KEN 33 Che Ropal Borouab of Kensington ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. 1911. Ordered by the Council to be printed. Vail & Co , Printers and Stationers, 170, Farringdon Road, E.C. ii. PUBLIC HEALTH COMMITTEE, 1911-12. Chairman : Councillor J. BROOKE-LITTLE. Vice-Chairman: Councillor R. D. BAXTER. The MAYOR (ex-officio). W. WHITAKER THOMPSON, Esq., J.P. Alderman A. G. McARTHUR, M.A., J.P. The Rev. PREBY. S. E. PENNEFATHER, D.D. Councillor Miss A. M. ALEXANDER. F. H. ANDERSON, M.D. J. CARNEGY-ARBUTHNOTT. A. G. COLVILE, LL.B. H. CORRY. Surg.-Gen. Sir C. McD. CUFFE, K.C.B., J.P. T. C. DYER. C. G. HATT. Miss A. S. HAYNE. Sir JAMES HOME, Bart. W. T. KEY. Lt.-Col. A. W. F. LANGMAN. F. NEALE. C. G. PADDON. Col. W. STAINFORTH. A. TISDALL. F. E. WILLIAMS. iii. PUBLIC HEALTH DEPARTMENT STAFF. Chief Sanitary Inspector. George M. Pettit. Sanitary Inspectors. J. R. Bagshaw. E. J. Bennett. T. Cutting, H. Dawes. J. H. Fowles. A. E. Friend. G. W. McQuinn. N. Males. C. G. Sexton. J. Steward. Inquiry Officer (Infectious Diseases). H. J. Oliver. Lady Sanitary Inspectors. Miss N. T. F. De Chaumont. Miss G. A. Looker. Health Visitors. Miss E. MacKay. Miss F. C. Hargrave. Clerks in the Department. E. R. Hill. H. A. Hillam. W. J. Essex. C. S. Sewell. J. H. Wilson. Mortuary Keeper. W. Sutton. Staff for Disinfection. W. Cambridge (Engineer), F. Chillcott, A. Nunn. Medical Officer of Health. J. E. Sandilands, M.D., D.P.H. v. To the Mayor, Aldermen and Councillors of the Royal Borough of Kensington. Ladies and Gentlemen,— I have the honour to submit my third annual report, which contains, in accordance with the Regulations of the Local Government Board, a summary of the action taken for the prevention of disease and an account of the sanitary state of the Borough of Kensington during the year 1911. Outbreaks of measles and epidemic diarrhoea have been responsible for an excessive death-rate among the infant population and no provision has yet been made for the cleansing of the large numbers of children who attend the elementary schools in a verminous condition. Under these circumstances the record for the year cannot be regarded as in all respects satisfactory, I have the honour to be, Ladies and Gentlemen, Your obedient Servant, J. E. SANDILANDS, Medical Office?- of Health. Public Health Department, Town Hall, Kensington, W. lst May, 1912. vii. TABLE OF CONTENTS. A.—Vital Statistics. Page Population 3 Births 4 Deaths 5 „ from Zymotic Diseases 7 „ of Infants 7 Infantile Mortality, Causes of 8 B.— Prevalence of Disease. Infectious Diseases 17 Small Pox 17 Diphtheria 17 Scarlet Fever 19 Enteric Fever 21 Puerperal Fever 22 Ophthalmia Neonatorum 22 Measles 24 Whooping Cough 25 Epidemic Diarrhcea 25 Consumption or Phthisis 28 Other Tuberculous Diseases 40 Cancer 40 C.—Food Supply. Milk Shops 43 Ice Cream Vendors 44 Underground Bakehouses 45 Slaughter Houses 45 Sale of Food and Drugs Acts 45 Margarine 47 Water Supply 47 D.—Housing. Inhabited Houses 51 Council's Lodging Houses 51 Houses Let in Lodgings 52 Furnished Rooms 52 Common Lodging Houses 54 Housing (Inspection of District) Regulations 1910 54 House-to-House Inspection 56 D.—Housing—continued. Page Underground Rooms 56 Customs and Inland Revenue Acts 56 E.—Factories and Workshops. Women's Workshops 59 Home Work 60 Men's Workshops 63 Home Office Tables 63 F.— Sanitation. Dust Removal 69 Drainage Work 69 Public Lavatories 69 Nuisance from Smoke 69 Sanitary Inspection 69 Legal Proceedings 70 Disinfection 72 Verminous Persons 73 Public Mortuary 74 Vaccination 75 G.—Appendix. Local Government Board Tables. Table I.—Vital Statistics, 1911 and Previous Years 79 Table II.—Infectious Diseases 80 Table III.—Causes of Death 81 Table IV.—Infantile Mortality 82 Table XII.—Phthisis : Sanatorium and Hospital Accommodation 94 London County Council Summary. Table V.—Proceedings during 1911 83 Other Statistical Tables. Table VI--Work of Sanitary Inspectors 84 Table VII.—Deaths, Sex, Age and Cause 85 Table VIII.—Births and Deaths in Quinquennial Periods 91 Table IX.—Zymotic Deaths in Quinquennial Periods 92 Table X.—Zymotic Death Rates in Quinquennial Periods 92 Table XI.—Vaccination Returns, 1910 93 viii SUMMARY OF STATISTICS, For the year 1911. Population (Estimated) 172,300. Area of Borough in Acres 2,291 Density of Population per Acre 75 Houses Inhabited ..... 27,507 Persons per House ..... 6*3 Number of Marriages .... 1,684 Number of Births ..... 3,223 Birth Rate ..... 18-7 Number of Deaths ..... 2,389 Crude Death Rate ..... 13-9 Corrected Death Rate .... 1 5'0 Infantile Mortality:— Deaths under 1 year 435 Infantile Deaths per 1,000 Births - 135 Deaths from Phthisis 155 Phthisis Death Rate 0.90 Deaths from the Zymotic Diseases - 359 Zymotic Death Rate - 2.08 VITAL STATISTICS 3 VITAL STATISTICS The Metropolitan Borough of Kensington as constituted under the London Government Act, 1899, covers an area of 2,291 acres, and is co-extensive with the Civil Parish and Registration District of the same name. The line of demarcation formed by Holland Park Avenue, High Street, Notting Hill Gate and the Bayswater Road divides the Borough into approximately equal halves described in previous years and in this Report as North and South Kensington respectively. The Borough is further sub-divided into nine wards. South Kensington includes the wards of Holland, Earl's Court, Queen's Gate, Redcliffe and Brompton, and is co-extensive with the South Kensington Parliamentary Division. North Kensington, containing the wards of St Charles, Golborne, Norland and Pembridge, is not co-terminous with the Parliamentary Division of the same name, in that it extends northwards to include an area of 100 acres with a population of 3,600 persons which is still allotted, for parliamentary purposes only, to Chelsea. The rateable value of the Borough is £2,419,344. Population.—The enumerated population in Kensington on April 3rd, 1911, is shown in the Census returns of the Registrar-General as having amounted to 172,402, as compared with a Census population of 176,628 in the year 1901. During the ten years 1901-1910, the births outnumbered the deaths by 10,145, although the total population was reduced by 4,226 between the Censuses of 1901 and 1911. In the same period the loss to the Borough by excess of emigration over immigration has accordingly amounted to more than 14,000 persons. The following figures which show with sufficient accuracy the effects of emigration, must not be taken as exact since the decennium under consideration which ends for Census purposes in April, 1911, has been assumed to end on December 31st, 1910, in calculating the number of births and deaths. Decennium 1901-1910. North Kensington. South Kensington. The Borough. Number of Births 25,123 9,939 35,062 Number of Deaths 15,910 9,007 24,917 Excess of Births over Deaths 9,213 932 10,145 Census Population, 1901 91,018 85,610 176,628 Census Population, 1911 88,191 84.208 172,402 Decrease per cent, in 10 years 3 1 2 Net Decrease in ten years 2,824 1,402 4,226 Add excess of Births over Deaths 9,213 932 10,145 Loss by excess of Emigration over Immigration A. Total 12,037 2,334 14,371 B. Per cent. 13 3 8 From the figures given above it is evident that emigration from the northern half of the Borough has proceeded at an alarming rate since the last Census, but the sub-districts in which the loss has been greatest cannot be accurately defined until the populationss for the individual wards have been published by the Registrar-General. For the present it will therefore be sufficient to note that the magnitude of the loss in the Golborne Ward is undoubtedly masked by the increase in the population of St. Charles' Ward, which has resulted from an influx of tenants into the new houses on the St. Quintin's Park Estate. As the difficulty of finding tenants for the lodgings in such Wards as Golborne increases, the housing problem becomes more and more perplexing. Landlords find themselves in a dilemma where the choice lies between receiving the lowest class of tenant and leaving their houses unoccupied. If they elect to take lodgers of doubtful character, their property is knocked about and the rent is not paid. On the other hand if no more than half the tenements in a lodging house are let to persons who pay regularly, and the rest of the house 4 stands empty, legitimate returns on the capital outlay are eaten up by the cost of necessary repairs. It will accordingly be readily understood that the task which is set the Council of securing satisfactory lodgings for the less fortunate of the working class population in the Ward of Golborne and similar districts is one of the utmost difficulty, and further that no small part of the difficulty experienced has been directly due to an exodus from Kensington to districts where better accommodation can be obtained at lower rents. In calculating the number of persons at all ages living in the whole Borough on any given date in the new intercensal period, it will be necessary to assume that this exodus has continued at approximately the same rate, and on this assumption the population in the middle of the year 1911, twelve weeks after the Census enumeration has been estimated to have numbered 172,300, and to have been distributed in North and South Kensington and in the several Wards of the Borough, as shown in the following Table:— The Borough 172,300 North Kensington 88,150 South Kensington 84,150 Wards :— North Kensington St. Charles 21,260 Golborne 25,470 Norland 22,710 Pembridge 18,710 South Kensington Holland 20,060 Earl's Court 17,750 Queen's Gate 14,040 Bedeliffe 18,390 Brompton 18,910 In regard to the social status of the population it may be said that the majority of the inhabitants of North Kensington live in poverty; in South Kensington persons living in poverty constitute only a small fraction of the population. In so far as the figures are available, the population, the number of inhabited houses and the rateable value of property since 1801 have been shown in the annual reports for 1908 and previous years, and need not be given again in this report. Marriages.—The marriages celebrated during the year numbered 1,684. The number of marriages celebrated annually and the annual marriage rate since 1856 were given in the annual report for 1908, Appendix II., Table A, page 60. Births.—The number of Births registered in the district was 3,037, but this figure does not include 186 infants born of Kensington mothers in Queen Charlotte's Lying-in Hospital and other institutions beyond the Borough. The total number of births belonging to the Borough was, therefore, 3,223. The birth-rate expressed as the number of births per 1,000 of the population was 18-7. Arranged as to sex and legitimacy the births were as follows:— Male. Female. Total. Legitimate 1,602 1,449 3,051 Illegitimate 75 97 172 Total 1,677 1,546 3,223 5 The following Table shows the number of births and the birth-rate in North and South Kensington and in the several Wards, after distribution of the births at the Borough Infirmary, Queen Charlotte's Hospital, and other Institutions. Total Births. Birth-rate per 1,000 of the Population. North Kensington 2,316 26.3 South Kensington 907 10.8 St. Charles 590 27.8 Golborne 849 33.3 Norland 558 24.6 Pembridge 319 17.0 Holland 219 10.9 Earl's Court 204 11.5 Queen's Gate 126 9.0 Redcliffe 216 11.7 Brompton 142 10.2 Tbe Borough 3,223 18.7 The effects of social status on the birth-rate are illustrated by the fact that the rate for South Kensington is less than half the rate for North Kensington, whilst the birth-rate for Golborne Ward in the North is more than three times as great as the rate for the Ward of Queen's Gate in the South. To a certain extent this wide discrepancy is no doubt due to differences in the numbers of married women in the districts compared. The births occurring every year in Kensington have fallen in round numbers from 4,500 in 1880, to 3,200 in the present year. The steady decline in the birth-rate is shown in Table VIII. Appendix, p. 91, where the number of births and the birth-rates both for London and Kensington are given for each quinquennial period since 1856. The figures for each year were given in the Annual Report for 1908. Illegitimate Births.—The illegitimate births numbered 172, and were equivalent to a rate of 10 per 10,000 persons living as compared with a rate of 8 for London in the year 1910. Deaths.— The corrected number of deaths was 2,389. The corrected death-rate was 15 0 as compared with a crude death-rate of 13.9 per 1,000 living. To obtain the corrected number of deaths, which represents the true mortality among the population, it is necessary to add the deaths of Kensington "residents" occurring beyond the district to the number registered as actually taking place in the Borough, and to subtract from the total thus arrived at the deaths of " nonresidents " occurring in institutions or other places in Kensington. The following figures show how the corrected number of deaths given above have been obtained:— Total deaths registered in the Borough 2,712 Deaths of residents bsyond the Borough 399 3,111 Deaths of non-residents within the Borough 722 Corrected number of deaths belonging to the Borough 2,389 The corrected death-rate is designed to represent the mortality that would have occurred had the age and sex distribution of the population in Kensington been the same as that of the population of the country as a whole. The age and sex composition of the population in Kensington favours a low mortality, and the effect of making allowance for these disturbing factors is to raise the crude death-rate of 13.9 to the coirected rate of 15.0 already given. Where comparisons are instituted 6 between populations with a widely different age and sex composition the use of corrected deathrates is essential, but in Kensington and in the Metropolis as a whole the influence of age and sex is for practical purposes the same, and the crude death-rates shown in the following Table may be accepted as roughly representing the relative mortality in the two areas. Crude Death-rates per 1,000 living. Kensington. London. 1896-1900 16.3 18.8 1901-1905 14.7 16.4 1906-1910 13.8 15.1 1911 13.-9 _ The mortality in Kensington is somewhat less than in London as a whole; in both areas the death-rate is remarkably low and has fallen steadily during the past fifteen years. The number of deaths and the death-rates in Kensington and London for each quinquennial period since 1881 will be found in Table VIII. Appendix, p. 91. The number of deaths occurring in each year since the same date and the annual death-rates have been published in the Appendix of the Annual Reports for 1908 and previous years. The number of deaths at all ages with the corresponding death-rates in the Borough, in North and South Kensington and in the several Wards was as follows:— • Districts. Number of Deaths. Crude Death-rate per 1,000 inhabitants. North Kensington 1,528 17.3 South Kensington 861 10.2 St. Charles 363 17.1 Golborne 476 18.7 Norland 416 18.3 Pembridge 273 14.6 Holland 232 11.6 Earl's Court 228 12.8 Queen's Gate 112 8.0 Redcliffe 175 9.5 Brompton 114 8.2 The Borough 2,389 13-9 The mortality in North Kensington was very much greater than in South Kensington, the difference being mainly due to the prevalence of poverty in the former area. It should further be borne in mind that the high death-rate for St. Charles, Golborne and Norland in the North represent averages based on the combined experience of the good and bad areas which the figures embrace; and for this reason the Ward rates which are in themselves excessive can only be accepted as indicating the incidence of a very much heavier mortality on those streets and neighbourhoods where the inhabitants live in a state of social degradation. 7 Causes of Death.—These are set out in detail in the Appendix. Causes of Death.—These are set out in detail in the Appendix. The following list shows certain causes of death which are important in themselves or from the fact that they contributed a considerable share to the total mortality for the year:— Cause of Death. Number of Deaths. Principal Zymotic (or epidemic) diseases 359 Epidemic influenza 25 Puerperal fever 4 Phthisis 155 Other tuberculous diseases 48 Cancer 197 Bronchitis 173 Pneumonia 174 Heart diseases 268 Bright's disease 68 Diseases and accidents of parturition 7 Premature birth 41 Accidents 63 Old age 98 All other causes 709 2,389 The diseases described in the above list as the " principal zymotic diseases," are small-pox, measles, scarlet fever, diphtheria, whooping cough, enteric fever (including fever not otherwise defined) and diarrhoea ; together they were responsible for 359 deaths, or considerably more than double the numoer of deaths from the same causes that occurred in the year 1910. Serious outbreaks of measles and epidemic diarrhoea have been responsible for this heavy mortality from the zymotic diseases which has taken the great majority of its victims from the child population under the age of five years. One fourth of the total number of deaths were registered as due to diseases of the heart or the organs of respiration. Tuberculosis, a preventable disease, caused more than 200 deaths, of which 155 were due to tuberculosis of the lungs. It should also be noted that cancer was the cause of 197 deaths, as compared with 179 deaths from the same disease in the previous year. The periods of life in which the various causes of death claim the majority of their victims are indicated in Table VII. Appendix, p. 85, and except in the case of deaths under the age of one year will be considered in the section devoted to the prevalence of disease in the Borough during the year. The number of deaths and the death-rates from each of the seven principal zymotic diseases in Kensington together with the zymotic death-rates for London and Kensington will be found in Tables IX. and X. Appendix, p. 92, arranged in quinquennial periods since 1871. INFANTILE MORTALITY. The deaths among infants under the age of one year numbered 435, the infantile mortality rate being equivalent to 135 deaths per 1,000 births. By expressing the number of deaths in proportion 'to the number of births, the influence of age distribution is eliminated and a reliable standard is afforded for measuring the comDarative mortality in different districts. standard is attorded tor measuring the comparative mortality in dmerent districts. 1 he following Table shows a decline in the infantile death-rate from 172 in the quinquennium 1896-1900 to 120 in the years 1906-1910. In the year under consideration the rate rose to 135. Period. Deaths under one year per 1,000 Births. Kensington. London. 1890-1900 172 163 1901-1905 144 140 1906-1910 120 115 1911 135 8 This increased mortality has been largely due to an excessive number of deaths from summer diarrhoea, but it is satisfactory to note that in spite of the prolonged intense heat experienced in the summer months, the total death-rate still remained well below the average rates recorded ten years ago. The mortality was further increased by the occurrence of a serious epidemic of measles which carried oft no less than 21 infants who had not completed their first year of life. The difference between the infantile death-rates recorded in the various districts of the Borough is very marked, as will be seen from the following figures:— District. Deaths under one year. Deaths under one year per 1,000 Births. North Kensington 342 148 South Kensington 93 103 St. Charles 74 125 Golborne 123 145 Norland 99 177 Pembridge 46 144 Holland 23 105 Earl's Court 18 88 Queen's Gate 12 95 Redcliffe 26 120 Brompton 14 99 The Borough 435 135 The figures in the second column of the Table show that the infantile death-rate in North Kensington has been nearly half as high again as in South Kensington. The mortality in the Norland district, which contains Notting Dale, was equivalent to 177 deaths per 1,000 births, whilst the unsatisfactory social conditions prevailing in Golborne and certain parts of the Pembridge Ward are reflected by rates which exceeded 140 in both districts. For the Ward of Earl's Court an infantile death-rate of less than 90 was recorded. Causes of High Infantile Mortality.—The influences which contribute to the production of an excessive mortality among infants are to be sought in the conditions which accompany poverty. Lack of food, both for mother and child, improper food, crowding of persons in rooms, want of air, uncleanly homes, neglect deliberate or inevitable and ignorance are perhaps the conditions which chiefly affect the health of infants in the homes of the poor. The chief diseases which were registered as the immediate cause of death are summarised in the following list:— Cause of Death. Number of Deaths. 1910 1911 Common infectious diseases 23 48 Diarrhoea (including enteritis, etc.) 33 123 Premature birth 66 41 Congenital defects 27 10 Wasting diseases 48 53 Tuberculous diseases 15 15 Syphilis 1 7 Bronchitis and pneumonia 89 63 Overlaying 4 4 Other causes 39 71 345 435 9 The above being the assigned causes of death, it will be convenient to consider first the apparent effect of want of breast milk, artificial feeding, the employment of mothers and other factors which might affect the health of infants adversely. Artificial Feeding—Out of the total infant population it may be assumed that a very large proportion is at the outset breast fed, and inquiries have in fact shown that out of 527 children born in and surviving to the end of the year 1911, 97 per cent. were being fed on the breast alone at the age of 10-20 days. Between the ages of three weeks and three months, the proportion of breast-fed children is reduced to 87 per cent., whilst the following tabulated summary of the Health Visitors returns shows that out of 719 children who were born in 1911 and survived to the end of the year, 68 per cent, were still being fed on the breast alone at the age of 6 months. Infant Feeding. Infants visited 1911, Survivors. Survivors. Survivors. Deaths at ages 2 days to 9 months Diarrhœa. All causes. Period to which history refers. Age Period 10-20 days. Age Period 20 days to 3 months. Age Period 5-7 months Onset of illness. Onset of illness. Method of Feeding. Number. Percentage. Number. Percentage. Number. Percentage. Number. Percentage. Number. Percentage.. Cow's milk (new) 12 2 38 5 77 11 26 48 49 32 Condensed milk 2 — 7 1 17 2 5 9 10 7 Breast and cows 5 1 25 4 85 12 7 13 20 13 Breast & condensed 0 0 6 1 18 2 6 11 8 5 Other foods 1 — 11 2 34 5 4 8 11 7 Total artificial 20 3 87 13 231 32 48 89 98 64 Breast alone 527 97 597 87 488 68 6 11 54 36 Totals 547 100 684 100 719 100 54 100 152 100 From the above Table it will be seen that the history of infants who died affords a striking contrast to the history of the feeding of those who survived. In the infant population the number of breast-fed children steadily diminishes with each month of life, and for this reason it may be fairly assumed that the proportion of infants who are still at the breast at the mean age of 6 months, either represents accurately the proportion so fed among infants aged 2 days to 9 months, or tends to understate their numbers. On this assumption, if artificial feeding exercised no influence on a child's chances of survival or death, only 32 per cent. of those who died during the year between the ages of 2 days and 9 months would have been artificially fed before their fatal illness, whereas, as a matter of fact, the proportion of the artificially fed amounted to no less than 64 per cent. of the children dying at the ages mentioned. Of the children dying from summer diarrhoea, only 11 per cent, were fed on breast milk alone, and even when the deaths from diarrhoea are excluded, more than 50 per cent, of the children dying from all other causes are still derived from the class of the artificially fed, as compared with the very much lower proportion of 32 per cent. in the same class among those who survived. Evidently then artificial feeding carries with it an element of danger to life in the homes of the poor, but the recognition of this elementary fact is very far from justifying the additional conclusion that the whole or even the greater part of the blame for the deaths which occur should 10 be laid at the door of cowkeepers and purveyors of milk. There is for instance a growing belief that summer diarrhoea is due to the specific infection of food, and further, that the infectious material, without which epidemic diarrhœa cannot occur, generally finds access to the food of infants in their homes, rather than at the farms and in the milkshops from which their milk supply is derived. The improper use of sound milk or its use in conjunction with foods which are giossly unsuitable, must also be regarded as important factors in the causation of deaths from wasting diseases for which the mother, rather than the dairyman, is responsible. A third important cause of death is to be found in the inability of certain mothers to supply the breast milk which their babies require, ihe natural milk may be poor in quality, insufficient in quantity, or rich and-sufficient but endowed with properties which give rise to dyspepsia. The existence of one or more of these defects in the breast milk of the mother must inevitably lead to a wasted condition of the baby she is nursing, if breast feeding is continued without expert advice. Human milk is not always of good quality, does not always suit the child that takes it, and for this reason the circulation of pamphlets blindly insisting on breast feeding at all costs is to be deprecated. It is not uncommon for a mother, whose milk is unsuitable, to keep her child at the breast until wasting is well marked; when it is too late cow's milk is given, the patent foods recommended in advertisements for such cases are tried one after the other, and finally at the eleventh hour medical advice may be sought If death occurs the child is classed with the artificially fed, when it really belonged to a class containing an appreciable number of children, whose start on a downward course is directly due to their being fed with breast milk which does not meet their needs. Occupation of Mothers.—In the next Table the infants born in and surviving to the end of the years 1910 and 1911, have been classified according to the occupation of the mother during pregnancy. For the purpose of comparison the infants born dead or dying in the years 1910 and 1911 from all causes and from prematurity, have been classified in the same way. Occupation of Mothers during Pregnancy, 1910-1911. Infants of Occupied Mothers. Survivors. Deaths, all causes. Death from Prematurity. Still Births Occupation of Mothers. Number Per centage. Number Percentage Number Percentage Number Percentage Laundry Work 352 13 80 19 10 13 8 13 Charwoman 163 6 34 8 4 5 3 5 Dressmakers, etc. 32 1 4 1 1 1 0 0 Cook, Domestic Servant 59 2 4 1 3 4 0 0 Hawker, Coster 13 1 4 1 0 0 0 0 Other Occupations 39 1 4 1 1 1 3 5 Total Occupied Mothers 658 24 130 31 19 24 14 23 Housework only 2113 76 290 69 57 76 47 77 Totals 2771 100 420 100 76 100 61 100 Of 420 mothers whose infants died, 31 per cent, followed some occupation during pregnancy, and 19 per cent, were engaged in laundry work. Out of 2,771 mothers whose infants survived to the end of the calendar year in which they were born, 658, or 24 per cent, were occupied during pregnancy, and 352, or 13 per cent. were employed in laundries. When all kinds of employment are considered together, the difference between the two classes of mothers is inconsiderable, but in the case of laundry work it should be noted that the proportion of occupied women is 50 per cent. higher among those whose infants died. So wide a discrepancy is hardly likely to be accidental, 11 and suggests that the infant's chance of surviving is substantially less if the mother is a laundry woman. On the other hand the figures do not justify the conclusion that laundry work exercises an adverse effect on the child during pregnancy, since the majority of the women employed in laundries during pregnancy return to the same work after their confinement, with the result that their babies have to be minded during the day by neighbours, whose methods of bottle feeding generally leave much to be desired. Mention may also be made of the fact that in deaths from prematurity and in still-births, which are necessarily due to ante-natal conditions, the occupation of the mother during pregnancy appears to exercise no influence. Thus in the Table of occupations during pregnancy the proportion of mothers engaged in laundry work is given under the three headings " Survivors," " Deaths from Prematurity," and " Still Births," as 13 per cent. in each case. Having discussed the possible effects of two important factors on the infantile death-rate, it remains to consider the part played by the various assigned causes of deaths in contributing to the total mortality for the year. The deaths in 1911 have amounted to 435, and have exceeded the number registered in 1910 by 90. The whole of this excess is accounted for by an increase in the deaths from diarrhoea from 33 to 123, whilst measles and whooping cough together added 22 to the number of deaths assigned to these causes in the previous year. Bronchitis and pneumonia accounted for 63 deaths, 53 deaths were attributed to wasting diseases, and 41 to premature birth. The last two causes of death will be considered here since they are peculiar to infants, but for an account of the diarrhoea epidemic and of other diseases common to infants and adults, reference should be made to the section of the report entitled the " Prevalence of Disease." Premature Birth.—Premature birth was the assigned cause of 41 deaths, and of this number 11 occurred in children born of twin pregnancies. The association of twin pregnancy with death from prematurity is no doubt one of cause and effect rather than coincidence. In regard to other ani e-natal influences it has already been noted that the material available during the last two years does not afford any grounds for the conclusion that the occupation of the mother during pregnancy enhances the death-rate from this particular cause. The part played by illegitimacy would also appear to be insignificant, since only three of the children who died from prematurity are known to have been born out of wedlock. In the following Table the deaths of 104 premature infants have been classified according to the number of previous pregnancies in the mother, and for purposes of comparison a record has also been given of the previous pregnancies of mothers whose infants survived. Illegitimate children have not been included in the Table. Table I.—The Previous History of the Mothers of Infants dying of Prematurity in 1909-11 and of Infants born in 1910-11 and surviving at the end of the Year of Birth. Number of Previous Pregnancies. None. l 2 3 4 5 6 or more. Total. Deaths from Prematurity. Number of Mothers. 18 22 9 9 7 9 30 104 Percentage. 17 21 9 9 7 9 28 100 Survivors. Number of Mothers. 290 324 299 241 187 147 385 1873 Percentage. 15 17 16 13 10 8 21 100 The figures show that out of 1,873 births at term, 32 per cent. were of children born from the first or second pregnancy. Of the children who died from prematurity, the proportion born from the first two pregnancies was considerably higher, and amounted to 38 per cent, of the total number. [???] pregnancies after the fifth again contribute an unduly high proportion of premature births ending in the death of the child. There would thus appear to be a distinct tendency for the first two pregnancies and the pregnancies occurring after five previous conceptions to end prematurely in the birth of children who die. 12 The history of previous pregnancies ending in miscarriage, premature birth, or still birth is given in the following Table, both for the mothers of children who survived, and for the mothers of children who died of prematurity. Illegitimate children are again excluded. Table II.—The History of Previous Pregnancies in the Mothers of Infants Dying of Prematurity in 1909-11 (Class B.) and of Infants born in 1910-11, and surviving to the end of the Year of Birth (Class A.). A.—Total Mothers Furnishing Histories of Previous Pregnancies.* Pregnancies per Mother. Number of Mothers. Mothers with histories of Previous Pregnancies Terminating Prematurely or in Still Birth at Term. Number. Percentage. A B A B A B 2 324 22 26 5 8.0 22.7 3 299 9 8 4 3.0 44.4 4 241 9 22 3 9.1 33.3 5 187 7 27 0 14.4 0.0 6 147 9 27 8 18.4 88.9 Totals 1198 56 110 20 9.2 35.7 B.—Previous Pregnancies ending Prematurely or in Still Birth at Term and Total Pregnancies* Number of Mothers. Total Number of Previous Pregnancies ending Prematurely or in Still Birth. Pregnancies per Mother. Pregnancies. Number. Percentage. A B A B A B A B 2 324 22 648 44 26 5 4.0 11.4 3 299 9 897 27 10 6 1.1 22.2 4 241 9 964 36 33 3 3.4 8.3 5 187 7 935 35 33 0 3.5 o.o 6 147 9 862 54 35 10 4.1 18.5 Totals 1198 56 4306 196 137 24 3.2 12.2 * Infants dying of prematurity in 1909-11 and infants born in 1910-11 and surviving to the end of the year of birth are included the number of "Total Preganancies." The term "Previous Pregnancies" refers to the preganancies preceding the conception of children who died of prematurity in 1909-11, or who were born in 1910-11 and survived to the end of the year of birth. 13 The conclusion to be drawn from the figures given is that the proportion of mothers with histories of previous abnormal pregnancies is four times greater among those whose children die of prematurity (class B) than it is among those whose children survive (class A). The same relative excess is also shown by the class B mothers in the higher proportion of previous premature and still births to total pregnancies. It would thus appear that a considerable proportion of the large number of deaths from premature birth which occur every year tend to be supplied by a certain section of mothers who aie exceptionally prone to abnormal pregnancies rather than by the generality of mothers in the population at large. Should this conclusion be confirmed by subsequent investigations, the facts would be compatible with the assumption which is sometimes made that death from prematurity selects the infants of a certain section of mothers who endeavour to limit their families by the use of drugs for the purpose of preventing conception or producing miscarriage. The nigher proportion of premature births ending in death which occur in the later pregnancies, that is to say after the fifth, lends support to the same assumption, but the number available are ooviously too small to justify even a tentative conclusion as to the true cause of premature birth. Wasting Diseases.—During the year 53 deaths were attributed to wasting diseases, and of this number eight occurred in children who were born prematurely. Five further deaths occurred in infants less than three days old, making a total of 13 deaths which may be fairly attributed to ante-natal causes. Seven deaths occurred in children who were twins and born weakly. Nine of the children v\ ho died were illegitimate. The mother of one infant was feeble-minded and had borne five illegitimate children. The death of another child is attributed by the health visitor to gross neglect. 1 he mother in this case has borne six illegitimate children, and is described as well known to the Inspector for the National Society for the Prevention of Cruelty to Children. The social status of the infants who succumb to wasting diseases is indicated by the fact that 22 died, whilst 14 were also born, in the Infirmary. Illegitimate Births.—During the year the births of 172 children were registered as illegitimate and of this number 52 died. The death-rate expressed as the number of deaths per 1,000 illegitimate births thus amounted to 302 as compared with an infantile death-rate of 135 among the infant population as a whole. In view of the disabilities imposed by society on these unfortunate children and their mothers an even higher death-rate might have been expected. For a certain number of illegitimate children, satisfactory provision is made by rescue workers, but for the majority the Council's Health Visitors are unable to obtain the assistance that would be necessary to bring about a material reduction in the illegitimate death-rate. Still-Births.—The infants notified during the year as still born numbered 87, but this number is not included in the total births or deaths from which the annual rates for the Borough have been calculated. Information could only be obtained in regard to 46 out of the total number of stillbirths notified. Five were noted as illegitimate, six were born dead from six twin pregnancies, and six were born in wedlock of mothers employed in laundry work. Three mothers earned their living as charwomen and 25 were ascertained to have followed no occupation during pregnancy. Nine children were born from the first or second pregnancy, 15 from the sixth or some later conception and 13 from intermediate pregnancies. The fact should perhaps be recorded that in six cases the father of the child was occupied as a painter. In one of these instances the father had had several attacks of lead poisoning. In another the mother whose husband was a painter had been pregnant five times, all the pregnancies ended in still-birth, two at term and three at the end of the seventh month. PREVENTION OF INFANTILE MORTALITY. Notification of Births Act, 1907.—The information supplied under this Act, which has now been adopted throughout London, constitutes the starting point of the work of the Health Visitors. The Act requires all births to be notified within 36 hours to the Medical Officer of Health of the district in which they occur. During the year 3,223 births were registered as belonging to the Borough, and of this number 2,825 or 88 per cent. have been notified in accordance with the requirements of the Act. With the addition of 87 infants who were notified as still-born, the total number of births notified during the year amounted to 2,912. Work of the Health Visitors.—The two Health Visitors appointed by the Council have been to the homes of 1,766 newly-born infants and have paid 5,302 visits or re-visits during the }ear. The first visit is as far as may be possible timed to take place between the 10th and 20th day after the birth of the child and if the midwife or doctor in charge of the case has ceased 14 ing a printed card of advice is left with the mother. The printed instructions are explained and notes are made on the health of the child and other matters. If the infant is making good progress, it is not seen again until the age af six months, but where further advice is needed, interim visits are paid according to the necessities of each case. Inquiries are also made in the homes of infants who die before the age of 12 months or who are notified as still-born. The information obtained in this way has been summarised in the tables dealing with the causes of infantile mortality, and has already been fully discussed. "Want of Breast Milk," the want of timely medical advice and improper feeding are the evils against which the efforts of the Health Visitors are chiefly directed. Necessitous mothers are referred to the Charity Organisation Society or to one of the three dinner centres. Hospital letters are obtained for ailing infants whose parents cannot afford to pay for medical advice and the fullest use is made of the assistance offered to mothers of the poorer classes by various philanthropic agencies in the Borough. In the northern half of the Borough there |are now three schools for mothers where any necessitous woman who is nursing her baby can obtain a dinner in the middle of the day at a cost of one penny. At each school weekly consultations are also held and are attended both by nursing mothers and the mothers of bottle-fed babies. At these consultations each baby is weighed and at two schools the weighing is carried out by the Council's Health Visitors who attend once a week for this purpose and for the purpose of giving advice. At the third school advice is given to the mothers by a lady who is a qualified medical practitioner and Dr. Carter attends once a week at the school in the Bramley Road, to see any child whose progress is not satisfactory. At all three schools sewing classes are held and lectures on infant care are given. In a period of 12 months more than 470 mothers have attended the infant consultations at one or other of the three centres, and when the records are examined which show that many women continue to bring their babies to be weighed for six or seven months or even longer periods, it is evident that there is no lack of maternal instinct among the poorer classes and no narrow limit to the amount of good which is certain to be effected by teaching women who are so anxious to learn. The total number of dinners supplied to expectant or nursing mothers during the year amounted to 20,372, and it is of interest to note, without too strict an examination of the statistical value of the results, that two schools claim to have had no deaths from diarrhoea among their infants during the serious outbreak which occurred in the summer months. Mention should also be made of the Cooking Classes for mothers which are held at the Bramley Road School and the School in the Lancaster Road. Through the close connection which exists between the Schools and the Public Health Department, overlapping is avoided and a system has been established which cannot fail to effect a material improvement in the physique of the children of the poorer classes in Kensington. THE PREVALENCE OF DISEASE. 17 THE INFECTIOUS DISEASES. For administrative purposes the infectious diseases are divided into two classes, those which the householder is obliged by law to notify to the Medical Officer of Health, and those which are not compulsorily notifiable. In Kensington the following diseases are compulsorily notifiable :— Small Pox. Typhus Fever. Plague. Relapsing Fever. Cholera. Puerperal Fever. Diphtheria. Cerebro-spinal Fever. Erysipelas. Glanders. Scarlet Fever. Anthrax. Typhoid or Enteric Fever. Hydrophobia. Acute Poliomyelitis. Ophthalmia Neonatorum. Glanders, Anthrax and Hydrophobia in man were made notifiable on April 26th, 1909, with a view to affording further facilities for dealing at the earliest possible opportunity with the animal sources from which human beings almost invariably acquire the infection of these diseases. Cerebro-spinal fever was again made notifiable for a further period of 12 months from March 13th, 1911. No case of glanders, anthrax or hydrophobia was notified in Kensington. By order of the London County Council, the diseases known as ophthalmia neonatorum and acute poliomyelitis or acute polio encephalitis were made compulsorily notifiable on March 13th, 1911. SMALL POX. No case of small pox occurred in Kensington during the year ; 73 cases in all were notified in the Metropolis, and of this number 61 occurred in the two months February and March. The outbreak originated in the Mile End Infirmary and with this Institution a large number of the 40 cases which occurred in the Borough of Stepney were directly or indirectly connected. The cases occurring in Stepney, Bethnal Green, Poplar and Hackney, together accounted for 60 out of the total number notified. As a precautionary measure chicken pox, the disease most frequently confused with small pox, was made compulsorily notifiable from March 22nd to June 22nd, 1911, throughout London. Administrative action in Kensington was limited to visiting the notified cases of chicken pox which numbered 227, and persons reported as having been in contact with small pox infection in other Boroughs. DIPHTHERIA. During the year 212 cases of diphtheria were notified and of these 20 proved fatal, the seasonal incidence of the disease is indicated in the following table:— Diphtheria in 1911. Report for four weeks ended No. of Notifications. Kensington London. January 28 12 501 February 25 22 548 March 25 23 541 April 22 12 436 May 20 14 440 June 17 9 487 July 15 14 500 August 12 12 516 September 9 4 385 October 7 20 670 November 4 30 795 December 2 14 863 December 30 26 683 212 7,365 18 In 37 houses where diphtheria occurred the drainage system presented defects which were remedied in response to notices from the sanitary inspectors. During the last week of November and the first week in December an outbreak of diphtheria occurred in the Fox London County Council School which eventually lead directly or indirectly to the infection of 21 children. Of this number two died. The epidemic began in two class-rooms described respectively as Room A and Room Al. In Room A1 a child G.G., who appears to have developed the first symptoms of diphtheria on November 27th, continued to attend in an infectious state until November 29th. On December 1st she was notified as suffering from diphtheria and removed to hospital. No further notifications in regard to children in this room were received until December 5th, but subsequent inquiries proved that two girls who attended the infected class for the last time, on November 30th in one case and December 1st in the other, both developed diphtheria on their last day of attendance. Since December 1st was a Friday the absence of these children did not arouse suspicion until Monday morning, December 4th. On Saturday, December 2nd, the first case in Room A was notified in the person of a girl I.H. who attended school for the last time on November 29th, which was also the last day of attendance of two further girls in the same room who were notified as suffering from diphtheria on December 4th and December 5th respectively. On December 5th material for bacteriological examination was taken from the throats of all the children present in Rooms A and Al by one of the County Council's school medical inspectors. By order of two members of the Public Health Committee acting upon my recommendation, the affected rooms were closed from December 6th until Monday, December 11th, in order to prevent the children who had been examined from reassembling before the bacteriological results had been obtained. The bacteriological report showed that in Room Al no less than six children were harbouring diphtheria bacilli in their throats. In the adjacent Room A the results were in every case negative. When the children reassembled on Monday, December 11th, those who had been absent on the previous Tuesday were examined with the result that two girls in Room Al and three in Room A were found to be harbouring diphtheria bacilli and were excluded. In addition to this number, 26 other children who were absent from the same rooms for various reasons were visited in their homes. Bacteriological examinations were made in nine cases, with the result that one child with a mild form of sore throat proved to be suffering from diphtheria. One school child infected three others in the orphanage where she resided, whilst two other children in the same Institution were found to have diphtheria bacilli in their throats and were isolated in a separate dormitory. It is a remarkable fact and one which deserves to be recorded that when at the end of 12 days these children were again examined with a negative result and set free both developed diphtheria within 20 days. No other carrier could be found in the Institution, neither had any one of the children removed in December returned from hospital. They must accordingly be regarded as either having been self infected or as having derived a fresh infection from some unknown source. In either case their history points to the conclusion that healthy carriers cannot be sent to a hospital ward reserved for diphtheria without risk of infection. It is true that such children could be protected for the first weeks of their stay in hospital by the injection of antitoxin, but it is to say the least doubtful whether the accidental circumstance that artificial protection can be conferred could be held to justify the segregation of healthy carriers in diphtheria wards, if as the histories related suggest they may in certain cases be naturally liable to diphtheria. The history of another case illustrates the difficulty of diagnosis and the length of time during which a patient who has suffered from diphtheria may continue to be capable of infecting others. The circumstances were as follows:— A girl, E.W. attending in Room A, was reported as absent from school with a sore throat, on December 5th. She was attended by a medical practitioner with a considerable experience of the bacteriological examination of suspicious throats in a large children's hospital. In the swab which he took from the patient's throat and forwarded to the Lister Institute, the bacillus of diphtheria was not found. The recognised clinical signs of diphtheria were not present and in these circumstances the parents were informed by their doctor that in his opinion the fact that their child had been exposed to infection at school did not in the absence of bacteriological and clinical signs justify a diagnosis of diphtheria. The child was accordingly not notified. On December 23rd her brother developed diphtheria and was removed to hospital. In my view there is no doubt that E.W.'s illness was also due to diphtheria. During the month of April she was engaged in taking out daily a small child aged two years who lived in a street more than half a mile away from E.W.'s home. On April 14th this child developed laryngeal diphtheria and died in hospital after four day's illness. At the same time E.W. continued to attend the Fox school, and on April 17th a girl in the same class developed diphtheria. This was the only case that occurred and no suspicion attached to E.W. or any particular girl in the same room. On April 25th every child in the class was examined bacteriologically and E.W. was found to be carrying diphtheria bacilli both in the throat and nose. 19 There seems little doubt that E.W. infected both the child who died and the school girl in her own class, and if this be so then she again became capable of conveying infection four and a half months after the onset of the original attack of diphtheria. As already mentioned the action taken in dealing with this outbreak consisted in the closing of two rooms on December 6th, and the examination of all the children in the affected classes either at school or at home. The closed rooms were re-opened on December 11th, and although the permission to re-open was at the time criticised no further cases occurred among the children in these classes. In the infant's class one case occurred on December 12th, and one after the Christmas holidays was notified on January 13th. Outside the school the epidemic did not spread from house to house and with the exception of the first cases in Rooms A and Al, and one case in the Infants' class, all were accounted for by the orphanage outbreak or by the spread of infection among members of the same family. In the course of the outbreak 44 children were examined bacteriologically in their own homes or at the Town Hall in addition to the number examined in school by the school medical inspector. Of those examined outside the school five proved to be carrying diphtheria bacilli in their throats. The following table shows the number of cases of diphtheria and the mortality during 1911 and in previous years. Diphtheria in Kensington, 1901-1911. Year. Cases Notified. Case rate per 1,000 of population. Deaths. Death rate per 1,000 of population. Case Mortality per cent. 1901 250 1.41 38 0.21 15.2 1902 184 1.04 20 0.11 10.9 1903 158 0.90 24 0.14 15.2 1904 186 1.06 17 0.10 9.1 1905 125 0.71 9 0.05 7.2 1906 164 0.94 19 0.11 11.6 1907 234 1.34 24 0.14 10.3 1908 230 1.32 26 0.15 11.3 1909 169 0.98 19 0.11 11.2 1910 150 0.87 16 0.09 10.7 1911 212 1.23 20 0.12 9.4 From the figures given it will be seen that the disease has not been unduly severe in type, since the case fatality did not exceed ten deaths per hundred cases. The total number of cases notified has been considerably above the average, though less than the numbers notified in 1901, 1907 and 1908. SCARLET FEVER. During the year 227 cases of Scarlet Fever were notified, and of these only 3 proved fatal. The seasonal incidence of the disease is shown in the following table:— 20 Scarlet Fever in 1911. Report for four weeks ended No. of Notifications. Kensington London. January 28 18 597 February 25 19 597 March 25 18 562 April 22 8 579 May 20 18 649 June 17 15 669 July 15 23 740 August 12 16 833 September 9. 7 691 October 7 13 1,159 November 4 27 1.888 December 2 23 1,126 December 30 22 903 227 10,493 The total number of cases was the lowest recorded since 1898, and 182 below the average for the past 10 years. The type of the disease was also exceptionally mild, the case mortality being equivalent to only 13 deaths as compared with an average for the last ten years of 30 deaths among every thousand cases. Scarlet Fever in Kensington, 1901-1911. The Year. Cases notified. Case rate per 1,000 of population. Deaths. Death rate per 1,000 of population. Case mortality per cent 1901 475 2.69 15 0.08 3.2 1902 372 2.11 21 0.12 5.6 1903 330 1.88 14 0.08 4.2 1904 262 1.49 5 0.03 1.9 1905 332 1.90 21 0.12 6.3 1906 463 2.65 11 0.06 2.4 1907 522 3.00 9 0.05 1.7 1908 439 2.53 9 0.05 2.1 1909 417 2.40 7 0.04 1.7 1910 258 1.49 1 0.006 0.4 1911 227 1.32 3 0.02 1.3 In 84 instances inquiry elicted a definite history of contact with persons suffering from Scarlet Fever. Seven cases were due to infection in school; 17 were due to contact with persons recently discharged from Hospital after an attack of Scarlet Fever; 3 arose from contact with "missed cases" or persons who had suffered from unrecognised attacks of the disease. Id 16 cases the infection was derived from sources beyond the Borough. Defects in the drainage system were found in 30 of the houses where Scarlet Fever occurred. 21 ENTERIC FEVER The number of cases of enteric fever notified 'during the year was 20, the number of deaths being 4. The case-mortality, 20 per cent., shows the disease to have been severe in type. Among other points of interest in the following table will be noted the very remarkable decline in the prevalence of enteric fever which has taken place during the last ten years. Enteric Fever in Kensington, 1901-1911. Year Cases Notified. Case-rate per 1,000 of population. Deaths. Death-rate per 1,000 of population. Case-mortality per cent. 1901 97 0.55 11 0.06 11.3 1902 80 0.45 19 0.11 23.7 1903 61 0.35 9 0.05 14.8 1904 46 0.26 6 0.03 13.0 1905 49 0.28 13 0.07 26.5 1906 38 0.22 5 0.03 13.2 1907 40 0.23 5 0.03 12.5 1908 36 0.21 5 0.03 13.9 1909 47 0.27 8 0.05 17.0 1910 35 0.20 5 0.03 14.3 1911 20 0.12 4 0.02 20.0 Inquiries were made into the history of all the cases notified during the year, and in only two instances was the infection found to have been derived from contact with persons suffering from typhoid fever. Nine cases were imported ; one patient subsequently proved to be suffering from a disease which was not typhoid fever, and three patients gave a history of having eaten shell fish on or about the date when the infection may be assumed to have been acquired. In only one house where typhoid fever occurred was the drainage system found to be defective. The seasonal prevalence of the disease in London and Kensington is shown in the following table:— Enteric Fever in 1911. Report for four weeks ended No. of Notifications. Kensington. London. January 28 1 74 February 25 0 53 March 25 0 38 April 22 0 36 May 20 1 29 June 17 2 45 July 15 1 54 August 12 1 57 September 9 3 132 October 7 4 226 November 4 3 138 December 2 1 76 December 30 3 69 20 1,027 22 Half the cases which occurred were notified in the months of August, September and October, which were also the months of maximum prevalence for the Metropolis as a whole. Three cases were notified between December 2nd and December 30th, but of this number one should be allotted to the period of greatest prevalence since the history shows that the illness began on October 26th. PUERPERAL FEVER. Seven cases of puerperal fever were notified during the year and of this number four proved fatal. Three patients were attended in the first instance by midwives and four by doctors. Of the midwives' patients one developed eclampsia within twelve hours after delivery and died within two days; the case was obviously not one of puerperal fever. In the second case which also terminated fatally, instrumental delivery of a dead foetus was effected by a medical practitioner. The third patient suffered from a very mild attack of puerperal fever and made a good recovery. Of the doctors cases two were due to the retention of portions of the after-birth, and one to the instrumental delivery of a decomposed foetus. Of these three cases two died. The fourth case was mild and made a good recovery. In no instance did the same midwife or doctor or nurse attend more than one of the patients notified during the year. Acute Poliomyelitis.—Acute poliomyelitis was made compulsorily notifiable in London for the first time on March 13th, 1911. No instance of the disease having occurred in Kensington has been brought to the notice of the Council, but 69 cases have been notified elsewhere in the Metropolis. Acute poliomyelitis is a disease which occurs chiefly in childhood, attacks the central nervous system and gives rise to the condition known as infantile paralysis. In severe attacks which do not end in death, the patient suffers through life from wasting and paralysis of one or more of the limbs. As a rule the cases that occur are sporadic in their incidence and show no tendency to be followed by others in the same neighbourhood, but within recent years epidemic outbreaks of fatal forms of poliomyelitis have been reported on the Continent and in America. In the summer and autumn of the year 1911, 218 cases occurred in the counties of Devon and Cornwall and gave rise to no less than 42 deaths. The fatality was thus equivalent to close on 20 deaths among every 100 cases as compared with a fatality of less than 10 per cent. among persons who suffered from diphtheria in Kensington. When it is borne in mind that out of the 176 patients who survived a large number will suffer thoughout life from varying degrees of paralysis in one or more limbs, it becomes evident that acute poliomyelitis must be regarded as a very serious disease. From Dr. Reece's report to the Local Government Board on the outbreak in the SouthWest of England it also appears that in at least eleven houses more than one person was attacked, whilst five instances are recorded in which the number of persons falling ill in a single house exceeded three. There are thus grounds for the belief that the disease may spread by infection from person to person. As a preventitive measure disinfection is accordingly indicated, but the most urgent need is further knowledge as to the natural history and prevalence of the disease. With this end in view, acute poliomyelitis has been made compulsorily notifiable in London and a large number of other sanitary districts in England. Cerebro-Spinal Fever.—Cerebro-Spinal Fever and poliomyelitis possess certain features in common, which render their distinction, particularly in fatal cases, a matter of some difficulty. The evidence available does not, however, support the suggestion sometimes made that the two diseases may appear together in epidemic form at the same time and in the same locality. During the year 102 cases of cerebro-spinal fever were notified in London. Only one case was notified in Kensington. The patient died and post mortem examination proved that the cerebral symptoms had been due to tuberculosis of the meninges of the brain. OPHTHALMIA NEONATORUM. Ophthalmia in the newly-born is a frequent cause of total blindness or seriously defective vision. In the most virulent form the disease is generally due to gonorrhoea in the mother. For the prevention of blindness the adoption of two measures is necessary. The first and most effective 23 is the treatment of the eyes at birth with a view to safeguarding them from infection with the gonococcus and this treatment should be carried out in every case whether the mother shows signs of gonorrhoea or not. The second necessary step is to secure the immediate application of curative measures by a qualified person if any sign of ophthalmia appears. In such cases the delay of a few hours may make the difference between permanent blindness and recovery with normal vision. In London the supervising authority for midwives is the London Countv Council, a body which has already done much to secure attention to the eyes of infants at birth by enforcing the rules of the Central Midwives Board. For securing treatment when ophthalmia has developed the first necessary step was taken when the disease was made compulsorily notifiable in March, 1911. The duty of visiting the cases notified and seeing that appropriate treatment is obtained has in Kensington been allotted to the Council's Health Visitors. In cases where the eyes require constant attention the local branch of the Queen Victoria Jubilee Institute has very kindly arranged for their nurses to attend at the request of the Health Visitors on children who are under medical treatment in their homes. In certain cases it has also been found possible for patients to attend daily at the Western Ophthalmic Hospital in Marylebone, which is within easy access by train from Notting Hill Station. The London Hospital is unfortunately the only public institution in London, with the exception of the Infirmaries, where the mother and child can both be received as in-patients. Where immediate removal to hospital of mother and child is imperative, the Metropolitan Asylums Board ambulances are available without charge for the purpose, but the Board do not provide a nurse with the ambulance. During the year 22 cases of Ophthalmia Neonatorum were notified. Only one child, which was removed by ambulance to the London Hospital on the second day after birth, is known to have suffered permanent injury to the eyes. In this case there are large opacities on both corneae. Four children have died and 14 are known to have recovered with the eyes uninjured. In the case of two children admitted to the Infirmary, and one child who was treated at the Western Ophthalmic Hospital the parents moved and the final results were not ascertained. NON-NOTIFIABLE EPIDEMIC DISEASES. The immense cost which the community is called upon to bear in order that persons suffering from Scarlet Fever, Diphtheria, and certain other notifiable diseases may be removed from their homes and isolated in Hospital diverts in some measure the attention of the public from the very heavy mortality which results from epidemics of the diseases which are not notifiable. The part played by these two artificial classes of disease has accordingly been represented in the following table of deaths occurring in the year 1911. Epidemic Diseases. Notifiable. Deaths, 1911. Non-Notifiable. Deaths, 1911. Diphtheria 20 Measles 93 Erysipelas 8 Whooping Cough 54 Scarlet Fever 3 Influenza 25 Enteric Fever 4 Diarrhœa 184 Total 35 Total 356 Comment on such figures is unnecessary, except to say that they illustrated the urgency of the problem presented by such diseases as diarrhoea and measles without necessarily indicating notification as the solution. The following table shows the seasonal incidence of deaths from the non-notifiable cpidemic diseases and the age periods in which death occurs :— 24 Non-notifiable Epidemic Diseases in 1911. Report for four weeks ended Number of Deaths. Measles. Whooping Cough. Influenza Diarrhœa & Enteritis. January 28 30 6 3 4 February 25 23 11 4 5 March 25 25 7 i 5 April 22 7 5 1 2 May 20 8 13 3 4 June 17 2 3 0 4 July 15 2 4 1 7 August 12 0 2 0 32 September 9 1 2 1 63 October 7 0 1 2 29 November 4 0 0 0 12 December 2 0 0 2 6 December 30. 0 0 4 11 Total 93 54 25 184 Age at Death. Measles. Whooping Cough. Influenza. Diarrhœa & Enteritis. Under 1 year 21 25 1 123 Under 5 years 88 53 1 156 5 to 15 years 5 1 0 0 15 to 65 years 0 0 6 18 65 years and upwards 0 0 18 10 Total 93 54 25 184 Fatal diarrhoea is seen to be a disease of infancy occurring in the late summer and early autumn ; deaths from measles and whooping cough occur in early childhood; influenza is chiefly fatal in old age and late middle life, the number of deaths showing a marked remission in the summer months. MEASLES. The deaths from measles numbered 93 and with only five exceptions occurred in children under 5 years of age. The epidemic which resulted in so large a number of deaths began in December, 1910, when 17 children died of measles as compared with 8, 4 and 3 in the preceding months. In January, 1911, the number of deaths attaining 30 reached the maximum, but showed no substantial diminution until after the end of March when the deaths fell to 7 in the four weeks period ending on April 22nd. All cases of measles in children attending the elementary schools are notified by the head teachers and visited by the lady sanitary inspectors. During the year 702 cases were notified; 114 additional cases were found in the homes visited, the total number of cases coming to the notice of the Public Health Department being 816. Out of this number only 222 had received medical advice before they were visited by the inspectors. A leaflet is left with the mother of each family attacked calling attention to the serious nature of the disease and insisting on precautions being taken to prevent the spread of infection. The largest number of cases occurred in the Barlby Road School, where 98 children were attacked; St. Mary Abbott's School contributed the next largest number, notifying 56 cases of measles during the year. From the various class rooms or departments attacked unprotected children were excluded by the Education Authority for periods varying between 4 and 21 days on 24 separate occasions. The whole of the Infants' Department in the Gloucester Grove School was closed from June 19th to July 23rd. 25 The whole question of the control of measles is beset with difficulties; school closure and the exclusion of susceptible children frequently fail to prevent the spread of the disease, whilst the notifications sent by head teachers to the Public Health Department are, in large numbers of cases, not received until the time for effective action is long past. The best hope of reducing the heavy mortality from measles which occurs every year in Kensington would appear to lie in the adoption of measures designed to postpone the age of attack, and in the provision of hospital treatment for children whose home surroundings preclude the possibility of adequate nursing. Since the end of the year 1910, hospital treatment has been provided by the Metropolitan Asylums Board. During the year under consideration 102 children v\ith measles have been taken into the Metropolitan Asylums Board Hospitals, but the opportunities of the Public Health Department were limited during the epidemic period by the fact that admission was only available for pauper patients through the Relieving Officer. On May 30th, 1911, eight weeks after the epidemic was over the Local Government Board issued the Metropolitan Asylums (Measles) Order, 1911, which authorises the reception of non-pauper patients with measles on the recommendation of the Medical Officer of Health for the district in which they live. In future years the provision sanctioned by this Order should be of the greatest value. The age of attack could be postponed by the rigid exclusion from school of children under 5 years of age. Since large numbers of deaths occur each year as the direct result of attendance in the baby class the abolition of such classes should be unceasingly advocated by Health Authorities until it has become an accomplished fact. WHOOPING COUGH. The deaths from whooping cough numbered 54; the number of cases brought to the notice of the Public Health Department by the schools being 255. In the homes visited 83 addition d cases were discovered ; the total number of cases dealt with by the Sanitary Inspectors being 338. An advisory leaflet was left with the mother of each family visited. The largest number of cases occurred in the Gloucester Grove School, where 35 children were attacked; the Fox School contributed the next largest number, notifying 28 cases of whooping cough during the year. Of the cases visited only 65 had received medical treatment. The excessive fatality of the disease in young children was shown by the fact that 53 out of 54 deaths, or 98 per cent. of the tctat number registered during the year, occurred in children under the age of 5 years. The seasonal incidence of fatal attacks was greatest in the months of February and May, and least in the last four months of the year when only one death occurred. The measures to be adopted for reducing the death-rate from whooping cough are the same as those already recommended in the case of measles. Cases of whooping cough are received in the hospitals of the Metropolitan Asylums Board, but the provision made is limited to paupers, that is to say to children who are recommended for admission by the District Medical Officers of the Board of Guardians. During the year 66 Kensington patients were treated for whooping cough in the Board's hospitals. EPIDEMIC DIARRHœA. During the year 184 deaths were registered as due to the group of diseases described by the Registrar-General as Diarrhoea and Enteritis. This group includes a small number of deaths which were not caused by the form of enteritis commonly known as epidemic diarrhoea, but for two reasons the various types of diarrhoea will be treated together. The first reason is that an overwhelming majority of the deaths from diarrhoea in years which include many weeks of unusually hot weather are due to the epidemic type : the second is that the distinction made on death certificates between the infective and non-infective forms of diarrhoea is in many cases arbitrary, and therefore valueless. The mortality at all ages was equivalent to a death-rate of 1.1 per 1,000 and at ages under one year to 38 deaths per 1,000 births. The seasonal incidence of fatal cases in four-weekly periods has already been given in the Table on p. 24, which shows that up to June 17th no increase in mortality had occurred. On this date the epidemic wave began to rise, and did not disappear until November 4th. The weekly incidence of deaths is shown in the following Table, together with the temperature prevailing in the weeks to which the death returns relate, and the figures are limited to the epidemic period. 26 Deaths from Epidemic Diarrhœa. June 10th to November 4th, 1911, in Weekly Periods. Month. Week ending. Number of Deaths. Temperature of Air. N. Kensington. Norland. i Golborne. St. Charles. Pembridge. Hclland. Brompton. Redcliffe. Earl's Court. S. Kensington. June 10 1 62 deg. 1 1 17 1 57 „ l 0 1 24 4 59 „ 4 3 1 July 1 1 57 „ 1 1 0 8 0 66 ,, 0 0 0 15 2 65 „ 1 1 0 1 1 22 1 69 „ 1 0 1 0 0 29 7 71 „ 7 3 2 2 0 0 August 5 8 68 „ 8 3 2 2 1 0 0 12 16 72 „ 15 6 5 4 0 0 1 1 19 16 69 „ 13 5 5 2 1 0 0 1 2 3 26 18 64 „ 17 6 4 3 4 1 0 0 0 1 September 2 16 65 „ 16 3 9 2 2 0 0 0 0 0 9 13 67 „ 10 2 3 4 1 1 0 1 1 3 16 4 60 „ 4 1 0 3 0 0 0 0 0 0 23 17 54 „ 16 7 4 5 0 0 1 0 0 1 30 3 55 „ 2 1 0 1 0 1 0 0 0 1 October. 7 5 48 „ 4 3 1 0 0 0 0 0 1 1 14 4 52 „ 4 1 2 0 1 0 0 0 0 0 21 4 54 „ 4 0 2 1 1 0 0 0 0 0 28 2 48 „ 2 2 0 0 0 0 0 0 0 0 November 4 2 48 „ 2 0 0 1 1 0 0 0 0 0 Totals 145 133 49 42 30 12 4 2 2 4 12 The table shows a comparatively close correspondence between the rise and fall of the temperature of the air and the increase or diminution in the weekly mortality from diarrhoea. Attention has already been called to the fact that more than 90 per cent. of the infants who die of diarrhoea are artificially fed, and the obvious inference is that the chief cause of diarrhoea is the consumption of food in which early putrefaction has been produced by the excessive heat of the atmosphere. As against this theory, which does not meet with general acceptance, may be placed the fact that in spite of the excessive heat in 1911 certain districts either escaped altogether or were not attacked by diarrhoea until late in the year. At the end of the week terminating on August l2th, after six weeks of excessive heat, there were three districts in North Kensington where well-marked groups of deaths had occurred. One group was situated in the crowded streets north of the Great Western Railway, the second in the Blechynden Street area, and the third in Notting Dale. The distinguishing features common to these three areas are poverty, crowding in houses and the low social rank of the inhabitants. On the same date only one death, which occurred August 4th, had been registered as due to diarrhœa in the whole of the Pembridge Ward, as compared with 30 deaths in the neighbouring wards of Norland and St. Charles. The greater part of Pembridge is inhabited by well-to-do persons, but the Bolton Road division contains a small population which is on the whole as low in the social scale as any community in the Borough. It is therefore of interest to note that in this particular area, which presents all the conditions favourable to diarrhœa, no deaths occurred until August 31st, when an infant aged eight months died of "infective enteritis" at 19, Bolton Road. Within the next two days two further deaths from diarrhœa in infants occurred, one at 13, Bolton Road and one in the immediate neighbourhood, at 19, Lonsdale Road. A fourth child, admitted to the 27 Infirmary from 14, Bolton Road, died of diarrhœa on October 11th. For two months from July 1st the food of infants and adults in the two debased areas of Netting Dale and Bolton Road had been been exposed to the same tropical heat, but prior to August 31st the Bolton Road district escaped, whilst Notting Dale suffered a heavy death-rate from diarrhoea. This delay in the onset of the epidemic in a particular district strongly suggests that diarrhoea is an infective disease, and that the escape of the Bolton Road area was due to the absence of the infective agent in the neighbourhood during the earlier weeks of the epidemic. In the Holland Ward there is an area lying east of Campden Hill Road and south of Notting Hill Gate, which contains a working class population of several thousand persons with large numbers of young children and infants. This district, with a row of small cottages in Bulmer Terrace behind the northern side of Notting Hill Gate is completely cut off on every side from contact with poor neighbourhoods by extensive areas containing residences of the best class with large private and public gardens. In the whole district only one death was registered as due to diarrhoea, and this death in an infant aged 11 months did not occur till September 2nd. Earlier in the summer an old man aged 92 was removed from a house in the same district to the infirmary, where he died on July 8th. The death was registered as due to "simple enteritis"; it occurred before there had been any sustained rise in the atmospheric temperature, and was probably correctly attributed to diarrhoea of a non-infective type. If this death be neglected, we have a second instance of a district inhabited by the working classes which escaped attack by fatal diarrhoea for more than two months, and the facts again admit of the explanation that the absence of diarrhoea was due to the absence of the necessary infecting agent. On the other hand the immunity of the district in question may have been in some measure due to social status, since the inhabitants, though poor, are on the whole markedly superior to the great majority of the working classes who live in the Golborne and Norland Wards; but if this be so, the conclusion cannot be avoided that a very low standard of comfort, domestic cleanliness and nursery hygiene is sufficient to prevent epidemic diarrhœa. From the table of deatns from diarrhoea in the various Wards it will be seen that only 4 fatal cases occurred in the Ward of Holland during the epidemic. In one case the death of a man, aged 30 years, was attributed to mucous colitis, from which the patient had suffered for four years. A second case was that of the old man already mentioned, who was removed from the district in the Holland Ward, behind Notting Hill Gate, and died in the infirmary at the age of 92, from simple enteritis. Some 250 births are registered annually as occurring in Holland Ward, so that the lives at risk in this district among the child population under 3 years of age may be assumed to have numbered at least 600, and yet only two children died of diarrhoea, one at the age of 10 months and the other at the age of 11 months. Under the age of 1 year the mortality was thus equivalent to 8 deaths per 1000 births as compared with an infantile death rate of 38 per 1000 in the Borough as a whole, whilst the working classes, among whom the number of young children is comparatively great, constitute one-third of the total population in this Ward where the mortality from diarrhoea was so remarkably low. There is no reason to suppose that there is any material difference in the quality of the milk and other foods supplied to the working classes in different parts of the Borough, but the crowding together of tamilies in small houses which may contain four or five separate tenements is much more frequent among the working classes in North Kensington. Under these circumstances, on the assumption that diarrhaea is an infectious disease, the mortality in the northern half of the Borough may be explained by the readiness with which the infective agent may be conveyed from sick persons to the food of healthy children in their immediate neighbourhood. On the same assumption the immunity of the working classes in Holland Ward may be explained partly by the absence of the infective agent and partly by the absence of crowding of persons on space and in houses which materially diminishes the opportunities for infection to spread from the sick to the healthy. Prevention of Epidemic Diarrhœa.—Until the causes of summer diarrhoea have been ascertained, the measures to be adopted for its prevention must be to some extent empirical. The printed instructions which are given to mothers by the Health Visitors recommend that in hot weather milk should be sterilised by boiling and kept in a cool place in a clean jug, which is to be covered in order to prevent contamination by dust and flies. The importance of domestic cleanliness, of breast feeding and the proper use of cow's milk is impressed on mothers by the Health Visitor, and the same lessons are taught at the centres for infant consultations. It is on this teaching and on attention to the sanitary state of homes throughout the year that the prevention of diarrhoea chiefly depends. The daily removal of house refuse is a sanitary measure of the first importance which has not yet been undertaken, but which becomes more and more urgent as the number of housewives increases who are prevented from burning waste vegetable and animal matter by the substitution of gas stoves for coal fires. Among direct measures may be mentioned the publication by the Council of a leaflet on the prevention ot diarrhoea which was distributed by post among 2,000 mothers in 1911, and which will in future be left in the homes and supplied at the schools for mothers in the late spring and during the summer months. 28 TUBERCULOSIS The number of deaths from tuberculosis was 203, the death-rate being 1.18 per 1,000. The mortality in the years 1901-1911 from phthisis, other tuberculous diseases, and all forms of tuberculosis is expressed in the following table as the number of deaths per 100,000 persons living in the periods to which the death-rates refer. Tuberculosis in Kensington, 1901-1911. The Year. Deaths from Phthisis per 100,000 persons living. Deaths from other Tuberculous Disease per 100,000 persons. Total deaths from Tuberculosis per 100,000 persons living. 1901 132 45 178 1902 125 51 176 1.903 120 42 162 1904 129 66 195 1905 114 42 156 1906 123 49 172 1907 100 52 152 1908 104 46 150 1909 97 40 137 1910 80 29 109 1911 90 28 118 In the short space of twelve years the death-rate from tuberculosis has been practically halved: or, to be precise, the number of deaths per 100,000 persons living has been reduced by 47 per cent., and has fallen from 194 in 1898 to 118 in 1911. PHTHISIS. In the year under notice the deaths from tuberculous phthisis, or pulmonary consumption, numbered 155, and corresponded to a rate of 0.90 per 1,000 living. They were responsible for 76 per cent., or three-quarters of the total deaths from tuberculosis. Persons between the ages of 15 and 45 years of age—that is to say, in the best working years of life—furnished more than 56 per cent. of the total deaths, the mortality among males being considerable higher than among females. The death-rate from phthisis in 1898 was 126 per 100,000 living; in the year under notice the death-rate fell to 90. The difference between the two rates represents a reduction in the mortality from consumption of 29 per cent. in 12 years; and if reference is made to the table given above it will be seen that the death-rate in the year 1898 affords a fair standard for comparison, being less than the rates recorded in 1901, and even so lately as in 1904. It will be of interest to consider next in order the incidence of deaths from phthisis in 1911 upon the different Wards in the Borough as compared with the incidence in former years. Unfortunately, tabulated records suitable for the purpose of this comparison have not been given in the reports published prior to the year 1905; it has therefore been necessary to take the mean annual number of deaths in 1905-6 as the earliest standard available. 29 Deaths from Phthisis in Wards in 1905-6 and 1911. District. Deaths from Phthisis. Number in 1905. Number in 1906. Mean Annual Number 1905-6. Number in 1911. Increase or decrease per cent. North Kensington 139 154 146 107 -27 South Kensington 60 60 60 48 -20 St. Charles 32 34 33 30 -9 Golborne 37 48 42 25 -40 Norland . 54 52 53 31 -42 Pembridge 16 20 18 21 +17 Holland 21 21 21 11 -48 Earl's Court 10 13 12 15 +25 Queen's Gate 5 7 6 5 -17 Redcliffe 15 11 13 11 -15 Brompton 9 8 8 6 -25 The Borough 199 214 206 155 -25 The figures show that in North Kensington, the poorer half of the Borough, the percentage reduction in the number of deaths from phthisis has been greater than in the South, whilst the number of deaths occurring annually in the whole Borough has been reduced by 25 per cent. in five years. Norland probably contains a larger proportion of very poor persons than any other district, and shows the greatest reduction in phthisis mortality recorded in the wards of North Kensington. Taken as a whole the results are satisfactory, and show that the poorer districts have in each case contributed a large share of the substantial reduction in the number of deaths from phthisis which has taken place throughout the Borough in the last five years. In its bearing on the well-known fact that phthisis is in the main a disease of the poor, it will be noted that in each year dealt with in the above table the deaths in North Kensington have been more than twice as numerous as in the South, the population of the two areas being approximately equal in number. The places where deaths from phthisis occurred are set forth in the following list, and also afford some indication of the social status of persons attacked by fatal phthisis. Place of Death. Number of Deaths. Kensington Infirmary 59 Home 69 Brompton Hospital 4 St. Luke's Home 4 Outlying Hospitals and Asylums 16 Other Deaths beyond the Borough 3 Total 155 More than one third of the total number of deaths occurred in Poor Law Infirmaries; whilst 12 out of 69 patients who died at home had received medical relief from the Guardians during their illness. Thus 71 or approximately half the total number of 155 deaths occurred in persons who had applied to the Poor Law Authorities for medical relief. As an indication of social status the occupation of those who died will be given on a subsequent page, but all records in this connection must be understood to illustrate the effects of two factors operating in a vicious circle. Whilst poverty is a fertile cause of phthisis, it is also in a large measure itself the outcome of disabling chronic ailments, and among diseases of this class phthisis stands pre-eminent. 30 Tuberculosis Regulations, 1908.—These Regulations, under which all cases of consumption in " poor persons " have been made compulsorily notifiable, came into force on 1st January, 1909. " Poor persons" are defined as persons in receipt of relief from the Poor Rate and it is only to this class of patient that the Regulations of 1908 apply. Boards of Guardians through their officers are required to furnish to Medical Officers of Health the following information in respect to consumptive persons in receipt of relief, namely:— 1. On form A the addresses from which consumptive persons have been admitted to the infirmary. 2. On form C the addresses to which consumptive persons go on their discharge from the infirmary. 3. On form B the addresses of consumptives who are being attended in their homes by the District Medical Officer, and 4. On form D any change of address by a poor person who has been previously certified as suffering from consumption. For the purpose of preventing the spread of infection from pulmonary Tuberculosis, sanitary authorities are empowered to disinfect rooms, to disinfect or destroy infected articles, and to provide sputum bottles and disinfectants for the private use of consumptives in their homes They are also authorised to afford such "facilities" and to supply such "articles" as will diminish the risk of infection arising from the use of any room which is occupied by a poor consumptive as a sleeping apartment. Article IX provides that no Medical Officer of Health or Council shall put into force any enactment which subjects any persons notified under these regulations to any restriction or disability affecting himself, his employment or his residence on the ground that he is suffering from consumption. Compulsory powers of removal to or detention in hospital are thus deliberately withheld, neither will it be possible to forbid the employment of consumptive persons on premises, such as dairies, where their presence is a danger to the community. Nevertheless a large field for useful work remains, and public opinion will no doubt approve the provision of reasonable safeguards against the excessive hardship which might otherwise result from compulsory notification. The Regulations are silent on the subject of the institutional treatment of consumption because " any Sanitary Authority may provide hospitals for the use of the inhabitants of their district " under the powers conferred by the existing Public Health Act (v. Sec. 75 Public Health (London) Act, 1891, for London). And for this purpose they may themselves build hospitals or enter into an agreement with any person in charge of a hospital, for the reception of the sick inhabitants of their district on payment of such a sum as may be agreed on. The expression "hospital" means any premises for the reception of the sick (v. Sec. 141 of the above Act). The Sections quoted are important since they authorise sanatorium treatment and the segregation of advanced consumptives in institutions at the expense of the rates. It is also understood that the Local Government Board is prepared to recognise tuberculosis dispensaries as hospitals within the meaning of the Public Health Acts, but should technical difficulties stand in the way of such an interpretation, special sanction for the establishment of a Dispensary would no doubt be granted under Sec. 77 of the London Act which permits sanitary authorities with the permission of the Board to provide a temporary supply of medicine and medical assistance for the poorer inhabitants of their districts. Tuberculosis Regulations (Hospitals).—The Public Health (Tuberculosis in Hospitals) Regulations, 1911, came into force on May 1st, 1911. Broadly speaking they extend the system of the compulsory notification of phthisis to consumptive persons receiving medical treatment whether as out-patients or in-patients in any hospital, dispensary, or similar institution for the treatment of the sick which is not wholly supported by the contributions of the patients themselves. Poor Law institutions are excluded because they are already subject to the Regulations of 1908. Notifications from the medical officer of any hospital are required to be sent to the Medical Officer of Health for the area in which the hospital is situate and to contain a note of the home address of the patients to whom they relate. Article IV. (2) provides for the distribution of the notifications received in the following terms: "A Medical Officer of Health who receives a notification relating to a patient whose residence is not within the area for which he is Medical Officer of Health shall . . . transmit the notification to the Medical Officer of Health for the area in which the patient's residence is situate, and shall at the same time inform the Medical Officer of the Hospital that he has done so and shall give to him the name and address of the Medical Officer of Health to whom the notification has been sent." In London the Medical Officer of Health for each Borough is also 31 required to send to the Medical Officer for the County weekly lists of all notifications relating to persons residing within his Borough and received in pursuance of the Tuberculosis Regulations, 1908 and 1911. Since the majority of the patients attending the Brompton Hospital in Kensington do not reside within the Borough, the task of redistribution has materially increased the work of the clerical staff of the Public Health Department. Article VII. authorises the Council to carry out disinfection and to make the same provision for persons notified under the new Regulations as may be made for " poor persons " notified under the Public Health (Tuberculosis) Regulations, 1908. Notification of Consumption.—During the year 1263 notification certificates relating to persons suffering from consumption were received and dealt with in the Public Health Department. The sources from which these official certificates were forwarded were as follows, viz., from officers of Boards of Guardians, under the Tuberculosis Regulations, 1908, 364 certificates; from the Medical Officers of hospitals, under the Tuberculosis Regulations, 1911, 889 certificates; and from private medical practitioners under the system of voluntary notification existing in Kensington, 10 certificates. Notifications from Officers of Guardians.—The certificates, numbering 364, which were forwarded by officers of Boards of Guardians may be classified as follows : — Form of Certificate Parish or Union served by Officers who Certified. Total Notifications. Kensington Other Unions. Form A 150 14 164 Form C 69 64 133 Form B 66 0 66 Form D 1 — 1 Totals 286 78 364 Of the 66 certificates on Form B from District Medical Officers 47 related to persons under treatment in their homes who were subsequently removed to the Infirmary and re-notified on Form A. Only 19 cases remain in which consumptive persons sought medical advice from the District Medical Officers before the disease was so far advanced as to demand admission to the Infirmary. The admissions for consumption to the Kensington Infirmary numbered 150 and were duly notified on Form A; the discharges notified on Form C numbered 69, and to this figure may be added the 59 deaths from consumption which occurred in the Kensington Infirmary during the year. If this be done the following figures, based on the notification and death certificates received, will represent the record of the wards reserved for consumption in the Infirmary during the year 1911. Kensington Infirmary. Discharges 69 Deaths 59 Admissions 150 Discharges and Deaths 128 Balance 22 The balance 22 which represents the difference between the number of admissions and the number of discharges or deaths during the year is to be accounted for in one or more of the following ways:— (i) By an increase in the number of consumptives remaining in the infirmary at the end of the year 1911, as compared with the number under treatment at the end of 1910. (ii) By the discharge of patients to addresses beyond the Borough. (iii) By failure to notify the discharge of consumptive patients to addresses in Kensington. Of the 150 notifications of the admission of consumptive patients to the Kensington Infirmary 47 referred to persons previously notified by the District Medical Officers; 13 persons were admitted twice and one person was admitted four times during the year, notifications being sent on each occasion. 32 Notifications from Hospitals.—The certificates, numbering 889, which were forwarded by the Medical Officers of hospitals under the Regulations of 1911 are classified in the following summary :— Notifications of Phthisis by Hospitals. Description of Hospital Notifying. Number of Certificates as to Patients coming from Total Certificates Received. Kensington. Other Districts. Brompton Hospital for Consumption 15 372 387 St. Luke's House, Pembridge Square 3 37 40 Other Hospitals in Kensington 5 2 7 Total Certificates from Kensington Hospitals 23 411 434 Paddington & Kensington Tuberculosis Dispensary 323 — 323 27 other Hospitals beyond the Borough 132 - 132 Total from Hospitals not in Kensington 455 - 455 Total Certificates from all sources 478 411 889 From the above table it will be seen that out of 478 medical certificates relating to consumptives whose homes were in Kensington only 23 were in respect of persons receiving treatment from the medical officers of Kensington institutions. The figures in the second column show that no less than 411 certificates in respect of persons whose homes were not in Kensington were distributed by the Public Health Department and sent to the Medical Officers of Health of the districts concerned. The receipt of 323 certificates from the Tuberculosis Dispensary at No. 20, Talbot Road, in the Borough of Paddington, also indicates that this institution provides for a large majority of the consumptives in Kensington who obtain medical advice in hospitals. Voluntary Notification.—Under the system of voluntary notification, which has been in force in Kensington for a number of years, ten certificates from private practitioners were received ; but in future, that is to say from January 1st, 1912, onwards, the universal compulsory notification of consumption will render the voluntary system, which has done good service in its time, no longer applicable. Information from other Sources.—The names of children who are found by the Lady Inspectors to be living in contact with consumptive persons and who attend the elementary schools, are forwarded to Dr. Kerr, Medical Officer (Education), London County Council, in order that such children may receive especial attention at the hands of the school medical inspectors. In return, Dr. Kerr notifies any Kensington child that is found on inspection in school to be suffering from consumption to the Medical Officer of Health for the Borough. During the year 29 school children have been notified under this arrangement as suffering from consumption by the Medical Officer of the Education Authority. Persons Notified.—During the year 507 persons who had not been previously notified were reported to the Public Health Department as suffering from consumption. It should be noted that the figures given above in the sections under the heading "Notification" relate to the number of certificates received, and since in certain cases two or more certificates from different sources relate to the same patient, it is necessary to eliminate all duplicates in order to arrive at the number ot persons who were notified during the year as suffering from consumption. This necessary correction has been made, and the results are shown in the following table:— 33 Cases of Consumption Notified in 1911. Source of Information. Number of Cases. New Cases. Previously known. Total Cases. Officers of Guardians 102 47 149 Tuberculosis Dispensary 259 26 285 *Brompton Hospital 35 9 44 Other Hospitals for Consumption 21 3 24 General Hospitals 45 2 47 Medical Officer (Education) L.C.C. 26 3 29 Private Medical Practitioners 7 0 7 Reported by Sanitary Inspectors 9 0 9 Reported by other persons 3 1 4 Total cases notified in 1911 507 91 598 Death Certificates in 1911 64 91 155 Total cases reported for the first time in 1911 571 - — The chief significance of the above table lies in the fact that within the short space of 12 months, 507 cases of consumption during life and 64 cases after death were brought to the notice of the Public Health Department for the first time. More than half the notified cases were reported by the Tuberculosis Dispensary and it is safe to assume that if the Dispensary had not been established the majority of the consumptives now attending there would still be unknown to the Health Authority for the Borough and would still be taking no steps to obtain the treatment they require. That much remains to be done may be inferred from the figures in the table which show that, out of 155 deaths, 64 (or more than one third) occurred in persons who had not been notified as suffering from consumption. On the other hand the following figures show that already a small proportion of those who die have been known to the Council's officers for considerable periods of time. Deaths in 1911 of persons previously notified. Date of previous notification. Number of Deaths in 1911. 1902 1 1903 0 1904 1 1905 0 1906 1 1907 2 1908 1 1909 3 1910 26 1911 56 Total deaths of persons previously notified 91 * Of 44 cases notified from Brompton, 29 were reported voluntarily under a special arrangement with the Medical Officer of Health for the London County Council, which lapsed on May 1st, when the new Regulation came into force. 34 Before the advent of the Dispensary the great majority of consumptives were not notified until they were in the last stages of the disease and for this reason the figures given do not of themselves throw any light on the question of the average duration of phthisis from onset to death. At the same time, inadequate as they are, they still afford some indication of the well-known fact that consumptives may continue to live for five or ten years or even longer periods of time, although the disease is destined to end in death. The distribution of the notified cases in North and South Kensington and the various wards in the Borough is shown in the following table:— Distribution of Notified Cases. District. Number of Persons Notified. New Cases. Previously known. Total. North Kensington 419 78 497 South Kensington 88 13 101 St. Charles 96 15 111 Golborne 178 27 205 Norland 97 27 124 Pembridge 48 9 57 Holland 19 3 22 Earl's Court 24 3 27 Queen's Gate . 13 1 14 liedcliffe 23 4 27 Brompton 9 2 11 The Borough 507 91 598 The figures given are of interest as showing the very large number of consumptives reported in the poorer wards, but they must not be taken as representing the relative prevalence of phthisis in North and South Kensington. The Northern half of the Borough being the poorer area necessarily supplies a larger number of compulsory notifications under the tuberculosis regulations, whilst the figures are further swollen by notifications from the Tuberculosis Dispensary, an institution which makes no provision for persons residing south of Holland Park Avenue. Reference should therefore be made to the table of deaths among all classes as a more reliable guide to the proportional incidence of phthisis on the various districts in the Borough. The age and sex of the persons newly notified are shown in the following table. The high figure returned for the age period 5-15 years has resulted from the notification of large numbers of children by the medical officer of the Tuberculosis Dispensary. Age and Sex of Persons Notified. Under 5 years. 5-15 16-25 25-35 35-45 45-55 55 and upwards. Total. Male 8 65 35 35 44 38 24 249 Female 4 54 40 66 49 27 18 258 Total. 12 119 75 101 93 65 42 507 For the proper interpretation of the above table it must be understood tha.t the figures do not include persons who died from consumption in 1911 without having been notified to the Medical Officer of Health. 35 In 535 cases information was obtained as to the number of rooms occupied by consumptive persons and their families and is summarised in the two following tables :— Home or other Accommodation of Sick Persons previously unknown. Number of Rooms Occupied. 1 2 3 4 or more. Homeless Persons in the Infirmary. Common Lodginghouse Cases. Total Cases investigated. Number of consump tive patients 96 209 111 91 19 9 535 The figures show that more than half the cases notified occupied tenements containing less than three rooms. The inquiries made also elicited the fact that in no less than 194 instances the consumptive patient occupied a one or two room tenement, with more than one, and in certain cases with more than four, other presumably healthy persons. Rooms in Tenement. Persons in Tenement, including Patient Number of Cases. One Room Three persons 17 Four persons. 1] Five persons. 6 More than five persons 1 Two Rooms Three persons 27 Four persons 46 Five persons 27 More than five persons 59 Fortunately the natural resistance of the tissues to the invasion of tuberculosis is not easily overcome: otherwise we could calculate from the figures in this table that more than 600 persons are known to have lived with consumptive patients in tenements so small and crowded as to render their ultimate death from consumption a matter of certainty. That case to case infection under such conditions plays an important part in spreading consumption may be gathered from the histories of the patients visited. In 218 instances the patients had undoubtedly become infected by contact at home with one or more consumptive relatives. Three patients gave a history of intimate contact with a consumptive friend, and two persons appear to have been infected by a fellow lodger. In seven cases there was reason to believe that the infection had been acquired from contact with a consumptive fellow-worker, whilst nine further cases of phthisis were reported in the families of the patients visited. The occupation or status of the persons who died from consumption during the year was as follows:— Occupation of Consumptive Persons. Males— No. of Deaths. Artizan 16 Labourer 14 Cabman, coachman, stableman 7 Tradesman 10 Clerk 6 Porter, errand boy, hasvker 11 Butler, footman 4 Private secretary 2 Handyman, army pensioner, dentist, vinegar labeller, musician, son of a dyer, son of a labourer, son of a carman, son of a tailor, son of an insurance agent, son of a butcher, son of a painter, son of a street musician (1 each) 13 No information 2 — 85 36 Females— No. of Deaths. Domestic servant 7 Washerwoman, ironer 9 Wife or daughter of labourer 7 Dressmaker, needlewoman, upholsteress 3 Charwoman 6 Wife or daughter of carman, coachman 3 Wife or daughter of musician, policeman, solicitor, civil engineer (2 each) 8 Shop assistant, housemaid, waitress, nurse, clerk (1 each) 5 Wife or daughter of cabman, french polisher, ironmonger, postman, veterinary surgeon's dispenser, hairdresser, greengrocer, scavenger, Vacuum Company's operator, blindmaker, tailor, Army officer, clergyman, plumber, engineer's fitter (1 each) 15 Independent means 2 No information 2 — 70 Total number of Deaths 155 The above details are given in the case of deaths only, since the occupations of the notified patients, who constitute an artificial class created by statute, afford no index of the social status and employment of the total number of consumptives in the Borough. There is no trade employing any considerable number of persons in Kensington which especially predisposes to consumption, but the figures given are of interest in that they show that out of 155 deaths from consumption only eight occurred in well-to-do persons. Four cases in which no information was obtained were those of homeless persons from common lodging-houses or furnished rooms. The inference to be drawn is that in the future, as in the past, the abolition of consumption will continue to depend on the adoption of measures designed to bring into the lives of the poor those safeguards which render the rich practically immune to phthisis. Preventive Measures.—The measures to be adopted for the prevention of phthisis may be classified as direct and indirect. The prevention of overcrowding in homes and in workshops, the provision of adequate light and ventilation, and the closing or demolition of insanitary houses may be mentioned as examples of action which have no doubt been indirectly responsible for the steady decrease in the death-rate of phthisis which has occurred in the last twenty years. The scope of the sanitary inspectors is seriously limited by the fact that the working classes cannot pay rents which would, at the same time, secure adequate cubic space in the homes they occupy, and a profit for the landlord; but although difficulties stand in the way, there is every reason to believe that the improvement in the conditions of the homes, the workshops, and the schools of the healthy, will do more to prevent the spread of consumption than is likely to be effected by the closest attention to the environment of those who are already sick. The following description of the action taken by those who deal directly with existing centres of infection, must accordingly be understood to apply to a part only of the preventive work which is carried out in the Borough. Work of the Lady Sanitary Inspectors.—For the purpose of making inquiries, offering assistance and giving advice, 538 first visits and 575 revisits were paid by the Lady Inspectors to the homes of the consumptive persons who were notified to the Public Health Department during tne year. In addition, 81 visits were paid to the homes of persons who had died unnotified. For the sake of brevity, the action taken during the year for the prevention of consumption may be summarised in tabular form as follows:— 7.—The Number of Visits paid during the year. a. First visits after notification 538 b. Subsequent visits 575 c. Visits after death in persons not notified 81 Total visits paid during the year 1,194 37 II.—Provision for Home Treatment. Open-air shelters provided 3 Bedsteads and bedding lent 5 III.—Patients or Contacts sent to Hospitals or other Institutions. a. To the Tuberculosis Dispensary 36 b. To the Brompton Hospital 7 c. To the Millfield Home, Rustington 4 d. To other hospitals or institutions 10 e. To Maitland Sanatorium 4 Total number sent to institutions 61 IV.—Disinfection after Death or Removal to Hospital. Bedding disinfected by steam at Wood Lane 116 Number of rooms disinfected 174 Number of rooms stripped 24 V.— Prevention of Spread oflnfectim by Expectoration. Pocket sputum flasks supplied 29 Sputum cups supplied for use at home 67 Total 96 VI.—Children attending the elementary schools and notified to the Medical Officer (Education), London County Council, as living in contact with consumptive persons 296 VII.—Specimens of Sputum from suspects examined bacteriologically by the Lister Institute at the expense of the Council 15 At the first visit a printed card of advice is left, and the particulars as to the history, home surroundings and treatment obtained are subsequently entered on the case sheets containing the notes of every patient notified. Second visits are paid with the object of obtaining for patients the treatment they require, and of seeing that the advice given is carried out. From the summary given it will be understood that a very large amount of valuable work has been carried out by the Lady Inspectors during the year. The Board of Guardians.—The importance of the work done by the Board of Guardians in removing advanced and highly infectious cases of consumption to the Infirmary, cannot be overestimated. Wards are set apart with accommodation for some 60 consumptives, and from the notifications received it would appear that 134 phthisical patients were admitted from homes in Kensington during the year. That many of this number were in the last stages of the disease may be inferred from the fact that 59 died of phthisis in the Infirmary. Returns as to the average duration of stay in the Infirmary are not available; but the notifications show that thirteen patients were admitted twice during the year, whilst one consumptive entered and left the Infirmary on no less than four occasions. In the absence of compulsory powers of detention, some patients stay only a few weeks; others remain for many months, with the result that the Guardians may on the whole be said to succeed in securing the isolation of considerable numbers of infectious patients during substantial periods of time. The Tuberculosis Dispensary.---The Tuberculosis Dispensary at 20, Talbot Road, in the Borough of Paddington, and close to the poorer neighbourhoods of North Kensington, has now received Kensington patients from the northern half of the Borough during the whole of the year 1911, and the last half of the year 1910. The institution is conducted on the now familiar lines of its prototype in Edinburgh, and is entirely supported by voluntary contributions. The Medical Officer of Health for Paddington is the chairman of the Committee of Management, which includes in its numbers members of the Kensington Borough Council and Board of Guardians, and the Council's Medical Officer of Health. Persons receiving treatment attend as out-patients, but the fundamental difference between the Dispensary and the ordinary out-patient department of a special hospital for consumption lies in the fact that after the first attendance the patient is visited in his home by one of the Dispensary medical officers, who advises on the spot as to the 38 means to be adopted for giving practical effect to his recommendations as to open-air treatment and the prevention of infection. The second object of the visit, and an object which is of primary importance, is the examination of members of the patient's family for signs of incipient or advanced consumption. Tne visit of the doctor is then followed by a visit from the Dispensary nurse, who gives further assistance to the patient in following the advice he has received. Sanatorium treatment is provided on a limited scale, efforts are made to persuade advanced cases to enter the Infirmary, and the various needs of the patients are, so far as possible, met by a system of close co-operation with appropriate charitable agencies/ In the space available it is impossible to give an adequate description of the work of the Dispensary, and for further details reference should be made to the Report of the Dispensary Medical Officer for the year 1911, which will shortly be published. During the last half of the year 1910, 157 consumptive persons residing in North Kensington received treatment at the Dispensary; the notifications of persons suffering from consumption received during the whole of the year 1911, amounted to 323. Special Provision by the Council.—As the result of two detailed reports submitted by the Infectious Diseases Sub-Committee on December 21st, 1910, and on January 20th, 1911, the Council have decided to make further provision for the prevention of consumption by adopting the measures described in the following resolution:— (i.) That no action be taken in the direction of urging upon the Metropolitan Asylums Board the need for establishing Sanatoria for advanced cases of consumption. (ii.) That, as an experiment, a bed be maintained by the Council in Benenden Sanatorium or some other similar Institution for a period of twelve months, for the treatment of early cases of consumption, at a cost not exceeding £78, and that further beds, not exceeding five in number, be engaged as required during the same period at a cost of 30s. per week each while occupied. (iii.) That at the outset one open-air shelter be provided at a cost of £8 and lent for the home use of consumptives, and that further shelters, not exceeding five, be obtained as required to replace those lent. (iv.) That, as an experiment, the Medical Officer of Health be authorised to provide an additional bed in one or two selected cases where the conditions of occupation render such provision advisable, and where the means of the patients or their relatives do not, in his opinion, permit of the extra accommodation being obtained at their own expense. (v.) That, subject to the necessary provision being made in the Estimates for the ensuing financial year, the Medical Officer of Health be authorised, in conjunction with the Medical Officer of the Kensington and Paddington Tuberculosis Dispensary, to give effect to the foregoing recommendations as from the 1st April next. The foregoing resolution was passed by the Council at their meeting on February 28th, 1911, A suggestion by the Medical Officer of Health, that on payment by the patient of a minimum sum of 7s. 6d. or 10s. per week the Council should retain beds in an institution, such as St. Luke's Home, for advanced consumptives, did not pass the Public Health Committee. There is thus still no provision in the Borough for advanced consumptives who are able to contribute towards their maintenance in an institution, and who are not eligible for admission to the infirmary. In accordance with the terms of the Council's resolution the following provision has been made during the year for phthisical patients residing in Kensington. Additional Beds.—Five beds provided at the Council's expense have been lent to consumptive persons for the purpose of preventing the spread of infection. Case 1. The patient, F. G., a girl aged 12 years, was notified by the Dispensary as suffering from consumption on November 17th. She was visited on December 4th by the Council's Lady Inspector and found to be occupying the same bed with her three healthy sisters. Bed provided and placed beneath window. I he parents are contributing Is. a week with a view to purchasing the bed. Case 2. The patient, E. C., a girl aged 15 years, was notified by the Dispensary on May 12th. She was visited by the inspector on May 25th, and found to be sleeping in the same bed with her mother, who was in the last stages of consumption. Her sisters in the same room, which is large and airy, occupied a separate bed. Third bed provided. 39 Case 3. A B., notified by the Dispensary on December 9th, was found occupying the same bed with her husband. Provided separate bed and arranged for patient to sleep in a room hitherto unoccupied. Case 4. H. W. B., when notified in October, occupied a separate bed, but stated he would have to sleep with wife and children in the winter months, since the bed-clothes were insufficient for two beds in cold weather. Bedding provided. Case 5. C. B., an early case, provided with bed and open-air shelter on discharge from Sanatorium. Open-Air Shelters.—Three open-air shelters provided at the Council's expense, have been lent to consumptives. Case 1. C. B. provided with shelter on discharge from Sanatorium vide Case 5 above. Case 2. G. A., age 20, was notified by Dispensary on June 10th, and visited by the Council's inspector on June 14tn, when he was found occupying a small back room with his two younger brothers. Open-air shelter provided, from which patient has derived great benefit. Case 3. In this case two brothers, aged 14 and 1(J years, were both notified by the Dispensary as suffering from consumption, and were found to be sleeping in separate beds in a small bedroom. Shelter provided with great benefit, and slept in during heavy snow falls early in 1912. Open-air shelters are also provided by the Tuberculosis Dispensary, and are referred to on pp. 45, 40, of the Medical Officer's Report for 1910, in the following^passages: " Some ten shelters have now been constructed for us, most of which are in use All three patients mentioned in last year's report . . . have now slept outside in their back yards for nearly two years." The patients mentioned reside in Paddington, and open-air shelters have not in any instance been provided by the Dispensary at addresses in Kensington. The use of common yards by several families, objections on the part of landlords or patients, and other circumstances, render it on the whole improbable that the provision of shelters, in any considerable number of cases, will be found feasible. Sanatorium Treatment.—In accordance with the terms of the resolution quoted, one bed has been retained by the Council for a period of 12 months from May 1st, 1911, in the Maitland Sanatorium, with the option of securing such other beds (to the number of five) as may from time to time De available. Patients are not recommended for admission unless they are likely to derive substantial benefit from sanatorium treatment, and this end is secured in two ways. In the first place every applicant is required to forward a medical certificate to the Medical Superintendent of the Sanatorium, and unless the certificate is, in the opinion of the Superintendent, satisfactory, the patient is not admitted. In the second place the Dispensary Medical Officer has kindly consented to provide the necessary certificate, which is not accepted from other quarters unless the circumstances are exceptional. The Lady Sanitary Inspectors or the Dispensary Committee also arrange that no case shall be sent until due provision has been made for the patient's dependents during his absence and for after care on his return. During the 8 months between May 1st and December 31st, 1911, four cases have been admitted. Case 1. C. B., male, age 30 years, a wood machinist, was admitted on June 17th, with slight infiltration at the apices of both lungs, and stayed for two months. On discharge the patient's progress was described as "Very good," and his walking capacity as 9-10 miles. He has been provided with a bed and an open-air shelter, and is in regular work. Case 2. A. G., male, age 33 years, a postman, was admitted on November 29th, with infiltration of upper lobe of left lung. The Post Office continued to pay his wages during his stay in the Sanatorium. He was discharged on February 21st, after staying 12 weeks. Progress reported as excellent. Walking capacity 9-10 miles. Work—capable of hard work C grade. Has been in regular work since, and lives with windows of room wide open night and day. Case 3. H. H., male, age 49, a house painter, was admitted on May 4th. A moderately advanced case. Upper lobe and apex lower lobe of both lungs affected. The patient had been out of work through ill-health for 5 months before admission to the Sanatorium. Report on discharge, "not much progress, except in weight, and little prospect of permanent arrest." In spite of this unfavourable report, the patient obtained employment on his discharge, after 6 weeks treatment, and was at work on March 26th, 1912. although far from well. 40 Case 4. M. M., male, age 34, a builder's labourer, was admitted on August 4th, with early consolidation at apex of left lung. He had also been treated at the Dispensary lor tuberculous ulceration of the larynx, which was practically healed before he was admitted to the Sanatorium. He stayed for 12 weeks. Report on discharge, " Progress fair—general health much improvedstill some cough; has been able to do heavy garden and farm work. Before admission he had been out of work for 12 months, but not through ill-health. He is now employed in gardening work at Kensal House, but the larynx is again affected. The fact that provision had been made by the Council in the Maitland Sanatorium was brought to the notice of the Dispensary Committee, and their Medical Officer early in May, but out of the very large number of Kensington patients in their charge, only two were recommended by the Dispensary to apply for sanatorium treatment at the Council's expense. 1 he Dispensary Committee do not themselves provide sanatorium treatment for Kensington patients, and the result of their inability to find suitable cases has been that the Council's bed in the Maitland Sanatorium remained vacant from October 27th to November 29th. Ihe patient admitted on the latter date was recommended by one of the Medical Officers at the Brompton Hospital. Open-Air School.—In June, 1911, an open-air school for the reception of 120 scholars, drawn from among the children attending the Dispensary, was opened at Kensal House in the Harrow Road, in a district which is easily accessible from the northern parts of the Borough of Kensington. The school is attended by a number of Kensington children, but details will not be available until tlie report of the Dispensary Medical Officer has been published. Funds for maintenance are derived from voluntary contributions; the cost of teaching is paid for by the London County Council. Other Forms of Tuberculosis.—Other forms of tuberculosis not included under the head of phthisis caused 48 deaths, and of these 31, or more than half, occurred in children under the age of five years. Reference to the table at the beginning of the section on Tuberculosis will show that between the years 1901 and 1908 the death-rate from these diseases was subject to fluctuations, but did not decline to any marked extent. It is, therefore, highly satisfactory to report that the rate of 50 per IDO.OOO persons living, which was recorded in 1907, was followed in the next two years by rates of 46 and 40, and finally by a rate of 28 in the year 1911. CANCER. Cancer caused 197 deaths, and of this number 178 occurred in persons over the age of 45 years. Carcinoma was the form of cancer to which 92 deaths were attributed ; sarcoma was the assigned cause of 8 deaths; 97 deaths were certified as due to cancer or malignant disease without further definition. The parts of the body which were affected in each case are shown in the following table:— Deaths from Cancer, 1911. Parts Affected. Sex. Total. Male. Female. Buccal Cavity C. No. 39 12 1 13 Stomach, Liver, etc. C. No. 40 31 21 52 Peritoneum, Intestines, Rectum, C. No. 41 16 30 46 Female Genital Organs C No. 42 — 23 23 Breast C No. 43 — 19 19 Skin C No. 44 1 0 1 Other and unspecified Organs C No. 45 27 16 43 Totals 87 110 197 The numbers following the description of the parts affected refer to the classification of cause of death adopted by the Registrar General for use in England and Wales. THE FOOD SUPPLY. 43 THE FOOD SUPPLY All premises in the Borough where food is sold or prepared for sale are now regulated by Section 8 of the London County Council (General Powers) Act, 1908. Premises where milk is sold are required to be kept in accordance with the Dairies, Cowsheds and Milkshops Order, 1885, and the Regulations made thereunder by the Council. Unsound food is dealt with under Section 47 of the Public Health (London) Act, 1891. Proceedings in cases of adulteration are instituted under the Sale of Foods and Drugs Acts. MILK SUPPLY. At the end of the year the Register kept by the Council and revised from time to time in accordance with the requirements of the Milkshops Order, 1885, contained the names of 197 persons carrying on the trade of purveyors of milk on premises within the Borough. Under Section 5 of the London County Council (General Powers) Act, 1908, the Council are authorised to remove from or refuse to enter upon the Register, the name of any person proposing to sell milk on premises which are for any reason unsuitable for the purpose. Whilst reserving to themselves the right to object to premises on any reasonable grounds, the Council have by resolution expressed the opinion that the presence in a milkshop of such articles as paraffin, loose pickles, fish, fresh meat, fruit, vegetables or coals constitutes a source of contamination, and renders the shop unsuitable for the sale of milk. During the year 28 applications for registration were received from persons who proposed to sell milk. Of this number 26 were granted, after the premises in respect of which the applications had been made, had been inspected and found suitable for the sale of milk. One application from the occupier of a shop where paraffin oil and loose pickles were sold, was refused. In a second case registration was refused because the applicant, after due notice of the Council's requirements had been given, failed to provide a cover for the counter pan in which it was proposed to store the milk. In no case was it found necessary to remove from the register the name of any person on the grounds that milk was being sold on unsuitable premises. The alterations made in the Register of Milk Purveyors during the year 1911 are summarised in the following table:— The Register of Milk Purveyors. Class of Premises. Milkshops. General Stores. Restaurants. Totals. Transferred 5 6 2 13 Vacated and removed from Register 5 5 2 12 Premises added to Register 5 4 4 13 On Register December 31, 1910 128 43 25 196 On Register December 31, 1911 128 42 27 197 Increase + Decrease — -0 -1 +2 +1 The above table shows the number of premises entered in or removed from the Register. Thirteen businesses changed hands, the transfer necessitating the substitution in the Register of the name of the purchaser for that of the vendor. In the case of the 12 milkshops shown in the table as "vacated," the occupiers either left the neighbourhood or gave up the sale of milk on the premises in respect of which they were registered. Thirteen applications for registration were received and granted in respect of premises which had not been previously occupied as milkshops, the net result of the alterations made in the Register has been that the number of persons purveying milk in general 44 stores has been reduced by 1, whilst the total number of premises in the Borough where milk is sold has been increased from 196 to 197. It is accordingly satisfactory to note that the reduction in the number of third-rate milkshops, which was effected in 1910 by the removal from the Register of 84 general stores, seems likely to be permanent. The inspections of dairies and milkshops made during the year numbered 1,339, and notices were served requiring the remedy of defects which were found on 12 of the premises visited. Cowsheds.—The only milk produced within the Borough comes from a small cowshed in the Walmer Road, where four cows are kept. On September 21st the premises were viewed, and no onoosition was offered to the renewal of the occupier's license. The license was accordingly renewed by the London County Council at the licensing sessions held in October. During the year the occupier has removed a w.c. which formerly opened into the wash-house where the milk cans and other dairy utensils are scalded and cleaned. He has also ceased to keep poultry, which were a source of nuisance, and in adopting these measures at the instance of the sanitary inspector for the district, but without notice, he has effected a considerable improvement in the sanitary state of the premises in the neighbourhood of the cowshed. Ice Cream.—At the end of the year 173 premises were shown in the Register of places within the Borough where ice cream is prepared or sold. Fifteen places have been added to the Register and 12 have been removed during the year, the net result being that the number of premises upon which ice cream is made has been increased by three. The trade is regulated under the London County Council (General Powers) Act, 1902, which makes it an offence to store ice cream in a sleeping room or in any shed or room in which there is an inlet to a drain. Vendors of ice cream are also required to notify the occurrence of infectious disease amongst their employks or amongst persons living on their premises. The Act further provides that every itinerant vendor shall exhibit on his barrow the name and address of the person from whom the ice cream has been obtained. 172i visits to ice cream premises have been made by the inspectors during the year, and 2 notices have been served in respect of defects found. PLACES WHERE FOOD IS PREPARED Places in the Borough where food is prepared or sold are entered in a Register under the date on which they were finally inspected and found to comply with the requirements of the London County Council (General Powers) Act, 1908. The following table shows the number of such premises on the Register at the end of the years 1910 and 1911, together with the number added to or removed from the Register during the twelve months to which the report relates:— Provision Dealers. Restaurants. Butchers. Fried Fish Fishmongers. Greengrocers. Others. Total. Dec. 31st, 1910 195 153 94 43 28 27 5 545 No. added 17 3 15 — 8 18 2 63 Removed — 1 2 — — 1 — 4 On Register Dec. 30th, 1911 212 155 107 43 36 44 7 604 The inspections of the above premises during the year numbered 1,516, and resulted in the discovery of the following defects which were remedied after the service of notices:— Defects Found. Number of Defects. W.C. not separated from Food Store 2 W.C. defective 13 Drains defective 4 Gully within Food Store 5 Bedroom communicating with Food Store 1 Want of cleanliness 25 Defective ashpit accommodation 19 Other defects 22 Total number of defects found 91 45 The total number of notices served during the year amounted to 88, the difference between this figure and the figure 91 shown in the above table being accounted for by the fact that in three instances the notice served required the remedy of two defects on the same premises. In one case proceedings were instituted against the occupier of a restaurant who had failed after notice to remove a drain inlet from within a room where food was stored. The Court inflicted a fine of 20s., and provided a further penalty of 10s. per day in the event of the necessary work not being completed within seven days. Bakehouses.—There are 98 bakehouses in the Borough, and of this number 75 are underground. During the year one of the certified underground bakehouses has been vacated and is not included in the total (75), which refers to the number on the Register in December 31st, 1911. Notices requiring the premises to be cleansed were served in the case of 37 bakehouses, the total number of notices issued for this and other defects amounting to 42. In one case a summons was taken out under Section 8 of the London County Council (General Powers) Act, 1908, against a master baker who had persisted, in spite of warning, in keeping his bakehouse in a very filthy condition Owing to the fact that the defendant left the neighbourhood and could not be traced, the summons could not be served. The premises, which are underground, are now kept in a cleanly state by a new occupier. Slaughter-houses.—The ten slaughter-houses in the Borough were again licensed in October by the London County Council. They are kept in a cleanly state, and from a structural point of view are not open to objection. Pigs in considerable numbers are slaughtered at the Walmer Road premises, sheep are killed from time to time at various houses, cattle are rarely found in the pens, and on the whole the total amount of slaughtering in the Borough is insignificant. The inspections of slaughter-houses made during the year numbered 228. The names of the licensees and the addresses of the premises they occupy are shown in the following list:— Lonsdale Mews Mr. Grove. 278, Kensal Road Mr. Miles. 13, Archer Mews Mr. Bawcombe. 35, Earl's Court Road Mr. Matson. 10, Edenham Mews Mr. Gibson. 115, Church Street Mr. Osborne. 195, Clarendon Koad Mr. Simmons. 133, High Street, Notting Hill Miss Candy. 235, Walmer Road Mrs. Van. 113, Holland Park Avenue Mr. Holloway. Unsound Food.—The unsound food surrendered and destroyed during the year was as follows:— April 28th.—½ cwt. of Cod. May 17th.—6 stone of Plaice. May 19th.—60 Mackerel. June 19th.—6 stone of Skate. June 26th.—35 lbs. of Haddock. September 9th.—6 sides of Pork, 210 lbs. September 16th.—1 side of Bacon, 33 lbs. November 7th.—10 Chickens. Export of Food.—On October 4th, 1906, Regulations were issued by the Argentine Government, which required food imported from abroad to be accompanied by an official attestation of precautions taken to safeguard the wholesomeness of the food in question prior to its export from the country of origin. For the purpose of furnishing the necessary certificates to traders in Kensington, the Local Government Board, with the consent of the Council, which was given on April 11th, 1911, have designated the Medical Officer of Health to act as certifying officer for the Borough in connection with the export of foods of animal origin to Argentina. One certificate was given during the year to a company exporting hams to the Argentine, which are stored and packed on premises in Kensington. Food Poisoning.—In September, 1911, the Local Government Board issued a memorandum containing a number of recommendations as to the action to be taken in the investigation of illness attributed to poisoning by food, and in dealing with the food suspected During the year no such cases have been brought to the notice of the Public Health Department, but the sum of £40 allocated for the payment of diagnosis fees would provide for the necessary bacteriological and chemical analysis should an outbreak of food poisoning occur. SALE OF FOOD AND DRUGS ACTS. Each of the ten Sanitary Inspectors is appointed as an inspector under the above Acts, and is instructed to take samples in any place in the Borough which is not within his own sanitary district. During the year the Inspectors collected 701 samples, of which 65 (or 9 per cent.) were adulterated. 46 Proceedings were taken against 31 persons for adulteration or other offences, the fines and costs inflicted amounting to £37 18s. 6d. The samples collected were as follows:— Samples Collected by the Sanitary Inspectors. Name of Sample. Number Taken. Number Adulterated. Milk 285 24 Cream 26 13 Butter 124 ... Cheese 12 1 Pepper 6 ... Brawn 1 ... Bread 6 ... Flour 24 ... Sago 6 ... Sausages 24 5 Arrowroot 12 ... Corn Flour 12 ... Oatmeal 6 ... Olive Oil 6 ... Coffee 6 ... Preserved Vegetables 6 3 Tea 6 ... Potted Meats 5 ,,, Vinegar 19 ... Mustard 8 ... Spirits 60 8 Beer 8 ... Drugs 12 ... Sugar 7 7 Lime Juice 8 4 Cider 6 ... Total 701 65 Preserved Peas.—In three instances during the year proceedings were instituted against persons who had sold peas containing copper sulphate. In the first case a fine of 10s. with 10s. 6d. costs was inflicted, the amount of copper present having been certified as equivalent to 1-794 grains of the crystallised sulphate per pound. In the two remaining cases, which were defended, the amounts certified were equivalent to 1-656 grains, and 1-518 grains of copper sulphate per pound. For the defence it was urged that the summonses were bad, because they described the offence as a sale of peas certified to contain copper sulphate, whereas no such statement appeared on the analyst's certificate. It was further claimed and admitted that even if some copper sulphate had in fact been present in the peas, it could not in any case have contributed more than a small and unknown fraction of the total amount of copper certified as present by the analyst. The Bench was accordingly asked to find that the offence alleged in the summons had not been committed. After retiring to consider the evidence, the magistrates dismissed both cases without comment and without costs. Under these circumstances the results do not in any way justify the assumption that it had not been proved to the satisfaction of the Bench that the presence of copper in the peas to the extent certified by the Public Analyst was injurious to health. Salicylic Acid in Lime Juice.—Out of 8 samples of lime juice cordial which were taken during the year, four proved to contain salicylic acid in quantities varying from 2-62 grains to 613 grains per pint. In view of the suggestion of the Departmental Committee on Preservatives in Food "that salicylic acid be not used in a greater proportion than 1 grain per pint in liquid food," and that its presence in all cases should be declared, I recommended the institution of proceedings against a firm of large wholesale vendors, whose lime juice cordial had been certified to contain more than six times the amount of salicylic acid permitted in the finding of the Departmental Committee. The depressing effects of salicylic acid in medicinal doses of 5 to 10 grains are well known, but the difficulty of furnishing positive proof of demonstrable injury to health when the drug is taken in smaller quantities is considerable. Under these circumstances the Public Health 47 Committee deemed it advisable to support their case by the evidence of experts in various bi anches of the medical profession. Six medical men were accordingly approached. Of this number, one, how was an eminent physiologist, was strongly of the opinion that lime juice containing salicylic acid in the quantities certified would be injuiious to health. A no less eminent pharmacologist and physician expressed a diametrically opposite view. The four remaining experts were also unwilling to make any positive statement as to injury to health from the quantities of salicylic acid found in the lime juice analysed. The proposal to proceed was accordingly abandoned, and the lesult or lack of result serves to illustrate the highly unsatisfactory state of the existing law as to the use of preservatives in food. The lime juice of the vendors in this instance is distributed throughout the country, the fact that it contains salicylic acid is well known, and yet the 1 ecommendation of the Departmental Committee is ignored, and the heavy expense of conducting a highly technical test case is left to any authority among the many hundreds concerned that may be sufficiently altruistic to settle an issue which is not local, and which should therefore be determined by a Government Department in the interests of the whole community. Margarine and Butter Substitutes.—Under Section 9 of the Margarine Act, 1887, and Section 7 (4) of the Sale of Food and Drugs Act, 1899, manufacturers and wholesale dealers in margarine and margarine cheese are required to register their premises with the local authority. Bv Section 1 (1) of the Butter and Margarine Act, 1907, these requirements were extended to butter factories and to the premises of wholesale dealers in milk-blended butter. The following premises in the Borough are registered in accordance with the requirements of the above Acts:— Lipton, Ltd. 210, Portobello Road. „ 129, Bronipton Road. E. C. Nicholls 19, Church Street. C. E. Webb & Sons 39-41, Brompton Road. Pearks, Ltd. 165, Portobello Road. The above premises have been registered as those of wholesale dealers in margarine. The premises of Pearks, Ltd., have also been registered as those of wholesale dealers in mixtures of butter and milk. WATER SUPPLY. The water supply of Kensington is derived from the following sources, which are under the control of the Metropolitan Water Board. The northern half of the Borough lies within the Grand Junction division of the Western district, which is supplied mainly from the Thames at Hampton. The southern half of the Borough and a small area north of the Great Western Railway are supplied from the same source, and lie within the West Middlesex division of the Western district. The area south of the Brompton Road lies within the Chelsea division of the Western district, and is supplied entirely from the Thames at West Molesey. To every house in the Borough the water supply is now constant. Water Supply to New Houses.—During the year 53 newly erected houses were inspected and certified before occupation under Section 48 (2) of the Public Health (London) Act, 1891, as having a proper and sufficient supply of water. Legal Proceedings.—In two cases proceedings were instituted against persons who had failed to provide a proper and sufficient water supply on their premises. In each instance a Closing Order was made, the same to become operative in the event of the premises not having been provided with a proper supply of water within seven days. Water having been provided in both cases within the time specified, the Closing Orders were not enforced. HOUSING OF THE WORKING CLASSES. 51 HOUSING OF THE WORKING CLASSES. In the census year 1901, the tenements in the Borough of less than five rooms numbered 21,116, and accommodated a population of 73,425 persons distributed as follows:— Rooms in Tenement. Number of Tenements. Number of Persons. 1 5,695 11,334 2 7,776 27,800 3 4,757 20,210 4 2,887 14,081 Totals 21,115 73,425 The total number of inhabited houses in the Borough in 1911 was 27,507. The supply of small tenements is considerably in excess of the demand, but the accommodation where houses originally let to a single householder have been converted into tenements is necessarily unsuitable for working-class families. At the same time the state of cleanliness or filthiness in which rooms are kept bears a much closer relationship to the character of the occupiers than to the nature of the accommodation provided. In certain blocks of dwellings, where each family has a separate w.c. and where water is laid on to each floor, tenements are frequently found on inspection to be kept in a disgraceful state of domestic uncleanliness. Temporary improvement follows the service of notices, but no permanent change for the better is likely to be effected except through the education of the poorest classes in the elementary principles of cleanly living. Lodgings provided by the Council.—In October, 1901, under the powers conferred by Section 5 of the London Government Act, 1899, the Council adopted part III. of the Housing of the Working Classes Act, 1890. As amended by the Housing Act, 1900, this part of the principal Act enables local authorities to convert existing buildings into lodgines, or to establish or acquire lodging houses for the working classes either within or without their district. The total number of tenements provided by the Council for the working classes under the Housing Acts is shown in the following table:— Council's Lodging Houses. Rooms in a Tenement. Number of Tenements. Rent per Week. Tenements Let. Tenements Empty. 1 26 2/6 to 3/6 24 2 2 62 5/6 to 57 5 3 32 7/- to 8/- 30 2 Totals 120 2/6 to 8/- 111 9 The above tenements provided by the Council are all within the Borough. 52 Houses Let in Lodgings.—At the end of the year 2,091 lodging houses remained on the Council's register. Under the powers conferred by Section 16 of the Housing Act, 1909, new bye-laws for the prevention of overcrowding and the general regulation of lodging houses have been framed by the Council, and were confirmed by the Local Government Board in January 1912. Bye-Laws.—The new bye-laws are 26 in number, and do not differ materially from the bye-laws sanctioned in August, 1905, except in the following important respects, namely:— 1. Under Bye-Law 16 the duty of thoroughly cleansing and lime-washing every room in a lodging house once a year is now imposed on the owner of the house, that is to say, the person who is the owner within the meaning of the Public Health (London) Act, 1891, and who is in the new bye-laws described as the landlord. Formerly this duty was imposed on the person entitled to the profit arising from the letting of the rooms in a lodging house. In many cases such persons holding the house from the owner on a weekly tenancy are men of straw, and quite unable to pay for the work of annual cleansing and lime-washing. They were also required to maintain the windows of staircases, passages and rooms in working order. All these duties are now transferred to the owner, who is given a right of entry by Section 16 of the Housing, Town Planning, etc., Act, 1909, for the purpose of carrying out any work which he is required by the bye-laws to execute. With the transference of these duties to persons who are better able to perform them, considerable improvement should be effected in the general condition of the lodging houses in the Borough. 2. Sub-section 3 of Section 16 of the Housing Act, 1909, also provides that where work required by the bye-laws has not been done, the Council may themselves execute the necessary works and recover the cost in the manner provided by Section 15 of the same Act. 3. It should further be noted that whereas the old bye-laws were applicable to any class of premises in which separate tenements were let below a certain rental, the term "lodging house," and therefore the application of the new bye-laws, is by definition limited to houses intended for the working classes, and let to members of more than one family. 4.—Bye-Law 5 makes it illegal for persons of opposite sex above the age of 12 years, and not being persons living together as husband and wife, to occupy the same sleeping apartment. The age at which this prohibition applies has been raised from 10 to 12, and a serious defect has been removed from the old bye-law, which met the case of husband and wife by making it an offence for more than two persons of different sex to occupy the same bedroom. In this form the regulations for the separation of the sexes were often at fault in the worst cases, and permitted a girl of any age to share a room with her widowed father or elder brother, provided there was no third occupant over the age of 10 years. 5. Under the old bye-laws the "keeper" was responsible for cleansing common passages and staircases, for seeing that they were ventilated daily, and for maintaining the bedding and other articles in furnished rooms in a clean and wholesome condition. These duties are now transferred to the tenant of the house, who must either carry them out himself or take the whole responsibility for the default of any deputy he may appoint to act in his stead. The new bye-laws do not mention the " keeper," and their application has been materially simplified by the elimination of this many sided personage whose functions may be limited to those of a lodging house deputy and rent collector, or who may on occasions combine the office of keeper, tenant, landlord, and owner. Inspection.—The inspections and re-inspections of the registered lodging houses in the Borough numbered 7,265. Notices requiring the remedy of defects found were served in 1,032 instances, and 71 cases of overcrowding were abated. The owners of five lodging houses were summoned for failing to comply with notices requiring the execution of drainage work or other sanitary repairs. The tenant of one lodging house was summoned and fined 20s. for failing to abate a case of overcrowding, and four further summonses were taken out for various breaches of the lodging house bye-laws. Furnished Rooms.—Of the 2,091 lodging houses on the Council's Register 197 are let in furnished rooms, the rent charged being at the rate of Is. per room for one night, or 6s. for a complete week. No less than 141 of these furnished lodging houses are grouped together on a comparatively small site in Notting Dale, in close proximity to 19 Common Lodging Houses. Being homeless and without furniture or property of any kind save the clothes they stand up in, the majority of the occupiers of furnished rooms belong to the dregs of society. 1 he men are not 53 engaged in regular work, and a number of the women are prostitutes. During the year under consideration the Council received formal complaints of the annoyance caused to residents in St. James Square by the frequent occurrence of drunken brawls in the neighbouring streets and houses of Notting Dale. Indecent conduct and the use of houses in the area as brothels have also been alleged. At their meeting on December 5th, 1911, the Council accordingly recommended the appointment of a Special Committee, with power to co-opt members from outside the Council, to consider the conditions prevailing in Notting Dale. Several meetings of the Special Committee have been held, a number of witnesses have been examined, and a proposal has been considered that furnished rooms in debased areas like Common Lodging Houses should be licensed annually. By these means an improvement in the quality of the furniture and bedding supplied in furnished rooms would no doubt be secured, but for reasons which are sufficiently obvious the standard of cleanliness would still fall very far below that of the Common Lodging Houses, whilst drunkenness, immorality and violence would continue unchecked. The success of the conduct of Common Lodging Houses is mainly due to the fact that they do not admit married couples, and with the separation of the sexes one of the most frequent causes of violent drunken brawls has been removed; in houses let in furnished rooms women are knocked about by the men they live with, lie drunk on their beds in the daytime and fight amongst themselves. The inmates of licensed lodging houses also sleep in comparatively large common dormitories, at 9 a.m. they are obliged to leave their beds and go to the common kitchen, with the result that the sleeping rooms remain empty throughout the day with the windows wide open. Since there are no " married couples " the deputy can enter the dormitories at any hour, whilst the absence of occupants during the day affords him the opportunity for the necessary cleansing and sweeping. Before mid-day the beds have been made, and on the foot of each one the empty chamber pot stands throughout the day as evidence that all bedroom slops have been removed. In a house containing six furnished rooms occupied by six "married couples" the conditions will always differ widely from those which prevail in the Common Lodging Houses. The keeper cannot reasonably claim to intrude on the privacy of married couples at any hour of the night or day, he has no common kitchen for the use of his lodgers when their rooms are being cleaned, and even if he succeeded in turning them out, he could not enter six rooms at intervals during the day to see that they had not returned to bed. The County Council expedient for securing the cleanliness of chamber utensils, cannot be applied to rooms which are occupied by day as well as by night, and in general it may be said that the facilities for the maintenance of order which exist in Common Lodging Houses are conspicuous by their absence in furnished rooms. Young children and infants contribute materially to the dirtiness of the bedding and the rooms in furnished tenements, whilst the storage, cooking and service of food in a room which is occupied throughout the 24 hours, create insanitary conditions which cannot arise in the dormitories of Common Lodging Houses. There remains the question of drunkenness which may, without hesitation, be accepted as the chief cause of the evils that exist in Notting Dale. In Common Lodging Houses the introduction of alcohol into the dormitories is prohibited, and the control of the keeper over the inmates of a single common kitchen is sufficient to prevent its being made the scene of drunken debauches. In furnished tenements, on the other hand, no means are likely to be devised which would be adequate to prevent lodgers from taking liquor to their rooms and drinking throughout the greater part of the night. It is under these conditions that drunken quarrels between men and women arise, and lead in the end to the uproar which disturbs the residents in St. James Square. During the past two or three years certain reformers have made it their business to describe the occupants of furnished rooms as belonging to the "Common Lodging House type." At first this description appeared to be as harmless as it is undoubtedly accurate, but it is now known to have been devised for the express purpose of lending colour to the assumption that the same methods of control would meet with equal success in furnished rooms and Common Lodging Houses alike, merely because the users of both happen to belong to the same disorderly class. Since the conditions of life in the two classes of lodging are fundamentally different, any such assumption is without justification. The effects of an annual licence, as has already been stated, will do little or nothing to prevent disorder, and what is really needed is the segregation of the socially unfit in institutions under State control. If such a measure is impracticable, then the community must continue to harbour debased persons in its midst, and put up with the consequences of its own inability to do more than place the control of their homes and their morals in the hands of lodging house deputies. 54 Common Lodging Houses.—The Common Lodging Houses in the Borough number 22, and contain accommodation for G70 persons. From the following table it will be seen that 19 of these houses are situated in the Norland Ward:— Common Lodging Houses. Ward. Name of Keeper. Address of Common Lodging House. No. of Lodgers, for which licensed, in 1911 Male. Female. Total. Golborne Madden, James 194, Kensal Road 75 ... 75 Norland Rusha, Alfred 18, Bangor Street ... 24 24 „ Do. 20, do. ... 45 45 „ Reynolds, Charles 35, do. 22 ... 22 „ Phillips, Edward Sanders 5, do. 41 ... 41 „ Do. 7, do. „ Hankins, George 10, Crescent Street ... 25 25 „ Do. 28, do. 54 ... 54 „ Do. 30, do. „ Do. 40, do. ... 25 25 „ Rusha, Alfred 25, do. ... 57 57 „ Do. 27, do. „ Do. 31, do. 58 58 „ Do. 33, do. „ Davis, Sagel 66, St. Ann's Road 66 ... 66 „ Rusha, Alfred 84 Sirdar Road ... 53 53 „ Do. 36, do. „ Do. 38, do. 48 ... 48 „ Do. 40, do. „ Code, George 12, Penzance Place ... 43 43 Holland Redman, Emma 24, Peel Street 34 ... 34 „ Do. 22, do. Totals 398 272 670 In three streets in the Notting Dale area there are six houses capable of receiving 229 single women and eleven houses licensed to accommodate 223 single men. It is difficult to avoid the conclusion that the presence of this population of 500 persons, who for the most part come from the lowest ranks of society, must necessarily constitute an effective bar to the progress of social reform in the neighbourhood where the Common Lodging Houses are situated. Housing (Inspection of District) Regulations 1910.—These regulations prescribe the methods to be adopted by Local Authorities in causing inspections of their districts to be made with a view to ascertaining whether any dwelling houses therein are unfit for habitation. By Art. V., the Medical Officer of Health is required to include in his annual report information and particulars in " tabular form " in regard to the number of dwelling houses inspected for the purposes named above, and in regard to certain specific points which are marked with an asterisk in the tabular statement which follows:— INSPECTION OF HOUSES, 1911. HOUSING (INSPECTION OF DISTRICT) REGULATIONS. ART. I. (3) Number of dwelling houses recommended singly or in groups for early inspection 69* ART. III. Of 69 houses recommended for early inspection— a. The number for which records of the inspections were prepared 46 b. The number found fit for habitation and excluded from the records required by Art. III 10 c. The number reserved for inspection in 1912 13 55 ART. IV. Of 46 houses for which records were prepared— a. The number represented to the Council by the Medical Officer of Health with a view to Closing Orders being made 4* b. The number closed by order of the Council 4* c. The number in which defects were remedied without the making of Closing Orders 21* d. The number put into a fit state for habitation after the making of Closing Orders 1* e. The number pulled down in compliance with a demolition order 1 f. The number converted to some other use 6 g. The number found fit for habitation 2 h. The number outstanding on December 31st, 1911 15 General Character of Defects.*- -The premises dealt with during the year were mews dwellings built over stables occupied by horses. In each case through structural defects effluvia from the stable beneath had access to the dwelling rooms above. There is a common belief that the smell of horse manure is not injurious to health, but anyone who subscribes to such a creed would be quickly converted to an opposite way of thinking if he had the opportunity of experiencing the sickening stench that arises when an old stable floor is taken up or a choked drain inlet in a stable is cleared. An added danger arises from the fact that the drain inlets of the horse-pot type used in the stables axe as a rule untrapped, with the result that foul gases from the drains, or in the absence of an interceptor from the sewer itself, pass freely into the interior of the stable. In many of the cases reported on, an unventilated staircase was so arranged as to be entered at the foot from the innermost part of the stable, and appeared to have been constructed for the express purpose of conducting air contaminated in the manner described to the dwelling rooms above. When the staircases were entered from the mews way, foul air was still in certain instances admitted to the upper story through defects in the soffits of the stairs, in the matchboard partition walls or in the stable ceiling. A number of w.c.'s were found in cramped and most unsuitable positions beneath the staircases, where light and ventilation from the external air could not be obtained, and in certain cases nuisance was occasioned by untrapped or defective sink wastes which discharged below into stable drains. In addition to the above defects may be noted the dilapidated state of the woodwork and general structure of many of the houses visited. Results.—On the 21 premises where defects were remedied without the making of Closing Orders, horse-pots of the bell-trap type have been replaced by modern gullies, and the soffits and entrance of the staircases have been so constructed as to prevent the access of effluvia from the stables beneath to the dwelling rooms above. Through the public spirit of owners and their willingness to carry out the Council's requirements, a great deal of valuable work has been carried out, and in many houses ventilated cupboards for storing food have been provided, and other improvements have been made which could not have been obtained except from landlords who were anxious to do their best for their tenants. In G further cases the owner, being unable to bear the expense of the necessary work, has altered his premises so that they can no longer be used as dwellings. Closing Orders.—Of the four mews dwellings which have been closed by order of the Council, one has been rendered fit for habitation, one has been converted into a garage, with a loft overhead, to which access can only be had by means of a vertical ladder, and one has been demolished. In the fourth case the house remains unoccupied, but the undertaking to render the premises fit for habitation has not been carried out. Demolition Orders.—No demolition orders have been made during the year, but notice of the Council's intention to consider the question of the demolition of a certain dwelling house which had been closed, was served in the manner required by Section 18 of the Housing Act, 1909. Before the date named in the notice the premises were pulled down and no further action was taken. In a second case the owner of premises which had been closed attended an informal meeting of the Housing Sub-Committee, when the question of demolition was discussed. On an undertaking being given by the owner's representative that the premises would be rendered fit for habitation within two months, the formal procedure required by Section 18 was postponed. This undertaking has not been fulfilled. The house in question stands attached on either side in a row of seven other dwellings. When the Closing Order was made the premises were in a grossly insanitary state, but they are capable of being converted into a first-rate garage with dwelling rooms overhead. Their demolition would not only leave an unsightly gap in one side of a mews, but would also probably bring down the neighbouring houses. In this case, in the case already quoted of dwelling rooms converted into a loft and in others which will inevitably occur, it would accordingly appear that the obligation under Section 18 to demolish is either unintentional or inserted in the Act without a proper apprehension of the difficulties and absurdities that would arise if demolition were to be insisted on in every case. 56 House to House Inspection.—Article 19 (3) of the Sanitary Officers (London) Order, 1891, imposes on every Sanitary Inspector the duty of systematically inspecting his district at certain periods with a view to keeping himself informed of the nuisances existing therein that require abatement. Section 32 of the Housing Act, 1890, imposed a similar duty on inspectors for the special purpose of examining dwelling houses as to their fitness for human habitation, but prior to the end of the year 1910, there were no regulations prescribing the manner in which such inspections were to be made. In the autumn of the year 1910, regulations were issued which are so drawn as to limit the meaning of the phrase "inspection for the purpose Section 32 of the Housing Act, 1890, or of sub section (1) of Section 17 of the Act of 1909" to the examination of houses which have been formally represented by the Medical Officer of Health as requiring early inspection. Before such representations are made, large numbers of careful preliminary inspections over a wide area must be made, and these have not been shown in the summary of the year's work under the new regulations. The total number of "house to house inspections" during the year for the combined purposes of the Sanitary Officers Order so far as it relates to nuisance in dwelling houses and of the Housing Acts has amounted to 2,550. In this number, visits in response to complaints or to registered lodging houses have not been included, and as in former years the term "house to house inspection" has again been used to denote systematic visits to dwelling houses for the purpose of detecting nuisances which in certain cases are of such a nature as to lead to the premises being placed by the Medical Officer of Health on the periodical lists of unsatisfactory dwellings, in accordance with the requirements of Art. I. (3) of the Housing (Inspection of District) Regulations, 1910. Underground Rooms.—Nine underground rooms were found to be illegally occupied during the year. In each case the illegal occupation ceased on the service of a notice, and in no instance was it found necessary to close the rooms or to institute legal proceedings. Comprehensive action is being deferred until the Local Government Board have sanctioned the bye-laws regulating underground rooms which the Council have drafted in pursuance of the powers conferred by Section 17 of the new Housing Act. Customs and Inland Revenue Acts.-Under these Acts 31 certificates were issued by the Medical Officer of Health during the year, in respect to 59 tenements in 31 houses containing a total number of 70 separate dwellings. One certificate was granted under Section 35 of the Housing Act, 1909, which entitles the owner of a Common Lodging House to exemption from inhabited house duty, provided the Medical Officer of Health is able to certify that suitable accommodation and proper sanitary provision is available for the lodgers. FACTORIES AND WORKSHOPS. 59 FACTORIES AND WORKSHOPS. Section 132 of the Factory and Workshop Act, 1901, requires the Medical Officer of Health of every District Council to report specifically on the workshops and workplaces in his district, and to send a copy of his annual report to the Secretary of State. The total number of workshops on the Council's register is 1,767. Workshops where men are employed are placed under the supervision of the sanitary inspector in whose district they are situated; workshops where women are employed are inspected by the two lady sanitary inspectors, who also visit the premises of homeworkers and inspect the sanitary conveniences reserved for women in workshops, railway stations and other public places in Kensington. WOMEN'S WORKSHOPS Report of Lady Inspectors.—„The number of workshops at which female labour was employed at the end of 1911, was eight hundred and sixty-two (mostly laundries) being in North Kensington, and 530 (mostly dressmakers) in South Kensington. During the year 61 workshops were added to the register and 50 were removed „The subjoined Table summarises particulars of the factories and workshops on the register at the end of the year in North Kensington and South Kensington respectively. Workshops, etc. North Kensington. Sooth Kensington. Total for Whole Borough Dressmakers. Laundries. Miscellaneous Total. Dressmakers. Laundries. Miscellaneous. Total. No. on Register 58 212 62 332 375 12 143 530 862 No. of Rooms therein 97 662 97 856 712 32 '200 944 1,800 The number of persons employed varies with the period of the year, being, of course, greatest during the ' season ': it exceeds 10,000. „The businesses carried on at the registered premises are set out in the subjoined list:— Trade or Business. North Kensington. South Kensington. Total in the Borough. Art needlework 1 2 3 Blind-maker 1 1 Blouse-maker 4 8 12 Boot header 1 1 „ closer 2 2 Cigarette maker (Factories) — 2 2 Colour printer (Factory) 1 — 1 Corset maker 2 7 9 Cracker maker 1 1 Dressmaker and ladies'tailor 54 365 419 Dyer and cleaner (Factories) 2 3 5 Eyelet hole finisher (Factory) 1 — 1 Florist — 11 11 Furrier 1 7 8 Hair wash manufacturer 1 1 Hosier 1 1 Lamp shade maker — 2 2 Laundry (workshop) 156 12 168 ,, (factory) 56 — 56 Machinist 1 1 Mantle maker 1 4 5 Milliner 4 50 54 Outfitter _ 8 8 Photographer 2 14 16 Pickle manufacturer 1 1 Printer (Factories) — 2 2 Silversmith 1 1 Sweetmaker 1 1 Tailor 84 5 89 Typist — 5 5 Tyre Maker — 1 1 Umbrella manufacturer 1 1 2 Upholsterer 1 13 14 Violin string manufacturer 1 1 Waistcoat maker 8 8 Wig maker 1 8 9 Total 332 580 862 60 „Routine inspections of the workshops shown on the above list were carried out during the year, and complaints from His Majesty's inspectors or anonymous sources received immediate attention.'' Ventilation.—In response to notices, additional means of ventilation were provided in 28 of the workrooms visited. Whilst a very marked improvement in the ventilation of workshops has been effected in the last eleven years, it is still necessary to serve notices from time to time in cases where unventilated gas stoves are added in existing workrooms or where premises become occupied as workshops which have not hitherto been used for the purpose. Overcrowding.—Eleven cases of overcrowding were dealt with during the year, as compared with 10 in the year 1910, and 15 in the year 1909. Employers are provided by the Council with cards showing the maximum number of workers allowed in each workroom, and cases where the number shown on the card is deliberately exceeded are now of rare occurrence. Sanitary Conveniences.—During the year defects in 34 sanitary conveniences attached to workshops were found and remedied. In a workshop where the sanitary accommodation was insufficient for the number of workers employed, seven additional w.c.'s were provided, and in nine cases notices were served requiring the provision of separate accommodation for men and women employed in the same workshop. An analysis of the return made to the Home Office on „Home Work„ shows that 1,072 addresses and names of outworkers were received on the lists sent in by the employers residing in this Borough, and of these 788 were forwarded to the Councils of the respective districts in which they were situated; the remaining 284 being in Kensington. These 284 names and addresses, together with 306 received from other Councils, will, when divided by half (since most, if not all are duplicates sent in twice in the year) give approximately the number of homeworkers on the register of the Borough of Kensington. Of the 295 out-workers so registered, some are employed on premises which are factories or workshops within the meaning of the Factory and Workshop Act, 1901, others work in domestic workshops, whilst the remainder are the genuine „Home Workers„ engaged in their homes on the work given out to them by various firms and contractors in Kensington and other districts. HOME WORK The number of outworkers belonging to each of these three classes is shown in the following Table:— Home Work. Outworkers in Workshops or Factories 122 Outworkers in Domestic Workshops 24 Outworkers in their own Homes 149 Total number of Outworkers 295 The factories and workshops on the above list are included in the Table, which show the trades carried on in the workshops on the Council's register. 61 The nature of the work given out to the homeworkers in the 149 homes on the register is as follows:— Home Work. Nature of Work. No. of Premises. Tailoring 39 Ironing 31 Outfitting 17 Bootmaking 33 Dressmaking, Blousemaking 12 Shirt making 1 Waistcoat making 7 Upholstery 2 Millinery 1 Brush making 1 Lace mending 2 Fur making 1 Embroiderer 2 Total 149 In 20 instances in the course of inspection, addresses were found incorrectly given, or the outworker had left or given up work. Condition of Homes Visited.—The following Table shows the circumstances of the 149 homes where work is carried on:— Nature of Room used for Work. Condition of Rooms. Total Number of Rooms. Clean. Fairly Clean. Dirty. Rooms used for work only 26 4 0 30 „ for work and as living rooms 68 14 1 83 „ for work and as bed and living rooms 29 7 0 36 Totals 123 25 1 149 The sanitary defects remedied in the 149 homes were as follows:— Rooms cleansed 1 W.C.'s found defective and remedied 1 Number of Defects Remedied 2 On the whole the homeworkers, many of whom are women, belong to a respectable thrifty class and keep their rooms in a clean and tidy state. Their homes compare favourably with those of the lower labouring classes, and instances of persons in great poverty carrying on work for an insufficient wage in insanitary surroundings are in Kensington practically unknown. The foreign outworkers are for the most employed in registered workshops which are regularly inspected, and the practice of letting out sittings in workshops, which leads to grave abuses in certain districts, does not prevail in the Borough of Kensington. Infectious Disease.—Infectious disease occurred in 8 premises where home work was carried on. In no instance was it found necessary to make an Order under Section 109 to stop the work, nor to prosecute under Sections 109-110 as the infected persons were immediately removed to hospital, and disinfection carried out. In no case had there been any contact with the work carried on. 62 The appended Table summarises the work of the year, so far as it is capable of being expressed in this form:— Inspection of Women's Workshops. 1911. North Kensington. Sooth Kensington. Total for Borough. Dressmakers. Laundries. Miscellaneous Total. Dressmakers Laundries. Miscellaneous Total. 1. Workshop inspections, No. of Ill 229 214 554 616 6 207 829 1,388 2. „ re-inspections „ 6 81 9 43 158 — 46 204 250 8. Workrooms inspected „ 117 614 214 945 893 26 298 1,217 2,162 4. Workrooms found overcrowded — — — — 11 — — 11 11 5. ,, insufficiently ventilated 2 1 5 8 15 — 5 20 28 6. „ in a dirty condition. 2 27 8 32 11 — 2 13 45 7. ,, measured; Number of 1 — 3 4 65 — 4 69 73 8. Workshops, &c., reported to H.M. Inspector 1 2 8 6 31 — 10 41 47 9. Workshops, &c., reported by H.M. Inspector 2 3 7 12 40 — 16 56 68 10. Workshops, &c., newly discovered and registered 1 3 8 7 42 — 12 54 61 11. Workshops, &c., removed from register . 4 4 — 8 32 1 9 42 50 12. Domestic workshops and workplaces inspected 54 62 56 172 5 1 57 63 235 18. Written intimations issued 1 16 1 18 56 — 15 71 89 14. Statutory notices issued — 1 — 1 11 — 7 18 19 15. Sanitary defects remedied :— (a) Additional means of ventilation provided 2 1 5 8 15 — 5 20 28 (6) Rooms cleansed and whitewashed 5 37 8 45 11 — 2 13 58 (c) Yards, floors, roofs, &c., repaired — 3 — 8 8 — — 8 6 (d) Sanitary conveniences; defects remedied — 5 1 6 17 — 11 28 84 («) Dustbins provided or repaired — — — — 2 — 1 3 3 (/) Miscellaneous defects remedied — 8 — 8 10 — 5 15 23 16. Nuisances reported to Medical Officer ot Health — — 9 9 — — 6 6 15 17. Workroom cards distributed; Number of 2 — 2 70 — 5 75 77 Failure to send Lists of Outworkers.—Difficulties have again been experienced in obtaining lists of outworkers from employers who wait to be reminded of their duty in this respect. Eleven summonses were accordingly taken out against employers who had failed to send in lists due on the 1st of August. These cases were heard on November 21st, and the Justices inflicted fines of 20s. each in nine cases, the remaining two summonses being withdrawn. 63 MEN'S WORKSHOPS. The number of workshops at which men alone were employed at the end of the year 1911 was 905. It should be noted that by Section 157, the provisions of the Factory and Workshop Act, 1901, relating to temperature, ventilation, drainage of floors, the exhibition of abstracts ahd certain other matters do not apply to workshops conducted on the system of not employing children, young persons or women. In London, both in men's and women's workshops, the provision of sanitary conven ences is regulated by Section 38 of the Public Health (London) Act, 1891, the standard adopted being that required by the Sanitary Accommodation Order of 4th February, 1903. The following Table shows the various trades and occupations carried on in the men's workshops now on the register:— Trade or Business. North Kensington. South Kensington. Borough. Baker 61 37 98 Basket-maker 9 — 9 Blacksmith 18 21 39 Bootmaker 83 60 143 Builder 55 51 106 Cabinet-maker and Joiner 25 22 47 Carver and Gilder 1 6 7 Coach-builder 33 8 41 Cycle-maker 11 11 22 Firewood-manufacturer 23 — 23 French Polisher 1 2 3 Marble Mason 5 2 7 Printer 3 5 8 Saddler 7 10 17 Tailor 65 36 101 Trunk-maker 5 10 15 Umbrella-maker 3 2 5 Undertaker 7 4 11 Upholsterer 10 6 16 Watchmaker 20 21 41 Wig Maker — 14 14 Sundry businesses 75 57 132 Total 520 385 905 HOME OFFICE TABLES. The following Tables are supplied by request of the Secretary of State and contain a summary of the inspections made and the defects found and remedied in workshops and factories within the Borough where men, women, young persons or children are employed. In Table IV the chief classes of workshops are set forth. Table V. shows the number of cases in which action was taken in matters referred to the Council by H.M. Inspectors. 64 FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. I.—Inspection. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 140 9 — Workshops (including Workshop Laundries) 2,378 221 — Workplaces (other than Outworkers' premises included in part 3 of this Report) 244 14 — Total 2,762 244 — •Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts II.—Defects Found. Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. Number of Prosecutions. Nuisances under the Public Health Acts :—* Want of cleanliness 155 161 — — Want of ventilation 31 31 — — Overcrowding 12 12 — — Want of drainage of floors 7 7 — — Other Nuisances 43 43 — — Sanitary accommodation insufficient 15 15 — — unsuitable or defective 52 52 — — not separate for sexes 9 9 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) 2 2 — — Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 37 37 — — Other Offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) — — — — Total 363 369 — — 65 III.—Home Work. NATURE OF WORK.* OUTWORKERS' LISTS, SECTION 107. Inspections of Outworkers premises. Outwork in Unwholesome Premises, Section 108. Odtwork in Infected Premises, Sections 109, 110. Lists received from Employers. Addresses of Outworkers.§ Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110) Twice in the year. Once in the year. Received irom other Councils.} Forwarded to other Councils. Failing to keep or permit inspecion of lists. Failing to send lists. Lists. † Outworkers t Lists. Outworkers. Contractors Workmen. Contractors Workmen. 1. 2 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. Wearing Apparel— (1) making, etc. 84 88 817 15 ... 58 2„ 742 58 ... 10 149 2 2 ... 9 ... ... (2) cleaning and washing 24 22 59 2 ... 3 3 32 13 ... ... 3 ... ... ... ... ... ... Lace, lace curtains and nets ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... Artificial flowers ... ... 2 ... ... ... 2 2 ... ... ... ... ... ... ... ... ... ... Nets, other than wire nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tents ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sacks ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and Upholstery 2 ... 9 1 ... 4 ... 5 ... ... 1 ... ... ... ... ... ... ... Fur pulling ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather sorting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, etc. ... 7 3 ... ... ... ... 7 ... ... ... ... ... ... ... ... ... ... Carding, etc., of buttons, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper Bags and Boxes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Basket making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brush making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Racquet and tennis balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stuffed Toys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... File making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Electro Plate ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cables and Chains ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anchors and Grapnels ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cart Gear ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Locks, Latches and Keys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pea picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total ... 110 117 890 18 65 306 788 71 11 152 2 2 9 * If an occupier gives out work of more than one of the classes specified in column 1, and sub-divides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. f The figures required in columns 2, 3 and 4 are the total number of lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of outworkers in those lists. The entries in column 2 must necessarily be even numbers, as there will be two lists for each employer—in some previous returns odd numbers have been inserted. The figures in columns 3 and 4 will usually be (approximately) double of the number of individual outworkers whose names are given, since in the February and August lists of the same employer the same outworker's name will often be repeated. J In addition 16 addresses were received in error from other Councils and returned to the respective Councils. § In view of the wide discrepancies found to exist between the totals in the two columns when the returns are added together, it is desired that care may be taken to give exact figures. Only those addresses should be counted which have actually been received from or forwarded to other Councils during the year covered by the report. 66 IV.—Registered Workshops. Workshops on the Register (s. 131) at the end of the Year. Number. Important classes of workshops, such as workshop bakehouses, may be enumerated here. Dressmakers and Ladies' Tailors' 433 Workshop Laundries 168 Workshop Bakehouses 93 Other Workshops 1,012 Total number of workshops on Register 1,706 V.—Other Matters. Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 183) 47 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory ' and Workshop Act (s. 5) Notified by H.M. Inspectors 17 Reports (of action taken) sent to H.M. Inspectors 16 Other — Underground Bakehouses (s. 101):— Certificate granted during the year — In use at the end of the year 75 SANITARY WORK. 69 SANITARY WORK. Dust Removal. House Refuse is collected once a week and is either disposed of by cremation in the Council's destructor at Wood Lane or removed by barge from the wharf in Kensal Road. The period of seven days is the maximum period during which the Council are permitted by the Public Health (London) Act, 1891, to allow refuse to accumulate on premises within their district. Trade refuse is removed by the Council on payment of a fee in accordance with the provisions of Section 33 of the same Act. Fish offal and other offensive trade products, which could be removed on application as trade refuse, are for the most part removed and sold by the persons to whom this class of refuse belongs. In compliance with notices served by the Sanitary Inspectors, 630 new moveable ash-bins of galvanised iron have been provided during the year, and 190 fixed ash-pits of brick have been abolished under the powers conferred by Section 23 of the London County Council (General Powers) Act, 1904. Drainage Work.—All drainage work in connection with new buildings is carried out under the supervision of the Borough Engineer, who also supervises the construction of drains on existing premises where the work is undertaken by the owner on his own initiative. The reconstruction of drains found to be defective by the sanitary inspectors is carried out under their supervision, plans of any proposed alteration being submitted in the first instance to the Borough Engineer and then handed on to the Public Health Department. During the year „ house drains have been reconstructed under notices served by the Sanitary Inspectors. Nuisance from Smoke.—268 observations of chimney shafts in the Borough were made, and notices were served in two instances where black smoke was seen issuing in such quantities as to be a nuisance. In the following case proceedings were instituted under Section 23 of the Public Health (London) Act, 1891, which makes it an offence to so use a furnace that the smoke is not consumed, or to carry on any trade which occasions effluvia or otherwise annoys the neighbourhood or inhabitants without using the best practicable means for preventing such effluvia or annoyance. The defendant occupied a laundry, in the furnace of which he used a cheap, fine coal in place of coke, which burns without smoke. Serious annoyance was caused to persons in the neighbourhood by the soot and sparks which issued from the chimney shaft, and were blown by the wind into the yards of neighbouring houses The notices served were disregarded, and as the result of the proceedings which were instituted, the Bench inflicted a penalty of 40s. with £2 2s. costs. In a second case black smoke was observed, on January 8th, issuing during a period of 65 minutes from a chimney shaft, in reference to which a notice had been served four months previously. The persons responsible for the nuisance wrote a letter stating that they had been unable to obtain the fuel they were in the habit of using, and their explanation was accepted by the Committee, who did not recommend the institution of legal proceedings. Public Conveniences.—The Council provide five public lavatories containing water-closets: two are tor men only, and in three accommodation is provided for both sexes. In the women's lavatories there is free accommodation for those who are unable to pay. 1 here are also conveniences for women at eleven railway stations in the Borough. The public-house urinals entered from the street and available to the public number 75. The public conveniences in the Borough have been regularly inspected during the year, those for women in stations and elsewhere having been kept under observation by the Lady Sanitary Inspectors. On June 20th the Public Health Committee considered a letter from the Women Sanitary Inspectors' Association, urging the desirability of sufficient free sanitary accommodation being provided for women in London and other districts. In the form of a resolution which was approved by the Council, the Committee found that in Kensington there was a considerable lack of free accommodation for women, and expressed the hope that the Works Committee would give their earnest consideration to the subject with a view to further provision being made in the near future. Sanitary Inspection.—A complete list of members of the staff of the Public Health Department will be found on the page following the title page of this report. For the purposes of sanitary inspection the Borough is divided into ten districts, one of which is allotted to each of the ten male sanitary inspectors, who carry out duties under the Public Health Act, the Sale of Food and Drugs Acts, the London County Council General Powers Acts, and so far as men's workshops are concerned under the Factory and Workshop Act, 1901. A special enquiry officer has been appointed for the investigation of infectious disease and the supervision of disinfection. There are two female sanitary inspectors, whose duties consist in the inspection of workshops where women are employed, and in visiting cases of measles, whooping cough and consumption. The work of the two health visitors consists in visiting mothers of the poorer class and advising them in the care and management of their infants. A summary of the work of the sanitary inspectors will be found in Table VI., Appendix, p. 84. 70 LEGAL PROCEEDINGS. Legal proceedings were instituted in 41 cases, particulars of which are summarised in the following lists:— Legal Proceedings nnder the Public Health (London) Act, 1891, and Metropolis Local Management Act. Date. Name and Address of Defendant. Offence. Result. Jan. 3rd E. Newby, 61, Chancery Lane Failing to repair drain at 43, Bramley Road Withdrawn, on undertaking to deposit cost of work Jan. 19th J. Bryon, Osiers, Wandsworth Removing offensive matter during prohibited hours Fined 10s. July 18th A. Stannard, Osiers, Wandsworth Removing offensive matter in uncovered receptacle Fined 40s. „ T. Kempster, employe tt tt tt Fined 2s. „ Cockman Bros., Barber's Rd., Stratford Removing offensive matter during prohibited hours Fined 40s. Mar. 21st Walsh, 35, Oxford Road Kilburn Failure to clear choked drain in lodging house at 78, Southam Street Ordered to execute work in seven days „ „ „ „ Failure to execute sanitary repairs at 78, Southam Street it tt June 20th Marsh, 1, Mary Place Overcrowding in lodging house, 11, Lockton Street Fined 20s. „ Price, occupier it tt it Withdrawn. Defendant having left neighbourhood July 18th f. P. Evill, 18, South Row Annoyance to neighbours by issue of smoke from a furnace at 18, South Row Fined 40s. and two guineas costs July 4th E. W. Bowes, 20, Kensal Road Failure to repair drain and paving at 5, Admiral Mews Order to execute work in 14 days „ R. Whur, 28, Craven Terrace Constructing w.c. so as to be a nuisance at 21, Hazlewood Crescent Ordered to remedy defects in seven days „ „ „ „ Constructing w.c. at 21, Hazlewood Crescent without notice Fined 20s. Oct. 3rd T. Burnell, 3, Darnley Road Failure to execute sanitary repairs at 21, Snarsgate Street Fined £5. .. „ „ „ Failure to repair defective drain at 21, Snarsgate Street Fined £5 .. J. T. Lee, 6, Bramley Mews Failure to provide water supply at 8, Bramley Mews Ordered to provide water or close the house Dec. 5th C. Darrah, 23, Drayton Gardens The same at 23, Drayton Gardens „ „ 71 Date. Name and Address of Defendant. Offence. Result. Dec. 19th J. T. Lee, 6 Bramley Mews Failing to execute sanitary repairs at 7, Bramley Mews Ordered to execute work within one month Nov. 21st T. Doggett, 63, Kensington Park Rd. Failing to carry out sanitary repairs at 61, Wornington Road Withdrawn. Work having been carried out Nov. 21st J. Ryan, 115, Kensal Road Reconstructing w.c. at 55, Kensal Road so as to be a nuisance Withdrawn „ A. Highmore „ „ „ Withdrawn „ J. Ryan, 115, Kensal Road Reconstructing a w.c. at 55, Kensal Road without notice Fined 40s. „ A. Highmore, 13, Tavistock Crescent „ „ Fined 40s. „ Buzzacot, 40, Praed Street Failure to remedy dampness, etc., at 189, Lancaster Road Order to execute work in seven days „ B. Weston, 5 Parkholm Road Failure to repair defective roof, etc., at 71, Southam Street Order to execute work in 14 days Dec. 5th ... T. Doggett, 63, Kensington Park Rd. Failure to execute certain sanitary repairs at 61 and 75, Wornington Road Withdrawn. Work having been carried out „ „ „ „ The same at 8, Blenheim Crescent „ „ 9) F. F. Mira, 4, Old Manor Yard Failure to repair defective roof Withdrawn. Work done „ T. Doggett Failure to clean and limewash rooms in lodging house at 75, Wornington Road Withdrawn. Work completed „ „ „ „ The same at 61, Wornington Road » „ Dec. 19th J.T. Lee, 6, Bramley Mews Failure to execute sanitary repairs at 6, Bramley Mews Order to carry out work in one month Proceedings under London County Council (General Powers) Act, 1908. Date. Name and Address of Defendant. Offence. Result. Jan. 19th J. Bush, 5, Pater Street Preparing food in a room containing an inlet to a fcecal drain Fined 20s. 72 Proceedings under Factory and Workshop Act, 1901. Date. Name and Address of Defendant Offence. Result. Nov. 21st Dale—Skinner, 217, Brompton Road Failure to send list of outworkers Fined 20s. „ A. Barder, 193, Brompton Road „ „ „ „ „ H. Wetton, 22, Bute Street „ „ „ „ „ E. Brown, 43, Hans Crescent „ „ „ „ „ Harrods Ltd. „ „ „ „ „ Fine Needle Work Association, 6, Beauchamp Place „ „ „ „ „ Corby & Eads, 196, Brompton Road „ „ „ „ „ A. H. Pewsey, 41, Marloes Road „ „ „ „ „ D. Dancaster, 161, Cornwall Road C. Bierman, 62, Gloucester Road „ „ „ „ Withdrawn „ W. Parker, 22, Sussex Place „ „ „ „ DISINFECTION. Bedding is disinfected at the Council's disinfecting station at Wood Lane by exposure to steam under a pressure varying between 15 and 18 lbs. for 20 minutes. Soiled linen is disinfected by boiling under a pressure of 10 lbs. for ten minutes in the rotary washing machine. Cloth stuffs, dresses, etc., are disinfected by formalin vapour in the heated chamber of the steam disinfector. A formalin cupboard has been constructed for the disinfection by formalin of leather, furs and other articles which cannot be exposed to high temperatures. Rooms are disinfected by fumigation with the formalin vapour generated by the volatilisation of 30 tablets of paraform. Thirty tablets are guaranteed by the makers to produce 29 grammes of gaseous formaldehyde, an amount of vapour which is. sufficient to disinfect a room of 1,000 c.ft. Rooms vacated by consumptive persons are first sprayed with ½ per cent. solution of formic aldehyde (formalin 2 ounces to 1 gallon of water), and then sealed and fumigated with formalin vapour. 73 The following Table shows the number of disinfections carried out for various diseases during the year:— Disinfection, 1911. Nature of Infection. Rooms Disinfected. Premises Disinfected. Disinfections at Wood Lane Scarlet Fever 262 211 223 Diphtheria 233 203 208 Enteric Fever 22 21 23 Measles 145 90 20 Consumption 174 137 105 Other Diseases 120 99 98 Totals 956 761 677 Year. Weight of Articles sent from Premises. Number of Premises. Tons. Cwts. Qrs. Lbs. 1908 33 16 3 18 795 1909 33 5 2 23 789 1910 27 7 3 12 638 1911 27 14 2 6 677 The following number of articles was dealt with at the Wood Lane Disinfecting Station during the year:— Articles disinfected only 9,703 Articles disinfected and washed free of charge 3,459 Articles washed and charged for 522 Total articles dealt with in 1911 13,684 The Council have also undertaken to remove soiled dressings, free of charge, from St. Luke's House, an institution for persons in the last stages of consumption, where adequate provision is not made for the destruction of surgical dressings. In accordance with the undertaking given, dressings amounting to a total weight of 1 ton 4 cwts. have been removed from St. Luke's House during the year and destroyed at Wood Lane. VERMINOUS PERSONS. In place of providing their own cleansing station, the Council have hitherto done no more than make an arrangement with the Board of Guardians under which verminous persons can be cleansed at the expense of the Council, at the Able-bodied Workhouse in Mary Place. The number of persons cleansed under this arrangement is a negligible quantity, and only amounted to 34 during the year 1911. The use of premises attached to a workhouse cannot be properly offered except to the semi-destitute inmates of common lodging-houses, and for school children the use of such premises is, needless to say, out of the question. Should the Council erect their own station, the facilities offered will become widely known to adults through the school children who are 74 sent to be cleansed, and the task of eradicating vermin will be dealt with comprehensively by a single authority. Should the London County Council on the other hand be driven, by the failure of the Borough Councils, to make their own provision for school children, they cannot deal with adults, and the children will become re-infested after each cleansing by contact in their homes with verminous members of their families who are not of school age, and for this work, which would be bound to fail in its object, the Borough Council would pay as heavily through the Education Rate as they would through the Borough Rate in the event of a station of their own being provided, with the added disadvantage of having no direct control over the amount spent. Under the circumstances it is much to be regretted that the very considerable labours of the Baths and Infectious Diseases Sub-Committee, who have submitted a number of reports during the year on this subject, should have failed to bring about the provision of a cleansing station which is so eminently necessary for the well-being of the children attending the elementary schools. On November 7th a resolution was submitted to the Council by the Public Health Committee, which contained the recommendation that the Council do affirm the principle that a Cleansing Station shall be provided for the Borough. An amendment in favour of this recommendation being struck out, was carried by 29 votes against 21, and the remainder of the resolution containing details as to the site and cost of the proposed cleansing station was accordingly dropped. The site recommended was in Blechynden Mews. The estimated cost of building and equipment amounted to £808, and to this sum was added £109 as the value of the site, which is the property of the Council. The annual expenditure on staff, stores and maintenance was estimated at £230. Verminous Rooms.—308 verminous rooms were cleansed during the year in response to notices served under the powers conferred by the London County Council General Powers Act, 1904, 26 beds were disinfected, and 16 verminous beds were destroyed. PUBLIC BATHS AND WASHHOUSES I am indebted to Mr. Buck,Superintendent, for the subjoined particulars as to the use made of the Public Baths and Washhouses during 1911 and the three preceding years by washers and bathers:— Year. Washers. Bathers. 1908 71,321 130,088 1909 70,472 12.7,607 1910 73,342 139,237 1911 71,241 153,981 It is satisfactory to note that the numbers of bathers exceeded those recorded in any previous year, whilst the number of washers remained well above 70,000. MORTUARY AND CHAPEL OF REST During the year 261 bodies were deposited at the Mortuary under the following circumstances:— ]. At the request of the relatives of the deceased 52 2. At the request of undertakers, mainly at the instance of the relieving officers 30 3. At the request of the coroner (inquest cases):— Cases of sudden death 86 Cases of violent death 76 — 162 4. Brought in by the Police—Persons found dead 10 Accident cases 5 — 15 5. On account of death due to infectious disease... 2 Total number of bodies received 261 In 118 of the above cases post-mortem examinations were made under the coroner's warrant. 75 The number of bodies deposited in 1911 and the five preceding years, together with the number of inquests held and the number of post-mortem examinations made in the Mortuary is shown in the following Table:— Number of Bodies taken into the Mortuary. Year No. of bodies received at the Mortuary. No. of bodies upon v/hich Coroner's inquests were held. No. of bodies upon which post mortem examinations were made. 1906 341 217 127 1907 274 194 112 1908 251 174 107 1909 263 181 110 1910 233 145 103 1911 261 177 118 Unnecessary inconvenience having been caused by numerous applications from undertakers for the reception of bodies late at night, the period during which bodies will be received, except in case of emergency, has been limited on the recommendation of the Cemetery and Open Spaces Sub-Committee to the hours between 8 a.m. and 8 p.m., and undertakers have been notified to this effect. During the year 79 bodies were deposited in the Chapel of Rest, Avondale Park. Fifty-six bodies were deposited in the previous year. VACCINATION. 1 hrough the courtesy of Mr. King, the vaccination officer, I am able to publish in the Appendix, Table XI., the official returns respecting the vaccination of children whose births were registered in 1910. Out of a total number of 3.020 infants born 245 were not vaccinated on account of „ conscientious objection „on the part of the parents, and 145 remained unvaccinated through removal to places unknown.„ The total number of cases not finally accounted for or not vaccinated through „conscientious objection„ on the part of the parents thus amounted to 390 or to 13 per cent, of the births registered as compared with losses of 10, 8, 7, 8, 6, 6, 6, 5, 6 and 7 per cent, of the births registered in the preceding ten years. APPENDIX. 79 APPENDIX. Local Government Board Tables I—IV TABLE I. Vital Statistics of Whole Districts during 1911 and previous Years. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the Districts. Uncorrected Number. Nett. of Nonresidents registered in the District. of Residents not registered 111 the District. Under 1 Year of Age At all Ages. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1906 174,450 3,821 3 428 19.7 2,811 16.1 663 349 452 182 2,497 14.3 1907 174,020 8,288 3,428 19.7 2.824 16.2 704 351 433 126 2,471 14.2 1908 178,590 8,862 3,504 20.2 2,757 15.9 713 354 428 122 2,398 13.8 1909 178,160 8,187 3,381 19.5 2,770 16.0 692 371 379 112 2,449 14.1 1910 172,780 8,007 3,190 18.5 2,524 14.6 635 315 345 108 2,204 12.8 1911 172,800 3,037 3,223 18.7 2 712 15.7 722 3„ 435 135 2,889 13.9 * Rates calculated per 1,000 of estimated population. Area of District in acres (exclusive of area covered by water 2291 At Census of 1911. Total population at all ages 172,402 Number of inhabited houses Average number of persons per house 80 TABLE II. Cases of Infectious Disease notified during the Year, 1911. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward Total Casts Removed to Hospital. At all Ages. At Ages.—Years. St. Charles. Golborne. Norland. Pembridge. Holland. Earl's Court. Queen's Gate. Redcliffe. Brompton. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 212 3 62 105 19 23 ... ... 26 38 23 30 27 18 12 28 10 181 Erysipelas 123 4 3 5 5 46 46 14 19 33 21 15 8 6 7 11 3 ... Scarlet fever 227 ... 61 119 28 17 2 ... 45 37 31 30 27 21 7 18 11 194 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 20 ... ... 3 5 9 3 ... 1 2 2 1 4 2 8 3 2 13 Relapsing fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 7 ... ... ... 1 6 ... ... ... 1 1 3 ... 1 ... ... 1 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis Under Tuberculosis Regulations, 1908 124 1 3 9 16 44 49 2 21 25 35 5 7 7 11 10 3 5 Under Tuberculosis Regulations, 1911 370 8 109 59 147 47 6 73 152 60 48 12 16 1 13 6 63 Others 7 ... ... 1 ... 3 3 ... 2 1 2 ... ... 1 1 ... ... ... Chicken-pox 227 16 95 „ 10 7 ... ... 70 54 48 17 22 2 3 8 3 ... Cerebro-Spinal Meningitis 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 22 22 ... ... ... ... ... ... 2 11 5 1 1 ... ... 1 1 1 1340 46 233 450 143 302 150 22 259 355 228 145 108 74 45 92 40 407 81 TABLE III. Causes of, and Ages at, Death during the Year 1911. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occuring within or without the District. Total Deaths whether of Residents or non "Residents" in Institutions in the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. All causes Certified 2,389 435 135 99 62 70 271 568 749 1,316 Uncertified - - - - - - - - - - Enteric Fever 4 ... ... ... ... l 2 1 ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... Measles 93 21 39 28 5 ... ... ... ... 27 Scarlet Fever 3 ... 1 ... 1 ... 1 ... ... ... Whooping-Cough 54 25 21 7 1 ... ... ... ... 15 Diphtheria, and Croup 21 2 1 9 8 ... 1 ... ... ... Influenza 25 1 ... ... ... ... 2 4 18 3 Erysipelas 8 2 1 ... ... ... ... 2 3 12 Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... Dysentery 2 ... ... ... ... ... ... 2 ... Lead Poisoning 1 ... ... ... ... ... ... 1 ... 1 Phthisis, Pulmonary Tuberculosis 155 2 ... 1 7 21 66 46 12 236 Tuberculous Meningitis 19 6 4 5 3 ... ... 1 ... 11 Other tuberculous diseases 29 7 3 6 1 5 5 2 ... 20 Rheumatic Fever 2 1 ... ... 1 ... ... ... ... 1 Cancer, Malignant disease 197 ... ... 1 1 1 16 91 87 146 Bronchitis 173 29 6 2 2 ... 1 41 92 167 Broncho-Pneumonia 65 21 7 7 2 ... 2 9 17 18 Pneumonia (all other forms) 109 13 14 12 6 5 18 24 17 34 Other diseases of Respiratory Organs 36 4 1 ... 1 ... 6 9 15 14 Diarrhoea and Enteritis 184 123 27 6 ... ... 3 15 10 75 Appendicitis and Typhlitis 22 ... ... 1 5 2 3 7 4 2 Alcoholism 6 ... ... ... ... ... 2 4 ... 2 Cirrhosis of Liver 24 ... ... ... .. 1 ... 16 6 10 Nephritis and Bright's Disease 68 ... ... ... ... 2 9 29 28 26 Puerperal Fever 4 ... ... ... ... 1 3 ... ... 2 Other accidents and diseases of Pregnancy and Parturition 7 ... ... ... ... ... 7 ... ... 4 Congenital Debility and Malformation including Premature Birth 110 107 3 ... ... ... ... ... ... 41 Violent Deaths, excluding Suicide 63 6 1 3 4 9 13 15 12 22 Suicide 20 ... ... ... ... 3 6 10 1 3 Other Defined Diseases 878 64 6 10 14 19 104 234 427 422 Diseases ill-defined or unknown 7 ... ... 1 ... ... 1 5 ... 1 2,389 435 135 99 62 70 271 568 749 1,316 82 TABLE IV. INFANTILE MORTALITY DURING THE YEAR 1911. Deaths from stated Causes, in Weeks and Months, under One Year of Age. Cause or Death. Under 1 week. 1-2 Weeks 2-3 Weeks 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Yeas. All Causes. Certified 78 22 11 15 126 66 93 69 81 435 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 7 14 21 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... 1 ... ... 1 2 Whooping-cough ... ... ... ... ... ... 9 10 6 25 Diarrhœa ... •• ... 2 2 11 33 17 18 81 Enteritis ... 2 ... ... 2 12 10 9 9 42 Tuberculous Meningitis ... ... ... ... ... ... 1 1 4 6 Abdominal Tuberculosis ... ... ... 1 1 ... 2 1 1 5 Other Tuberculous Diseases ... ... ... ... ... ... 2 1 1 4 Congenital Malformation 4 ... 2 1 7 1 ... 1 1 10 Premature Birth 31 4 3 1 39 2 ... ... ... 11 Atrophy, Debility, and Marasmus 13 10 2 2 27 13 11 1 1 53 Atelectasis 13 ... ... ... 13 1 ... ... ... 14 Injury at birth 10 ... ... ... 10 ... ... ... ... 10 Erysipelas ... ... ... 1 1 ... 1 ... ... 2 Syphilis 1 2 ... 2 5 2 ... ... ... 7 Rickets ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... 1 ... 1 Convulsions ... 2 2 1 5 1 1 3 2 12 Gastritis ... 1 ... ... 1 2 ... 2 ... 5 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... 1 ... 1 11 6 4 7 29 Pneumonia (all forms) 2 ... ... 2 4 4 7 7 12 34 Suffocation, overlaying 1 ... ... ... 1 3 ... ... ... 4 Other causes 3 1 1 2 7 2 10 4 4 27 78 22 11 15 126 66 93 69 81 435 Nett Births in the year legitimate, 3,051. illegitimate, 172. Net Deaths in the year of legitimate infants, 383. illegitimate infants, 52. 83 TABLE V— PROCEEDINGS DURING 1911. PREMISES. NUMBER OF PLACES. Number of inspections, 1911. Number of notices, 1911. Number of prosecutions, 1911. On register at end of 1910. Added in 1911 Removed in 1911. On register at end of 1911. Milk premises. 196 13 12 197 1,339 12 0 Cowsheds 1 — — 1 45 — — Slaughter-houses 10 — — 10 228 — — Other offensive trade premises — — — — — — — Ice cream premises 170 15 12 173 172 2 — Registered houses let in lodgings 2,091 0 0 2,091 7,625 (a)*71 (a)*2 (6)†961 (b)†9 Total number of intimation notices served for all purposes, 2601. * (a) For overcrowding. † (b) For other conditions. Overcrowding—1911. Number of dwelling rooms overcrowded 83 Number remedied 83 Number of Prosecutions 2 Underground rooms— Illegal occupation dealt with during year 9 Number of rooms closed — Insanitary houses— Number closed under the Public Health (London) Act, 1891 0 Number closed under the Housing of the Working Classes Act 4 Number of premises cleansed under Sec. 20 of L.C.C. (General Powers) Act, 1904 308 Shelters provided under sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year No shelter Revenue Acts— Number of houses for which applications for certificates were received during year 33 Number of tenements comprised therein 74 Number of tenements for which certificates were (a) granted 59 (b) refused 4 Number of prosecutions under By-laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, etc. — (b) For prevention of nuisance arising from offensive matter running out of any manufactory, etc. — (c) For the prevention of keeping of animals in such a manner as to be injurious to health — (d) As to paving of yards, etc., of dwelling houses 1 (e) In connection with the removal of offensive matter, etc. 4 (f) As to cesspools and privies, removal and disposal of refuse, etc. — (g) For securing the cleanliness of tanks, cistens, etc. — (h) With respect to water closets, earth closets, etc. 3 (i) With respect to sufficiency of water supply to water closets — (J) With respect to drainage, etc. (Metropolis Management Act, section 202) — (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-laws) Act, 1899) 3 Mortuaries— Total number of bodies removed 340 Total number of infectious bodies removed 2 84 TABLE VI. Summary of the Work of the Sanitary Inspectors during the Year 1911. Number of Sanitary District. No. of Complaints from Inhabitants, &c. Number of Inspections made. Notices served. Houses Cleansed, Whitewashed, Repaired, &c. House Drains Water Closets. Ashpits. Cisterns Cleansed, Covered, Repaired, &c. Yards and Areas paved and drained. Sanitary Works completed in the year 1911, Legal proceedings—Number of Summonses Issued. Inspections of Dwelling Houses. Re-inspections of Dwelling Houses. Inspections of Dairies, &c. Inspections of Bakehouses. Of other Places where Food is prepared. Of Mews, Of other Premises and Places. Smoke Observations. Total Number of Inspections in the year 1911. Written Intimations of Nuisance. Notices served by order of the Public Health Committee. Notices served under the Lodging-House By-laws. Reconstructed, Repaired, Cleansed. Ventilated, Trapped, &c. Reconstructed, Repaired, &c. Supplied with Water. New W.C.'s provided. Ashpits Abolished. New Bins provided. 1 202 1,528 982 144 49 166 942 115 49 4,177 274 41 124 138 73. 24 162 11 ... 24 94 50 41 756 3 2 87 1,971 486 89 81 240 635 491 58 4,138 360 71 254 336 160 9 59 115 6 6 72 64 57 1,244 8 3 74 1,146 1,764 109 23 88 508 203 4 3,919 275 42 172 179 40 9 61 6 ... 11 67 12 69 639 1 4 134 1,032 1,434 108 44 139 450 224 4 3,569 323 76 136 84 47 10 42 21 3 9 54 10 20 367 6 5 252 1,243 1,363 208 48 96 744 170 8 4,132 268 46 62 108 27 11 49 55 ... 90 101 13 47 628 7 6 201 1,191 1,630 84 44 39 508 37 11 3,745 166 38 36 40 71 33 80 4 8 1 44 11 49 434 0 7 272 1,114 869 73 69 169 375 195 47 3,183 213 43 71 423 128 11 44 44 17 15 22 24 57 1,251 0 8 81 948 803 137 24 143 996 646 121 3,899 198 36 52 85 41 4 33 9 ... 7 30 13 15 349 3 9 389 1,375 1,185 283 85 82 733 202 51 4,385 391 78 105 162 52 26 63 45 13 16 89 66 56 704 3 10 102 1,061 801 104 59 354 831 188 15 3,515 133 38 20 64 49 14 47 14 3 11 58 10 16 337 0 Totals 1,794 12,609 11,317 1,339 526 1,516 6,722 2,471 368 38,662 2,601 509 1,032 1,619 688 151 640 324 50 190 631 273 427 6,709 31 85 TABLE VII. Causes of Death at different periods of life in the Year 1911. CAUSES OF DEATH. Classification No. Totals— All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. Totals— Under 5 Years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards. Totals — Above 5 Years. Total M F M F M F M F M F Total M F M F M F M F M F M F Total I. GENERAL DISEASES. Enteric Fever 1 4 3 1 ... ... ... ... ... ... ... ... • •• ... ... ... 1 2 ... 1 ... ... ... 3 1 4 Measles 6 93 40 53 9 12 15 24 15 13 39 49 88 1 4 ... ... ... ... ... ... ... 1 4 5 Scarlet Fever 7 3 1 2 ... ... ... 1 ... ... ... 1 1 1 ... ... ... ... 1 ... ... ... ... 1 1 2 Whooping-Cough 8 54 24 30 9 16 13 8 2 5 24 29 53 ... 1 ... ... ... ... ... ... ... ... ... 1 1 Diphtheria 9A 20 5 15 1 ... ... 1 2 7 3 8 11 2 6 ... ... ... 1 ... ... ... ... 2 7 9 Croup 9BC 1 1 ... 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza 10 25 14 11 1 ... ... ... ... 1 ... 1 ... ... ... ... 2 ... 2 2 9 9 13 11 24 Dysentery 14 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 2 Erysipelas 18 8 2 6 1 1 ... 1 ... ... 1 2 3 ... ... ... ... ... ... 1 1 ... 3 1 4 5 Pyæmia, Septicæmia 20 2 2 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... 1 ... 1 Pulmonary Tuberculosis 28A B 150 83 67 2 ... ... ... ... ... 2 ... 2 4 3 9 11 35 28 27 19 6 6 81 67 148 Acute Phthisis 29A 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 ... ... ... ... ... 4 4 Acute Miliary Tuberculosis 29B 1 1 ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis Meningitis 30 19 10 9 3 3 3 1 2 3 8 7 15 1 2 ... ... ... ... 1 ... ... 2 2 4 Tuberculosis of Peritoneum, &c. 31AB 16 9 7 3 2 2 ... 2 3 7 5 12 1 ... ... 1 1 1 ... ... 2 2 4 Tuberculosis of Spinal Column 32 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 Tuberculosis of Joints 33 2 ... 2 ... ... ... 1 ... ... ... 1 1 ... ... ... 1 ... ... ... ... ... ... 1 1 Tuberculosis of other organs 34 3 1 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... ... 1 2 3 Disseminated Tuberculosis 35 7 5 2 2 ... ... ... ... 1 2 1 3 ... ... 1 ... 1 1 1 ... ... ... 3 1 4 Rickets 30 3 1 2 ... 1 1 1 1 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 37 15 6 9 2 5 ... ... ... 2 5 7 ... ... ... ... 2 1 1 3 1 4 4 8 Cancer 39-45 197 87 110 ... ... ... 1 ... 1 ... 1 1 ... ... 1 5 11 41 50 39 48 86 110 196 Other tumours 46 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 Rheumatic Fever 47 2 1 1 1 ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 1 Chronic Rheumatism, &c. 48AB 5 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 2 ... 5 5 Gout 48C 5 3 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 2 3 2 5 Diabetes 50 17 7 10 ... ... ... ... ... ... ... ... ... ... 1 1 2 1 1 4 2 1 4 7 10 17 Exopthalmic Goitre 51 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... 3 3 Addison's Disease 52 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Leucocythæmia, &c. 53AB 3 2 1 ... ... ... ... 1 ... 1 ... 1 1 ... ... ... ... 1 ... ... ... ... 1 1 2 Carried forward 667 312 855 36 39 34 38 26 33 96 110 206 12 18 13 19 49 52 83 82 59 74 216 245 461 86 TABLE VII.—continued. CAUSES OF DEATH. Classification No. Totals— All Ages Under 1 year. 1 and under 2 years. 2 and under 5 years. Totals— Under 5 Years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards. Totals— Above Five Years. Total M F M F M F M F M F Total M F M F M F M F M F M F Total Brought forward 667 312 355 36 39 34 38 26 33 96 110 206 12 18 13 19 49 52 83 82 59 74 216 245 461 GENERAL DISEASES.—continued. Anæmia Chlorosis 54 9 5 4 ... ... ... 1 ... ... ... 1 1 ... ... ... ... 2 ... 2 2 1 1 5 3 8 Alcoholism 56 6 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 2 ... ... 3 3 6 Chronic Lead Poisoning 57AB 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Total for General Diseases 683 321 362 36 39 34 39 26 33 96 111 207 12 18 13 19 52 53 88 86 60 75 225 251 476 II.—DISEASES OF THE NERVOUS SYSTEM AND OF THE ORGANS OF SPECIAL SENSE. Encephalitis 60 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... 3 ... 3 Meningitis 61BC 6 4 2 1 ... ... ... 1 ... 2 ... 2 1 ... ... ... 1 1 ... 1 ... ... 2 2 4 Locomotor Ataxy 62 7 6 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 1 1 ... 6 1 7 Other Diseases of the Spinal Cord 63AB 15 10 5 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 2 3 6 1 10 5 15 Cerebral Hæmorrhage, Apoplexy 64AE 81 36 45 ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 2 13 13 21 28 36 45 81 Softening of Brain 65 7 3 4 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 2 1 2 3 4 7 Paralysis without specified cause 66AC 24 11 13 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 6 4 7 11 13 24 General Paralysis of the Insane 67 16 13 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 8 2 4 1 1 ... 13 3 16 Other forms of Mental Alienation 68 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... 3 3 Epilepsy 69 11 4 7 ... ... ... ... ... ... ... ... 1 1 1 ... 1 2 ... 3 1 1 4 7 11 Infantile Convulsions under 5 years 71AB 15 8 7 6 6 1 ... 1 1 8 7 15 ... ... ... ... ... ... ... ... ... ... ... ... ... Neuritis 73 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 2 Other Diseases of the Nervous System 74AD 13 5 8 1 ... ... ... ... ... 1 ... 1 ... ... ... ... 2 ... 1 3 1 4 4 8 12 Mastoid Disease 76A 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Other Diseases of the Ears 76B 2 ... 2 ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... 1 ... ... ... ... ... 1 1 Total for Diseases of the Nervous System, and of the Organs of Special Sense 206 104 102 8 6 1 ... 2 2 11 8 19 2 2 3 2 18 11 34 36 36 43 93 94 187 III.—DISEASES OP THE CIRCULATORY SYSTEM. Pericarditis 77 5 8 2 1 ... ... 1 ... ... 1 1 2 1 ... ... ... 1 ... ... ... ... 1 2 1 3 Acute Endocarditis 78AC 6 5 1 ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 ... 1 ... ... 1 5 1 6 Valvular Disease 79A 61 30 31 ... ... ... ... ... ... ... ... ... ... 1 3 ... 5 2 9 12 13 16 30 31 61 Fatty Degeneration of the Heart 79B 40 17 23 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 6 5 9 16 17 23 40 Carried forward 1001 480 521 45 45 35 40 28 35 108 120 228 15 21 22 21 79 68 138 139 118 152 372 401 773 87 TABLE VII.—continued. CAUSES OF DEATH. Classification No. T otals— All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. Totals— Under 5 Years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards. Totals— Above 5 Years. Total M F M F M F M F M F Total M F M F M F M F M F M F Total Brought forward 1001 480 521 45 45 35 40 28 35 108 120 228 15 21 22 21 79 68 188 139 118 152 372 401 773 DISEASES OF THE CIRCULATORY SYSTEM—continued. Other Organic Disease of the Heart 79C 146 77 69 ... 1 ... ... 1 ... 1 1 2 1 2 ... 1 14 12 26 17 35 36 76 68 144 Angina Pectoris 80 10 6 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 2 4 6 4 10 Arterial Sclerosis, &c. 81AC 39 26 l3 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 10 1 15 11 26 13 39 Cerebral Embolism and Thrombosis 82A 18 9 9 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 3 6 6 9 9 18 Other Embolism and Thrombosis 82B 4 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 2 1 3 4 Diseases of the Veins 83AD 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 2 Diseases of the Lymphatic System 84AB 2 1 1 1 1 ... ... ... ... 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Circulatory System 85AC 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Total for Diseases of the Circulatory System 334 175 159 2 2 ... 1 1 ... 3 3 6 2 3 6 1 26 18 58 40 80 94 172 156 328 IV.—DISEASES OF THE RESPIRATORY SYSTEM. Diseases of the Larynx 87AC 3 1 2 1 2 ... ... ... ... 1 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis 89 & 90 173 72 101 11 18 4 2 2 ... 17 20 37 1 1 ... ... 1 ... 17 24 36 56 55 81 136 Broncho-pneumonia 91 65 31 34 13 8 5 2 2 5 20 15 35 2 ... ... ... ... 2 3 6 6 11 11 19 30 Lobar-pneumonia 92A 21 13 8 ... 1 1 1 2 ... 3 2 5 ... 1 1 ... 1 2 6 3 2 ... 10 6 16 Pneumonia (type not stated) 92B 88 46 42 7 5 7 5 4 6 18 16 34 3 2 ... 4 11 4 9 6 5 10 28 26 54 Empyema 93A 4 3 1 ... 1 ... ... ... ... ... 1 1 1 ... ... ... 1 ... 1 ... ... ... 3 ... 3 Other Pleurisy 93B 4 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 2 2 4 Pulmonary Congestion, &c. 94 AD 9 2 7 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 6 2 7 9 Gangrene of the Lung 95 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Asthma 96 11 7 4 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 2 3 2 7 4 11 Fibroid Disease of Lung 98A 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 ... 3 3 Other Diseases of the Respiratory System 98 B 1 1 ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Total for Diseases of the Respiratory System 383 179 204 32 35 18 10 10 11 60 56 116 7 4 1 4 17 10 41 42 53 88 119 148 267 V.—DISEASES OF THE DIGESTIVE SYSTEM. Diseases of the Mouth, &c. 99AD 2 1 1 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Carried forward 1608 780 828 78 83 53 50 39 46 170 179 349 23 27 23 26 113 92 221 204 230 300 610 649 1259 88 TABLE VII.—continued. CAUSES OF DEATH. Classification No. Totals— All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. Totals— U nder Five Years. 5 and under 15 years. IS and under 25 years. 25 and under 4-5 years. 45 and under 65 years. 65 years and upwards. Totals— Above Five Years Total M F M F M F M F M F Total M F M F M F M F M F M F Total Brought forward 1608 780 828 78 83 53 50 39 46 170 179 349 23 27 23 26 113 92 221 204 230 300 610 649 1259 DISEASES OF THE DIGESTIVE SYSTEM—continued. Diseases of Pharynx, Tonsillitis 100AC 4 2 2 ... ... ... ... 1 ... 1 ... 1 ... 1 ... ... ... ... ... 1 1 ... 1 2 3 Perforating Ulcer of Stomach 102 13 6 7 ... ... ... ... ... ... ... ... ... ... ... 1 1 3 3 2 2 ... 1 6 7 13 Inflammation of Stomach 108 8 5 8 4 1 ... ... ... ... 4 1 5 ... ... ... ... ... 1 1 ... ... 1 1 2 3 Other Diseares of the Stomach 103B 9 6 3 2 1 ... ... 1 ... 3 1 4 ... ... ... ... ... ... 2 1 1 1 3 2 5 Diarrhoea and Enteritis 104 & 105 AH 184 93 91 62 61 11 16 5 1 78 78 156 ... ... ... ... 3 ... 7 8 5 5 15 13 28 Appendicitis 108 22 14 8 ... ... ... ... 1 ... 1 ... 1 4 1 2 ... 1 2 4 3 2 2 13 8 21 Hernia 109A 13 6 7 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 2 1 3 6 5 7 12 Intestinal Obstruction 109B 18 11 7 1 ... 1 ... ... ... 2 ... 2 ... ... ... ... 1 1 4 2 4 4 9 7 16 Other Diseases of the Intestines 110 5 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... 1 1 2 3 5 Cirrhosis of the Liver, &c. 113 AC 24 13 11 1 ... ... ... ... ... 1 ... 1 ... ... ... 1 ... ... 9 7 3 3 12 11 23 Biliary Calculi 114 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 1 2 Other Diseases of the Liver 115 18 12 6 1 ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... 5 4 5 2 11 6 17 Peritonitis (cause unstated) 117 5 3 2 ... ... ... ... ... 1 ... ... 1 1 ... ... ... 1 1 1 ... ... ... 3 1 4 Other Diseases of the Digestive System 118AB 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 1 2 Total for Diseases of the Digestive System 329 176 153 72 64 12 16 8 2 92 82 174 5 2 3 2 11 10 39 29 26 28 84 71 155 VI.—NON-VENEBEAL DISEASES OF THE GENITO-URINABY SYSTEM AND ANNEXA. Acute Nephritis 119 3 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... 2 1 3 Bright's Disease, &c. 120 AB 65 37 28 ... ... ... ... ... ... ... ... ... ... ... 1 1 5 2 17 11 14 14 37 28 65 Other Diseases of the Kidney 122AD 3 1 2 ... 1 ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... ... 1 1 1 2 Calculi of the Urinary Passages 123 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 1 2 Diseases of the Bladder 124 11 11 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 8 ... 11 ... 11 Diseases of the Urethra 125 AB 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... 1 ... 1 ... 1 Diseases of the Prostate 126 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... 3 ... 3 Uterine Tumour 129 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 ... ... ... 4 4 Other Diseases of the Uterus 130AB 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Ovarian Cyst (Tumour) 131 5 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 ... 1 ... 5 5 Other Diseases of the Female Genital Organs 132AB _2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 2 Total for ncn-Yeneral Diseases of the Genito Urinary System and Annexa 100 56 44 ... 1 ... ... ... 1 1 1 ... 1 2 6 7 22 17 26 17 56 43 99 Carried forward 2035 1011 1024 150 147 65 66 47 48 262 261 523 29 29 27 30 130 109 282 250 281 345 749 763 1512 89 TABLE VII.—continued. CAUSES OF DEATH. Classification No. Totals— All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. T otals— Under 5 Years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years 65 years and upwards. Totals— Above 5 Years. Total M F M F M F M F M F Total M F M F M F M F M F M F Total Brought forward 2035 1011 1024 150 147 65 66 47 48 262 261 523 29 29 27 30 130 109 282 250 281 345 749 763 1512 VII.—THE PUERPERAL STATE. Ectoptic Gestation 134D 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Puerperal Haemorrhage 135 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Other Accidents of Childbirth 136 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 2 Puerperal Fever 137 4 4 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 ... ... ... ... ... 4 4 Puerperal Albuminuria and Convulsions 138AC 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... 3 3 Total for Diseases of the Puerperal State 11 ... 11 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 10 ... ... ... ... ... 11 11 VIII.—DISEASES OF THE SKIN AND OF THE CELLULAR TISSUE. Senile Gangrene 142A 5 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 1 4 5 Phlegmon Acute Abscess 141 AB 13 3 10 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 2 3 ... 7 2 10 12 Diseases of tbe Integumentary System 145AD 3 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 1 2 3 Total for Diseases of the Skin and oi the Cellular Tissue 21 5 16 1 ... ... ... ... ... 1 ... 1 ... ... ... ... 1 1 2 3 1 12 4 16 20 X.—MALFORMATIONS. ... Congenital Malformation 150 AD 10 4 6 4 6 ... ... ... ... 4 6 10 ... ... ... ... ... ... ... ... ... ... ... ... ... XI.—DISEASES OF EARLY INFANCY. Premature Birth 151A 41 29 12 29 12 ... ... ... ... 29 12 41 ... ... ... ... ... ... ... ... ... ... ... ... ... Infantile Atrophy, Debility, and Marasmus 151B 53 25 28 23 27 2 1 ... ... 25 28 53 ... ... ... ... ... ... ... ... ... ... ... ... ... Icterus Neonatorum 151C 3 1 2 1 2 ... ... ... ... 1 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast Milk 151E 3 1 2 1 2 ... ... ... ... 1 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectusis 152B 14 8 6 8 6 ... ... ... ... 8 6 14 ... ... ... ... ... ... ... ... ... ... ... ... ... Injuries at Birth 152C 10 5 5 5 5 ... ... ... ... 5 5 10 ... ... ... ... ... ... ... ... ... ... ... ... ... Total for Diseases of Early Infancy 124 69 55 67 54 2 1 ... ... 69 55 124 ... ... ... ... ... ... ... ... ... ... ... ... ... XII.—OLD AGE. Old Age 154AB 98 28 70 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 27 70 28 70 98 XIII.—AFFECTIONS PRODUCED BY EXTERNAL CAUSES. Suicide by Poison 155 7 3 4 ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... 2 2 ... ... 3 4 7 Suicide by Drowning 158 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 2 Suicide by Firearms 159 5 5 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... 1 ... 5 ... 5 Carried forward 2313 1125 1188 222 207 67 67 47 48 336 322 658 29 29 27 34 134 121 289 255 810 427 789 866 1655 90 TABLE VI1.—continued. CAUSES OF DEATH Classification No. Totals— All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. Totals— Under 5 Years. 5 and under 15 years. IS and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards. T otals— Above 5 Years. Total M F M F M F M F M F Total M F M F M F M F M F M F Total Brought forward 2313 1125 1188 222 207 67 67 47 48 336 322 658 29 29 27 34 134 121 289 255 310 427 789 866 1655 AFFECTIONS PRODUCED BY EXTERNAL CAUSE S—continued. Suicido by Cutting or Piercing Instruments ... 160 4 4 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 ... ... ... 4 ... 4 Suicide by Jumping from High Place 161 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Suicide by Crushing 162 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Other Acute Poisoning 165 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 2 Burns 167 4 ... 4 ... 1 ... ... ... ... ... 1 1 ... ... ... 1 ... 2 ... ... ... ... ... 3 3 Absorption of Deleterious Gases 168 4 3 1 3 1 ... ... ... ... 3 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... Accidental Drowning 169 8 6 2 ... ... ... 1 1 ... 1 1 2 ... 1 2 ... 1 ... 1 ... 1 ... 5 1 6 Injury by Cutting or Piercing Instruments 171 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Injury by Fall 172 18 12 6 ... ... ... . 1 ... 1 ... 1 ... ... 2 ... 2 1 5 1 2 4 11 6 17 Injury by Machines 174 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . 2 ... ... ... 2 ... 8 Injury by other Crushing (vehicles, railways, &c.) 175 19 12 7 ... ... ... ... 1 ... 1 ... 1 2 ... 3 1 3 2 1 3 2 1 11 7 18 Effects of Heat 179 1 1 ... ... ... ... ... ... ... ... ... ...•.. 1 ... ... ... ... ... ... ... ... ... 1 ... 1 Homicide by Firearms 182 1 ... 1 ... ... ... ... ... ... ... ... . . . ... ... ... ... ... 1 ... ... ... ... ... 1 1 Fractures (cause not specified) 185 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Other Violence 186 2 1 1 ... 1 ... ... ... ... ... 1 1 ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Total for Affections produced by External Causes 83 53 30 3 3 ... 1 3 ... 6 4 10 3 1 7 5 12 7 18 7 7 6 47 26 73 XIV.—ILL-DEFINED CAUSES. Heart Failure 189A 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Other Ill-defined Causes 189BE 6 5 1 ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... 1 4 ... ... ... 4 1 5 Total for Ill-defined Causes 7 5 2 ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... 1 4 1 ... ... 4 2 6 Grand Totals 2389 1175 1214 225 210 67 68 51 48 343 326 669 32 30 34 36 143 128 307 261 316 433 832 888 1720 91 TABLE VIII. Births and Deaths in Kensington ; Birth-rates and Death-rates ; and Infantile Mortality 1881-1910 in Kensington and London. Number of Births. Birth Rate per 1,000 living. Number of Deaths. Death Rate per 1,000 living. Deaths under One Year. Deaths under One Year per 1,000 Births. Period Kensington. London. Kensington. London. Kensington. London. 1881-1885 21,883 26.1 34.3 13,438 16.4 21.0 3,211 150 150 1886-1890 19,428 23.5 32.2 13,816 16.7 200 3,060 157 154 1891-1895 18,512 220 30.9 14,235 16.9 20.2 3,105 167 156 1896-1900 18,665 21.6 29.6 14,075 16.3 18.8 3,203 172 163 1901-1910 35,062 200 — 24,917 14.8 — 4,644 132 — The above rates from 1891—1910 have been obtained by dividing the total deaths registered in the periods shown, by the sum of the populations assumed to have been present in Kensington in the middle of each year in the corresponding period The figure resulting has been multiplied by 1,000. The populations in the middle of each year have been estimated by the following method. The increase or decrease between the census enumerations is assumed to have been in arithmetical progression, and the population in the middle of the census year has been obtained by adding to or subtracting from the population ascertained by enumeration early in April onefourth of the annual increase or decrease. This rule has been depvied from in the census year 1901 when the enumerated population amounted to 176,628. The average annual increase from 1896 to 1901 amounted to 1,200, the average annual decrease between 1901 and 1911 being 422. In view of the remarkable increase which had taken place in the short period of five years preceding the census of 1901, it has been assumed that this increase is not likely to have been converted into a substantial loss in the census year. The population in the middle of 1901 has therefore been represented as stationary, by the round number 176,600 as compared with the census figure 176,628. round number 176,600 as compared with the census figure 176,628. Below the populations estimated by this method are given :— Census Populations 1891—166,308 1896—170,465 Estimated Population in the middle ot the year 1891—166,500 1896—170,700 1892—167,340 1897—171,880 1893—168,180 1898—173,0(50 1894—169,020 1899—174,240 1895—169,860 1900—175.420 Total, 1891—1895 840,900 Total 1896—1900 865,300 Census Populations 1901—176,628 1911—172,402 Estimated Population in the middle of the year 1901—176,600 1906—174,450 1902-176,170 1907—174,020 1903—175,740 1908—173,590 1904—175,310 1909—173,160 1905—174,880 1910—172,730 Sum ot Populations 1S01—1910 = 1,746,650 92 TABLE IX. Deaths from the Seven Principal Diseases of the Zymotic Class; and Zymotic Death-rate, in Kensington and London, 1871-1910. Quinquennial Period. Deaths from the Seven Principal Zymotic Diseases. Zymotic Death-rate, per 1,000 persons living. Small-pox. Measles. Scarlet Fever. Diphtheria WhoopingCough. Typhus Fever. Enteric Fever Pyrexia. Diarrhoea Total. Kensington. London. 1871-1875 189 289 249 85 345 27 130 55 603 1,972 2.97 4.06 1876-1880 151 370 323 95 531 13 105 28 605 2,221 2.87 3.64 1881-1885 107 326 153 96 427 5 115 18 438 1,685 2.05 3.26 1886-1890 1 442 135 305 387 ... 77 4 421 1,772 2.14 2.74 1891-1895 9 297 152 806 312 ... 92 7 440 1,615 1.92 2.70 1896-1900 ... 448 105 249 262 2 87 2 504 1,659 1.93 2 64 1901-1910 13 579 115 212 432 1 86 1 846 2,285 1.81 TABLE X. Death-rate in Kensington, per 1,000 persons living, from each of the Seven Principal Diseases of the Zymotic Class ; Arranged also, in two groups; viz. (1) The four notifiable infectious diseases—Smallpox, Scarlet Fever, Diphtheria, and "Fever"; and (2) The three non-notifiable diseases—Measles, Whooping-Cough, and Diarrhoea. Quinquennial Period. 1 2 3 4 5 6 7 Death-rate per 1,000 from— Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. "Fever." Diarrhoea. The Seven Diseases. The Four Notifiable Infectious Diseases. (Columns 1, 3, 4, and 6.) The three on-notifiable Infectious Diseases (Columns 2, 5, and 7). 1856-1860 0.14 0.49 0.89 — 0.66 0.46 0.89 3.53 1.48 2 05 1861-1865 0.19 0.80 0. 91 0.24 0.51 0.68 0.76 4.09 2.02 2.07 1866-1870 0.10 0.49 0.97 0.15 0.57 0.42 1.08 3.78 1.65 2.18 1871-1875 0.28 0.44 0.37 0.13 0.52 0.32 0.91 2.97 1.11 1.86 1876-1880 0.19 0.48 0.42 0.12 0.69 0.19 0.78 2.87 0.92 1.95 1881-1885 0.13 0.39 0.19 0.12 0.52 0.17 0.53 2.05 0.60 1.45 1886-1890 0.00 0.58 0.16 0.87 0.47 0.10 0.51 2.14 0.63 1.51 1891-1895 0.01 0.35 0.18 0.36 0.87 0.12 0.52 1.92 0.67 1.25 1896-1900 0.00 0.52 0.12 0.29 0. 30 0.11 0.58 1.92 0.52 1.40 1901-1910 0.00 0.83 0.07 0.12 0.25 0.05 0.49 1.8l 0.24 1.07 93 TABLE XI. Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1910. (Vide page 75.) DATE. Registration Sub-Districts comprised in Vaccination Officer's District Number of Births returned in Birth List Sheets. Number of these Births duly entered in Columns 1, 2, 4, and 5 of the Vaccination Register (Birth List Sheets), viz. : Number of these Births which are not entered in the Vaccination Register, on account, (as shown by Report Book) of Column I. Successfully Vaccinated. Column II. Column V. Dead, Unvaccinated. Postponement by Medical Certificate. Removed to other Districts, and notified to Vaccination Officers of the Districts. Removal to places unknown, or which cannot be reached, and cases not having been found. Total Number of Certificates of Successful Vaccinations received during each of the Calendar Years. Insusceptible of Vaccination. Certificate of Conscientious Objection. 1910. 1911. 1910. 1 2 3 4 6 7 8 9 10 12 13 1st January to 30th April Kensington Town 852 695 1 62 45 1 4 44 Brompton 146 107 3 16 12 1 1 6 1st May to 31st Dec. Kensington North 869 676 — 82 71 2 1 37 2,470 2,634 Kensington Central 526 394 3 43 46 2 3 35 Kensington South 627 514 6 42 31 5 6 23 Total 3,020 2,386 13 245 205 11 15 145 94 TABLE XII. PHTHISIS: SANATORIUM AND HOSPITAL ACCOMMODATION. Classes for which accommodation is provided. By whom provided. Where situated Total number of Beds How are patients selected ? Are patients under the care of a resident Medical Officer ? What charge, if any, is made for the use of Beds. Do the Sanitary Authority use— (1) their Isolation Hospital, or (2) their Small-pox Hospital for cases of Phthisis ? Do the Sanitary Authority reserve Beds in any Phthisis Sanatorium : If so, how many, and in what Sanatorium ? Do the Sanitary Authority provide portable openair Shelters or Tents ? (a) Early cases The Council Maitland Sanatorium 1 Reading 1—6 By the Medical Officer of the Tuberculosis Dispensary Yes There is no charge but patients are encouraged to contribute. No One bed is reserved in the Maitland Sanatorium throughout the year, with the option of filling five others if available. Yes. The provision of six shelters is authorised and three are in use at the present time. (b) Intermediate cases The Council (c) Advanced cases The Board of Guardians The Infirmary 60 Yes A Tuberculosis Dispensary, supported by voluntary contributions has been established to serve the whole of North Kensington and the Borough of Paddington. The Medical Officers of Health of Kensington and Paddington are members of the Executive Committee. INDEX. Page. Adulteration of Food 45 Appendix 79 Area of the Borough 8 Baths and Washhouses 74 Births and Birth Rates 4 Births, Notification of 18 Births and Birth Rates Tables I. and VIII 79 & 91 Cancer 40 Chapel of Rest for the Dead 75 Common Lodging Houses 54 Consumption 28 Cow House 44 Customs and Inland Revenue Acts 56 Dairies and Milkshops 43 Deaths and Death Rates— In Districts 6 From Principal Causes 7 From Zymotic Diseases 7 & 28 Among Infants 7 Deaths and Death Rates, Tables— 1906—1911 Table I 79 Causes of at Ages, Summary, Table III 81 Infantile Mortality, Table IV 82 Causes of by Sexes at ages, Table VII. 85 In Quinquennia, 1881—1910 Table VIII 91 Zymotic Diseases, Deaths from, Table IX 92 Zymotic Death Rates, Table X. 92 Diarrhoea 25 Diphtheria 17 Disinfection 72 Dust, Removal of 69 Enteric Fever 21 Factories and Workshops 59 Food Supply 43 Food, Adulteration of 45 Furnished Rooms 52 Health Visitors 13 Home Office Tables 64-66 Home Work 60 Houses let in Lodgings 52 Housing (Regulations) 1910 54 Housing of Working Classes 51 Ice Cream Vendors 44 Illegitimate Births 5 Infantile Mortality 7 Infectious Diseases 17 Notification and Removal, Table II 80 Inspection, Sanitary 69 Inspectors, Work of, Summary, Table VI 84 Inquests 75 ii. Pagb. Local Government Board Tables I.—IV 79-82 London County Council Summary of Work, Table V Margarine 47 Marriages Measles 24 Milkshops Milk Supply 48 Mortuary 74 Notifiable Diseases 17 Notification of Births Outworkers' Premises 60 Phthisis 28 Places where food is prepared 44 Population Distribution in Wards 4 Prosecutions 70 Public Health (Tuberculosis) Regulations, 1908 Public Health (Tuberculosis in Hospital) Regulations 1911 Puerperal Fever 22 Registered Lodging Houses Sanitary Inspection 69 Sanitary Inspectors' Work, Table VI 84 Scarlet Fever 19 School Children, Cleansing of Slaughter Houses 45 Small Pox ... ... ... ... ... .. ... ••• 17 Smoke Nuisances 69 Tuberculous Diseases Tuberculosis Regulations, 1908 and 1911 Underground Rooms Vaccination Returns, Table XI. Verminous Persons 73 Water Certificates 47 Water Supply 47 Whooping Cough Workshops and Factories 59 Zymotic Diseases 7 & 17 Deaths from in Quinquennial Periods, Table IX 92 Death Rates from in Quinquennial Periods, Table X 92