HOL 15 The Metropolitan Borough of Holborn. REPORT FOR THE YEAR 1915 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, of 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; late Medical Officer of Health of the St. Olave District, Southwark, and the Holborn District Board of Works. London: DIPROSE, BATEMAN & CO., sheffield street, lincoln's inn fields, w.c. 1916. 6941 INDEX. page Introduction 5 Population and Houses 7 Estimated Civil Population 1915 7 Registered Births and Birth-Rates 8 Ditto Corrected 8 Mortality 9 Deaths Registered 9 Deaths in Public Institutions within the Borough 9 Ditto outside the Borough 9 Corrected Deaths and Death-rates 9 Infantile Mortality 10 Maternity and Child Welfare 11 Prevention of Infantile Mortality 11 (1) Care and feeding of Infants 11 (2) Notification of Births Act, 1907 11 (3) Modified Milk for Infants 11 (4) Holborn Maternity Centres 12 (5) Creches (Day Nurseries) 14 (6) Dinner Tickets 14 (7) Ante-Natal Work 14 Senile Mortality 15 Deaths from Epidemic Diseases 15 Ditto ditto during 1915 and ten preceding years 16 Ditto Measles 16 Ditto Whooping Cough 17 Ditto Diarrhoea and Enteritis 17 Ditto Phthisis 17 Ditto Influenza 17 Ditto Alcoholism 18 Ditto Cancer 18 Inquests 18 The Public Mortuary 18 Infectious Diseases 18 Notification of Infectious Diseases during 1915 and ten preceding years 19 Small Pox 20 Scarlet Fever 20 Ditto Errors in Diagnosis 20 Ditto Secondary Cases 20 Ditto Return Cases 20 Diphtheria 20 Ditto Errors in Diagnosis 20 Ditto Secondary and Return Cases 21 Enteric Fever 21 Cerebro-Spinal Fever 21 Polio-Myelitis and Encephalitis 21 Glanders, Anthrax and Hydrophobia in man 21 Ophthalmia Neonatorum 22 Whooping Cough 22 Phthisis or Consumption 22 Ditto ditto Notification Public Health (Tuberculosis) Regulations. 1912 23 Tuberculosis Dispensary 23 Tuberculosis Dispensary—Report of Tuberculosis Officer 24 (1) New Patients 24 (2) Attendances and Examinations 25 (3) Diagnosis 25 (4) Treatment 26 (5) Home Conditions 26 (6) Reports 26 (7) Contracts 27 (8) Results of Treatment 27 (9) Miscellaneous 27 Bacteriology 28 Disinfections 28 Shelter during disinfection of houses 28 Cleansing of Persons Act, 1897—New Cleansing Station 28 A 2 4 page Housing of the Working Classes Acts 29 Housing, Town Planning, &c., Act, 1909, Section 17 29 Underground Sleeping Rooms 29 Erection of Dwellings for Working Classes 29 Premises closed voluntarily, demolished, rebuilt, &c. 30 Sanitary Work 82 House-to-house inspections 32 Water Supply to New Buildings 33 Ditto to Tenement Houses 33 By-laws as to Houses let in Lodgings 34 Revenue Acts 34 Overcrowding 34 Removal of House Refuse 34 Removal of Manure 35 Common Lodging Houses Acts, 1851 and 1853 36 Factories, Workshops and Workplaces 36 Bakehouses 36 Home Work 37 Places where Food is prepared for Sale 37 Slaughter House 37 Dairies, Cowsheds and Milkshops 37 Public Health (Milk and Cream) Regulations, 1912 38 Ice Cream 39 Unsound Food 39 Offensive fumes from factories 39 Smoke Abatement 39 Meteorology of London, 1915 40 APPENDIX. TaBle I. Vital Statistics of whole Borough during 1916 and previous years 41 Table II. Cases of Infectious Disease notified during the year 1915 42 Table III. Causes of, and Ages at Death during the year 1915 43 Table IV. Infantile Mortality during the year 1915 44 Table V. Sanitary Inspectors' Work—Inspections, &c. 45 Table VI. Ditto Notices served 46 Table VII. Proceedings during 1915 48 Table VIII. Factories, Workshops, Laundries, Workplaces and Homework 49 (1) Inspections 49 (2) Defects found 49 (3) Homework 50 (4) Registered Workshops 51 (5) Other matters 61 Table IX. Legal Proceedings—Public Health (London) Act, 1891 52 Ditto Public Health (Milk and Cream) Regulations, 1912 52 Ditto Sale of Food and Drugs Acts 52 Table X. Meteorology of London, 1915 53 REPORT of the Medical Officer of Health For the Year 1915. 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 1915, the various statistics of the year refer to the fifty-two weeks ended Saturday, January 1st, 1916, as adopted by the Registrar-General and known as the Registration Year. On account of the great changes in the local populations due to the War, the Registrar-General has estimated the death rates for this year (1915) on the estimated civil populations which have been estimated by means of the National Register as mentioned on page 7. On account of these great changes, the death-rates cannot be fairly compared with those of previous years. The London death-rates as estimated by the Registrar-General on the civil population have not yet been published. The Infantile mortality of the Borough for the eighth year in succession, although higher than for the year 1914, was less than the London rate, namely, 96 per 1,000 in comparison with 112 per 1,000 for London. The principal changes introduced during the year have been:— Opening of the Tuberculosis Dispensary at the University College Hospital on the 2nd February, 1915. Opening of the Holborn Maternity Centre and Invalids' Kitchen, 75, Lamb's Conduit Street, in the same month. As flies carry the germs of various diseases, the Public Health Committee gave their sanction for the distribution of leaflets respecting their prevention. The daily collection of house refuse was extended to Warner Street and Little Bath Street. 6 Since August, 1914, arrangements were made for co-operation between the Civil and Military Sanitary Services. This co-operation in the Borough included work connected with the prevention of infectious diseases and verminous conditions; the weekly inspection of Drill Halls and houses where soldiers were billetted, the inspection of food supplied for soldiers in Restaurants, Drill Halls, Billets, &c., and food prepared by Government Contractors. 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. One Sanitary Inspector and two Clerks have now enlisted in H.M. Forces. No temporary Inspector was appointed and only one temporary female Clerk. The work therefore had to be re-arranged and the remaining staff willingly undertook additional duties as required. I have the honour to be, Gentlemen, Your obedient Servant, W. A. BOND. 7 POPULATION AND HOUSES. The enumerated Population at the Census taken on Sunday, April 2nd, 1911, 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. Further details were given in my Annual Reports for 1912 and 1913. ESTIMATES OF CIVIL POPULATIONS, 1915. The war has made it impossible to adhere to the methods of estimation of local and national populations hitherto in use. Men of military age have been largely drafted to military training centres or sent abroad with the Army, and the remainder of the male adult population, as well as, to a lesser extent, the female population, has migrated on an unprecedented scale into areas other than those in which it was enumerated at the last census. Under these circumstances estimates of local populations based on the census returns were clearly inadmissible, and it became necessary to search for a substitute. Fortunately this was ready to hand in the shape of the National Register. Those who were absent from their homes on the Registration Day were afterwards allocated to their proper district. The method by which the estimates of civil populations have been derived from the National Register is as follows:— The ratio of the total population less the males aged 15-65 years to the number of females aged 15 to 65 years at the date of the census was calculated for each administrative area, and this ratio was applied to the number of females on the National Register; the resulting product plus the number of males aged 15 to 65 years on the National Register was taken to be the number of the civil population of the district. Other small adjustments for the population in institutions which were not registered together with a number of persons of no fixed abode were distributed evenly over the whole country. These adjustments raised the original estimates by about one per cent. 8 The following are the revised estimates of civil populations at the middle of the year 1915:— St. Giles and Bloomsbury 20,594 Holborn Sub-District 19,811 Holborn Borough 40,405 London 4,310,030 REGISTERED BIRTHS AND BIRTH-RATES. District. Males. Females. Both Sexes. Birth rate per 1,000 Legitimate. Illegitimate. Total. St. Giles and Bloomsbury 123 135 240 18 258 11.0 Holborn 170 166 824 12 336 14.5 Whole Borough 293 301 564 30 594 12.7 Note.—The birth-rates for 1915, as suggested by the Registrar-General, have been based upon the existing estimates of total population for 1914 as the births registered are not only those of the children of civilians. CORRECTED BIRTHS AND BIRTH-RATES. I received from the Registrar-General information of the births in outlying institutions in London of 74 legitimate infants and 35 illegitimate infants whose mothers were residents of the Borough. 22 of the 564 legitimate births and 11 of the 30 illegitimate births were infants of mothers who were non-residents of the Borough. The corrected numbers therefore are as follows:— District. Corrected number of Births of Residents. Corrected Birth-rate per 1000. Legitimate. Illegitimate. Total. 1915. 1914. Whole Borough 616 54 670 14.4 16.4 In London the corrected number of births was 101,649, or a rate of 22.6 per 1,000, in comparison with 24.3 for 1914. 9 MORTALITY. The following deaths have been registered in the Borough (1915): — St. Giles and Bloomsbury. Holborn. Total. Males 99 897 496 Females 87 293 380 Total 186 690 876 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. King Albert's Hospital _ _ 4 _ Military Hospital, Endell Street _ _ 22 French Hospital 6 1 29 — Children's Hospital 334 National Hospital — — — 64 London Homoeopathic Hospital 6 12 _ 66 2 2 _ 15 Alexandra Hospital — — — 4 Private 2 — 17 4 Total 18 24 72 487 There were 385 deaths of Civil "Residents" in various Workhouses, Infirmaries, Asylums, Hospitals, &c., outside the Borough, 75 of whom were removed from Common Lodging Houses in the Borough. Of the total, 202 formerly resided in St. Giles and Bloomsbury, and 183 in the Holborn District. CORRECTED DEATHS AND DEATH-RATES, 1915. 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, 1915. Death Hate for 1915. Corresponding period 1914. In Borough. Beyond Borough. St. Giles and Bloomsbury 186 62 72 12 202 327 15.9 15.1 Holborn Sub-District 690 516 487 1 183 375 19.0 16.5 Whole Borough 876 578 559 — 385 702 174 15.8 Registration London ... ... ... ... ... 72,399 # 14.4 * Not yet reported by Registrar-General. B 10 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 births, 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 births. Deaths under 1 year per 1,000 corrected births. Holborn Borough (4 108 78 315 96 London 11,869 — — — 112 Death-rate per 1,000 corrected births in 1915 and in eight preceding years during which details respecting births have been supplied. 1907. 1908. 1909. 1910. 1911. 1912. 1913. 1914. 1915. Whole Borough 131 1ll 101 100 113 78 100 88 96 London 116 113 108 103 129 91 105 104 112 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. Seventeen of the 64 infants that died under one year of age were known to be illegitimate children. A newly-born infant found in Queen Square was also probably illegitimate. Of the 64 deaths of infants during the year the Lady Sanitary Inspector was able to obtain further details respecting 54. Of these 8. principally cases of premature birth, died before taking food; only 21 were breast fed, and 25 artificially fed. In 10 of these the mothers worked in factory or workshop, 3 were engaged in charing or other work outside the home, and 11 were in domestic service. There were 8 deaths from diarrhœal diseases. 5 of these took place in the third or summer quarter. Of 59 deaths 25 were from prenatal causes and 34 from postnatal causes. 3 of the above deaths were infants of Belgian refugees. The principal causes of death of these 67 children under one year of age are given in Table IV. of the Appendix. 11 MATERNITY AND CHILD WELFARE. 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. During the year 451 first visits were made. In 7 cases for various reasons enquiries could not be carried out. In the remaining 444 cases, 2 were stillborn, 5 children did not live long enough to take any food, 37 were being artificially fed, and 400 were being 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 1915, was as follows:— Notified once only (a) By Doctors or Medical Students 309 (b) „ Midwives 211 (c) „ Parents and others 11 Notified twice (a) By Doctors and Parents 3 (b) „ „ „ Midwives 2 (c) „ Midwife and Parent 1 Total 537 During the same period 594 births were registered in the Borough; the corrected number of births of residents was 670. (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 b 2 12 from me. During the year 48 new certificates were issued, of which 46 were used. Including 17 children who were taking the milk at the beginning of the year 1915, the milk was used by 63 children during the year, in comparison with 65 during the previous year. In the majority of cases the infants thrived well on the milk. In a number of cases the use of the milk was after various periods and for various reasons discontinued. There were 4 deaths of the 63 infants who had been taking prepared milk during the year, 3 of which were at 6 months old and upwards. One died from whooping cough, one from pneumonia, one had left off prepared milk for two months before death on account of removal to hospital. The remaining one had cleft palate and was unable to suck breast; prepared milk was tried when six weeks old; although it then gained weight, it died less than three weeks afterwards from marasmus. 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 63 children who were taking prepared milk during the year, the parents of as many as 45 children were so assisted. (4) Holborn Maternity Centres. (a) Passmore Edwards Settlement School for Mothers and Baby Clinic. In my Annual Report for 1913 I gave an account of the Passmore Edwards Settlement School for Mothers which was opened on the 29th September, 1913. The Clinic is held every Monday from 2 to 4.30 p.m., and in 1914 there was commenced a needlework and instruction class for mothers every Wednesday from 2.30 to 4.30 p.m. On account of the opening of the Holborn Maternity Centre at 75, Lamb's Conduit Street, in February, 1915, as this is much more convenient for many of the Holborn mothers, the number of new entries from the Holborn Borough was much reduced during the year, viz., only 28 in comparison with 92 in the preceding year, and in the month of December the number in attendance had been reduced to 14. Also on account of the Holborn Maternity Centre, the Health Visitor who had been attending every Monday and Wednesday, for a time attended only on Mondays, and since June, on account of the reduction in the Holborn cases, has practically ceased her attendance at this Centre. (b) Holborn Maternity Centre and Invalid Kitchen. The Holborn Maternity Centre and Invalid Kitchen was opened in February, 1915, in premises in Lamb's Conduit Street leased from the Committee of the Factory Girls' Country Holiday Fund, one of the great advantages being a good 13 yard overhung by beautiful trees, where the mothers and babies may sit when it is warm enough, and almost fancy that they are in the country. The Centre was fortunate in that it was the development of lectures, classes and other work for women and girls of all ages, and had been going for many years in the parish of St. Peter, Saffron Hill. Those who were responsible for this earlier work together with many of the mothers and babies who had profited by it, formed the nucleus of the new venture. Mrs. Colman, M.D., kindly promised to act as Hon. Medical Officer of the Centre, and Miss Pearson, a fully qualified whole-time Superintendent, was appointed. Medical Consultations are held every Wednesday from 2.30 to 5 p.m. A needlework and instruction class for mothers is held every Monday afternoon. The Health Visitor attends every Monday and Wednesday afternoon to assist in the work. Since Christmas there has also been a class on Thursdays for mothers expecting their first babies at which informal advice and instruction are given and teaching in the making of baby clothes. In the invalid kitchen 2,420 meals were provided for invalids and nursing mothers. There is also a Provident Club into which 53 of the mothers are paying. From the time of opening to the end of the year 90 Holborn infants attended, and of these 35 were still attending at the beginning of 1916. (c) Branch Centre at London Medical Mission. In January, 1916, a Branch with fortnightly consultations on Tuesday afternoons was started by kind permission of Miss Stansfield at the London Medical Mission, Short's Gardens, Endell Street, Dr. Goonetelleke, the Medical Officer, kindly giving his services. (d) Kingsway Crèche. The Kingsway Creche, formed on the opening of the new building of the West London Mission in December, 1911, has some large airy and well lighted rooms at the top of the building. A School for Mothers in connection with the Creche was begun in May, 1915. There were 32 infants on the register at the end of the year and of these 9 were residents of Holborn. On account of the opening of the Holborn Maternity Centre and the Branch in Short's Gardens, this work has been discontinued since February, 1916, and it is now again being continued only as a Creche, although Dr. Lydia Leney still attends weekly as Hon. Medical Officer. About 50 babies and young children are received daily. 14 (5) Creches (Day Nurseries). In addition to the Kingsway Creche mentioned above, there are also the following Day Nurseries in the Borough:—St. John's, Fisher Street, Red Lion Square; Field Lane Institution, Vine Street, Clerkenwell Boad; St. Alban's, 8, Greville Street, Brooke Street. All but the last-named applied to the Board of Education for grants, and in accordance with the requirements of that Board in connection therewith, I inspected the same and gave certificates as desired. (6) Dinner Tickets for Poor, Deserving Mothers. In order to encourage the continuance of breast feeding by poor deserving mothers, Councillor Walter Hazell, J.P., has for some years arranged to pay for dinner tickets to enable such mothers to obtain a sixpenny dinner at a restaurant in the Borough. On account of the opening of the invalid kitchen in connection with the Holborn Maternity Centre only 18 such tickets were made use of last year. (.7) Ante Natal Work. Notification of, and Classes for, Expectant Mothers. As a large number of the mothers of the Borough are attended by the Maternity Departments of the five large hospitals in the neighbourhood of the Borough, in the latter part of the year 1914, I wrote to the secretaries of those hospitals to know whether they would be prepared to co-operate with this Council respecting the home visiting of expectant mothers by kindly furnishing a weekly list of such cases belonging to this Borough. Although four of the hospitals had agreed to this co-operation, and printed forms for the purpose had been supplied, I only received weekly lists from the University College Hospital. Changes and reduction of staff due to the War has interfered with the work, and at the Royal Free Hospital, the Maternity Wards, which were nearly completed at my visit when arrangements were made in January, 1915, were soon afterwards used for wounded soldiers. Direct information of such cases is often obtained by the Health Visitor. Classes for expectant mothers were introduced at the School for Mothers, Passmore Edward's Settlement, and at the Holborn Maternity Centre. 15 SENILE MORTALITY. The number of deaths of persons 65 years of age and upwards was in:— St. Giles and Bloomsbury 116 Holborn Sub-District 113 Holborn Borough 229 St Giles and Bloomsbury. Holborn Sub-District. TOTAL. Of those the numbers were— 65 years and under 70 70 „ „ 75 75 „ ,, 80 80 „ ,, 85 85 „ „ 90 90 „ „ 95 95 ,, „ 100 100 years of age and upwards 35 31 27 16 4 1 2 - 27 31 30 18 6 1 - - 62 62 57 34 10 2 2 - 116 113 229 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 55 in comparison with a decennial average of 53. The death-rate for the Borough was only l.37 in comparison with 166 for London. Number. Epidemic Death-Rate. St. Giles and Bloomsbury Holborn Sub-District Holborn Borough And for Loudon 21 34 55 7,114 1.02 1.72 1.37 1.66 The following are the number of deaths from the separate diseases:— St. Giles and Bloomsbury. Holborn Sub-District. Holborn Borough. London. Small-pox ... ... ... 3 Measles 5 14 19 2,272 Scarlet Fever 1 — 1 332 Diphtheria and Membranous Croup 6 5 11 699 Whooping Cough 3 9 12 1,146 Typhoid Fever 1 — 1 120 Typhus — — — — Diarrhœa (under 2 years of age) 5 6 11 2,542 Total 21 34 55* 7,114 * Exclusive of Military and Naval deaths. 16 DEATHS FROM EPIDEMIC DISEASES OCCURRING IN THE BOROUGH DURING THE YEAR 1915 AND DURING THE PRECEDING TEN YEARS. Year. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhoea. Total. Number. Hate per 1000. Number. Rate per 1000. Number. Rate per 1000. Number. Rate per 1000. Number. Rate per 1000. Number. Rate per 1000. Number. Kate per 1000. Number. Rate per 1000. 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 6 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 1911 — — 15 0.31 3 0.06 3 0.06 3 0.06 2 0.04 33* 0.67* 59 1.21 1912 — — 25 0.52 0 0.00 6 0.13 7 0.15 1 0.02 8* 0.17* 47 0.98 1913 — — 7 0.15 0 0.00 4 0.08 6 0.13 0 0.02 12* 0.25* 29 0.61 1914 — — 11 0.24 2 0.04 3 0.06 9 0.19 6 0.13 11* 0.24* 42 0.90 Average for 10 years 19051914. 0.0 0.00 14. 4 0.29 2.2 0.04 4.9 0.10 11.5 0.22 2.5 0.05 18.0 0.35 53.5 1.04 1915 — — 19 0.47 1 0.02 11 0.27 12 0.30 1 0.02 11 0.27 55† 1.37 London, 1915. 3 0.00 2,272 0.53 332 0.08 699 0.16 1,146 0.27 120 0.03 2,542* 0.59* 7,114 1.66 * The Registrar General since 1911 has taken the deaths from Diarrhœa and Enteritis under two years of age. † Exclusive of Naval and Military deaths. MEASLES. We received information of 268 cases in comparison with 203 in 1914, 75 in 1913, 202 in 1912, 101 in 1911, and 234 in 1910. There were 19 deaths or a rate of 0.47 per thousand in comparison with a decennial rate of only 0.29. Of these only 5 belonged to St. Giles and Bloomsbury and 14 to the Holborn District. 13 of the 19 were under 2 years of age. 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:— Wild Street Class Room A. February 4th to 19th. St. George-the-Martyr „ B. February 4th to 12th. Do. „ D. April 28th to May 14th. Princeton Street „ B. February 15th to 26th. Do. „ B. October 27th to 6th November. St. Giles „ C. April 28th to May 4th. St. John-the-Evangelist „ D. December 13th to 23rd. 17 Since the Measles Order of the Local Government Board of the 30th May, 1911, in addition to Poor Law cases, persons that cannot be satisfactorily isolated and nursed at home can be removed to hospitals of the Metropolitan Asylums Board, on the recommendation of the Medical Officer of Health, provided accommodation is available. 4 cases were so removed during the year. In December arrangements were made for the notification and treatment of Measles and German Measles as required by The Public Health (Measles and German Measles) Regulations, 1915, which came into operation on January 1st, 1916. WHOOPING COUGH. Whooping cough was returned as the cause of 12 deaths during the year, in comparison with 9 in the preceding year and 3 in 1910. 3 of the deaths were in St. Giles and Bloomsbury and 9 in the Holborn District. All were children under 5 years of age, 10 being under 2 years. The death-rate was 0.30 per 1,000 in comparison with the decennial average of 0.22. On the 9th August, 1912, the Local Government Board issued an Order providing for the admission of any person who is not a pauper to a hospital of the Metropolitan Asylums Board on the recommendation of the Medical Officer of Health, provided more accommodation is available than is required for pauper patients. No case was so removed during the year. DIARRHŒA AND ENTERITIS. The number of deaths from diarrhœa and enteritis was only 13, and of these 11 were under 2 years of age. Of the 11, 5 belonged to St. Giles and Bloomsbury and 6 to the Holborn District. 8 were children under 1 year of age. The Registrar-General in 1911 introduced a change in the method of classification of diarrhœal deaths. He takes the deaths from diarrhoea and enteritis under two years of age, instead of deaths at all ages from cholera, dysentery and diarrhoea. In estimating rates, he takes the number of deaths per 1,000 births instead of per 1,000 of the population. In the Borough this rate was only 16'4 per 1,000 births, in comparison with 25.0 for London with 2,542 deaths under two years of age. 6 of our deaths (under two years of age) and 1,299 London deaths occurred during the summer quarter, in comparison with 28 and 4,310 respectively during the exceptionally hot one of 1911. PHTHISIS. For details see pages 22 to 27. INFLUENZA. During the year there were 7 deaths registered as due to influenza, in comparison with 4 in 1914. c 18 ALCOHOLISM. Only 26 deaths were assigned to alcoholism or cirrhosis of liver, 12 in St. Giles and Bloomsbury and 14 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. 54 deaths were registered as due to cancer or malignant disease, 32 belonging to St. Giles and Bloomsbury and 22 to the Holborn District. OTHER CAUSES OF DEATH. Further details as to causes of and ages at death are given in Table III. of the Appendix. INQUESTS. Coroner: Walter Schroder, Esq., Office, Manor Place, Paddington Green, W. Inquiry Officer: Mr. G. Stabb, 46, Baker Street, King's Cross Boad. The following inquests on the bodies of Parishioners were held:— District. Total Number. Cause of Death. Natural. Accidents. Suicide. Murder St. Giles and Bloomsbury 39 24 12 2 1 Holborn 41 17 12 6 6 Total 80 41 24 8 7 THE PUBLIC MORTUARY, GOLDSMITH STREET. 85 bodies were received (53 being parishioners), and on these 51 inquests (27 of parishioners) were held, and 38 post-mortems (21 of parishioners) made. NOTIFICATIONS OF INFECTIOUS DISEASES. Excluding Naval and Military cases, and duplicate notifications, 198 notifications of Phthisis, 92 notifications of Whooping Cough, and 27 notifications of Chicken Pox, the number of notifications of infectious diseases in the Borough during 1915 was 273 in comparison with a decennial average of 256. The notifications per 1,000 of the population were less than for London, namely 6.78 per 1,000 in comparison with 7.52 for London. For further details, see the following Table and Table II. of the Appendix NOTIFICATIONS OF INFECTIOUS DISEASES IN THE BOROUGH DURING 1915, AND DURING THE PRECEDING TEN YEARS, AND RATES PER 1,000. (Excluding Naval and Military Cases). 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. 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 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 1912 0 0.00 88 1.83 113 2.36 12 0.25 0 0.00 48 1.00 0 0.00 0 0.00 5 0.10 1 0.02 0 0.00 267 5.56 1913 0 0.00 59 1.23 131 2.75 7 0.15 0 0.00 29 0.61 1 0.02 0 0.00 3 0.06 0 0.00 2 0.04 232 4.86 1914 0 0.00 63 1.35 173 3.71 15 0.32 0 0.00 22 0.47 4 0.09 0 0.00 6 0.13 0 0.00 0 0.00 283 6.06 Average for 10 years 1905.1914. 0.2 0.00 61.4 1.22 134.5 2.65 16.0 031 0.2 0.00 39.6 0.77 1.7 0.03 0.1 0.00 1.9 0.04 0.4 0.01 0.2 0.00 256.2 5.05 1915 0 0.00 67 1.66 154 3.82 6 0.15 0 0.00 28 0.70 2 005 0 0.00 6 0.15 10 0.24 0 0.00 273 6.78 London,1915 13 0.00 9,094 2.12 16,974 3. 95 607 0.14 11 0.00 3,842 0.89 276 0.06 4 0.00 760 0.18 627 0.15 97 0.02 32,305 7.52 Chicken-pox was notifiable from October 19th, 1901, to January 6th, 1903, 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, and from 17th March to 30th June, 1915, during which period 27 notifications were received. Anthrax, nil; Glanders, nil; Hydrophobia, nil; There were also the following voluntary notifications of Phthisis:- 1904 344 1905 208 1906 191 1907 171 1908 152 1909 Voluntary 16 ,, Poor Law 326 ― 342 1910 Voluntary 16 „ Poor Law 154 ― 170 1911 Voluntary 3 „ Hospital 81 ,, Poor Law 104 ― 188 1912 Private 35 ,, Hospital 79 „ Poor Law 96 ― 210 1913 Private 58 ,, Hospitals 73 ,, Poor Law 73 ― 204 1914 Private 42 „ Hospitals 49 ,, Poor Law 44 ―135 1915 Private 84 ,, Hospitals 49 „ Poor Law 65 ―198 C 2 Also 92 notifications of Whooping Cough which was made notifiable in Holborn for 5 years from 1st April, 1914. 20 SMALL POX. There was no notification of small-pox in the Borough during the year. In London 11 cases were notified, and 90 in England and Wales. SCARLET FEVER. Excluding duplicates, the number of notifications of scarlet fever was 154 in comparison with 173 in the year 1914. Of these 106 belonged to St. Giles and Bloomsbury and 48 to the Holborn District. All but 2 of the cases were removed to Hospital. The number of notifications was equal to 3.82 per 1,000 in comparison with 3.95 for London. The average for the preceding decennium in the Borough was 2.65 per 1,000. Four of the cases were nurses at Hospitals in the Borough. Errors in Diagnosis. During the year 9 cases were returned as not suffering from scarlet fever, or 5.8 per cent. of the notifications. Secondary Cases of Scarlet Fever. Excluding the above 9 cases, of the remaining 145 notifications, 93 occurred at houses in which there was no secondary case. In 12 houses 2 cases occurred, in 3 houses 3 cases, and in 2 houses 4 cases. In one large institution for about 720 employees 12 cases occurred. In one instance the primary case occurred in the October of the preceding year. Return Cases of Scarlet Fever. Excluding the above large institution at which some of the secondary cases were possibly infected by cases after their return from Hospital, of the remaining secondary cases, 2 were " return " cases, i.e., cases occurring in a house soon after the return home of a patient from Hospital. DIPHTHERIA. The number of cases of diphtheria was 67 in comparison with 63 in the year 1914. Of these 31 belonged to St. Giles and Bloomsbury and 36 to the Holborn District. All but 2 were removed to Hospital. The notification rate was 1.66 per 1,000 in comparison with 212 per 1,000 for London. The average for the preceding decennium for the Borough was 1.22 per 1,000. Three of the cases were nurses at a Hospital in the Borough. Errors in Diagnosis. Seven of the patients were returned from the Hospitals of the Metropolitan Asylums Board as not suffering from diphtheria, or 10.4 per cent. of the cases notified. 21 Secondary and Return Cases. Excluding the above 7 cases and the 3 Hospital nurses, of the remaining 57 cases, 54 occurred in houses in which there was no secondary case. The only secondary case occurred at a house in which the primary case was removed to Hospital on the 9th September in the preceding year, and did not return home until the 4th January, 1915, nearly four months afterwards. The secondary cases were notified on the 16th and 26th January and the 2nd March, 1915. ENTERIC FEVER. Excluding duplicates there were 6 notifications in comparison with 15 in the preceding year. Five belonged to St. Giles and Bloomsbury District and 1 to the Holborn District. Four were removed to Hospital. These notifications corresponded to a rate of 0.15 per 1,000 in comparison with 0.14 for London. Errors in Diagnosis. Two cases were returned from the Hospitals of the Metropolitan Asylums Board not suffering from enteric fever, or 33 3 per cent. of the cases notified. All the remaining 4 cases were not contracted in the Borough. Two were contracted in France, one during travels in England, and the other was a housemaid in Westminster, and only came here, on account of her illness, two days before removal to Hospital. CEREBRO-SPINAL FEVER. (Epidemic Cerebro-Spinal Meningitis.) Ten cases were notified during the year, 7 belonged to St. Giles and Bloomsbury and 3 to the Holborn district. 627 cases were notified in London. These notifications corresponded to a rate of 0.24 per 1,000, in comparison with 0.15 for London. POLIO-MYELITIS AND ENCEPHALITIS. No notification was received during the year. There were 97 notifications in London. GLANDERS, ANTHRAX AND HYDROPHOBIA. No notification was received. 22 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. Six cases were notified in the Borough during the year, 1 in St. Giles and Bloomsbury and 5 in the Holborn District. Two of the infants were treated at Hospitals, and 4 by the doctors in attendance. In one of the latter cases I made arrangements for attendance of a nurse from the Metropolitan and National Nursing Association, Bloomsbury Square. WHOOPING COUGH. The Public Health Committee directed the attention of the Council to the difficulty of preventing children suffering with whooping cough associating, not only with members of their own family, but with other children to whom they might convey the infection, and expressed the opinion that in order to ensure more complete and earlier information respecting cases of whooping cough, and with a view to further effort being made to minimise its spread, the disease should be added to the list of notifiable diseases. The Local Government Board approved this provided that the notification was limited to a period of five years and only Sections 55, 66 and 68 (1) (a) and (b) of the Public Health (London) Act, 1891, were applied to the disease. These three sections deal with notification, removal to hospital, and penalty on exposure of infected persons respectively. This was agreed to by the Council and the Order came into operation on the 1st day of April, 1914. 92 notifications of the disease were received during the year 1915. PHTHISIS (CONSUMPTION) and other forms of TUBERCULOSIS. The number of deaths from phthisis during the year was 73, or a death-rate of 1.81 per 1,000, in comparison with 1.97 for 1914. Of these 38 belonged to St. Giles and Bloomsbury, a death-rate of 1.85, and 35 to the Holborn District, or a death-rate of 1.77 per 1,000. During the past year of the 73 deaths, 2 occurred in common lodging houses, and 22 had been removed to infirmaries from common lodging houses in the Borough, that is about 32.8 per cent., 17 from St. Giles and Bloomsbury, and only 7 from the Holborn District. The corrected number of deaths in London was 6,782, equal to a rate of l.58 per 1,000, compared with l.39 for 1914. 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 1905-1915, inclusive 23 Year. Holborn Borough. London. Rate per 1,000 Deaths Death-Rate per 1,000. Crude. Corrected. 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 1912 95 1.98 1.74 1.35 1913 89 1.87 1.60 1.30 1914 92 1.97 1.69 1.39 1915 73 1.81 (?) 1.58 In addition there were 9 deaths from Tuberculous Meningitis and 4 deaths from other forms of Tuberculosis. Notifications. By the Public Health (Tuberculosis) Regulations, 1912, the notification of all forms of Tuberculosis was made compulsory. Excluding duplicates and military and naval cases the total number of notifications received was 198, of which 84 were private cases, 49 hospital cases, and 65 poor-law cases. Of these 162 were pulmonary cases and 36 non-pulmonary. Of the total number of pulmonary cases 31, or 19'1 per cent., were residents of common lodging houses, and were all but 1 at once or soon afterwards removed to workhouse infirmaries. With few exceptions the remaining 131 lived in tenement houses, and 77 of these were removed to infirmary or hospital, 54 remaining at home, but some of these had previously been in infirmaries, hospitals or sanatoria. Tuberculosis Dispensary. (At University College Hospital.) After careful consideration of various proposed schemes, arrangements were finally made with the University College Hospital for the use of their Dispensary as the Borough Tuberculosis Dispensary. The scheme was approved by the Local Government Board, the London County Council, the National Insurance Commission and the London Insurance Committee, and the Dispensary was opened on the 2nd February, 1915. 24 The following is the Report of the Tuberculosis Officer, M. M. Khan, M.B., B.S. Lond., M.R.C.S., L.R.C.P., from the opening of the same to the end of the year:— The record of attendances for the period under consideration is not all that could be desired, but account must be taken of the fact that the arrangements for the Dispensary treatment of persons residing in the Borough of Holborn only came into operation at the beginning of February, 1915. Moreover, the specially appointed Tuberculosis Health Visitor did not commence her duties until the beginning of April of the same year. The scheme is now beginning to work more smoothly, and the attendances are increasing slowly but steadily, and there is hope that the next annual report will be more satisfactory. The Borough of Holborn is well supplied with General Dispensaries and Hospitals, so that competition is keen and patients naturally do not like changing their doctors. A great deal more could be done by the local practitioners to assist the Dispensary in its campaign against Tuberculosis. They could at least advise their patients to have their contacts examined at the Dispensary. Many of the doctors send their patients to the General and Special Hospitals instead of referring them to the Dispensary, which has been specially equipped for the diagnosis and treatment of Tuberculosis. 1.—New Patients. The total number of new patients examined during the period under consideration was 110. Of these 46 were insured and 64 non-insured. The table below gives a summary of the cases. Insured. Males. Females. Non-Insured. Children under 16. Adults. Males. Females. Totals. No. of persons examined for the first time, at or in connection with the Dispensary 34 12 41 8 15 110 No. of persons found to be suffering from Pulmonary Tuberculosis 274 10 6 8 55 No. of persons suffering from non-Pulmonary Tuberculosis 000000 No. of persons found to be non-tuberculous 6 6 28 1 5 46 No. of persons in whom the diagnosis was doubtful 1 2 3 1 2 9 25 2.—Attendances and Examinations. Insured. Non-Insured. Totals. Total number of attendances during the period February to December, 1915 167 181 348 Number of the above attendances at which systematic examinations and records were made 106 114 220 3.—Diagnosis. In all doubtful cases the diagnosis was based on:— (a) Family history. (b) Sputum examination. (c) X-rays. (d) Cutaneous tests of Yon Pirquet and Moro. (e) Observation (e.g. periodical weighing, examination, etc.) Children with indefinite signs were kept under observation, when the above tests gave negative results. A considerable proportion of these cases are still under supervision. (a) A history of probable infection of a near relative was obtained in 33 of the cases. (b) Sputum examinations. The majority of the specimens were examined by the anti-formin method, and in all doubtful cases three examinations were made, when possible. Total number of specimens examined— Insured. Non-Insured. Total. 42 35 77 Tubercle bacilli found in 40 specimens. (c) X-rays were used on four occasions. Of these 2 were negative, 1 was positive, and the fourth confirmed the diagnosis of a sarcoma of the mediastinum. (d) The cutaneous reactions were only used in children with indefinite physical signs. Positive. Negative. Yon Pirquet's test 3 2 Moro's test 1 0 d 26 4.—Treatment. With regard to treatment, the cases were classified into those requiring:— Number of Cases. (a) Sanatorium treatment 19 (b) Hospital treatment 32 (c) Advanced hospital treatment (d) Hospital observations 3 (e) Dispensary treatment or supervision 30 Dispensary Treatment. In addition to the usual cod liver oil and malt, tonics and cough mixtures, various inhalations, creosote in capsules, and garlic juice were tried in suitable cases. The inhalations proved very beneficial in laryngeal cases. Tuberculin was advised in five cases. Four of these declined its administration. The fifth case was given small doses of B.E., and she has increased in weight, although the lung signs show no improvement, and there is no diminution of expectoration. 5.—Supervision of Home Conditions. All notified cases were visited by the Tuberculosis Health Visitor, and the usual B. forms filled up whenever possible. Some of the patients notified were either dead or had removed without leaving their new address. Only such cases as were too unwell to attend at the Dispensary received a visit from the Tuberculosis Officer. Insured. NonInsured. Uncertain. Total. Visits of Dispensary Nurse 154 185 63 402 Visits of Tuberculosis Officer 10 5 0 15 6.—Reports. Medical reports of patients were forwarded to:— (a) The Medical Officer of Health, (b) The London Insurance Committee, Public Authorities. (c) Practitioners. 27 Total number of reports:— Insured. Non-Insured. Total. Public Authorities 89 70 169 Practitioners 9 1 10 The above figures do not include the monthly reports to the Medical Officer of Health. 7.—Contacts. A good deal of difficulty has been experienced in securing the systematic examination of all contacts, and this part of the work has not been satisfactory. Many of the families resented the suggestion that some of their members might be tubercular. The figures are as follows: 30 contacts submitted to examination, and 45 either refused or gave vague promises, which they did not keep. Of the 30 contacts examined, 3 were found to be suffering from pulmonary tuberculosis, 3 were doubtful, and 24 were free from active disease Of the 3 tubercular contacts, 1 was an adult (31 years) and 2 were children (6 years). 8.—Result of Treatment. The available figures are given below:— Diseases arrested or quiescent 12 Improved 16 Stationary 11 Worse 1 Dead 15 Total 55 9.—Miscellaneous. Of the patients recommended for hospital treatment, 14 were admitted to the University College Hospital. Four doubtful cases (children) were admitted to the University College Hospital for observation. Two consultations were held with the Medical Adviser of the London Insurance Committee. d 2 28 BACTERIOLOGY. The following table gives details of the examinations made during the year. Diphtheria. Enteric Fever. Consumption. Number Submitted. Result of Examination. Number Submitted. Result of Examination. N umber Submitted. Result of Examination. 75 52 bacilli not found 23 bacilli found 7 6 Negative 1 Positive 117 87 bacilli not found 30 bacilli found DISINFECTIONS. During the 52 weeks ended January 1st, 1916. District. Rooms. Bedding, &c. Number of Articles. Number of Persons using Shelter. St. Giles and Bloomsbury 302 4,533 — Holborn 168 2,138 — Whole Borough 470 6,671 — 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 not necessary to use the shelter during the year. CLEANSING OF PERSONS ACT. During the year 68 persons (62 men and 6 women) infested with vermin had their bodies and clothing disinfested free of charge. All had their bodies cleansed in the new Cleansing Station at the Public Mortuary, and 498 articles were disinfested in the Council's steam apparatus. 29 HOUSING OF THE WORKING CLASSES ACTS. Housing, Town Planning, &c., Act, 1909. Proceedings under Section 17. Houses Inspected. Represented by Medical Officer of Health. Defects Remedied without Closing Orders. Closed Voluntarily. General Character of Defects. Remarks. Leather Lane Buildings Yes (in 1913) No — Insufficient light and ventilation of rooms, staircase and W.c.'s. Defective roofs, dampness and dilapidations Closing order made April, 1913. Demolition order made February, 1915 Appeal against demolition order pending Eagle Street, No. 53 No Yes Yes ditto — Evelyn Buildings Tea (in 1913) No — ditto Closing order made. ditto. determined February, 1915. Red Lion Passage, No. 14 Yes No — ditto Closing order made 1915. Much work carried out, but house still closed 35 Underground rooms 4 21 6 Not in accordance with the Regulations In 8 of the rooms no action was necessary. A number of other houses were inspected by me, but were not reported to the Housing of the "Working Classes Committee, as they did not appear to me to be in a state so injurious or dangerous to health as to be unfit for human habitation. Underground Rooms habitually used as Sleeping Places. In accordance with the Sub-Section 7 of the same Section (17) of the Act I again prepared and submitted suggested regulations. These were approved by the Council, and after minor verbal alterations received the consent of the Local Government Board, February 2nd, 1915. A number of underground rooms were inspected by me during the year, and of these 35 were reported to the Committee. Six of the 35 rooms were closed voluntarily; in 21 the defects were remedied without Closing Orders, and in the remaining 8 no action was necessary. Erection of Dwellings for the Working Classes. Short's Gardens and Neal Street Site. On account of the War the erection of the dwellings has been postponed. 30 LIST OF PREMISES CLOSED, DEMOLISHED OR REBUILT DURING 1915. St. Giles and Bloomsbury. Alfred Mews, Nos. 18, 19 and 20. Extension to Messrs Heal & Co.'s premises being built. Alfred Place, No. 29. New Jewish Synagogue being built. Betterton Street, Nos. 15 and 16. Sites still vacant. Bloomsbury Place, No. 7. Demolished (Southampton Row widening). Denmark Place, No, 20. New offices built. Denmark Street, No. 24. New offices built. Drury Lane, Nos. 192 and 193. Site still vacant. Francis Street. Temporary Police Court removed. Site vacant. Goldsmith Street, Nos. 3, 5 and 7. Site still vacant. Gower Street, Nos. 22 to 42. Site still vacant. Great Queen Street, Nos. 77 and 77b. Being rebuilt. Do. Nos. 55 and 56. Demolished and being rebuilt. Great St. Andrew Street, Nos. 40, 41 and 42. New extension to Shaftesbury Hotel being built. Herbrand Street. New Ambulance Station built. High Holborn, Nos. 171 to 181. Site still vacant. Keppel Street (North Side). Part of site still vacant. Do. (South Side). Site still vacant. Kingsway. Site between West African House and Central House. Built upon. Do. Central House. Built. Do. Imperial Buildings. Being built. Do. (East Side). Corner site of North Side of Sardinia Street. Built. Public Trustee's Offices. Little Earl Street, Nos. 11, 12 and 13. Site still vacant. Lincoln's Inn Fields, Nos. 53, 54, 55 and 56. Rebuilt. Public Trustee's Offices. Lumber Court, Nos. 1, 2, 3 and 4. New Theatre being built. Malet Street. New Theatre completed. Do. New Offices do. Montague Place (North side). Site still vacant. Neal Street, Nos. 34 to 46. Site still vacant. New Yard, Nos. 1, 2 and 3. Demolished and being rebuilt. Nottingham Court, Nos. 13 to 16. Site still vacant. Parker Street, No. 53. Site still vacant. Russell Mews. Site still vacant. Short's Gardens. New premises being built over Electric Power Station. 31 Short's Gardens, Nos. 30 and 32. Site still vacant. Southampton Row, Nos. 37 to 53. Demolished (Southampton Row widening) Torrington Mews, Nos. 1 to 23. Site still vacant. Do. (East), Nos. 6, 7, 8, 9 and 10. Demolished. Tottenham Court Road, Nos. 200 and 203. Site still vacant. Do. Nos. 193 and 195. New extension to Messrs Heal & Co's premises being built on part of site. Tower Street, Nos. 14, 15, 16 and 17. New Theatre being built. Upper Bedford Place, Nos. 43 to 51. National Hotel being built. Vernon Place, Nos. 7, 8 and 9. Demolished (Southampton Row widening). West Street, Nos. 10, 12, 14 and 16. New Theatre being built. Woburn Mews, No. 23. Site still vacant. Do. Nos. 14 to 22. National Hotel being built. Woburn Place, Nos. 42-53. Site still vacate. Holborn. Beauchamp Street, Nos. 1, 2, 3 and 3a, Brooke Street, Nos. 13, 14, 15 and 16 and Greville Street, Nos. 10 and 11. Completed for "Prudential" new additional offices. Bishop's Head Court, No. 1. Still unoccupied. Boswell Court, Nos. 8 to 13. Site still vacant. Brooke Street, Nos. 13, 14, 15 and 16. See Beauchamp Street. Cockpit Yard, No. 10. Premises still closed. Cross Street, Nos. 15, 16 and 17. Being rebuilt. Do. No. 19. Being rebuilt. Devonshire Street, Nos. 44 to 47. Site still vacant. Dorrington Street (North Side), Nos. 1 to 12. Rebuilt. Dunstable Court, South End. Site still vacant. Do. North End. Being rebuilt. Eagle Street, Nos. 42 and 43. Rebuilding completed. Do. No. 53. Premises still closed. East Street, Nos. 39 and 40. Site still vacant. Emerald Street, No. 30. Premises still closed. Farringdon Road, No. 61. Demolished. Greville Street, Nos. 10 and 11. See Beauchamp Street. Harpur Mews, Nos. 12, 13 and 14. Premises demolished and being rebuilt. Hatton Garden, No. 7. Rebuilding completed. Do. No. 36. Rebuilt. Do. No. 48. Rebuilding completed. Do. No. 55. Demolished. Hatton Wall, No. 9. Being demolished. 32 Henry Street, No. 5. Site still vacant. High Holborn, Nos. 73 and 78. Jockey's Fields. No. 14. Practically demolished and rebuilt. Lamb's Conduit Passage, Nos. 14 to 20. Site still vacant. Do. No. 8. Being demolished. Lamb's Conduit Street, Nos. 10 and 12. Site still vacant Long Yard, No. 10. Demolished. Millman Street, No. 66. Premises still closed. New North Street, Nos. 14a and 15. Site still vacant. Do. Nos. 20, 21 and 28. Site still vacant. Do. Nos 22 to 27. Rebuilding. New North Street, Nos. 29 to 33. Demolished. Old Gloucester Street, No. 6. Site still vacant. Red Lion Square, No. 25. Being demolished. Red Lion Street, No. 48. Site still vacant. Do. No. 44. Being demolished. Star Yard, Lamb's Conduit Street, Stables and dwelling-house. Part of site still vacant. Yorkshire Grey Yard, Nos. 1 and 2. Demolished. Do. No. 3. Premises now used for storage. SANITARY WORK. HOUSE TO HOUSE INSPECTIONS, 1914. St. Giles and Bloomsbury. Arthur Street. Bainbridge Street. Broad Street (part of). Betterton Street. Bucknall Street. Castle Street. Charing Cross Road (part of). Clark's Buildings. Clark's Mews. Denmark Place. Denmark Street. Drury Lane. Endell Street. Gilbert Street. Goldsmith Buildings. Goldsmith Street. Great Earl Street. Great Queen Street (part of). Great St. Andrew Street. Great White Lion Street. Herbrand Street. High Street. Kenton Street. Lawrence Street. Little Denmark Street. Little Earl Street. Little Russell Street. Little St. Andrew Street. Little White Lion Street. Lumber Court. Neal Street. New Compton Street. New Turnstile. Nottingham Court. 33 St. Giles and Bloomsbury—continued. Phoenix Street. Shaftesbury Avenue (part of). Short's Gardens. Smart's Buildings. Stacey Street. Tottenham Court Road. Wild Court. Wild Street. Willoughby Street. Woburn Mews. Woburn Place. Holborn. Albion Buildings. Back Hill. Charles Street. Dane Street. Devonshire Street. Eagle Street. East Street. Emerald Street. Evelyn Buildings. Eyre Street Hill. Great James Street. Hatton Garden. Hatton Wall. Hatton Yard. High Holborn (part of). John's Mews. Lamb's Conduit Passage. Lamb's Conduit Street. Leather Lane (part of). Little Bath Street. Little Gray's Inn Lane. Little James Street. Millman Place. Mount Pleasant. Museum Street. New North Street. Old Gloucester Street. Old North Street. Ormond Yard. Pooles Buildings. Princeton Street. Quality Court. Eed Lion Passage. Eobert Street. Summer Street. Verulam Street. Warner Street. WATER SUPPLY TO NEW BUILDINGS. During the year I inspected and gave certificates for the following premises:— 36, Hatton Garden. 30, Eussell Square. 7, Hatton Garden. I inspected also a number of other new buildings to be used only for business purposes therefore no certificates for these were required. WATER SUPPLY TO TENEMENT HOUSES. In accordance with the Public Health Act, and Section 78 of the London County Council (General Powers) Act, 1907, 3 notices were served for the provision of additional water supply in tenement houses. e 34 BY-LAWS AS TO HOUSES LET IN LODGINGS. At the end of the year, 629 houses were registered under these By-laws, of these, 305 are in St. Giles and Bloomsbury, and 324 in the Holborn District; 9 such houses were removed from the Register principally on account of the closing or demolition of the houses, and in some cases because the houses are now occupied only by members of one family, and 1 was added to the Register. During the year, there were 998 inspections of these premises, excluding a very large number of periodical inspections and re-inspections. 7 notices were served for 8 overcrowded rooms, and 217 notices for other breaches of the By-laws, exclusive of 644 notices that were served for annual cleansing as required by the By-laws. OVERCROWDING. The number of dwelling rooms found to be overcrowded was 15, 8 of these were dealt with as breaches of the By-laws as to houses let in lodgings. These numbers are much fewer than usual, because so many men have joined H.M. Forces. REVENUE ACTS. No application was received during the year for Certificates from me under the above Acts. REMOVAL OF HOUSE REFUSE. In the main thoroughfares and a number of other streets there is a daily collection. From all other premises in the Borough in accordance with the contract all house refuse has to be removed at least twice weekly and oftener if required by the Medical Officer of Health. The number of streets in which there is a daily collection was increased by the addition of Warner Street and Little Bath Street without any additional cost. As usual much attention was given to securing the regular removal of house refuse, and a large number of inspections were made by the Inspectors and me, including early morning inspections of the streets in which there is a daily collection. On account of the War a number of dustmen enlisted or undertook other work, and a number of barges and railway trucks were requisitioned by the Government, The Dust Contractors therefore sometimes had much difficulty in maintaining an adequate supply of efficient dustmen and securing the removal of the refuse by train or barge. The greatest difficulty was experienced during 35 the early part of January when there was, in addition, a strike of dustmen. This fortunately, however, only lasted three days. On account of these difficulties it was sometimes found impossible to secure the removal of refuse at least twice weekly from all the houses in the Borough. Also on account of these difficulties the Council issued a leaflet in January, 1915, appealing to the patriotism of all occupiers to reduce the house refuse as much as possible by burning all paper, vegetable and other refuse. 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. More applications than usual were received because many waste paper merchants, the Salvation Army and other collectors of waste paper, cardboard, etc., had discontinued the collection on account of changes due to the War. REMOVAL OF MANURE. The removal of manure was again generally carried out satisfactorily, only four genuine complaints were received, in comparison with two in the year 1914, and in the three preceding years no complaints. 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. 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 1915:— The Salvation Army Shelter, 25, Charles Street, for 241 lodgers, was closed, at Michaelmas. Of these 14 are in St. Giles and Bloomsbury for 1,060 lodgers. „ 6 „ Holborn District for 381 „ Total 20 in the Borough for 1,441 „ E 2 36 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 Lodgers. 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 6, 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. 40. Eagle Street 50 M 28, Orde Hall Street 22 M 4, Greville Street 53 M 39, Queen Square 52 M 29, Hatton Wall 94 M 12 and 13, Took's Court 110 M FACTORIES, WORKSHOPS AND WORKPLACES. During the year there were 213 inspections of factories, 695 inspections of workshops and 2,385 of workplaces. 167 Intimation Notices for sanitary defects were served and 26 Statutory Notices. BAKEHOUSES. At the end of the year 1915, there were 29 bakehouses in the Borough, of which 12 were in St. Giles and Bloomsbury and 17 in the Holborn District. One in the former District at 155, High Holborn, and two in the latter District at 33, Great Ormond Street, and 92, Theobald's Road, were closed during the year. During the year, in addition to my inspections, there were 176 inspections of bakehouses, including 37 inspections of the factory bakehouses. Six notices were served for sanitary defects. 37 HOME WORK. Details are given in the preceding Table, and in Table VIII. 3 of the Appendix. Many inspections of homeworkers' premises are also made during house to house and periodical inspections of lodging houses and dwelling houses in which homeworkers 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. The number of these places on the Register at the end of 1915 was 359; 2,014 inspections were made, and 41 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 783 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 7 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 165, of which 77 were in St. Giles and Bloomsbury and 88 in the Holborn District. In all 14 dairies and milk shops were newly registered, 9 belonging to St. Giles and Bloomsbury and 5 to the Holborn District, and 36 were removed from the Register. 38 In addition to my inspections the Sanitary Inspectors made 507 inspections of these premises, and 2 notices were served for sanitary defects or breaches of regulations, and in some cases alterations were carried out without the service of notices. PUBLIC HEALTH (MILK & CREAM) REGULATIONS, 1912. The following particulars of proceedings taken in the year 1915, under the above Regulations, made in pursuance of the Public Health (Regulation of Pood) Act, 1907, are given in the form suggested by the Local Government Board in their circular letter dated 27th October, 1913, and a copy was sent to the Board in January, 1916. 1.—Milk, and Cream not sold as Preserved Cream. Number of samples examined for the presence of preservatives. Number in which a preservative was reported to be present Milk 223 nil Cream 5 1 (a) Nature of Preservative found and Action taken. (a) Cream. (1) Boric Acid 0.174 per cent. Vendor cautioned and information sent to Medical Officer of Health of District where Wholesale Dealer carries on business. 2.—Cream sold as Preserved Cream. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the labels as to preservatives were correct:— (I.) Correct statements made 22 (II.) Statements incorrect — Total 22 (b) Determination made of milk fat in cream sold as preserved cream:— (I.) Above 35 per cent. 22 (II.) Below 35 per cent. — Total 22 39 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V. (1) and the proviso in Article V. (2) of the Regulations have not been observed:— None. 3.— Thickening Substances. Any evidence of their addition to cream or to preserved cream. Action taken where found. None found. 4.—Other observations, if any:— None. ICE CREAM. During the year there were 70 premises in the Borough where ice cream was manufactured or sold, and in addition to my inspections 77 inspections of these premises were made. 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. 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:— 155 pecks strawberries. 1 trunk cod fish. 1 ease cat fish. OFFENSIVE FUMES FROM FACTORIES. Only one complaint of nuisances from offensive fumes was received during the year. This was apparently due to a temporary defect, as no nuisance was found on inspection. SMOKE ABATEMENT. The smoke shafts in the Borough were frequently kept under observation. In only 32 cases the inspections were recorded, and in few cases were smoke nuisances discovered. 40 Only three complaints of smoke nuisances were received during the year. Six Intimation Notices were served, but in no case, was it necessary to serve a Statutory Notice. For further details of Sanitary Work and Legal Proceedings see Tables V., VI., VII., VIII., IX. and X. METEOROLOGY OF LONDON, 1915. The mean temperature of the year was 49.9, and was 0.4° above the average for the preceding 75 years as deduced from observations at Greenwich, under the superintendence of the Astronomer Royal. The rainfall was 30.55 inches, and was 6.38 inches below the average of the preceding 65 years. The daily mean duration of bright sunshine was 4.12 hours, and was 0.02 hours below the average of the preceding 18 years. It was 34 per cent. of the total possible sunshine. Further details are given in Table XI. of the Appendix. 41 APPENDIX. TABLE I. Vital Statistics of Whole District during 1915 and Previous Years. Name of District—The Metropolitan Borough of Holborn. Year. 1 Population estimated to Middle of each Year. 2 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. 3 Nett. Number. 6 Rate. 7 of Nonresidents registered in the District. 8 of Residents not registered in the District. 9 Number. 10 Rate per 1,000 Births. 11 Number. 12 Rate. 13 Number. 4 Rate. 5 1908† 52,224 1,543 1,066 20.1 1,064 20.1 599 403 118 111 868 16.4 1909 51,191 1,438 986 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 1912 48,026 1,250 901 18.8 907 18.9 549 357 70 78 715 14.9 1913† 46,949 868 797 16.7 910 19.9 583 358 80 100 685 14.4 1914 46,832 703 765 16.4 888 19.0 558 408 67 88 738 15.8 1915 40,405 (Civil Population) 594 670 14.4 876 21.8 559 385 64 96 702* 17.4 Area of District in acres (exclusive of area covered by water) 405.6 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 ,, ,, Total families or separate occupiers 11,030 „ ,, N.B.—In the above Table the populations, birth-rates and death-rates for the years 1908-1914 inclusive have been estimated from the Census Populations of 1901 and 1911. For the year 1915 the population is the CIVIL population as estimated by the Registrar-General from the National Register; the birth-rate for 1915 is calculated on the estimated population at the middle of 1914, and the death-rates on the above estimated Civil population. * Excluding Military and Naval cases. † 53 weeks in Registration year. 42 TABLE II. Cases of Infectious Disease notified during the year 1915. (Excluding Naval and Military Cases.) Name of District—Holborn. Notifiable Disease Number of Cases Notified. Total Cases 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 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-pox — — - — — — — — — — — Cholera (C), Plague (P) — — — — — — — — — — — Diphtheria (including Membranous Croup) 67 3 18 34 9 3 — — 31 36 65 Erysipelas 28 2 — 5 3 7 4 7 15 13 11 Scarlet Fever 154 1 38 86 21 8 — — 106 48 152 Typhus Fever — — — — — — — — — — — Enteric Fever 6 — — — 4 2 — — 5 1 4 Relapsing Fever — — — — — — — — — — — Continued Fever — — — — — — — — — — — Puerperal Fever 2 — — — 2 — — — 1 1 1 Cerebro spinal fever 10 1 4 1 2 1 — 1 7 3 8 Polio-myelitis — — — — — — — — — — — Ophthalmia neonatorum 6 6 — — — — — — 1 5 1 Pulmonary Tuberculosis 162 — 2 9 26 60 56 9 82 80 77 Other forms of Tuberculosis 36 2 8 12 8 2 4 — 24 12 11 Glanders — — — — — — — — — — — Anthrax — — — — — — — — — — — Hydrophobia — — — — — — — — — — — *Chicken-pox 27 2 9 12 1 2 — 1 19 8 — †Whooping Cough 92 18 51 23 — — — — 32 60 9 Totals 590 35 130 182 76 85 64 18 323 267 339 †Whooping Cough was made notifiable in Holborn for five years from 1st April, 1914. *Chicken-pox was made notifiable in London from the 17th March to 30th June 1915 inclusive. 43 TABLE III. Cause of, and ages at, Death. (Excluding Naval and Military Cases.) 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 or "Residents" or " Nonresidents " 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 702 64 28 25 25 21 102 208 229 327 375 578 Uncertified — — — — — — — — — — — — 1 Enteric Fever 1 — — — — 1 — — — 1 — 2 2 Small-pox — — — — — — — — — — — — 3 Measles 19 6 7 5 1 — — — — 5 14 2 4 Scarlet Fever 1 — — — 1 — — — — 1 — — 5 Whooping Cough 12 3 7 2 — — — — — 3 9 1 6 Diphtheria and Croup 11 1 1 3 6 — — — — 6 5 6 7 Influenza 7 — — — 1 — 2 2 2 1 6 — 8 Erysipelas 2 — — — — — — — 2 — 2 — 9 Phthisis (Pulmonary Tuberculosis) 73 — 1 2 — 5 27 31 7 38 35 15 10 Tuberculous Meningitis 9 2 2 — 3 1 1 — — 5 4 60 11 Other Tuberculous Diseases 4 — 1 — — — 2 — 1 3 1 46 12 Cancer, Malignant Disease 54 _ _ — — 1 4 28 21 32 22 36 13 Rheumatic Fever 2 — — — — — 2 — — 1 1 1 14 Meningitis 5 1 — 2 — — 1 1 — 3 2 19 15 Organic Heart Disease 70 — — — 1 4 8 27 30 29 41 18 16 Bronchitis 72 3 — — — — 5 19 45 31 41 5 17 Pneumonia (all forms) 70 7 6 7 3 2 15 18 12 28 42 57 18 Other Diseases of Respiratory Organs 7 — — 1 — — — 5 1 3 4 8 19 Diarrhoea and Enteritis 13 8 3 1 — — — 1 — 6 7 56 20 Appendicitis & Typhlitis — — — — — — — — — — — — 21 Cirrhosis of Liver 17 — — — — — 3 8 6 10 7 4 21a Alcoholism 9 — — — — — 6 2 1 2 7 1 22 Nephritis and Bright's Disease 23 — — — — — 2 11 10 13 10 8 23 Puerperal Fever — — — — — — — — — — — — 24 Other accidents and diseases of Pregnancy and Parturition 1 — — — — — 1 — — 1 — 4 25 Congenital Debility and Malformation, including Premature Birth 22 22 — — — — — — — 9 13 50 26 Violent Deaths, excluding Suicide 33 3 — 2 6 4 5 10 3 16 17 22 27 Suicide 8 — — — — — 6 1 1 3 5 — 28 Other Defined Diseases 156 8 — — 3 3 12 43 87 77 79 156 29 Diseases, Ill-Defined or Unknown 1 — — — — — — 1 — — 1 1 All causes 702 64 28 25 25 21 102 208 229 327 375 578 SUB-ENTRIES included in above figures— 14 (a) Cerebro-Spinal Meningitis 2 1 — 1 — — — — — 2 — 8 28 (a) Polio-myelitis — — — — — — — — — — — 1 (b) Actinomycosis 1 — — — — — 1 — — 1 — — 44 TABLE IV. Infantile Mortality during the Year 1915. 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 4 Weeks. 4 Weeks and under 3 Months 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. All Causes. Certified 9 3 3 2 17 11 16 10 10 64 Uncertified — — — - _ — — — — — Small Pox — — — — — — — — — — Chicken Pox — — — - - - - - - - Measles — — — — — — 1 2 3 6 Scarlet Fever — — — — — — — — — — Whooping Cough — — — — — — 1 1 1 3 Diphtheria and Croup — — — — — — — — 1 1 Erysipelas — - - - - - - - - - Tuberculous Meningitis — — — _ — — 1 1 — 2 Abdominal Tuberculosis — — — - - - - - - - Other Tuberculous Diseases — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — 1 — — 1 Convulsions 1 — — 1 2 1 — — — 3 Laryngitis — — — — — — — — — - Bronchitis — — — — — — 1 1 1 3 Pneumonia (all forms) — — — — — 2 2 1 2 7 Diarrhoea — — — — — - 1 — 1 2 Enteritis — — — — — 2 3 — 1 6 Gastritis — — — — — — — 1 — 1 Syphilis — — 1 — 1 — — — — 1 Rickets — — — — — — — — - — Suffocation, overlying — — — — — 1 — — — 1 Injury at birth — — — — — — — — — — Atelectasis — — — — — — — — - — Congenital Malformations — — — — — — 2 — — 2 Premature Birth 6 3 — — 9 — — — — 9 Atrophy, Debility, Marasmus 1 — — 1 2 5 3 1 — 11 Other causes 1 — 2 — 3 — — 2 — 5 9 3 3 2 17 11 16 10 10 64 Nett Births registered during the calendar year legitimate, 616 illegitimate 54 Nett Deaths registered during the calendar year of legitimate infants 47. illegitimate „ 17. 45 TABLE V. Sanitary Inspectors' Work.—Inspections, &c. Inspector Bennett. Inspector Clark. Inspector Larard. Inspector Orange. Whole Borough Inspections. Infectious Diseases 135 86 96 168 475 Dwelling Houses 150 238 83 6 477 Lodging Houses 339 212 187 260 998‡ Common Lodging Houses — 20 7 - 27 Dairies, Cowsheds and Milkshops 41 211 255 - 607 Ice Cream—Manufacture or Storage 21 9 47 — 77 Slaughter-house — 7 - - 7 Market Streets 327 49 407 - 783 Butchers' Shops 540 113 278 - 931 Bakehouses 20 58 98 - 176 Other Food Shops 354 95 541 - 990 Laundries 1 1 3 6 11 Other Workshops 158 118 157 114 547 Out-Workers' Rooms and Registers 31 49 61 160 301 Other Workplaces 91 31 88 1 211 Factories (excluding Bakehouses and Laundries) 39 24 76 3 142 Smoke shafts 2 18 12 - 32 Urinals - 47 2 - 49 Miscellaneous 236 134 161 8 539 Periodical Inspections 1,507 2,317 2,727 7 6,558* Dust 36 142 76 — 254† Mews 164 119 41 - 324 Maternity - - - 463 463 Total Inspections 4,192 4,098 5,403 1,186 14,879 No. of Re-Inspections 922 1,220 731 582 4,924 Do. do. Maternity - - - 1,469 Visits other than Inspections and Re-Inspections 377 886 596 208 2,173 Do. do. Maternity - - - 107 Total 5,491 6,204 6,729 3,552 21,976 * 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. ‡ See also Periodical Inspections. 46 TABLE VI. Sanitary Inspectors' Work.—Notices served. [\###] Inspector Bennett. Inspector Clark. Inspector Larard. Inspector Orange. Total. Intimation Notices—Total served 167 275 248 128 818 Houses 134 225 177 115 651 The house or part of the house in a dirty condition 43 49 35 17 144 The house or part of the house in a damp condition - 3 8 3 14 The house in a dilapidated condition 4 22 19 5 50 The watercloset so foul as to he a nuisance 4 13 14 13 44 Do. without a water supply 7 3 16 - 26 Do. with a deficient supply of water 2 12 3 - 17 Do. improperly constructed — 1 — - 1 Do. so defective as to he a nuisance 8 16 14 20 58 Do. stopped 12 53 28 16 109 Do. placed in an improper position — — — — - Insufficient external ventilation to watercloset - 3 - 1 4 Insufficient watercloset accommodation - - - 1 1 Absence of watercloset accommodation — - - - - Absence of proper watercloset accommodation for persons of each sex See under Workshops &c. The soil pipe defective — 2 - - 2 Do. unventilated - - - - - Do. improperly ventilated - - - - - The yard paving defective 5 1 1 - 7 Do. dirty 1 6 3 6 16 Do. undrained - - - - - The area improperly paved - - - - - Do. dirty - 9 3 1 13 Do. undrained - - - - - The inlet of surface drain improperly trapped - 1 - - 1 A gully trap improperly placed within the house - - - - - The waste pipe of sink improperly connected with the drain - - 5 2 7 Do. do. improperly trapped... - - - — - Do. do. untrapped - 6 4 - 10 Do. of lavatory improperly connected with the drain - - - - - Do. do. improperly trapped - - - - - Do. do. untrapped 1 - - - 1 Do. of bath directly connected with the drain - - - - - Do. do. improperly trapped - - - - - Do. do. untrapped - 1 - - 1 The water cistern so foul as to be a nuisance 17 1 2 7 27 Do. being without a close fitting cover 2 7 2 - 11 Do. being placed in an improper position - - - - - Do. defective - 12 - 2 14 An accumulation or deposit of refuse 2 20 15 8 45 The absence of proper ashbin 28 13 2 3 46 The ashbin defective 23 6 9 8 46 The drain foul - - - - - Do. defective 3 8 2 - 13 Do. choked or stopped 6 14 16 18 54 Do. unventilated - - - - - 47 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 - 1 — — 1 Do. do. defective 3 15 10 1 29 The water supply used for domestic purposes connected with the cistern which is used for flushing the watercloset - - - - - The absence of proper water supply 1 1 — 1 3 The roof defective 15 33 39 5 92 The guttering defective — 2 4 — 6 The paving of wash-house defective — 1 1 — 2 The want of proper manure receptacle — 4 — — 4 An animal kept in such place or manner as to be a nuisance 1 2 - - 3 The house or part of the house overcrowded — 2 2 2 6 An underground room occupied as a dwelling contrary to the provisions of the Act 6 4 - 3 13 The space below floor in the basement or ground floor being unventilated - - — - — Do. improperly or insufficiently ventilated - - - - - A chimney sending forth black smoke in such quantity as to be a nuisance See also under Workshops 2 2 A urinal improperly constructed, drained or offensive - - - - - Do. with no supply of water - - - — — Other nuisances 1 17 7 — 25 *Factories, Workshops and Work Places 33 50 71 13 167 Dirty 11 11 14 7 43 Waterclosets, defective or dirty 9 18 26 4 57 Do. insufficient - 1 - - 1 Do. absence of separate accommodation for sexes - - 1 1 2 Drains, soil pipes, &c., defective 3 7 8 - 18 Improperly ventilated - - - 3 3 Overcrowded - - - - - Chimney sending forth black smoke 2 2 2 - 6 Other nuisances 9 8 24 2 43 Ashbins 3 9 7 — 19 Breach of Bye-laws or Regulations— †Lodging-houses 42 71 47 64 224 Dairies, cowsheds, milkshopsand slaughterhouses - 1 - - 1 Keeping of animals - 4 - - 4 Removal of Refuse — 3 — — 3 London County Council(GeneralPowers)Acts Urinals — — — — — Verminous Rooms 21 18 26 40 105 Ashpits — 1 — — 1 Foodshops — — 1 — 1 Statutory Notices 8 42 40 29 119 * 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." 48 TABLE VII. Proceedings during 1915. PREMISES. NUMBER OF PLACES— Number of Inspections 1916. Number of Notices 1915. Number of Prosecutions 1915. On register at end of 1914. Added in 1915. Removed in 1915. On register at end of 1915. Milk premises 187 14 36 165 507 2 0 Cowsheds 0 0 0 0 0 0 0 Slaughter-houses 1 0 0 1 7 0 0 Other offensive trade premises 0 0 0 0 0 0 0 Ice Cream premises 65 6 1 70 77 0 0 Registered houses let in lodgings 637 1 9 629 998 (a)*7 (a)*0 (b)*217 (b)*0 *(a) For overcrowding. *(b) For other conditions. Total number of Intimation notices served for all purposes 818 Overcrowding, 1915— Number of Dwelling Rooms overcrowded 15 N umber remedied 15 Number of prosecutions 0 Underground Rooms— Public Health (London) Act, 1891— Illegal occupation dealt with during year 13 Number of rooms closed 13 Housing, Town Planning, etc., Act, 1909— Breach of regulations dealt with 20 Number of rooms closed 5 Insanitary Houses— Number closed under the Public Health (London) Act, 1891 0 „ „ ,, ,, Housing and Town Planning 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 105 Shelters provided under Section 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year 5 Revenue Acts— Number of houses for which applications were received during the year 0 Number of dwellings comprised therein 0 Number of tenements for which certificates were (a) granted 0 ; (6) refused 0 ; (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 to 85 Total number of infectious bodies removed to 0 49 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) 213 19 4 - Workshops (including Workshop Laundries) 695 73 7 — Workplaces 2,385 75 15 — Total 3,293 167 26 — 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 43 43 — 1 Want of ventilation 3 3 — — Overcrowding — — — — Want of drainage of floors — - - — Other nuisances 86 86 — — Sanitary accommodation insufficient 1 I — — unsuitable or defective 57 57 — — not separate for sexes 2 2 — — 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 Rteport) — — — — Total 192 192 — 1 * Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the 'ublic Health Acts. G TABLE VIII.-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. men. Contractors Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) Making, &c. 126 229 420 8 3 16 128 - - - - — - — — (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 2 - 12 - - - 2 - — — - — — — - Brush making 2 - 12 - - - 2 - — — - — — — - Pea Picking - - - - - - - - - - - - - - — Feather sorting - - - - - - - - - - - - - - - Carding, &c., of Buttons, &c. — — — - - - — - — — - — — — - Stuffed Toys — - — - — — - — — - — — — — Basket making - - - - - - - - - - - - - - - Total 130 229 444 8 3 16 132 — — — — — — — — * 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 ist 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 sendiDg 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 repeated. 51 TABLE VIII continued. 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Important classes of workshops, such as workshop bakehouses, maybe enumerated here. Laundries (including 2 factory laundries) 12 Bakehouses (including 4 factory bakehouses) 30 Other Workshops 1,154 Total number of workshops on Register 1,196 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) 6 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 11 Report (action being taken) sent to H.M. Inspector 11 Other — Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 20 G 2 52 TABLE IX. LEGAL PROCEEDINGS. Public Health (London) Act, 1891. Date. Name. Address. Offences. Result. 1915. April 1 Stevens, Thos. 37 - 63, Southampton Row Nuisance from demolition of old buildings Summons dismissed. May 14 Luff, Mr. 53, Great Ormond Street Defective drain Order to abate in 14 days. Costs 10s. 6d. June 16 Bodien, Mrs. 47, Eagle Street Absence of proper water supply Defendant convicted, Fine £5, Costs £3 3s. Nov. 12 Harris, Alfred 31, Old Gloucester Street Breach of lodging house bylaws Breach abated. Defendant ordered to pay 10s. 6d. costs. „ 19 Soanes, S. 38, Theobald's Road Dirty workshop and defective W.C. Defendant fined 20s., and costs 21s. „ 19 Soanes, S. 1, Orde Hall Street Defective Ashbin and waste pipe Defendant fined 20s., and costs 21s. Dec. 17 Morrell, John... 7, Claik's Buildings Dirty yard Ownership changed. Summons withdrawn. Public Health (Milk and Cream) Regulations, 1912. 1915. Jan. 15 Sudbury Dairy Co. 138, Theobald's Road Selling preserved cream unlabeled Defendant convicted and fined £3. 3s. and £2. 2s. costs. „ Edwards Creameries Ltd. do. Summons dismissed. Sale of Food and Drugs Acts. Feb. 5 Stephens, Mrs. 70, Milman Street Selling milk 8.3 per cent. deficient in fat Defendant convicted and fined £1 and 12s. 6d. costs. Mar. 19 Jones, Sarah 9, Lamb's Conduit Passage Selling milk 166 per cent. deficient in fat Defendant convicted and fined £1 and 12s. 6d. costs. April 16 Evans, Thos. 87, Leather Lane Exposing for sale margarine without labels Defendant convicted and fined £1. Costs 10s. 6d. „ Norman, F. E... 73a, Clerkenwell Road Selling milk with 5.5 per cent. added water Defendant convicted and fined £1. Costs 10s.6d. April 30 & May 7 Farrell, F. K 1, Clark's Buildings Selling milk 7.0 per cent. deficient in fat Defendant convicted and fined £1 and 10s. 6d. costs. May 14 Harshfield, May 13, Lamb's Conduit Street Selling milk 6.0 per cent. deficient in fat Defendant convicted and fined 9s. 6d. and 10s. 6d. costs. „ Jones, John 71, Red Lion Street Selling milk 9.6 per cent. deficient in fat Warranty proved. Summons dismissed. „ Walker, John 21, Little Earl Street Selling butter containing 6 per cent. excess of water Defendant convicted and fined £3 and 10s. 6d. costs. „ Aerated Bread Co., Ltd. 278, High Holborn Selling milk 9 per cent. deficient in fat Summons dismissed. „7 Williams, Z. 73, Mount Pleasant Selling milk with 12.2 percent. added water Summons dismissed. Warranty proved. 53 TABLE IX —continued. LEGAL PROCEEDINGS.—continued. Sale of Food and Drugs Acts.—continued. Date. Name. Address. Offence. Result. 1915. July 16 Walters, Mary 21, High Street Selling milk 11.3 per cent. deficient in fact Warranty proved. Summons dismissed. „ Farrell, F. K 1, Clark's Buildings Selling milk 13.3 per cent. deficient in fat Defendant left the district. Summons not served. „ 29 Express Dairy Co., Ltd. Hart Street Selling milk 4.6 per cent. deficient in fat Warranty proved. Summons dismissed. „ Davies, Sarah 2, Portpool Lane Selling milk 13 per cent. deficient in fat Defendant convicted. Ordered to pay 12s. 6d. costs. „ Evans, John 19, New North Street Selling butter containing 81 per cent. of foreign fat Defendant convicted and fined £2 and 10s. 6d. costs. „ Oliver, B. 183, Shaftesbury Avenue Selling milk with 16.7 per cent. added water Summons dismissed. Warranty proved. Sept. 10 Matthias, Mrs. 22, Cross Street Selling milk with 20 per cent. added water Summons dismissed. (See H. McNeil). „ McNeil, H. 22, Cross Street Selling milk with 20 per cent. added water Defendant convicted and fined 40s. TABLE X. Meteorology of London, 1915. (Deduced from observations at Greenwich under the superintendence of the Astronomer Royal.) 1915. Air Temperature. Bright Sunshine. Rain and other forms of Precipitation. Mean of— Mean of A. and B. Difference from Average.* Daily Mean. Difference from Average.* Per cent. of possible. Total fall. Difference from Average,* Maximum A. Minimum B. °f °f °f °f hrs. hrs. % m.m m.m. January 43.6 35.7 39.7 +1.1 1.13 -0.22 13 93 +45 February 46.4 35.0 40.7 +1.1 2.75 +0.54 28 81 +43 March 48.1 35.7 41.9 +0.0 2.87 -0.42 24 20 -19 April 55.4 38.2 46.8 -0.4 5.33 +0.06 39 31 -9 May 63.9 43.4 63.7 +0.6 6.90 +0.48 45 83 +34 June 70.6 49.0 59.8 +0.6 7.27 +0.6 44 14 -38 July 71.4 52.7 62.0 -0.4 6.42 -0.42 40 78 +17 August 71.4 53.8 62.6 +1.1 5.23 -1.22 36 82 +23 September 67.7 48.2 58.0 +0.9 6.20 +0.97 49 51 -4 October 56.8 42.6 49.7 -0.4 2.29 -0.81 21 50 -21 November 44.8 33.8 39.3 -4.2 1.83 +0.10 21 62 +6 December 48.3 39.3 43.8 +3.6 1.16 +0.06 15 131 +85 Year 57.4 42.3 49.9 +0.4 4.12 -0.02 34 776 or 30.55 ins. +162 or +6.38 ins. * The averages used are obtained from observations extending over 65 years for Rain, 75 Temperature, and 18 years for Sunshine. *