section 202) 0 (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Act, Section 202) 0 Mortuaries— Total number of bodies removed 107 Total number of infections bodies removed 0 51 TABLE VIII. FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 1.—Inspection. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Intimations. Statutory. Factories (including Factory Laundries) 148 18 1 Workshops (including Workshop Laundries) 746 121 18 — Workplaces 2,486 125 22 - Total 3,380 264 41 — 2.—Defects Found. Particulars Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. * Nuisances under the Public Health Acts:— Want of cleanliness 65 65 — — Want of ventilation 6 6 — — Overcrowding 6 6 — — Want of drainage of floors — — — — Other nuisances 81 81 — — Sanitary accommodation insufficient 2 2 — — unsuitable or defective 53 53 — — not separate for sexes 15 15 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) — — — — Breach of special sanitary requirements for bakehouses (SS. 97 to 100) — — — — Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) — — — — Total 228 228 — — * Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. H TABLE IX— continued. 3.—Home Work NATURE OF WORK.* Outworkers' Lists, Section 107. Outwork in Unwholesome Premises. Section 108. Outwork in Infected Premises, Sections 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. † Outworkers. † Lists. Outworkers. Contractors. Workmen. Contractors Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, &c. 120 178 557 7 9 24 126 - — — - — — — - (2) Cleaning and washing — — — — — — — - — — - — — — - Household Linen - - - - - - - - - - - - - - - Lace, Lace Curtains and Nets - - - - - - - - - - - - - - - Curtains and Furniture - - - - - - - - - - - - - - - Hangings - - - - - - - - - - - - - - - Furniture and Upholstery - - - - - - - - - - - - - - - Electro Plate - - — - - — - - - — - — — - - File making - - - - - - - - - - - - - - - Brass and Brass Articles - - - - - - - - - - - - - - - Fur pulling - - - - - - - - - - - - - - - Cables and Chains - - - - - - - - - - - - - - - Anchors and Grapnels - - - - - - - - - - - - - - - Cart Gear - - - - - - - - - - - — — — - Locks, Latches and Keys - - - - - - - - - - - - - - - Umbrellas &c. - - — - - — - - — — - — — — - Artificial Flowers - - — - - — - - — — - — — — - Nets, other than Wire Nets - - - - - - - - - - - - - - - Tents - - — - - — - - — — - — — — - Sacks - - — - - — - - - - - - - - - Racquet and Tennis Balls - - - - - - - - - - - - - - - Paper Bags and Boxes 4 - 41 - - — 4 - — — - — — — - Brush making 2 - 6 - - — 2 - — — - — — — - Pea Picking — - — - - — — - - — - — - - - Feather sorting - - - - - - - - - - - - - - - Carding, &c., of Buttons, &c. - - - - - - - - - - - - - - - Stuffed Toys — - — - - — — - — — - — — — - Basket making 2 - 4 - - — 2 - — — - — — — - Total 128 178 608 7 9 24 134 — — — — — — — — * If an occupier gives out work of more than one of the classes specified in column 1, and subdivides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in column 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. † The figures required in columns 2, 3 and 4 are the total number of lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of outworkers in those lists. The entries in column 2 must necessarily be even numbers, as there will be two lists for each employer—in some previous returns odd numbers have been inserted. The figures in columns 3 and 4 will usually be (approximately) double of the number of individual outworkers whose names are given, since in the February and August lists of the same employer the same outworker's name will often be 53 TABLE VIII.—continued. 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. N umber. (1) (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. Laundries (including 3 factory laundries) 12 Bakehouses (including 1 factory bakehouses) 32 Other Workshops 1,130 Total number of workshops on Register 1,174 5.—Other Matters. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 13 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (s. 5) Notified by H.M. Inspector 26 Report (action being taken) sent to H.M. Inspector 26 Other — Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 21 54 TABLE X. LEGAL PROCEEDINGS. Sale of Food and Drugs Acts. Date. Name. Premises. Offence. Result. 6061 Jan. 27th Mrs. Hunter 18, Eagle Street Selling butter containing 84 per cent. foreign fat Defendant convicted and fined 10s. and 12s. 6d. costs May 12th Mrs. Walters 17, High Street Selling milk containing 5.4 per cent. added water Warranty proved. Summons withdrawn. „ 19th Luigi Terroni 138, Clerkenwell Road Selling milk containing 5.1 per cent. added water Defendant convicted and fined 10s. and 12s. 6d. costs. „ „ Andrew Pizzala 17, Charles Street Selling milk containing 6.8 per cent. added water Defendant convicted and fined 20s. and 12s. 6d. costs. June 2nd Thomas Liles 3a, Beauchamp Street Selling milk 7.3 per cent. deficient in fat Warranty proved. Summons withdrawn. „ „ Mary Goldberg 73a, Clerkenwell Road Selling butter containing 84 per cent. foreign fat Defendant convicted and ordered to pay 12s 6d. costs. „ 9th David Jones 7, Betterton Street Selling Demerara sugar, containing 100 per cent. of white sugar crystals Defendant convicted and fined £2 and £1 3s. costs. July 21st Almasio, A. 24, Betterton Street Selling milk 13 per cent. deficient in fat Defendant convicted and fined 30s. and 12s. 6d. costs. Sept. 27th Ashburton Club & Restaurant, Limited 28, Red Lion Square Selling milk 8.0 per cent. deficient in fat Defendant convicted and fined 20s. and 12s. 6d. costs. „ 28th Luigi Terroni 138, Clerkenwell Road Selling milk 6.6 per cent. deficient in fat Defendant convicted, 12s. 6d. costs. Dec. 8th Daniel Sheehan 3, Devonshire Street Selling butter containing 0.758 per cent. crystallised boric acid Defendant convicted and fined 40s. and 23s. costs. LEGAL PROCEEDINGS. Public Health (London) Act, 1891. Date. Name. Address. Offence. Result. 1911. Sept. 27th and October 11th Giddens, H. F. 12, Eagle Street Overcrowding Nuisance abated. Summons withdrawn.