KEN 34 The Royal Borough of Kensington. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH r 1912. Vail & Co, Printers and Stationers, 170, Farringdon Road, E.C. ii. PUBLIC HEALTH COMMITTEE, 1912-13. Chairman: Councillor R. D. BAXTER. Vice-Chairman : Councillor Lt.-Col. A. W. F. LANGMAN. The MAYOR (ex-officio). Sir THOMAS HEWITT, K.C., J.P. Alderman A. G. McARTHUR, M.A., J.P. The Rev. PREBY. S. E. PENNEEATHER, D.D. Councillor Miss E. BENTHAM, M.D. „ M. D. BRINTON. „J BROOKE-LITTLE. „ J. CARNEGY-ARBUTHNOTT. „ A. G. COL VILE, LL.B. „ H. CORRY. „ T. C. DYER. „ H. FREYBERG. F.S.I. „ W. B. GRANDAGE, M.D. „C. G. HATT. „ Miss A. S. HAYNE. „ W. T. KEY. „ C. S. MEEK. „ A. J. RICE-OXLEY, M.A., M.D., M.R.C.P. „ W. K. SANDERSON. „ Col. W. STAINFORTH. „ A. TISDALL. 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 fourth 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 1912. Increased duties and responsibilities have been placed on the Council's Sanitary Inspectors by their designation as the officers who are authorised to carry out the requirements of the Housing (Inspection of District) Regulations, 1910, and the Rag Flock Act, 1911. The clerical work of the office has also been materially increased by the extension of compulsory notification to consumptive patients in every class of life. In these circumstances I desire to take this opportunity of acknowledging the zeal and loyalty with which the staff have worked, and of thanking the Council and the Public Health Committee for the consideration and support they have extended to the Department throughout the year. I have the honour to be, Ladies and Gentlemen, Your obedient Servant, J. E. SANDILA.NDS, Medical Officer of Health. Public Health Department, Town Hall, Kensington, W. 31st March, 1913. 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 15 Small Pox 15 Diphtheria 15 Scarlet Fever 16 Enteric Fever 17 Puerperal Fever 17 Ophthalmia Neonatorum 18 Poliomyelitis 18 Measles 20 Whooping Cough 20 Epidemic Diarrhoea 21 Consumption or Phthisis 21 Other Tuberculous Diseases 34 Cancer 34 C.—Food Supply. Milk Shops 37 Ice Cream Vendors 38 Places where Food is Sold 38 Bakehouses 39 Slaughter Houses 39 Unsound Food 39 Sale of Food and Drugs Acts 40 Cream Regulations, 1912 41 Margarine 41 Water Supply 42 D. —Housing. Inhabited Houses 45 Council's Lodging Houses 45 Houses Let in Lodgings 46 Furnished Rooms 46 Common Lodging Houses 50 Housing (Inspection of District) Regulations 1910 50 House-to-House Inspection 53 D.—Housing—continued. Page Underground Rooms 53 Customs and Inland Revenue Acts 53 E.—Factories and Workshops. Women's Workshops 57 Home Work 58 Men's Workshops 61 Home Office Tables 61 F.—Sanitation. Dust Removal 67 Drainage Work 67 Nuisance from Smoke 67 Public Lavatories 67 Sanitary Inspection 67 Legal Proceedings 68 Disinfection 69 Verminous Persons and Rooms 70 Rag Flock Act, 1911 71 Public Baths and Washhouses 71 Public Mortuary 72 Vaccination 72 G.—Appendix. Local Government Board Tables Table I.—Vital Statistics, 1912 and Previous Years 75 Table II.—Infectious Diseases 76 Table III.—Causes of Death 77 Table IV.—Infantile Mortality 78 London County Council Summary Table IX.—Proceedings during 1912 87 Other Statistical Tables Table V.—Births and Deaths in Quinquennial Periods 79 Table VI.—Zymotic Deaths in Quinquennial Periods 80 Table VII.—Zymotic Death Rates in Quinquennial Periods 80 Table VIII.—Deaths, Sex, Age and Cause 81 Table X.--Work of Sanitary Inspectors 88 Table XI.—Vaccination Returns, 1911 89 Table XII.—Houses let in Furnished Lodgings 90 viii. SUMMARY OF STATISTICS, For the year 1912. Population (Estimated) 172,000. Area of Borough in Acres 2,291 Density of Population per Acre 75 Houses Inhabited 28,028 Persons per House 6.1 Number of Marriages 1,637 Number of Births 3,318 Birth Rate 19.3 Number of Deaths 2,287 Crude Death Rate 13.3 Corrected Death Rate 14.3 Infantile Mortality:— Deaths under 1 year 305 Infantile Deaths per 1,000 Births 92 Deaths from Phthisis 1 79 Phthisis Death Rate 1.04 Deaths from the Zymotic Diseases 136 Zymotic Death Rate 0.79 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 3,900 persons which is still allotted, for parliamentary purposes only, to Chelsea. The rateable value of the Borough is £2,426,919. The product of a rate at one penny in the £ is £9,369. Population.—On the assumption that the decline which took place in the intercensal period 1901-1911, will be somewhat less marked in the current decade, the population of the Borough in the middle of the year 1912 is estimated to have numbered 172,000, and it is on this figure that the birth rate and the death rates for the year have been calculated. The Census returns, as revised since my last report, show a net decrease in the population in ten years of 4,311, or 2.5 per cent. for the Borough, of 2,918 or 3'2 per cent. for North Kensington, and of 1,393 or 1.7 per cent. for South Kensington. The Census figures for the several wards have now been published, and are given in the following Table:— ###] [Census Population, 1901. Census Population, 1911. Increase + Decrease — Difference per cent. Estimated Population, 1912. The Borough 176,628 172,317 -4,311 - 2.5 172,000 North Kensington 91,018 88,100 -2,918 - 3. 87,885 South Kensington 85,610 84,217 -1,393 - 1.7 84,115 St. Charles 21,937 22,737 + 800 + 3.5 22,798 Golborne 26,307 25,567 - 740 - 2.9 25,513 Norland 23,449 21,187 -2,262 -10.7 21,018 Pembridge 19,325 18,609 - 716 - 3.8 18,556 Holland 20,391 20,263 - 128 - 0.6 20,254 Earl's Court 18,064 17,618 - 446 - 2.5 17,585 Queen's Gate 14,284 14,286 + 2 — 14,286 Redcliffe 18,713 19,101 + 388 + 2.0 19,131 Brompton 14,158 12,949 -1,209 - 9.3 12,859 In South Kensington it is satisfactory to note that in two wards there has been no decline, in Holland and Earl's Court the decline has been insignificant, whilst Brompton, with a decrease of 1,209 or close on 10 per cent., is the only ward in the South in which a serious loss has occurred. The most remarkable feature of the figures for North Kensington is the inequality of the losses in the poorest areas. Both in Norland and Golborne the large number of empty tenements is very noticeable, but whilst the former ward has suffered a loss of 2,000, or more than 10 per cent. the loss in Golborne has only amounted to 740, or less than 3 per cent. The increase in the population in St. Charles' Ward has been due to the erection and occupation of new houses on the St. Quintin's Park Estate. A fall in the excessive rents which the working classes are obliged to pay for their lodgings might be expected to follow in districts where the number of persons is diminishing, but it is to be feared that the advantages of such a result are unfortunately likely to be outweighed by the necessity for accepting undesirable tenants of the lowest class which the necessity for accepting lower rents usually involves. 4 For the year 1912 the population for each ward has been calculated on the assumption that the rise or fall in the intercensal period has continued at a slightly reduced rate, and the results have been shown in the fifth column of the above Table. Marriages.—The marriages celebrated during the year numbered 1,637. 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 3,068, but this figure does not include 250 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, 3,318. The birth-rate expressed as the number of births per 1,000 of the population was 19.3. Arranged as to sex and legitimacy the births were as follows:— ###] Male. Female. Total. Legitimate 1,597 1,538 3,135 Illegitimate 94 89 183 Total 1,691 1,627 3,318 Still births cannot be registered and are therefore not included in the above figures. 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. North Kensington Total Births. Birth-rate per 1,000 of the Population. 2,363 27 South Kensington 955 11 St. Charles 610 27 Golborne 825 32 Norland 577 27 Pembridge 351 19 Holland 266 13 Earl's Court 200 11 Queen's Gate 128 9 Redcliffe 229 12 Brompton 132 10 The Borough 3,318 19 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 of child-bearing age in the districts compared. The births occurring every year in Kensington have fallen in round numbers from 4,500 in 1380, to 3,300 in the present year The steady decline in the birth-rate is shown in Table V. Appendix, p. 79, where the number of births and the birth-rates both for London and Kensington are given for each quinquennial period since 1881. The figures for each year were given in the Annual Report for 1908. The fact that the total number of births has risen by 128, from 3,190 in 1910 to 3,318 in the present year, affords some hope that a limit may have been set to a downward movement which will end in national extinction if it is not checked. 5 Illegitimate Births.—The illegitimate births numbered 183, and were equivalent to a rate of 11 per 10,000 persons living as compared with a rate of 9 for London in the year 1911. Notification of Births.—The Notification of Births Act, 1907, requires every birth to be notified within 36 hours to the Medical Officer of Health, either by the father of the child or by some person in attendance upon the mother in her confinement, and applies to still-born children as well as to children who are born alive. The requirements of the Act are advertised on the back of the rate-demand note, and brought to the notice of parents who fail to notify by a printed circular letter. Out of the 3,068 live births registered as having occurred in Kensington, 2,716 or 89 per cent. were notified to the Medical Officer of Health. The unnotified births accordingly amounted to 352 or 11 per cent. of the number registered during the year. The subjoined figures show that 3,004 births in all were notified, and that the notification certificates received from various sources numbered 3,021, and included 17 duplicates. Source of Notification. Notifications received. Duplicate notifications. Number of Births Notified. Still Births. Live Births. Total Births. Midwives 1,495 10 48 1,437 1,485 Parents 648 4 8 631 689 Medical Practitioners 564 3 29 5 32 561 Other Persons 119 0 8 116 119 Births in the Borough 2,821 17 88 2,716 2,804 Institutions outside the Borough 200 — 7 193 200 Total 8,021 17 95 2,90 9 8,004 Of the notifications received 200 were forwarded by the London County Council, and related to infants born of Kensington mothers in Queen Charlotte's Hospital and other Institutions beyond the Borough. Still Births. -The infants notified as still-born numbered 95. Still-births are not registered, ana it should be noted that they are accordingly not included in the numbers on which the birthlates for the Borough and the various wards have been calculated. Information could only be obtained in regard to 40 out of the total number of still-born infants notified. Ten were noted as illegitimate, three were born dead from three twin pregnancies, and five were born in wedlock of mothers employed in laundry work. In 29 cases the mother is known to have followed no occupation. Twelve children were born from the first or second pregnancy, 16 from the sixth or some later conception, and 12 from intermediate pregnancies. A history of one or more previous miscarriages or still-births was obtained in 9 cases, and of two or more in 5 cases. The immediate cause of still-birth where detailed information was obtained, appears to have been in 9 cases haemorrhage during pregnancy, in 6 cases difficult labour and in 4 cases malpresentation. In 21 cases labour and pregnancy, according to the mother's statement, were normal, and no cause for the still-birth could be assigned. No reference has been made to syphilis as a cause of miscarriage and still-birth, because the necessary inquiries for obvious reasons cannot be undertaken by the Council's Health Visitors. Deaths.—The corrected number of deaths was 2,287. The crude death-rate was 133 and the corrected death-rate 14.3 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 " non- 6 residents " occurring in institutions or other places in Kensington. The following figures show how the corrected number of deaths given above has been obtained:— Total deaths registered in the Borough 2,524 Deaths of residents beyond the Borough 446 2,970 Deaths of non-residents within the Borough 683 Corrected number of deaths belonging to the Borough 2,287 The corrected death-rate is designed to represent the mortality that would have occurred bad 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 13.3 to the corrected rate of 14.3 already given. Where comparisons are instituted between populations with a widely different age and sex composition the use of corrected death rates 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 18.5 1901-1905 14.7 16.4 1906-1910 13.8 14.9 1911 13.9 15.0 1912 13.3 — 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 V. Appendix, p. 79. 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 South Kensington 1.410 877 16.0 10.0 St. Charles Golborne Norland Pembridge 339 409 376 286 15.0 16.0 18.0 15.0 Holland Earl's Court Queen's Gate Redcliffe Brompton 199 229 118 224 112 10.0 13.0 8.0 12.0 9.0 The Borough 2,287 13.0 7 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. 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 136 Epidemic influenza 28 Puerperal fever 6 Phthisis 179 Other tuberculous diseases 48 Cancer 228 Bronchitis 209 Pneumonia 161 Heart diseases 278 Bright's disease 75 Diseases and accidents of parturition 9 Premature birth 60 Accidents 77 Old age 74 All other causes 719 2,287 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) diarrhoea and enteritis. 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 179 were due to tuberculosis of the lungs. It should also be noted that cancer was the cause of 228 deaths, as compared with 197 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 III. Appendix, p. 77, 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 VI. and VII. Appendix, p. 80, arranged in quinquennial periods since 1881. infantile mortality. The deaths among infants under the age of one year numbered 305, the infantile mortality rate being equivalent to 92 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 comparing the death-rates in different districts. The following Table shows a decline in the infantile death-rate from 172 in the quinauennium 1896-1900 to 120 in the years 1906-1910. In the year under consideration the rate fell to 92, the lowest infantile death-rate ever recorded in Kensington. Period. Deaths under one year per 1,000 Births. Kensington. London. 1896-1900 172 162 1901-1905 144 139 1906-1910 120 114 1911 135 129 1912 92 — 8 This remarkably low rate has been due to the absence of any serious outbreak of measles, and to the cold summer which prevented the occurrence of epidemic diarrhcea. 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 245 104 South Kensington 60 63 St. Charles 59 97 Golborne 76 92 Norland 70 121 Pembridge 40 114 Holland 13 49 Earl's Court 11 55 Queen's Gate 13 102 Redcliffe 16 70 Brompton 7 53 The Borough 305 92 The figures in the second column of the Table show that the infantile death-rate in North Kensington has been half as high again as in South Kensington. The mortality in the Norland district, which contains Notting Dale, was equivalent to 121 deaths per 1,000 births, whilst the unsatisfactory social conditions prevailing in certain parts of the Pembridge ward are reflected by a rate which exceeded 114. For the ward of Holland an infantile death-rate of less than 50 was recorded. Causes of Infantile Mortality.—In the following Table the deaths occurring in infants under the age of 12 months during the year 1912 and the two preceding years have been classified according to the nature of the disease which was in each case certified as the cause of death. Cause of Death. Number of Deaths. 1910 1911 1912 Common infectious diseases 23 48 19 Diarrhcea (including enteritis, etc.) 33 123 32 Premature birth 66 41 60 Congenital defects (including injury at birth and atelectasis) 27 10 23 Wasting and debility 48 53 62 Tuberculous diseases 15 15 13 Syphilis 1 7 15 Bronchitis and pneumonia 89 63 40 Overlaying 4 4 4 Other causes 39 71 37 345 435 305 9 It will be noticed that in 1912, more than one-fourth of the deaths were due to premature birth or congenital defects, that is to say to antenatal causes. Until the nature of these causes has been determined, it is not likely that any considerable reduction will be effected in the number of the deaths returned in each year under these two heads. Wasting diseases, bronchitis and pneumonia together produced 102 deaths, or more than one-third of the total number, and here there is no doubt scope for preventive work. Improper feeding through ignorance is not only a cause of wasting, but also a frequent predisposing cause of the condition in which a child is specially liable to be attacked by bronchitis or pneumonia with fatal results. Among the exciting causes of the latter diseases may be mentioned insufficient and improper clothing, and exposure to cold either in the home or out of doors. Diarrhoea, which caused 32 deaths, is no doubt due in a certain proportion of cases to improper feeding. In years marked by excessive heat during the summer months, when the deaths from this cause in infants alone may exceed 120 as they did in 1911, the diarrhoea in the great majority of cases should probably be regarded as a symptom of a specific infectious disease, which the greatest care on the part of the mother may fail to prevent. The deaths from congenital venereal disease (syphilis) amounted to 15, as compared with 7 deaths and 1 death from the same cause in the years 1910-11. On the whole it seems probable that this increase is only apparent, and has resulted from the entry of the true cause of death on the death certificate in place of the symptoms of syphilis, such as debility or wasting to which deaths from congenital venereal disease appear to have been ascribed in past years. The Effect of Age.—In its bearing on the scope of preventive work, the age incidence of death in infants is important. Of the total deaths 91 took place in the first week, and 132 or more than one-third in the first three weeks of life. Premature birth and congenital defects accounted for 74 or more than half of the deaths occurring at this early period. Thirty-two children died of wasting or debility before the age of 14 days, and of this number a large proportion were no doubt either born prematurely or with some constitutional or physical defect. The conclusion suggested is that in the first three weeks of life close on 100 deaths occurred which were not preventable, in the sense that they took place in defective children whom no ordinary care could have saved. At this period, there were only 3 deaths from pneumonia and bronchitis and cne death from diarrhcea. After the first month a large proportion of the deaths, which decline steadily in number with advancing age, may be regarded as an unnecessary and avoidable loss to the community. The dangers of weaning and artificial feeding are shown by the appearance of 13 deaths from diarrhoea in the age period 3—6 months, and of deaths from tuberculosis after the fourth week, whilst the deaths from wasting must now be accepted as directly due to want of breast milk and improper feeding, rather than to congenital debility. In regard to infectious disease, it is interesting to note that infants in the first halt year are practically immune to measles, and that all the nine deaths from this disease in infancy occurred after the age of six months. Unfortunately the same cannot be said of whooping cough, which caused deaths from the age of four weeks onwards. A detailed analysis of the deaths in infants according to age and cause will be found in Table IV. in the Appendix. Illegitimacy.—Sixty-five deaths occurred among illegitimate infants. The illegitimate births numbered 182. The mortality among the illegitimate was accordingly equivalent to a rate of 357 deaths per 1,000 births, as compared with a rate of 79 among those born in wedlock. With the lamentable exception of syphilis, which in proportion to the total numbers, caused four times as many deaths among the illegitimate, there has been no striking difference between the two classes in the incidence of the chief causes of death or in the incidence of death at various ages in the first 12 months of life. If these somewhat unexpected results are not due to fallacies arising from the inadequacy of the numbers under consideration, the inference suggested is that the preventable deaths among the legitimate are due to disabilities of the same kind, if not of the same degree, as those which lead to the death of the infants of single women. Thus the lot of a child which is put out to be minded during the day by the grandmother or some other elderly woman is much the same, whether the mother is obliged to go out by a lazy, drunken husband, or by the fact that she has no husband to support her. In either case it is to be feared that the antiquated methods of the grandmother cannot be regarded as an unimportant factor in the causation of excessive infantile death-rates. Occupation of Mother.—The subjoined Table shows the occupation of the mother and other particulars recorded by the Health Visitors in their visits to the homes of infants who died in 1912, and of infants who were notified in and survived to the end of the same year. No particulars have been obtained in the case of infants in homes where the income presumably exceeds 40s. per week, as this class of home is not visited and illegitimate children have been excluded. 10 A comparison of the percentages shown in the Table suggests that the death-rate is distinctly greater amongst the infants of mothers engaged in laundry work and other occupations, than it is amongst the infants of married women whose work is confined to the performance of household duties. These results are consistent with those obtained in former years. Artificial Feeding.—On the grounds that congenital debility is the predominating cause of death in the newly born, 67 infants who died before the age of seven days have been excluded from the figures in the Table that relate to methods of feeding. The records which were made of 104 deaths between the ages of 7 days and 12 months, show that more than 45 per cent. occurred in infants who were being artificially fed before the onset of their fatal illness, whereas the records of previous years suggest that less than 35 per cent. of the total infant population are artificially fed in the same age period. The fact that the artificially fed contribute more than their share to the total number of infant deaths is established, and for this reason it has not been considered necessary to make an annual census of their numbers at several age periods. The firs visit is made between the ages of 10 and 20 days, and it is to this period that the records of the feeding of children who survived to the end of the year 1912 relate. They show that 93 per cent. were still being fed on the breast alone in their second or third week of life, but they cannot be used for the purpose of comparison with the records of the deaths of infants at every age after the 7th day. Particulars Recorded. Cases in which Particulars were Recorded. Survivors. Deaths. Number. Per Cent. Per Cent. Number. a. Occupation of Mother— Laundry work 174 14 18 25 Charing, house-work (out) 45 4 7 10 Other occupations 43 3 4 5 No occupation 976 79 71 102 Totals 1,238 100 100 142 b. Mode of Feeding— Cow's milk alone 42 8 22 23 Breast and cow's milk 22 2 11 11 Condensed milk alone 12 1 2 2 Other foods with milk 16 1 11 12 Total artificial 92 7 46 48 Breast alone 1,161 93 54 56 Totals 1,253 100 100 104 c. Number of Rooms in Tenement— 1 227 19 20 28 2 754 63 58 80 3 145 12 13 18 4 or more 68 6 9 12 Totals 1,194 100 100 138 Basement rooms only 174 15 11 15 11 Housing.—The figures in the Table suggest that the size of the tenement, that is to say the number of rooms occupied by the family of an infant exercises no effect on its chances of survival. And these results may with some probability be explained by the fact that the parents' income does not in the majority of cases increase with the size of their family and their need for larger tenements. In other words an increase in air space may mean a diminution in the food supply. The fact that the percentage of infants in basement rooms has been less among those who died than among those who have survived admits of no explanation except that a misleading result has been produced by the use of numbers which are too small to be used for statistical purposes. PREVENTION OF INFANTILE MORTALITY. Work with a view to improving the physique of infants and reducing the infantile death-rate is carried out by the Council's Health Visitors and a number of highly efficient voluntary agencies. During the year the two Health Visitors have been to the homes of 2,284 newly-born infants, and have paid 5,605 visits or re-visits for the purpose of giving advice in infant management. 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 attending 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 progress in a satisfactory home, and especially if the mother's previous history as to ability to nurse and rear her children is good, a second visit may not be necessary. Where, as in the case of a first baby, the mother is in need of further advice re-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. 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 267 instances, infants in the Wornington Road district have been referred to the Lancaster Road School for Mothers, and have been visited from the outset by the hospital nurse attached to the School. In the northern half of the Borough there are now three "schools for mothers" maintained by voluntary contributions, 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 centres sewing classes are held and lectures on infant care are given. In a period of 12 months more than 590 mothers have attended the infant consultations at one or other of the three centres. The total number of dinners supplied to expectant or nursing mothers during the year amounted to 25,229, and cooking classes for mothers have been held both at the Bramley Road School and the school in the Lancaster Road. Special mention should also be made of the extension of the Bramley Road scheme by which children at any age under 5 years may now be brought to the "infant" consultations, so that the school, to quote the words used in the Annual Report of the Committee, is now able "to carry on a most important work, viz.: the bridging of the gap between early infancy and the medical inspection of children of school age." Through the close connection which exists between the schools for mothers 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. 15 THE INFECTIOUS DISEASES. For administrative purposes the epidemic 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. 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, 1912, without any limitation of the period during which the Order is to continue in force. SMALL POX. No case of small pox occurred in Kensington during the year; 6 cases in all were notified in the Metropolis, and of this number 3 occurred in Woolwich in the first two months of the year. In April one case was notified in Woolwich and one case occurred in the Port of London. The last case notified during the year occurred during the first week of September in the Borough of St. Pancras. DIPHTHERIA. During the year 180 cases of diphtheria were notified and of these 5 proved fatal. The seasonal incidence of diphtheria, with that of scarlet fever and enteric fever is illustrated by the subjoined Table:— /###]Report for four weeks ended No. of Notifications. Diphtheria. Scarlet Fever. Enteric Fever. January 27 24 24 0 February 24 25 26 0 March 23 13 16 0 April 20 15 25 1 May 18 15 22 1 June 15 19 25 0 July 18 14 46 0 August 10 13 23 4 September 7 11 13 2 October 5 13 14 1 November 2 4 80 2 November 30 5 20 3 December 28 9 13 1 180 297 15 The increased prevalence of diphtheria in the first two months of the year had already become well marked in the preceding month of December, and followed on a large increase in the number of notifications throughout London in the late autumn of the year 1911. With the exception of six cases which occurred in an orphanage, there was no marked incidence on any particular ward to account for the 49 cases notified in January and February from various parts of the Borough. In the months of October and November only 9 cases in all were notified, as against the monthly average of fifteen. In 51 cases the source of infection appears to have been 16 as follows:—In residential institutions other than schools or hospitals, 11 cases; in schools, 9 cases; in hospital wards, 10 cases; from a case previously notified in the patient's home, 8 cases; from an unrecognised case in the patient's home, 3 cases; from a diphtheria patient discharged from hospital, 2 cases; from sources beyond the Borough, 8 cases. In 28 houses where diphtheria occurred the drainage system presented defects, which were remedied in response to notices from the sanitary inspectors. For diagnostic purposes or the detection of healthy carriers, swabbings were taken from the nose or throat of suspected persons in 340 instances, and examined for the presence of diphtheria bacilli at the Council's expense in the bacteriological laboratories of the Lister Institute. In 52 cases the diphtheria bacillus was found. Anti-toxin was administered at the Council's expense to 14 diphtheria patients, to 19 persons who had been in contact with patients, and to 4 persons who were suspected to be suffering from diphtheria, or to 37 persons in all. By a resolution passed at the meeting of the Council on January 16th, the fee payable to practitioners for the administration of the Council's antitoxin to contacts was reduced from 5s. to 2s. 6d., and by a further resolution passed on December 17th, the Council's offer to supply anti-toxin and to pay fees for medical assistance in connection therewith was limited to cases of diphtheria patients and persons suspected to be suffering from diphtheria. Out of 180 patients notified only 8 had acquired the infection from a recognised case of diphtheria in the same house, although the number of susceptible persons exposed to infection at home could not well have been less than 300. This is the usual experience in any district and in any year, and shows diphtheria to be, save in exceptional circumstances, a disease of low infective power. It is also now recognised that untoward results have followed the administration of anti-toxin to healthy persons, and although such results are uncommon, they contra-indicate the promiscuous use of anti-toxin as a preventive measure against a disease to which so many susceptible persons are exposed without becoming infected. Of the eight persons infected at home by previously notified cases, the majority had probably acquired the disease before the notified case had been seen by a medical practitioner. In these circumstances had some three hundred healthy persons in contact with the 180 patients notified during' the year received prophylactic doses of anti-toxin at a cost to the Council of £75, less than 8 persons and possibly none would have been saved from an attack of diphtheria, and this result could not have been achieved without some slight risk of injury to one or more of the 300 contacts, who, as a matter of fact, escaped without any special measures being adopted. The following Table shows the number of cases of diphtheria and the mortality during 1912 and in previous years. Diphtheria in Kensington, 1901-1912. Year. Cases Notified. Case-rate per 1,000 of population. Deaths. Death-rate per 1,000 of population. Case-mortality per cent. 1901—1910 1911 1,850 212 1.06 1.23 212 20 0.12 0.12 11.5 9.4 1912 180 1.05 5 0.03 2.8 From the figures given it will be seen that the disease has been exceedingly mild in type, since the case fatality did not exceed three deaths per hundred cases. The number of cases notified was 180 as compared with extremes of 125 in 1905, 234 in 1907, and the annual average of 185 cases during the past ten years. SCARLET FEVER. During the year '297 cases of Scarlet Fever were notified, and of these only 5 proved fatal. The seasonal incidence of the disease which has already been shown with that of diphtheria, was heaviest in the months of June, July, and again in October. In the Metropolis as a whole there was no corresponding increase in the early summer months, but the October rise was general throughout London. Of the 46 cases notified in the four weekly period ending on July 13th, 24 occurred in the two Wards of St. Charles and Golborne, and 8 in the Ward of Holland. 17 Six cases were notified from one lodging house in the Telford Road, and six occurred in the northern half of Ladbroke Grove. Four out of 8 cases were notified in the Dartmoor Street area of Holland Ward. There was no common source of infection in schools or in the milk supply, but the grouping of the cases in streets or houses situated in close proximity to one another suggests that the disease was probably spread by children mixing together in the streets of the districts attacked. The total number of cases notified was 85 below the annual average for the 10 years 1901-1910. The type of the disease was also exceptionally mild, the case mortality being equivalent to only 17 deaths as compared with an average of 30 deaths among every thousand cases, in the last intercensal period. Scarlet Fever in Kensington, 1901-1912. The Year. Cases notified. Case rate per 1,000 of population. Deaths. Death rate per 1,000 of population. Case mortality per cent. 1901—1910 3,870 2.22 115 0.07 3.0 1911 227 1.32 3 0.02 1.3 1912 297 1.73 5 0.03 1.7 In 84 instances inquiry elicited a definite history of contact with persons suffering from Scarlet Fever. Nineteen cases were due to infection in schools; 12 were due to contact with persons recently discharged from hospital after an attack of Scarlet Fever; 5 arose from contact with "missed cases" or persons who had suffered from unrecognised attacks of the disease. In 6 cases the infection was derived from sources beyond the Borough. Three patients acquired the disease in hospital, and in two instances the symptoms of Scarlet Fever appeared in less than three days after an operation for the removal of the tonsils. Defects in the drainage system were found in 24 of the houses where Scarlet Fever occurred. ENTERIC FEVER. The number of cases of enteric fever notified during the year was 15, the number of deaths being 4. Such figures are too insignificant to afford a proper basis for discussing the seasonal incidence and the fatality of this disease in Kensington. In the decennium 1901-1910, the receipt of 529 notifications of typhoid fever and the occurrence of 86 deaths gave an annual average of 53 cases and 9 deaths. The following figures show the remarkable decrease in the prevalence of the disease, which has taken place in the last two years:— Decennium 1901—1910 Cases 529 Deaths 86 Averages „ „ 53 „ 9 1911 „ 20 „ 4 1912 „ 15 „ 4 Of the 15 patients notified 7 had acquired the infection beyond the boundaries of the Borough. In only one case was the disease alleged to have followed the consumption of shell-fish, and in 7 cases no clue as to the source of infection could be obtained. PUERPERAL FEVER. Eight cases of puerperal fever were notified during the year and of this number six proved fatal. Three patients were attended in the first instance by midwives and five by doctors. In two of the cases attended by midwives labour was normal; in the third case the birth of the child was followed by severe haemorrhage. In two of the doctors' cases the child was delivered by instruments; the confinement in the third case took place in the Infirmary; two patients were in good circumstances and details as to the progress of labour were not obtained. In no instance 18 did more than one case of puerperal fever occur in the practice of the same midwife or doctor during the year. Two cases were removed to the Infirmary, one case was removed to a general hospital, and one to a special hospital for women. By an Order dated February 18th, 1911, the Metropolitan Asylums Board were authorised to admit to their hospitals, with the consent of the Local Government Board, certain classes of poor persons who were formerly not eligible for admission. Under this Order the consent of the Board was subsequently given to the admission of poor persons suffering from measles, whooping cough, or puerperal fever. By an Order dated August 20th, 1912, the Local Government Board further authorised the Managers of the Metropolitan Asylums Board to admit into any of their hospitals a person suffering from puerperal fever who is not a pauper, and who has been recommended for admission by the Medical Officer of Health for the Metropolitan district in which the said person is residing. After the publication of this Older only two cases of puerperal fever were notified before the end of the year 1912. Both patients were in good circumstances and unsuitable for admission to a public hospital. When a midwife has been in contact with infection, her washable clothing is boiled and other clothing is disinfected by the staff of the Public Health Department. As soon as she has disinfected herself, her clothing and her appliances to the satisfaction of the Supervising Authority, she is allowed to resume her work. The premises where puerperal fever has occurred are inspected, but they are not in ordinary circumstances disinfected. OTHER NOTIFIABLE DISEASES. Ophthalmia Neonatorum.—Twenty-two cases of ophthalmia in newly-born infants were notified during the year. The results recorded were as follows:— Recovery with unimpaired vision in both eyes 15 cases One eye vision impaired—One eye vision normal 1 case One eye blind—One eye vision normal 1 case Both eyes vision impaired without blindness 1 case Blindness in both eyes and death of patient 2 cases Death during course of treatment 2 cases Total 22 cases Thus out of 18 infants who survived, 15 recovered with unimpaired vision. Of the three remaining infants one presented opacities in both cornæ which were not central, but which encroached on the lower margin of the pupil. One was blind in one eye and one presented an opacity in one eye which occluded vision except through the upper half of the pupillary aperture. In addition to the 22 notified cases of ophthalmia, 11 infants were reported by the London County Council Inspector of Midwives as suffering from inflammation of the eyes, which did not result in any impairment of vision. The Health Visitors visit every case of inflammation or ophthalmia in their respective districts as soon as the notification is received, and assist the mother of the infant to obtain the necessary treatment. 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. Similar arrangements have also been made with the Ranyard Nurses, who are prepared to pay four visits daily to cases of ophthalmia in their district on the Hammersmith border of North Kensington. 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. Anterior Poliomyelitis—Only one case of this disease was notified in 1912. The patient was a girl aged 2 years. Her family were in fairly good circumstances, occupying 5 rooms and the father was employed as a printer's machine minder. There was no evidence of vermin in the house and no animals were kept at the time of the inquiry, but three rabbits had recently died on the premises. The child had been in contact with a patient suffering from measles on the day before the first symptoms of acute anterior poliomyelitis appeared. 19 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 'J able of deaths occurring in the year 1912. Epidemic Notifiable. Deaths, 1912. Diphtheria 5 Erysipelas 5 Scarlet Fever 5 Enteric Fever 4 19 Diseases. Non-Notifiable. Deaths, 1912. Measles 27 Whooping Cough 25 Influenza 28 Diarrhoea 70 150 Comment on such figures is unnecessary, except to say that they illustrate 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 epidemic diseases and the age periods in which death occurs:— Non-notifiable Epidemic Diseases in 1912. Report for four weeks ended Number of Deaths. Measles. Whooping Cough. Influenza, Diarrhoea & Enteritis. January 27 3 2 3 4 February 24 1 2 4 3 March 23 0 1 7 4 April 20 2 2 1 5 May 18 1 1 1 5 June 15 2 2 1 5 July 13 0 4 0 5 August 10 0 0 0 6 September 7 1 0 0 October 5 0 1 1 8 November 2 6 2 2 7 November 30 ... 5 2 3 G December 28 ... 6 6 5 5 Total 27 25 28 70 Age at Death. Measles. Whooping Cough. Influenza. Diarrhoea & Enteritis. Under 1 year 9 9 0 32 Under 5 years 26 22 0 40 5 to 15 years 0 3 0 5 15 to 65 years. 1 0 17 12 65 years and upwards 0 0 11 13 Total 27 25 28 70 20 Fatal diarrhoea is seen to be a disease of infancy, increasing in prevalence in the late summer and easy 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 27 and with only one exception occurred in children under 5 years of age. In the first 9 months of the year after the serious outbreak of 1911, the deaths from Measles remained well below the average number. In the last quarter of the year a noticeable rise in the death-rate has since proved to have been the beginning of an extensive epidemic in the first Quarter of 1913. 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 485 cases were notified; 144 additional cases were found in the homes visited, the total number of cases coming to the notice of the Public Health Department being 629. Out of this number only 159 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 Wornington Road School, where 75 children were attacked; Buckingham Terrace School contributed the next largest number, notifying 51 cases of measles during the year. The cases admitted to the hospitals of the Metropolitan Asylums Board numbered 140. WHOOPING COUGH. The deaths from whooping cough numbered 25; the number of cases brought to the notice of the Public Health Department by the schools being 240. In the homes visited 64 additional cases were discovered; the total number of cases dealt with by the Sanitary Inspectors being 304. An advisory leaflet was left with the mother of each family visited. The largest number of cases occurred in the Portobello Road School, where 20 children were attacked; the Wornington Road School contributed the next largest number, notifying 11 cases of whooping cough during the year. Of the cases visited only 54 had received medical treatment. The limitation of fatal whooping cough to young children was shown by the fact that 22 out of 25 deaths, or 88 per cent. of the total number registered during the year, occurred in children under the age of 5 years. During the first 7 months of the year beds in the hospitals of the Metropolitan Asylums Board for persons suffering from whooping cough were only available for pauper patients applying for admission through the officers of the Poor Law Guardians. On August 9th, 1912, the Local Government Board issued the Metropolitan Asylums (Whooping Cough) Order, 1912, which authorises the admission to the hospitals of the Managers of the Metropolitan Asylums Board of nonpauper patients with whooping cough on the recommendation of the Medical Officer of Health. The following restrictions, which also apply to cases of measles, are imposed by the Order, namely:— 1. That the Managers shall not receive a non-pauper case, unless they have more accommodation than is required tor pauper patients. 2. That the recommendation of the Medical Officer of Health shall be accompanied by such information respecting the circumstances of the patient as the Managers may require, and 3. That when it becomes necessary to determine the priority in which patients shall be admitted, the Managers shall have regard to each patient's need of isolation in the interests of the public health. Information is required by the Managers under the following heads:—l. Number of children under 5 years of age in family who have not had the disease, ii. Number of rooms occupied by patient's family, iii. Is the patient seriously ill? iv. Do you consider the home conditions prejudicial to the patient's chances of recovery? The questions in themselves are sufficient to indicate the circumstances under which the Medical Officer of Health J5 now able to secure the removal of patients with whooping cough or measles to hospital. During the year 82 cases of whooping cough were admitted to the hospitals of the Metropolitan Asylums Board. 21 EPIDEMIC DIARRHŒA During the year diarrhoea and enteritis caused 70 deaths as compared with 184 deaths from the same group of diseases in 1911. The striking reduction in the mortality under this head was due to the unusually cold weather which prevailed throughout the summer months. Diarrhoea in its epidemic form is chiefly fatal in young children under the age of 5 years. From the Table on p. 19 it will, however, be seen that more than 43 per cent. of deaths from diarrhoea and enteritis occurred in persons over 5 years of age, as compared with only 28 per cent. in the preceding year. This anomalous incidence is due to the fact that the group diarrhoea and enteritis includes a number of intestinal ailments which attack older persons, which have no special seasonal incidence and which are consequently not affected by the temperature prevailing in the summer months. Thus, in spite of one of the hottest and one of the coldest summers on record, the deaths from diarrhoea and enteritis in persons over the age of 5 years numbered 28 in 1911, and 30 in 1912. In children under the age of 5, the deaths numbered 156 and 40 respectively in the same two years. The subject of diarrhoea and its prevention was dealt with at length in my last report and need not be considered further in a year when the number of deaths from the disease has been comparatively small. TUBERCULOSIS The number of deaths from tuberculosis was 227, the death-rate being 1.32 per 1,000. The mortality in the years 1901-1912 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, 1901-1912. Period. Number of Deaths and Death-rate per 100,000 persons living. Phthisis. Other Tuberculous Diseases. Tuberculosis—All Forms. Deaths. Death-rate. Deaths. Death-rate. Deaths. Death-rate, 1901-1910 1,966 113 807 46 2,773 159 1911 155 90 48 28 203 118 1912 179 104 48 28 227 132 Since 1900 the death-rate from tuberculosis has varied between extremes of 195 per 100,000 ii: 1904, and 109 in 1910, as compared with a rate of 132 in the year under consideration, and an average rate of 159 in the ten years 1901-1910. On the whole the figures afford ground for the hope that the reduction in the mortality from this disease which has occurred in the last six years will be maintained. PHTHISIS. In the year under notice the deaths from tuberculous phthisis, or pulmonary consumption, numbered 179, and corresponded to a rate of T04 per 1,000 living. They were responsible for 79 per cent., or more than 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 58 per cent. of the deaths, the mortality among males being higher than among females. The death-rate was considerably higher than in 1911, and only 8 per cent. below the average rate in the decennium 1901-1910. 22 It will be of interest to consider next in order the incidence of deaths from phthisis upon the different Wards in the Borough. Deaths from Phthisis in Wards, 1906-1912 District. Number of Deaths. Death-rates per 10,000. 1906. 1907. 1908. 1909. 1910. 1906-10. 1912. 1906-10. 1912. North Kensington 154 113 139 121 96 623 132 12 15 South Kensington 60 61 42 47 42 252 47 6 6 St. Charles 34 25 25 20 21 125 28 11 12 Golborne 48 31 43 29 31 182 39 14 15 Norland 52 40 50 50 30 222 45 20 21 Pembridge 20 17 21 22 14 94 20 10 11 Holland 21 16 12 16 8 73 12 7 6 Earl's Court 13 15 11 15 11 65 10 7 6 Queen's Gate 7 7 2 5 5 26 5 4 4 Redcliffe 11 15 10 8 13 57 13 6 7 . Brompton 8 8 7 3 5 31 7 5 5 The Borough 214 174 181 168 138 875 179 10 10 The intimate connection between phthisis and poverty is illustrated by the experience of North Kensington, where the mortality has been three times greater than in South Kensington. Norland and Golborne are the two poorest wards and returned the highest death rate, whilst the rate in the former ward was no less than six times greater than in Queen's Gate. The whole of the excess of 24 in the number of deaths in 1912 over the number registered as due to phthisis in 1911 was contributed by the Wards of Golborne and Norland in the northern division of the Borough. 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 73 Patient's Home 74 Brompton Hospital 1 St. Luke's Home 4 Outlying Hospitals and Asylums 25 Other Deaths beyond the Borough 2 Total 179 More than one-third of the total number of deaths occurred in Poor Law Infirmaries; whilst 7 out of 74 patients who died at home had received medical relief from the Guardians during their illness. Thus 80 or approximately half the total number of 179 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. Tuberculosis Regulations, 1908.—These Regulations, under which all cases of consumption in "poo; 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 23 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. 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 tne 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. Tuberculosis Regulations, 1911.—The Public Health (Tuberculosis Regulations, 1911), complete the system of compulsory notification, and came into force on January 1st, 1912. They extend compulsory notification from "poor persons" and hospital patients to the patients of private medical practitioners. At the time of writing, with the hospital and poor law regulations, they have been superseded by a consolidating Order which applies to every class of patient, and for this reason need not be described in detail. Action Authorised.—Each Order that has been issued has authorised the following measures:— 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. Upon the receipt ot a notification the regulations require the Medical Officer of Health, or an Officer acting under his instructions, to make such inquiries and take such steps as may be desirable for preventing the spread of infection and removing conditions favourable to infection. The Council are also authorised to assist in the detection of consumption by arranging for the bacteriological examination of sputum free of charge at the expense of the rates. National Insurance Act-This Act came into operation on July 15th, 1912, and by is 8 (b) provides at the expense of the insurance funds for the treatment in sanatoria or other institutions or otherwise of insured persons suffering from consumption or any other form of tuberculosis. Section 16 makes the annual sum of one shilling and threepence in respect of each insured person in any given county available for defraying the cost of treatment, with an additional sum of one penny per head, which may be used for the purposes of research. Section 17 authorises under certain conditions the extension of sanatorium benefit to the dependents of insured persons. If this is done and the sums available out of the insurance funds are not sufficient to meet the cost of treatment, the deficit may be made good in equal shares by the County Council and the Treasury. It is important to note that sanatorium benefit does not, as is frequently supposed, necessarily mean admission to a sanatorium, and may be conferred on an insured person in the form of treatment at home or at a tuberculosis dispensary, or by any other method that may be suited tc the medical needs of the patient. At the request of the Insurance Committee, forms of application for sanatorium benefit have been kept at the Town Hall, where they have been supplied to insured persons. The work of the department has been materially increased by correspondence in connection with insured consumptives, and by visits to their homes for the purpose of giving advice which cannot be withheld by a department which has undertaken to assist notified consumptives of every class. Much time has also been spent in the preparation of reports and in conferences with the Tuberculosis 24 Dispensary, the Brompton Hospital, and with Officers of the Local Government Board and the London County Council, on the question of ways and means for the establishment of a comprehensive scheme for dealing with insured and non-insured consumptives. In regard to finance it has been suggested that the Borough Council might be willing to pay one half of the cost of the treatment of the uninsured provided the other half were paid by the Treasury, and provided the whole of the cost of the treatment of the insured were met out of the insurance funds. As regards tne administrative control of such scheme, it has been suggested that this should be placed in the hands of the Borough Council and their officers. Since the negotiations with the various bodies concerned are still in progress, further space need not be devoted to the description of proposals which are certain to be modified before they are included in the scheme which is finally approved. Notification of Consumption.—During the year 1,945 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, 402 certificates; from the Medical Officers of hospitals, under the Tuberculosis Regulations, 1911, 1,218 certificates; and from private medical practitioners under the Tuberculosis Regulations, 1911, 265 certificates. Notifications from Officers of Guardians.—The certificates, numbering 462, 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 210 19 229 Form C 93 60 153 Form B 80 0 80 Totals 383 79 462 Of the 80 certificates on Form B from District Medical Officers 63 related to persons under treatment in their homes who were subsequently removed to the Infirmary and re-notified on Form A. Only 17 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 210, and were duly notified on Form A ; the discharges notified on Form C numbered 93, and to this figure may be added the 73 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 1912. Kensington Infirmary. Discharges 93 Deaths 73 Admissions 210 Discharges and Deaths 166 Balance 44 The balance 44 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 1912, as compared with the number under treatment at the end of 1911. (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. 25 Of the 210 notifications of the admission of consumptive patients to the Kensington Infirmary 63 referred to persons previously notified by the District Medical Officers; 19 persons were admitted twice and 4 persons were admitted three times during the year; notifications being sent on each occasion. Notifications from Hospitals.—The certificates, numbering 1,218, 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 19 455 474 St. Luke's House, Pembridge Square 2 31 33 Other Hospitals in Kensington 6 2 8 Total Certificates from Kensington Hospitals 27 488 515 Paddington & Kensington Tuberculosis Dispensary 508 — 508 Brompton Hospital—South Wing, Chelsea 39 — 39 33 other Hospitals beyond the Borough 156 — 156 Total from Hospitals not in Kensington 703 — 703 Total Certificates from all sources 730 488 1,218 From the above Table it will be seen that out of 730 medical certificates relating to ccnsumptives whose homes were in Kensington only 27 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 488 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 508 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. Notifications from Private Practitioners.—Under the Tuberculosis Regulations, 1911, 265 notification certificates were received from private medical practitioners. Twenty-eight certificates in regard to school children were forwarded by the school medical inspectors. Persons Notified.—During the year 858 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 of 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:— 26 Cases of Consumption Notified in 1912. Source of Information. Number of Cases. New Cases. Previously known. Total Cases Officers of Guardians 180 38 168 Tuberculosis Dispensary 416 54 470 Brompton Hospital 25 11 36 Other Hospitals for Consumption 37 11 48 General Hospitals 44 4 48 Medical Officer (Education) L.C.C. 21 4 25 Private Medical Practitioners 180 17 197 Reported by Sanitary Inspectors 1 0 1 Reported by other persons 4 0 4 Total cases notified in 1912 858 139 997 Death Certificates in 1912 29 150 179 Total cases reported for the first time in 1911 887 — — The chief significance of the above Table lies in the fact that within the short space of 12 months, 858 cases of consumption during life and 29 cases after death were brought to the notice of the Public Health Department for the first time. Nearly 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 tney require. That much remains to be done may be inferred from the figures in the Table which show that, out "of 179 deaths, 29 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 1912 of persons previously notified. Date of previous notification. Number of Deaths in 1912. 1903 3 1904 2 1905 I 1906 1 1907 1 1908 1 1909 1 1910 9 1911 28 1912 103 Total deaths of persons previously notified 150 27 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 tnemselves 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 rhat 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 701 120 821 South Kensington 157 19 176 St. Charles ... ... ... 182 32 164 Golborne 276 47 323 Norland ... ... ... 180 33 213 Pembridge 113 8 121 Holland ... ... 34 6 40 Earl's Court 34 4 38 Queen's Gate 25 1 26 Redoliffe 34 4 38 Brompton 30 4 34 The Borough 858 139 997 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 high figures for North Kensington are very largely due to notifications from the Tuberculosis Dispensary, an institution which makes no provision for persons tesiding 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. (Vide p. 22.) The age and sex of the persons newly notified are shown in the following Table. The high figures 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 Disnensarv :— Age and Sex of Persons Notified. Under 5 years. 5-15. 15-25. 25-35. 35-45. 45-55. 55 and u pwards. Total. Male 14 85 47 64 79 52 32 373 Female 4 72 98 143 85 53 30 485 Total ... 18 157 145 207 104 105 62 858 28 For the proper interpretation of the above Table it must be understood that the figures do not include persons who died from consumption in 1912 without having been notified to the Medical Officer of Health. In 887 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. l 2 3 4 or more. Homeless Persons in the Infirmary or in Asylums. Common Lodginghouse Cases. Total Cases investigated. Number of consumptive patients 160 345 138 180 46 18 887 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 272 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 Patieni Number of Cases. One Room Three persons Four persons Five persons More than five persons 20 23 6 3 Two Rooms Three persons Four persons Five persons More than five persons 37 60 53 70 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 900 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 287 instances the patients had undoubtedly become infected by contact at home with one or more consumptive relatives. Twelve patients gave a history of intimate contact with a consumptive friend, and three persons appear to have been infected by a fellow lodger. In twelve cases there was reason to believe that the infection had been acquired from contact with a consumptive fellow-worker, whilst six cases appear to have become infected by living in houses found to have been previously occupied by phthisical persons. \ The occupation or status of the persons newly notified and of those who died from consumption during the year was as follows:— 29 Occupation of Consumptive Persons. Occupation. Cases. Deaths. Males. Females. Males. Females. Accountant — — 1 Aerated water maker 1 — — — Artist, draughtsman 1 — 1 — Baker 2 — — — Bank manager — — 1 — Bank messenger, picture palace attendant 2 — — — Barrister 1 — 1 — Blacksmith 1 — — — Bootmaker 7 — 2 — Brass finisher, brass engineer 1 — 1 — Briar pipe maker — 1 — — Brickmaker, bricklayer 1 — 3 — Builder 2 — — — Butcher, butcher's boy 2 — — — Butler 2 — — — Canvasser 1 — — — Caretaker — 3 — — Carpenter 7 — 4 — Cellarman 1 — — — Chaircaner 1 — — — Charwoman — 9 — 4 Chauffeur 4 — — — Chimney sweep 2 — 1 — Clerk 9 3 8 — Coachman, carman, stableman 8 — 9 — Coach painter 3 — 1 — Combmaker 1 — — — Commercial traveller 1 . — 1 — Compositor 2 — 1 — Cripple 1 — — — Crossing-sweeper — — 1 — Dispenser 1 — — — Domestic servant 4 67 — 10 Dressmaker, milliner, sempstress — 23 — 8 Dyer — 1 — — Electrical engineer, electrician 3 — — — Engineer student 1 — — — Errand boy 2 — 2 — Fireman 1 — — — Feather cleaner — 1 — — Florist's assistant — 1 — — Furniture porter 2 — — — Gas mantle maker — — — 1 Gardener 2 — 1 — Gipsy 1 1 — — Grocer 1 — — — Hairdresser 1 — 1 — Handyman 2 — — — Hawker, general dealer, costermonger 5 2 4 1 House painter 14 — — — Industrial chemist 1 — — — Infant 9 6 — — Insurance agent 2 — 1 — Iron driller, hammerman 1 — 1 — Journalist - — 1 — Carried forward 117 118 43 24 30 Occupation. Cases. Deaths. Males. Females. Males. Females. Brought forward 117 118 43 24 Labourer 31 — 6 — Lampshade maker — 1 — — Laundry work 2 48 1 11 Library boy 1 — — — Living on own means 6 18 3 2 Lodging house keeper — 1 — 1 Managing director 1 — — — Mason — — 1 — Medical practitioner, student 1 — 2 — Milkman 2 — — — Motor trimmer 1 — — — Music hall artist — 1 — — N avvy 1 — — — Newsvendor 1 — — — Nun — 1 — — Nurse—asylum, hospital, monthly — 4 — 1 Paperhanger 1 — — — Pastry cook 3 — — — Persons in asylums—C.L.H., etc. 46 18 — — Photographer 1 — — — Plasterer 3 — — — Plumber — — 1 — Police constable 3 — — — Porter—coal, shop, railway, etc. 8 — 4 — Postman, telegraph boy, sorter 6 — — — Printer's apprentice 1 — - - — Publican, potman 5 — 4 — Rag sorter, rag dealer 3 — — — Rent collector — 1 — — Road sweeper 1 — — — Salvation Army officer 1 1 1 — Scaffolder 2 — 1 — School boy, girl (elementary) 77 70 5 3 School master, mistress 1 2 — 1 Shop assistant, shop keeper 2 10 10 2 Sign writer 1 — — — Slater — — 1 — Soldier — — 1 — Son of artizan or labourer above school age 8 — — — Street singer — — 1 — Sweetmaker — 1 — — Tailor, tailoress 11 2 3 — Tin plate worker — — 1 — Tubeman 1 — — — Typist — 1 — — Unspecified occupations 17 24 7 11 Upholsterer 1 — — — Valet — — 2 — Waiter, waitress 1 ] 2 — Warehouseman 1 — — — Watchmaker 1 — — — Wife or daughter of tradesman, artizan or labourer — 162 — 23 Wood chopper 3 — — — Totals 373 485 100 79 31 The above figures cannot in themselves indicate the effect of occupation on the prevalence of consumption, and no conclusions can be drawn until they have been compared with the Census figures which will shortly be published, and which will show the proportion of persons in the total population engaged in various occupations. It may, however, be noted that 55 cases and 16 deaths occurred among shoemakers, clerks and tailors or dressmakers, that is to say among persons who lead an indoor life and frequently work in an atmosphere which is close because the means of ventilation in their workplaces are either inadequate or not used. 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, 831 first visits and 854 revisits were paid by the Lady Inspectors to the homes of the consumptive persons who were notified to the Public Health Department during the year. In addition, 102 visits were paid to the homes of persons who had died. For the sake of brevity, the action taken during the year for the prevention of consumption may be summarised in tabular form as follows:— I.— The 'Number of Visits -paid during the year. a. First visits after notification 831 b. Subsequent visits 854 c. Visits after death 102 Total visits paid during the year 1,787 II.—Provision for Home Treatment. Bedsteads and bedding lent 10 III.—Patients or Contacts sent to Hospitals or other Institutions. a. To the Tuberculosis Dispensary 38 b. To the Brompton Hospital 5 c. To the Millfield Home, Rustington 8 d. To other hospitals or institutions 25 e. To Maitland Sanatorium 13 Total number sent to institutions 89 1 V.—Disinfection after Death or Removal to Hospital. Cases where bedding, etc., was disinfected by steam... 207 Number of rooms disinfected 275 Number of rooms stripped 21 V.—Children attending the elementary schools and notified to the Mcdical Officer (Education), London County Council, as living in contact with consumptive persons 405 VI.—Specimens of Sputum from suspects examined bacteriologically by the Lister Institute at the expense of the Council 30 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. 288 pocket sputum flasks and 252 sputum cups have been purchased by the Council during the year for the use of consumptives. The greater number of these flasks and cups have been distributed at the Tuberculosis Dispensary; the remainder have been taken to the homes of consumptive patients by the Lady Inspectors. 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. 32 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 rectifications received it would appear that 183 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 73 died of phthisis in the Infirmary. Returns as to the average curation of stay in the Infirmary are not available; but the notifications show that 19 patients were admitted twice during the year, whilst four consumptives entered and left the Infirmary on no less than three 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 years 1911 and 1912. 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 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 is the examination of members of the patient's family for signs of incipient or advanced consumption. The 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 cf 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 1912, which will shortly be published. During the year 1911, 470 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 1912 amounted to 508. Special Provision by the Council.— Eight new beds provided at the Council's expense have been lent to consumptive persons for the purpose of preventing the spread of infection, and two lent last year were returned, after removal of the patient, and after disinfection lent again. The circumstances of out-patients to whom beds were lent, were as follows:— Case 1. G. B., a lad aged 18 was found sleeping with two brothers. A second bed provided March 20th. Case 2. W. V., a boy, aged 9, sleeping with father and brother. A second bed provided March 20th. \ Case 3. E. Y., aged 33, sleeping with husband and child. A second bed provided March 21st. Case 4. M. F., sleeping with husband and child. A second bed provided April 30th. Case 5. A. B., sleeping with husband and child. A second bed provided May 14th. Case 6. M. C., sleeping with husband and two children. A second bed provided July 4th. Case 7. A. S., sleeping with husband. Very advanced case. A second bed provided November 4th. Patient died and bed was returned December 12th. Case 8. A. C., sleeping with two others. A second bed provided November 11th. Case 9. E. M., sleeping with husband and child. A second bed provided November 27th. Case 10. G. L., sleeping with husband. An advanced case. A second bed provided December 18th. Open-air Shelters.—Three open-air shelters have been provided by the Council, and a small number have been supplied by the Tuberculosis Dispensary. At the end of the year all the Council's shelters had been returned, and experience in London and other large towns has shown 33 that consumptive patients, with few exceptions, object strongly to advertising their condition by erecting a shelter which cannot, in crowded neighbourhoods, be concealed from their neighbours and fellow lodgers. Sanatorium Treatment.— In the first four months of the year one male bed, and from May 1st onwards one male bed and one female bed have been reserved by the Council in the Maitland Sanatorium, with the option of securing other beds when available. The sum of £200 voted for this purpose was subsequently increased to £300. 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. Thirteen patients have been admitted to the Maitland Sanatorium at the Council's expense during the year. Case 1. A. M., female, 37, wife of an insurance agent, admitted 1st February, with slight consolidation of right lung, and very early infiltration of upper lobe of left lung. Stayed 12 weeks. "Progress very good, will need continued care." Husband paid 5s. weekly towards treatment Has left Kensington. Case 2. P. R., male, 6, son of a meat porter, admitted 23rd February, with upper lobe of right lung congested and infiltrated. Stayed 10½ months "Has made excellent progress." Part payment made by Invalid Children's Aid Association. The patient was still in the Maitland Sanatorium at the end of the year. Case 3. H. J., male, 39, assistant porter, admitted 4th March, both lungs seriously affected. Stayed 8 weeks. "Can do light work easily. Walking capacity very good." Does odd jobs now. Case 4. K. K., female, 16, housemaid, admitted April 23rd with slight dulness over upper lobe of right lung. Stayed 13 weeks. "Had peritonitis while at Maitland, which spoilt an otherwise good record." This patient has not returned to work, but her health has not deteriorated since he± discharge. Case 5. H. L., male, 45, corn chandler, admitted 6th May with both lungs seriously affected. Stayed 19 weeks. "Progress excellent (disease not active). Full 'C' work." Is fit to earn his living, and expects to obtain a post as porter at a Tuberculosis Dispensary. Case 6. F. H., female, 19, domestic servant, admitted May 17th, with consolidation of upper lobe of right lung and infiltration of upper lobe of left lung. Stayed 10 weeks. "A very unsatisfactory case. Appears to have no resistance." Now at home doing no work. Case 7. J. W., male, 28, fireman, admitted 25th May with pleurisy tubercular (not quiescent) of left lung. Stayed 1 month. "Progress excellent, no sign of invasion by tuberculosis. A case of preventive treatment." Paid 10s. a week towards treatment. Is at work as a fireman, and in good health. Case 8. S. B., male, 18, employe G.W.R., admitted May 30th, with slight consolidation of upper lobe of left lung. Stayed 12 weeks. "Progress excellent. Full ' C' work." Been steadily at work since return and keeping " perfectly well." Case 9. B. N„ female, 19, shop assistant, admitted 19th June, with infiltration of upper lobe of right lung; upper lobe of left lung "dull." Stayed 26 weeks. "Made progress during stay, but requires prolonged good conditions." Had not been discharged from the sanatorium at the end of the year. Case 10. T. S., male, 32, coal porter, admitted 16th August, with consolidation of upper lobes of both lungs. Stayed 71 weeks. Report on discharge: "Full 'C' work, walking capacity 10 miles." In full work at the end of the year. Case 11. G. H„ female, 35, laundry manager, admitted 25th September, with infiltration ot upper lobe and apex of middle lobe of right lung. Stayed 12 weeks. "Full grade work. Has made excellent progress during stay at Sanatorium." Now at work. Case 12. S. A., male, 28, general dealer, admitted 16th October, with early infiltration of right lung and consolidation of upper lobe of left lung. Stayed 9 weeks. "Full grade work. General condition much improved." Removed to better rooms on return, and still at work. Case 13. C. S., male, 40, admitted December 20th, with slight infiltration of apex of right lung and consolidation of upper lobe and apex of lower lobe of left lung. Stayed 12 weeks. Discharged 14th March, 1913. "Good progress in general health. Walking capacity 6 miles." Had not been discharged from the Sanatorium at the end of the year. The following cases were admitted to the Maitland Sanatorium during the year 1911:— 34 Case 1. C. B., male, age 30. Discharged September, 1911. In work at end of 1912. (Left the Borough in March, 1913). Case 2. A. G., male, 33. Discharged February 19th, 1912, with walking capacity 9-10 miles, and returned to work as a postman, living under good conditions. In hospital with pleurisy June 12th. Discharged from postal service for ill-health August. Took unsuitable work and became worse. Sent by Insurance Committee to Holt Sanatorium, March, 1913. Case 3. H. H., male, 49, house painter. Discharged July, 1911. At work for next 14 months. Nine weeks Victoria Park Hospital as insured person, autumn, 1912. Returned to work April 14th, 1913. Case 4. M. M., male, 34, builder's labourer. Discharged November, 1911, and subsequently returned to work. Sustained injury to back whilst at work in October, 1912, and has since done no work and received compensation. Except for this injury he appeared to be well and hearty and fit for work at the end of the year 1912. As regards the selection of the cases admitted to the Maitland Sanatorium at the Council's expense in 1911, it may be noted that three patients after 12 months are still able to earn their livelihood, if disabilities not due to tuberculosis may be disregarded, and that the disease has not in any case ended fatally. On the other hand the patient A. G. only returned to regular work for four months before he was permanently incapacitated by his disease. The difficulty of prognosis is illustrated by the case of A. G., in which the damage to the lungs on admission was less than in any of the other three cases. 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. Funds for maintenance are derived from voluntary contributions; the cost of teaching is paid for by the London County Council. The report for 1911, which is the most recent report available, mentions the admission of 84 children, but does not state how many of this number came from Kensington. Other Forms of Tuberculosis.—Other forms of tuberculosis not included under the head cf phthisis caused 48 deaths, and of these 25, 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 the death-rate from these diseases has been reduced from 46 per 100,000 in the decennium 1901-1910, to 28 in the last two years 1911 and 1912. (Vide p. 21.) CANCER Cancer caused 228 deaths, and of this number 205 occurred in persons over the age of 45 years. Carcinoma was the form of cancer to which 144 deaths were attributed; sarcoma was the assigned cause of 7 deaths; 77 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, 1912. Parts Affected. Sex. Total. Male. Female. Buccal Cavity, No. 39 14 0 14 Stomach, Liver, etc., No. 40 23 35 58 Peritoneum, Intestines, Rectum, No. 41 19 25 44 Female Genital Organs, No. 42 — 44 44 Breast, No. 43 — 31 31 Skin, No. 44 0 1 1 Other and unspecified Organs, No. 45 20 16 36 Totals 76 152 228 The numbers following the description of the parts affected refer to the classifical ion of causes of death adopted by the Registrar General for use in England and Wales. THE FOOD SUPPLY. 37 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 Food 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 204 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 34 applications for registration were received from persons who proposed to sell milk. Of this number 33 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 dairy in which cream and butter were stored in a basement room containing a drain inlet and a w.c. was, in the first instance, refused. In this instance the applicant had also committed the technical offence of occupying as a dairy premises not previously used for the purpose without giving the month's notice to the Council which is required by the Milkshops Order, 1885. The Committee were satisfied that there had been no intention to contravene the Order, and the applicant was subsequently registered after giving a written undertaking that milk, cream or other foods would not be stored in the basement of the premises. Proceedings were instituted against the occupier of a small general shop in North Kensington, who was alleged to be selling milk regularly on Sundays although he had not been registered by the Council as a milk purveyor. Milk was in fact sold on a particular Sunday, but the purchaser, a boy who was anxious to bring the mission entrusted to him to a successful issue, stated that the milk was required for his sick mother, whereas it was proved in Court that his mother was in good health. In these circumstances there was no evidence before the Court of the habitual sale of milk, and the summons was adjourned sine die. 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 1912 are summarised in the following table:— The Register of Milk Purveyors. Class of Premises. Milkshops. General Stores. Restaurants, Totals. Transferred 11 6 1 18 Vacated and removed from Register 4 3 1 8 Premises added to Register 4 3 9 16 On Register December 31, 1911 127 42 27 196 On Register December 31, 1912 127 42 35 204 Increase + Decrease — +_0 +0 +8 +8 38 The above table shows the number of premises entered in or removed from the Register. Eighteen 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 8 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. Sixteen 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 being that the number of persons purveying milk in general stores has remained unaltered, whilst the total number of premises in the Borough where milk is sold has been increased from 196 to '204. 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 1,362, and notices were served requiring the remedy of defects which were found on 19 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 opposition 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, but the applicant's request for permission to increase the number of cows from four to ten was refused. Ice Cream.—At the end of the year 171 premises were shown in the Register of places within the Borough where ice cream is prepared or sold. Sixty-seven places have been added to the Register and 69 have been removed during the year, the net result being that the number of premises upon which ice cream is made has been decreased by two. 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 employes 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. 184 visits to ice cream premises have been made by the inspectors during the year, and 14 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 1911 and 1912, 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. On Register Dec. 30th, 1911 212 155 107 43 36 44 7 604 No. added 34 13 9 2 11 20 3 92 Removed 4 6 1 2 — 2 15 On Register Dec. 31st, 1912 242 162 115 43 47 62 10 681 The inspections of the above premises during the year numbered 1,229, 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 1 W.C. defective 12 Drains defective 7 Gully within Food Store 1 Bedroom communicating with Food Store — Want of cleanliness 36 Defective ashpit accommodation 10 Other defects 15 Total number of defects found 82 39 Bakehouses.—There are 96 bakehouses in the Borough, and of this number 75 are underground. As the result of 607 inspections in the year 45 notices were served, the work required in 33 cases being the cleansing of walls and ceilings. In the month of May a request was received from the occupier of an underground bakehouse for permission to open stall board windows, the permanent closing of which had been included in the conditions under which the bakehouse had been certified and permitted to continue. Some doubt having arisen as to whether there is any legal obligation for the occupier of an underground bakehouse to continue to comply with the conditions under which the Council's certificate had been granted, the Public Health Committee defined their attitude in regard to stall board ventilation in the following resolution, which was passed on July 11th, 1911:—That an underground bakehouse which is ventilated by openings in the stall board at a height of less than 12 inches above the adjoining pavement or footway shall for the purposes of s. 98 of the Factory and Workshop Act, 1901, be deemed to be on sanitary grounds unfit for use as a bakehouse;" and " b. That openings shall not be permitted in any part of the stall board of an underground bakehouse unless the Medical Officer of Health is able to certify that they are not so placed and constructed as to render the premises they ventilate unfit on sanitary grounds for use as a bakehouse." In the. case referred to the stall board windows were hinged at the top and opened inwards, the lower border of the opening being less than 2 in. above the level of the footway. The bakehouse is provided with ample ventilation from other sources, and the stall board window has now been closed by the occupier under protest without it becoming necessary to institute legal proceedings. 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. Two houses are not used on more than two or three occasions during the year. In the remaining eight houses sheep are killed from time to time, but cattle are rarely slaughtered within the Borough. In the slaughter house in the Walmer Road, according to the occupier, more than 400 pigs are killed during the year. The slaughter house inspections for the year numbered 268. Unsound Food.—The unsound food surrendered and destroyed during the year is shown in the following list:— March 6th.—1 cwt. dabs. March 31st.—32 boxes of tomatoes. April 23rd.—2 cwt. of herrings. May 14th.—1 fore-quarter, head, pluck and kidneys of a sheep. September 11th.—59 rabbits. October 1st.—4 pigs' plucks affected with tuberculosis; 1 pig's pluck damaged by blood aspiration. October 8th.— 6 tomatoes. October 17th.—1 cwt. of plaice. The circumstances attending the surrender of the tuberculous pigs' plucks, which the inspector found hanging up in a slaughter house, illustrate the difficulties which result from the failure of local authorities to agree upon a common line of action in the condemnation of carcases affected with tuberculosis. At the time of the inspector's visit there were 18 pigs carcases in the slaughter house, and of this number four had been marked with an incision on the fore-leg to indicate to the consignee in the market to which the pigs were to be sent that evidence of tuberculosis had been found. The practice of the consignee is to submit all carcases marked in this way for inspection by the market inspector. The statements of the slaughterer as to the existence of this practice having been confirmed by the market authorities, he was permitted to send the four carcases, which presented considerable tuberculous lesions in the submaxillary glands, to the market, where the most careful examination failed to reveal signs of tuberculosis in any other part. The heads were accordingly taken and the rest of the carcases permitted to be sold, although it was known that four tuberculous mesenteries and plucks belonged to certain carcases among the 18 consigned which may have been the same four that presented tuberculosis of the glands in the head. In these circumstances a local slaughterer would rightly consider himself very hardly used if the adoption of the recommendations of the Royal Commission in Kensington were to lead to the seizure of pigs which he knows could be sold with the permission of another authority provided the heads were surrendered. In his Annual Report for 1911, the Medical Officer of Health for the City of London has made the following statement in regard to this question:— "At present each authority interprets the recommendations of the Royal Commission according to its own ideas, the result being chaotic confusion. Science is never at a standstill, and the Royal Commission's advice as to pigs is now 15 years old, and no longer in accordance with the views held by the most advanced authorities in other countries. "In no other country is the entire carcase of a pig destroyed on account of a speck of tubercle in one particular gland. This, however, is the course recommended by the Commission. Certainly 40 in cases where the animal is inspected at the time of slaughter (when the evidence of the organs is present, and the Inspector is in a position to give a definite opinion), the existence of any degree of disease should be an indication of the necessity for further examination, and in such cases the back bone should be cut down and the kidneys and other glands throughout the body should be carefully inspected. If there is no further evidence of disease, it would appear to be perfectly safe to remove the part affected (usually the head) and to allow the rest of the carcase to be used for food." The confusion referred to exists, and in justice to dealers in meat and to meat inspectors it should be put an end to by Regulations which the Local Government Board are empowered to make. Prosecution.—On March 6th 7 stone of dabs in the initial stages of putrefaction were seized on premises occupied as a fried fish shop. At the time of the seizure, namely, about 11 a.m., the occupier was cleaning the fish with a view to preparing them for human food. They had been sold the same morning in Billingsgate about 7 a.m. Proceedings were instituted, and the Billingsgate vendor was fined £5. A statement by the purchaser in Court that he had intended to surrender the fish was accepted, and the summons in this case was withdrawn. On a second summons the Billingsgate vendor was again fined £5 for selling 7 stone of stale dabs, which had also been bought on March 6th and surrendered by the purchaser on the morning of the same day at the Town Hall. It is of interest to note that this second conviction would probably have been quashed on appeal. In the case of Rex v. Ascanio Puck & Co. in the King's Bench Division on October 18th, 1912, the Judge upheld the contention that inasmuch as the purchaser had voluntarily taken the goods to the Sanitary Inspector there was no liability to seizure, because at the time the Inspector took possession of them they were not intended by the local dealer for the food of man nor had they been sold, exposed or deposited for sale or preparation for sale by the purchaser. SALE OF FOOD AND DRUGS ACT. 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 699 samples, of which 66 (or 9 per cent.) were adulterated. Proceedings were taken against 22 persons for adulteration or other offences, the fines and costs inflicted amounting to i!43 lis. 6d. The samples collected were as follows:— Samples Collected by the Sanitary Inspectors. Name of Sample. Number Taken. Number Adulterated. Milk 252 19 Cream 22 11 Butter 105 1 Cheese 26 . . . Pepper 6 . . . Brawn 8 . . . Margarine 1 . . . Flour 12 . . . Rice 12 10 Sausages 17 8 Arrowroot 14 . . . Corn Flour 12 . . . Oatmeal 15 . . .. . . Linseed. 5 1 Coffee 6 . . . Preserved Vegetables 8 4 Sweets 24 . . . Potted Meats 10 3 Vinegar 24 1 Mustard 14 . . . Spirits 70 7 Currant Jelly 5 . . . Drugs 20 1 Lard 11 Total 699 66 41 Salicylic Acid in Lime Juice.—In my last Report, reference was made to certain samples of lime juice taken in the year 1911, which contained from 2 to 6 grains of salicylic acid per pint. Owing to the conflicting opinions expressed by eminent members of the medical profession who were approached in regard to the question as to whether lime juice containing these amounts of salicylic acid was injurious to health, proceedings were not instituted. In February, 1912, a letter from the Council was addressed to the Local Government Board, pointing out the difficulties in such cases which arose through the absence of official standards, and urging legislation in accordance with the recommendations of the Departmental Committee on Preservatives in Food. In April the Board replied, stating that the whole question of preservatives in food and the amendment of the Sale of Food and Drugs Acts was receiving their consideration. In the meantime the issue of regulations as to preservatives in milk and cream has been the only action taken by the Board. Cream Regulations.—The Public Health (Milk and Cream) Regulations, 1912 made by the Local Government Board in pursuance of the powers conferred by Section 1 of the Public Health (Regulations as to Food) Act, 1907 came into force on October 1st, 1912. They prohibit absolutely the presence of any kind of preservative in milk or in cream containing less than 35 per cent. of milk fat, and the addition of any thickening substance except sugar to cream of any kind. In the case of cream containing 35 per cent. of fat or more, the effect of the Regulations is to permit the addition of boric acid, borax or peroxide of hydrogen, provided the cream so preserved is sold in vessels bearing a label with a printed declaration of the percentage of borax or peroxide which has been used. The addition of any other kind of preservative is prohibited. The weak point in the Regulations is that they omit, no doubt intentionally, to prescribe a standard, that is to say, they omit to lay down the percentage of boracic acid which shall not be exceeded in the addition of this substance for the purpose of preserving cream, and so the trade and local authorities are left in the old position of intolerable uncertainty which attends the process of getting a standard settled by the judgment of courts of summary jurisdiction on the expert evidence given by the two parties concerned. The Board have been advised that in hot weather cream cannot be preserved by less than 0.4 per cent. of boracic acid. Their Regulations show that they are willing to allow the preserved cream trade to continue, and it follows that they have come to the conclusion that cream containing 0.4 per cent. is not injurious to the consumer under a system of compulsory declaration. In these circumstances, the obvious course for the Board to have followed would have been to name the standard which is, in their opinion, compatible with the preservation of the trade and the public health at the same time. Action Taken.—The number of premises in the Borough in which preserved cream is known to be sold is 99. Classified according to the trade carried on, these premises are as follows, namely: registered milkshops, 39; shops of provision dealers, 44 ; restaurants, 10; and poulterers' shops, 6. The cream supplied is bought from 11 different wholesale firms. Of this number six attach descriptive labels to the jars containing the cream which do not comply with the Regulations, and six attach declaratory labels in printed type which does not comply in that it is too small. In all, no less than 63 out of 99 retail firms were found to be selling cream in jars with labels which did not satisfy the requirements of the Regulations. The suggestion that these 63 firms should be warned was not adopted by the Public Health Committee, who decided to take no action until a decision had been arrived at as to whether it would not be advisable to approach the Local Government Board with the request that the Regulations should be amended in important particulars. 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. By 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, Brompton 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. 42 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 Moulsey. To every house in the Borough the water supply is now constant. Water Supply to New Houses.—During the year 47 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. HOUSING OF THE WORKING CLASSES. 45 HOUSING OF THE WORKING CLASSES. In the census year 1901, the tenements in the Borough of less than five rooms numbered 21,115, 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 1912 was 28,028. 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 lodgings, 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 Tenement. Number of Tenements. Rent per Week. 1 26 2/6 to 3/6 2 62 5/6 to 7/- 3 32 7/- to 81- Totals 120 2/6 to 81- The above tenements provided by the Council are all within the Borough. At the end of the year 106 were let and 14 were empty. 46 Houses Let in Lodgings. —The number of houses let in lodgings on the Council's register at the end of the year was 2,094, as compared with 2,091 at the end of 1911, the increase being due to the addition of three houses in the Princes Road. The effect of registration is to render the premises subject to the requirements of the Council's Bye-Laws made under Section 94 of the Public Health (London) Act, 1891, as extended by Section 16 of the Housing, Town Planning, etc., Act, 1909, with respect to houses intended for the working classes, and let in lodgings or cccupied by members of more than one family. The mode of letting which may be held to justify registration has not been defined in any Act of Parliament. When the landlord who lets the lodgings resides on the premises no difficulty arises. The status of a house when the landlord does not reside has been defined by the following legal decision: "An ordinary six-roomed house, not specially constructed to be let in separate tenements, having one common internal staircase and one front door, each floor of which is let to and occupied by a separate family, the landlord living elsewhere, and only attending once a week to collect rents, is a house let in lodgings within the meaning of Section 94." The decision is worth quoting because it aptly describes the majority of the lodging houses in Kensington which are regulated by the Council's Bye-Laws, and indicates the unsatisfactory nature of the accommodation which is directly due to the fact that these houses are " not specially constructed to be let in separate tenements." A block of artizan's dwellings, on the other hand, where the landlord does not reside, and which is divided into tenements, each of which is occupied by one family, is not a house let in lodgings, and is not controlled by the Council's Bye-Laws. Inspection. -The inspections and re-inspections of the registered lodging houses in the Borough numbered 8,704. Notices requiring the remedy of defects found were served in 1,236 instances, and 75 cases of overcrowding were abated. The owners of six lodging houses were summoned for failing to comply with notices requiring the execution of drainage work or other sanitary repairs, and five further summonses were taken out for various breaches of the lodging house bye-laws. Furnished Rooms.—Of the 2,094 lodging houses on the Council's Register, 187 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. A complete list of the furnished lodging houses in the Borough will be found in Table XII., Appendix p. 90. The following Table shows that no less than 143 houses out of the total number are situated in the Norland Ward, whilst 110, if those in Portland Road and Talbot Grove be excepted, are grouped on a comparatively small site in the Notting Dale neighbourhood and in close proximity to 18 houses which are licensed and let as common lodging houses. The Portland Road, which contains 24 houses, may be regarded as within the influence of Notting Dale. The 24 houses in the Bolton Road area constitute a separate and entirely isolated centre, as do four houses in the Treverton Street area, and five houses in Blechynden Street, which are let by the keeper of a common lodging house in Kensal Road. In the absence of precise information, the date when these new centres were established must be left for the present undetermined, and further it must be clearly understood that the figures in the Table for the year 1897 are taken from reports which related to Notting Dale only, and which neither stated nor implied that furnished lodging houses were in this year limited to what was then known as the special area. At the same time it is very generally held that the reduction of the number of furnished houses in Notting Dale by 56, which resulted from the purchase by Miss Octavia Hill and by the Council of a large number of such houses in St. Katherine's Road and Kenley Street prior to the year 1907, led to an extension of the furnished room trade into other parts of the Borough. Between the year 1907 and 1913, the total number of furnished lodging houses in the Borough has increased by 18. With the exception of three houses in the Talbot Grove at the north-east corner of the Norland Ward, no-fresh districts have been invaded, whilst the total increase is nearly wholly accounted for by the conversion of 15 houses in the same Ward of Norland, from unfurnished into furnished tenements, and of this number 9 are in the Portland Road. The only other street in which there has been a notable addition to the numbers is the Bolton Road, where the furnished houses have been increased by five, from 16 to 21. The Table shows a decrease in the total number of rooms which are let furnished, but these results should be accepted with some reserve. In a considerable number of cases furnished and unfurnished rooms may be found in the same house. The returns for 1907 show the "number of occupied rooms," without any other distinction, in houses where furnished lodgings were let, and it is not clear that unfurnished lodgings may not in certain instances have been included in the figures for that year which the Table contains. On the whole the results up to date need not be regarded as serious, but it is to be feared that in the absence of fresh legislation or a new interpretation of the existing law, the greater number of the houses in Portland Road and Princes Road may at no distant date come to be let in furnished lodgings, even if the evil does not spread to other districts. 47 Houses in which Rooms are let Furnished for short periods at a rental of l0d. or Is. per night payable in advance, and 5s. or 6s. for seven consecutive nights. Street or District. 1897. November, 1907. February, 1913. Number of Houses. Number of Houses. Number of Furnished Rooms. Number of Houses. Number of Furnished Rooms. Bangor Street 19 34 313 30 201 Crescent Street 18 23 168 25 153 St. Katherine's Road 59 27 196 28 216 Kenley Street 26 2 13 1 7 Sirdar Road 10 20 144 19 109 Notting Dale Special Area 132 106 834 103 686 St. Ann's Road No record 5 30 5 22 Princes Road ,, 2 12 6 26 Pottery Lane ,, — — 2 10 Portland Road ,, 15 88 24 112 Talbot Grove ,, — — 3 18 Norland Ward No record 128 964 143 874 Brarriley Road No record 2 12 — — Lockton Street ,, 3 24 7 35 Blechynden Street ,, 6 28 5 24 Raymede Street ,, 1 8 1 8 Treverton Street ,, 3 24 4 28 Manchester Road ,, 3 18 — — St. Charles Ward No record 18 114 17 95 Bolton Road No record 16 130 21 147 Lonsdale Road ,, 3 22 3 18 Pembridge Ward No record 19 152 24 165 Peel Street No record 1 5 1 3 Campden Street ,, 1 8 — — Holland Ward No record 2 13 1 3 Edenham Street No record 2 12 — — Southam Street ,, — — 2 12 Golborne Ward No record 2 12 2 12 The Borough No record 169 1,255 187 1,149 48 The following Table shows that 37 per cent, or more than one third of the houses contain unfurnished as well as furnished lodgings, and that it is exceptional for all the so-called " furnished " lodging houses in one street to be let furnished throughout. List of Houses in which Furnished Lodgings only are let and of Houses in which Unfurnished as well as Furnished Lodgings are let: Street or District. Number of Houses. Bangor Street. Crescent Street. St Katherine's Road. Kenley Street. Sirdar Road. St. Ann's Road Princes Road. Pottery Lane. Portland Road. Talbot Grove. Total in Norland Ward. Furnished lodgings only 14 15 22 1 11 4 3 I 13 3 87 Unfurnished and furnished lodgings 16 10 6 — 8 1 3 l 11 — 56 Total 30 25 28 1 19 5 6 2 24 3 143 Street or District. Number of Houses. Lockton Street. Blechynden Street. Raymede Street. Treverton Street. Bolton Road Lonsdale Road. Peel Street Southam Street. Totals. Norland Ward. The Borough. Furnished lodgings only 3 4 1 3 15 2 — 2 30 87 117 Unfurnished and furnished lodgings 4 1 — 1 6 1 1 — 14 56 70 Total 7 5 1 4 21 3 l 2 44 143 187 In 1897, the houses in Notting Dale where unfurnished as well as furnished rooms were let constituted only 14 per cent, of the total "furnished" lodging houses, as compared with 37 per cent, in 1912, so that on these figures there is a suggestion that an altered demand may be gradually leading to the conversion of furnished into unfurnished tenements, unless the drop in the proportion of the furnished tenements took place at one time, and was due to the completion of the Central London Tube Railway and the exodus from Notting Dale of the men who had been employed in its construction. Reference to the Table in the Appendix will show that out of these 187 houses, 39 are let by landlords who are also the keepers of common lodging houses. Mr. Hankins lets furnished rooms in 11 houses in Crescent Street, which adjoin his common lodging houses in the same street. Mr. Rusha lets furnished rooms in 13 houses in Crescent Street and Bangor Street, where he is also the keeper of common lodging houses. Mr. Madden lets 10 houses in furnished rooms in Blechynden Street, Portland Road and the Treverton Street districts at a distance of more than half a mile from his common lodging house in the Kensal Road. Mr. Reynolds lets furnished rooms in four houses which adjoin his common lodging house in Bangor Street, and furnished rooms are also let at No. 9, by Mr. Nagle, the keeper of the common lodging house at Nos. 5 and 7 in the same street. If the superintendent of Dr. Barnardo's Home in Penzance Place be excluded there are 7 keepers of common lodging houses in the Borough, of whom two only do not let furnished rooms. The number of persons who keep more than five houses for the purpose of letting furnished lodgings, without also keeping common lodging houses, only amount to six, and these six persons between them let furnished rooms in 44 houses. The trade in furnished rooms in the case of 83 houses, or close on half the total number is accordingly in the hands of 11 persons, of whom five also keep common lodging houses. The remaining 105 houses are distributed amongst no less that 45 keepers in a small way of business as compared with the other eleven who constitute the backbone of the furnished room system in Kensington. The common lodging houses no doubt serve as feeders to the furnished rooms which are let by the same keepers, but the figures show that without the trouble of keeping a licensed lodging house to serve as the starting point of operations, anyone who understands the business can still find tenants for the furnished rooms in ten or more bouses and enjoy profits which are commonly believed to be substantial. 49 It has been assumed that those who read this report will be aware of the sanitary and social evils which the furnished room system fosters and perpetuates. This class of tenement is either let to homeless persons who are often very dirty, to prostitutes who ply their trade elsewhere, or to couples who use the rooms for immoral purposes. Their lamentable condition is produced by a sequence of events which move in a vicious circle. Through the filthy habits of some of the tenants who use them, it is difficult for a keeper to find a hard working, respectable woman to carry out the necessary cleaning, and because the cleaning is scamped only dirty people take the rooms. Bedding, crockery and utensils have not infrequently been stolen by the lodgers and pawned ; the meanest possible provision is accordingly made with the result that tenants of a certain class do not hesitate to abuse in the grossest fashion accommodation which so far from being worth a shilling a night would be dearly bought at any price. There does not appear to be any reason for doubting the statement of the keepers that a nightly lodger will on occasions use the greater part of a washstand as fuel for his fire, and the condition of furnished rooms is in the first instance due not so much to the wilful intention on the part of keepers to neglect their premises as to their practice of accepting for the sake of the rent, tenants whom they know will make their lodgings filthy. The administrative difficulties that stand in the way of securing the maintenance of cleanly conditions were dealt with in my last Report, and suggest that what is required is the total abolition rather than the regulation of the furnished room system. It has been suggested that this desirable lesult may be achieved if the recommendations of certain members of the Special Committee appointed by the Council in December, 1911, are carried out. The very valuable report of this Committee has been published in the Minutes of the Council, to which reference should be made for further information as to the conditions prevailing in the furnished rooms of Notting Dale. Inspection.—The inspections of houses let in furnished lodgings during the year numbered 1,920. In the Notting Dale area alone 77 notices requiring dirty bedding to be cleansed were served, and 7 beds were destroyed. In the same district 145 verminous rooms were dealt with, and 265 registered lodging houses were cleansed at the instance of the Sanitary Inspector. In the returns as to furnished and unfurnished rooms, the two classes of lodgings have been distinguished as regards inspection, but owing to the clerical work which such a course would have involved they have not been distinguished in the records of the sanitary notices served. Common Lodging Houses.—The Common Lodging Houses in the Borough number 22, and contain accommodation for 673 persons. From the following table it will be seen that 19 of these bouses 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 1912. 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 ,,, Nagle, William 5, do. 44 ... 44 ,, Do. 7, do. ... ,, Hankins, George 10, Crescent Street ... 25 25 ,, Do. 28, do. 54 64 ,, Do. 30, do. ... ,, Do. 40, do. ... 25 25 ,, Ruslia, 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 34, 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 401 272 673 50 In four streets in the Notting Dale area there are six houses capable of receiving 229 single women and six houses licensed to accommodate 292 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 leform 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. On March 12th, the Council designated the ten District Sanitary Inspectors and the chief Sanitary Inspector as the officers to undertake the preparation of lists of houses and to make the necessary inspections under the direction and supervision of the Medical Officer of Health The following Table shows the work of the year in the form required by the Board:— 1. Number of dwelling houses recommended singly or in groups for early inspection 44 2. Represented to the Council by the Medical Officer of Health with a view to Closing Orders being made 10 3. The number closed by order of the Council 2 4. The number put into a fit state for habitation after the making of a Closing Order Nil. 5. The number in which defects were remedied without the making of Closing Orders 55 The fact that the number of the houses in which defects were remedied exceeds the number recommended for inspection is accounted for by the completion of work in 1912 in certain houses which were represented in 1911, as will be understood from the following figures:— 1. Houses recommended for inspection and still under consideration at the end of 1911 52 2. Houses recommended for inspection in 1912 44 Total 96 Result of Recommendations for Inspection. Date of Inspection. 1911. 1912. Total. Houses in which inspection revealed no defects 9 — 9 Houses in which the defects were remedied 29 26 55 Empty houses represented for Closing Orders — 8 8 Houses closed by order of the Council — 2 2 Houses vacated without a Closing Order 14 8 22 Results obtained in the year 1912 52 44 96 It will be noted that in 22 houses the action taken by the Council resulted, not in a remedying of defects, but in the eviction by the owner of the occupying tenants. The situation of these 22 vacated houses is as follows:— 1, 2, 4—6 Lion Mews 5 houses 1—6 and 8, Dunworth Mews 7 „ 7—13, Colville Mews 7 „ 4a, 15 and 10, Russell Gardens Mews 3 „ Total 22 houses 51 In the case of Lion, Dunworth and Russell Gardens Mews, notices were served under Section 15 of the Housing, Town Planning, etc., Act, 1909, which enables a local authority, if the landlord fails, to enter a dwelling house and themselves carry out such works as may be necessary to render it in all respects fit for human habitation. The expenses incurred by a local authority in such work can then be recovered from the landlord in annual instalments. In rural districts where the demand for houses exceeds the supply, there is a certainty that any cottage which may be put into good order and repair will continue to be occupied. This of course means that the landlord of the cottage will receive in rents money wherewith to repay his debt to a local authority carrying out work under Section 15. In Kensington very large numbers of tenements intended for the working classes are unoccupied; there is accordingly no strong probability that the repair and alteration of tenements in such places as Dunworth Mews will lead to their continued occupation, with the result that certain landlords on receiving notices under Section 15, evict their tenants rather than incur the expense of extensive repairs which the rents are not sufficient to cover. In these circumstances there are three courses open to the Council under the Housing Acts, namelv: (i) to carry out the necessary work and attempt to recover the expenses incurred from a landlord whose action has expressed the conviction that they will not be met out of the rents received; (ii) to make a Closing Order, which would in the end entail demolition and prevent once and for all the adaptation of the premises to some use other than that of human habitation; or (iii) to lake no further action on the grounds that the premises being vacant, there can no longer be any breach of the implied contract with the tenant under Section 14 that the premises are in all respects reasonably fit for habitation. In the cases under consideration the third course has been followed, and in my view the Council would not be justified in saddling a landlord, who is content to leave his houses empty, with the cost of alterations and repairs unless it could be shown that the accommodation was needed and was likely to be used by the working classes. Neither is it clear that any material advantage would accrue from the wholesale demolition of premises vacated in these circumstances. Negotiations with the owner of Nos. 7—13, Colville Mews, made it clear from the outset that ne intended to evict his tenants rather than carry out the works required. On an undertaking being given that the premises would no longer be let for human habitation, it was decided that no notices should be served, and in the end some of the buildings were converted into a Picture Palace. Had the procedure under Section 15 been strictly followed, the owner would have found himself either saddled with a heavy debt to the Council and the necessity of finding tenants for seven renovated mews dwellings, or bound by a Closing Order to forego the opportunity of converting the houses into business premises and to await the order for their demolition. It would thus appear that the framers of Sections 14-18 of the Housing Act, 1909, did not fully appreciate the serious economical difficulties which would be met with in the administration of these particular sections of the Act in districts where the supply of houses is considerably in excess of the demand. General Character of Defects.—Of the 96 houses in reference to which reports were made to the Housing Sub-Committee during the year, 69 consisted of mews dwellings over stables. The chief defect found on such premises is in the construction of the staircase, which, instead of being entered direct from the open air can only be entered from the stable. By means of these staircases foul effluvia are conducted from the stable beneath to the dwelling rooms above. Defects in the stable ceiling, in the match boarding partition walls and in the soffits of the staircase have also been found admitting effluvia to the upper story of the premises. Among other conditions reported may be mentioned w.c.'s in cramped positions with insufficient light and ventilation, foul horse-pots of the bell-trap type in the stable floor, and various defects in the drainage system. Of the mews premises reported during the year as having been dealt with in the manner indicated in the following Table, 46 were first submitted in 1911, and 23 in 1912:— Number of mews dwellings reported 69 Number in which no defects were found 9 Number in which defects found were remedied 38 Number which were vacated 22 Eighteen of the premises reported were registered lodging houses, each containing eight rooms, and in the case of nine houses the rooms were let furnished. The chief defects consisted in general dilapidations, such as broken floors, hearths, chimney jambs, partition walls and window fiames, of so extensive a nature as to render the houses unfit for the use of lodgers. Many of the rooms were verminous, those in the basement were damp, and in certain instances defects in the drainage system were found. Of these houses all but six in the Bolton Road were submitted for the first time in 1912, the final results being as follows:— Number of registered lodging houses reported 18 Number in which defects were remedied 10 Vacant houses represented for Closing Orders 8 52 Nine two-room cottages were also reported during the year. In six of these cottages the walls were underpinned, and the dampness remedied by the insertion of damp-proof courses. Light and ventilation were provided for the staircases, and other necessary repairs executed. The remaining three cottages were in South End Gardens. Two were closed by Order of the Council, the third presenting no defect except a leakage in the roof, which was remedied. The results were accordingly as set out below: Number of two-roomed cottages reported 9 Number in which defects were remedied 7 Number closed by Order of the Council 2 Closing Orders.—The above two cottages were the only dwelling houses closed by Order of the Council during the year. On inspection they were found to be excessively damp, dark and dirty. The ground floor in one case was 4 in. below the level of the pavement outside, the only through ventilation provided was by means of a small air brick in the rear wall, the rooms were small with low ceilings, and badly lighted by small dilapidated windows. The tiles of the roof were defective, and the whole structure of the premises through age was in a worn out condition and incapable of repair, except at an expense which the value of the cottages would not have justified. Eight registered lodging houses which had been left vacant in the Golborne Ward with the result that they had been completely wrecked by the hooligans of the neighbourhood, were represented to the Council with a view to Closing Orders being made. The amount of damage done in a short time was extensive, water fittings having been torn out, cupboards, baluster rails and the panels of doors removed for firewood, large holes having been made in the partition walls, whilst in many cases rain poured through the defective roof and soaked through to the floor of the first storey. The Closing Orders were recommended with a view to ensuring that the houses should be rendered fit for human habitation before they were bought for a few pounds as a speculation, and let off in tenements for anything they would fetch—and the recommendation is still under the consideration of the Housing Sub-Committee. Demolition Orders. -No demolition order has been made in respect to the two houses which have been closed. They are not a source of danger to neighbouring dwellings, and their demolition would serve no purpose except that of enabling the Council to comply with the precise letter of the Housing Acts. Procedure for the Remedy of Defects.—From the figures which have been given, it will have been understood that defects were found in 87 out of 96 houses inspected for the purpose of the Housing Regulations. With a view to securing the remedy of the defects reported, statutory notices have been served either under Section 4 of the Public Health (London) Act, 1891, or under Section 15 of the Housing Act, 1909. In certain cases specifications of the works required have been drawn up and agreed to by the owners concerned, with the result that defects have been remedied without the service of statutory notices. Seven houses were vacated without the service of notices, the owner having declared his intention to convert them into business premises. Two were closed by order of the Council, and eight vacant houses were represented with a view to Closing Orders being made. The nature of the action taken, with the results obtained, is shown in the following Table:— Procedure for Remedy of Defects in 87 Dwelling Houses. Number of Houses. Defects Remedied. Vacated. Total. Notices under s. 15, Housing Act, 1909 5 14 19 Notices under Public Health (London) Act, 1891 28 1 29 Negotiation without Notice 22 7 29 Represented under s. 17, Housing Act, 1909 — 10 10 Totals 55 32 87 53 The explanation of these results is to be sought in the scope of Section 15 of the Housing Act, 1909, which authorises the Council to require work of any kind and any extent, provided it is necessary to render the premises in all respects reasonably fit for human habitation. In these circumstances it is to be feared that the length of the specifications of work required under this section has so alarmed property owners that they have emptied their houses rather than comply with the Council's notices. The notices under the Public Health Act have been less ambitious, but have still secured the execution of a large amount of valuable and necessary work, and have only led to the vacation of premises in one instance. House to House Inspection.—In addition to the inspections which have been carried out with the formalities required by the Housing (Inspection of District) Regulations, 1910, 1,865 bouse to house inspections have been made during the year for the purpose of detecting and securing the remedy of sanitary defects. The inspections of registered lodging houses are not included in this figure. Underground Rooms,—Twenty-two 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 regulations as to 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 152 certificates were issued by the Medical Officer of Health during the year, in respect to 152 tenements in 58 houses containing a total number of 169 separate dwellings. FACTORIES AND WORKSHOPS. 57 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 1,844. 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 and factories at which female labour was employed at the end of 1912 was eight hundred and seventy-six, 335 (mostly laundries) being in North Kensington, and 541 (mostly dressmakers) in South Kensington. During the year 52 workshops were added to the register and 38 were removed. "The subjoined Table summarises particulars of the 67 factories and 809 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 63 210 62 335 381 13 147 541 876 No. of Rooms therein 105 654 95 854 720 35 212 967 1,821 "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 3 8 11 Boot header 1 1 ,, closer 2 — 2 Cigarette maker (Factories) — 1 1 Colour printer (Factory) 1 — 1 Corset maker 2 6 8 Cracker maker 1 1 Dressmaker and ladies' tailor 60 369 429 Dyer and cleaner (Factories) 2 3 5 Eyelet hole finisher (Factory) 1 — 1 Florist — 10 10 Furrier 1 7 8 Hair wash manufacturer 1 1 Hosier 1 1 Lamp shade maker — 2 2 Laundry (workshop) 154 13 167 (factory) 56 — 56 Machinist — 1 1 Mantle maker 1 4 5 Milliner 4 57 61 Outfitter — 3 3 Photographer 2 14 16 Pickle manufacturer 1 — 1 Printer (Factories) — 3 3 Silversmith — 1 1 Sweetmaker 1 1 Tailor 34 5 39 Typist — 5 5 Tyre Maker — 1 1 Umbrella manufacturer 1 1 2 Upholsterer 1 13 14 Violin string manufacturer 1 — 1 Waistcoat maker 3 — 3 Wig maker 1 9 10 Total 335 541 876 58 "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 27 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.—Nine cases of overcrowding were dealt with during the year, as compared with 11 in the year 1911, and 10 in the year 1910. 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 29 sanitary conveniences attached to workshops were found and remedied. HOME WORK. An analysis of the return made to the Home Office on "Home Work" shows that 1,045 addresses and names of outworkers were received on the lists sent in by the employers residing in this Borough, and of these 798 were forwarded to the Councils of the respective districts in which they were situated; the remaining 247 being in Kensington. These 247 names and addresses, together with 360 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 303 outworkers so registered, some are employed on premises which are factories or workshops within the meaning of the Factory and Workshops 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. The number of outworkers belonging to each of these three classes is shown in the following Table Home Work. Outworkers in Workshops or Factories 110 Outworkers in Domestic Workshops 25 Outworkers in their own Homes 168 Total number of Outworkers 303 The factories and workshops referred to in the above list are included in the Table which shows the trades carried on in the workshops on the Council's register. 59 The nature of the work given out to the homeworkers in the 168 homes on the register is as follows:— Home Work. Nature of Work. No. of Premises. Tailoring 47 Ironing 33 Outfitting 23 Bootmaking 33 Dressmaking, Blousemaking 15 Shirt making 1 Waistcoat making 5 Upholstery 4 Millinery 1 Brush making 1 Lace mending 1 Fur making 1 Embroidery 3 Total 168 In 14 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 168 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 27 7 3 37 „ for work and as living rooms 71 13 0 84 „ for work and as bed and living rooms 34 13 0 47 Totals 132 33 3 168 The sanitary defects remedied in the 168 homes were as follows:— Rooms cleansed 3 W.C.'s found defective and remedied 2 Number of Defects remedied 5 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. 6O Infectious Diseases—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. 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. 1912. North Kensington. South Kensington. Total for Borough. Dressmakers. Laundries. Miscellaneous Total. Dressmakers Laundries. Miscellaneous Total. 1. Workshop inspections, No. of 88 198 208 489 546 7 174 727 1216 2. „ re-inspections 10 24 5 39 98 6 59 163 202 3. Workrooms inspected ,, 92 610 214 916 882 24 220 1126 2042 4. ,, measured „ 8 — 1 9 59 7 66 75 5. „ cards distributed, No. of 9 — — 9 64 — 6 70 79 6. Workshops, &c., newly discovered and reported to H.M. Inspector 3 1 — 4 31 1 5 37 41 7. Workshops, &c., reported by H.M. Inspector 7 2 8 17 45 1 15 61 78 8. Workshops, &c., newly registered 6 1 — 7 33 1 11 45 52 9. Workshops, &c,, removed from register . 1 3 — 4 29 — 5 34 38 10. Domestic workshops and workplaces inspected 43 55 52 150 5 1 25 31 181 11. Sanitary defects remedied:— (a) Additional means of ventilation provided — — — — 9 — 18 27 27 (i) Rooms cleansed and whitened 1 16 2 19 8 3 — 11 30 (c) Overcrowding abated — — — — 7 — 2 9 9 (d) Sanitary conveniences ; defects remedied — 8 1 9 11 1 8 20 29 (e) Miscellaneous defects remedied — 19 — 19 9 3 2 14 83 12. Written intimations issued 1 12 4 17 28 3 16 47 64 13. Statutory notices issued — 1 — 1 4 — 4 8 9 61 MENS WORKSHOPS. The number of workshops at which men alone were employed at the end of the year 1912 was 1,040. 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 and 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 conveniences 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 which includes 5 factory bakehouses:— Trade or Business. North Kensington. South Kensington. Borough. Baker (including 5 Factory Bakehouses) 60 36 96 Basket-maker 9 — 9 Blacksmith 21 24 45 Bootmaker 94 70 164 Builder 53 67 120 Cabinet-maker and Joiner 25 28 53 Carver and Gilder 1 6 7 Coach-builder 35 9 44 Cycle-maker 11 13 24 Firewood-manufacturer 20 — 20 French Polisher 1 2 3 Marble Mason 4 3 7 Printer 8 8 16 Saddler 7 13 20 Tailor 69 51 120 Trunk-maker 6 12 18 Umbrella-maker 3 2 5 Undertaker 8 4 12 Upholsterer 20 11 31 Watchmaker 20 24 44 Wig Maker — 14 14 Sundry businesses 81 87 168 Total 556 484 1,040 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. 62 FACTORIES, WORKSHOPS. WORKPLACES AND HOMEWORK I.—Inspection. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 151 16 Workshops (including Workshop Laundries) 2,339 166 — Workplaces (other than Outworkers' premises included in part 3 of this Report) 185 17 — Total 2,675 199 — II.—Defects Found. Particulars Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances wider the Public Health Acts:—* Want of cleanliness 81 81 — — Want of ventilation 35 35 — — Overcrowding 9 9 — — Want of drainage of floors — — — — Other Nuisances 81 81 — — Sanitary accommodation insufficient unsuitable or defective not separate for sexes 10 10 — — 74 74 — — 3 3 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) — — — — Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 45 45 — — Other Offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) — — — — Total 338 338 — — * Including those specified in Sections 2, 8, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts III.—Home Work. NATURE OF WORK.* OUTWORKERS' LISTS, SECTION 107. Inspections of Outworkers premises. Outwork in Unwholesome Premises, Section 108. Outwork 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 from other Councils.‡ Forwarded to other Councils. Failing to keep or permit inspection of lists. Failing to send lists. Lists.† Outworkers † Lists. Outworkers. Contractors. Workmen. Contractors Workmen. 1. 2 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. Wearing Apparel— (1) making, etc. 98 128 832 4 ... 10 355 775 31 ... ... 114 3 3 ... 8 ... ... (2) cleaning and washing 26 9 51 1 1 1 5 16 12 ... ... 6 ... ... ... ... ... ... Lace, lace curtains and nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Artificial flowers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nets, other than wire nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tents ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sacks ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and Upholstery 4 ... 9 ... ... 4 ... ... 1 ... ... ... ... ... ... ... ... ... Fur pulling ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather sorting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 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 128 137 892 7 1 15 360 798 44 ... ... 121 3 3 ... 8 ... ... * If an occupier gives out work of more than one of the classes specified in column X, 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. †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. ‡ In addition 11 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. 64 IY.—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' 442 Workshop Laundries 167 Workshop Bakehouses 91 Other Workshops 1,144 Total number of workshops on Register 1,844 V. —Other Matters. Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 41 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 10 Reports (of action taken) sent to H.M. Inspectors 10 Other — Underground Bakehouses (s. 101):— In use at the end of the year 75 SANITARY WORK. 67 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, 652 new moveable ash-bins of galvanised iron have been provided during the year, ana 229 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 105 house drains have been reconstructed under notices served by the Sanitary Inspectors. Nuisance from Smoke—304 observations of chimney shafts in the Borough were made, and notices were served in six instances where black smoke was seen issuing in such quantities as to be a nuisance. In no case was it found necessary to institute legal proceedings to procure the abatement of nuisance from black smoke. Public Conveniences.—The Council provide five public lavatories containing water-closets: two are for men only, and in three accommodation is provided for both sexes. In addition there are 12 urinals for men under the charge of the Council. In the women's lavatories there is free accommodation for those who are unable to pay. There 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. 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 Housing Acts, 1890-1909, the Sale of Food and Drugs Acts, the Rag Flock Act, 1911, 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 women 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, in visiting cases of ophthalmia in newly born infants and in assisting with the work at two of the schools for mothers. A summary of the work of the sanitary inspectors will be found in Table X., Appendix, p. 88. 68 LEGAL PROCEEDINGS. Legal proceedings were instituted in 23 cases, particulars of which are summarised in the following lists:— Legal Proceedings under the Public Health (London) Act, 1891, and Metropolis Local Management Act. Date. Name and Address of Defendant. Offence. Result. Feb. 13th C. F. Crosson, 144, Portobello Road Failure to carry out certain sanitary repairs at 33, Sirdar Road Fined 20s. and ordered to execute work in seven dajs ” ” ” ” The same at 48, Sirdar . Road Fined 20s. Work to be done in seven days ” ” ” ” The same at 52, 54, and 56, Sirdar Road Withdrawn. The works having been completed ” ” ” ” Failure to cleanse and limewash rooms at 52, Sirdar Rd. ” ” ” C. H. Bowes, 20, Kensal Road Failure to carry out sanitary repairs at 97, Southam Street Withdrawn. The necessary works having been completed. ” ” ” ” Failure to cleanse and limewash rooms at 97, Southam Street ” ” Feb. 20th J. Cook, 161, Portobello Road Failure to carry out sanitary repairs at 161, Portobello Road Ordered to carry out the necessary works Mar. 19th L. Cohen, 199, Westbourne Grove Failure to repair drain at 199, Westbourne Grove ” ” ” April 2nd R. W. Larkins & Co., 24, Love Lane, EC. Selling 7 stone of unsound fish (dabs), to T. H. Hills Fined £5. ” ” ” ” Selling 7 stone of unsound fish to L. Ross Fined £5. April 2nd L. Ross, 55, Sirdar Road Having unsound fish deposited on his premises for sale Withdrawn on evidence that defendant intended to surrender the fish July 16th E. W. Bowes, 22, Kensal Road Failing to provide a proper sanitary bin at 4, Admiral Mews Withdrawn. The bin having been provided ” A. Russell, 134, Wornington Road Failure by occupier to cleanse bedding and rooms at 134, Wornington Road Fined 20s. Aug. 6th F. Domsalla, 18, Pembroke Mews Failure to provide suitable w.c. accommodation at 18, Pembroke Mews Withdrawn. The work having been executed 69 Date. Name and Address of Defendant. Offence. Result. Oct. 1st Murrell, Wm., 342, Fulham Road Failing to provide a proper supply of water at 342, Fulham Road Withdrawn. The water having been provided Nov. 5th H. J. Edwards, 17, Rosenau Road Failing to cleanse and limewash rooms at 10, Wornington Road Fined 20s. Nov. 19th Rider & Sons, 37, Bramley Road Failing to clear the choked gully at No. 8, Great Western Terrace Withdrawn. The work having been done and costs of £1 1s. paid „ W. Morgan, 119, Wornington Road Keeping a dog in such a manner as to render the premises filthy Fined 5s. or five days imprisonment in default „ H. Boyer, 14, South Wharf Removal of offensive matter by water in a carriage not properly constructed Fined 40s. Dec. 3rd Cartage Co., Ltd., Paddington Basin „ „ „ Fined 40s. „ „ „ „ ” ” ” Dismissed. The offensive nature of the matter removed, not being proved Proceedings under the Dairies, Cowsheds and Milkshops Orders, 1885, 1886. Date. Name and Address of Defendant. Offence. Result. Nov. 19th J. Eaton, 1, East Row Selling milk without being registered Summons adjourned sine die 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 pouring 8 ounces of commercial formalin (a fluid containing 40 per cent. of formic aldehyde) over 4 ounces of permanganate of potash crystals supplied for the purpose in the form of a solid block. With these quantities 70 grammes of gaseous formaldehyde are produced, an amount which is sufficient to disinfect any room measuring less than 2,000 c.ft. Rooms vacated by consumptive persons are first sprayed with per cent. solution of formic aldehyde (formalin 2 ounces to 1 gallon of water), and then sealed and fumigated with formalin vapour. 70 The following Table shows the number of disinfections carried out for various diseases during the year:— Disinfection, 1912. Nature of Infection. Rooms Disinfected. Premises Disinfected. Disinfections at Wood Lane. Scarlet Fever 343 281 295 Diphtheria 215 166 160 Enteric Fever 15 12 13 Measles 77 50 3 Consumption 275 234 207 Other Diseases 94 68 108 Totals 1019 811 786 Year. Weight of Articles sent from Premises. Number of Premises. Tons. Cwts. Qrs. Lbs. 1909 33 5 2 23 789 1910 27 7 3 12 638 1911 27 14 2 6 677 1912 32 1 3 1 786 The following number of articles was dealt with at the Wood Lane Disinfecting Station during the year:— Articles disinfected only 11,103 Articles disinfected and washed free of charge 3,087 Articles washed and charged for 518 Total articles dealt with in 1912 14,708 The Council have also undertaken to remove soiled dressings, free of charge, from St. Luke's House, an institution receiving persons in the last stages of consumption, where adequate provision is rot made for the destruction of surgical dressings. In accordance with the undertaking given, drssings amounting to a total weight of 1 ton 10 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 could be cleansed at the expense of the Council, at the Able-bodied Workhouse in Mary Place. The number of persons cleansed under this arrangement has been a negligible quantity, and only amounted to 19 during the year 1912. In July, 1912, the use of the casual wards in Mary Place was discontinued on their being transferred to the Metropolitan Asylums Board, and the Borough is now without provision of any kind for the cleansing of verminous persons, although the inspections of the school nurses show that large numbers of children whose clothes and bodies are verminous, attend the elementary schools in Kensington. Should the Council erect their own station, the facilities offered will become widely known to adults through the school children who are sent to be cleansed, and 71 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-Committees, who have submitted a number of reports 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. At the meeting of the Council on July 10th, the following motion was put and carried by 29 votes against 20. " That in the opinion of this Council it is necessary that a Cleansing Station for verminous persons, including children, should be established in North Kensington, any resolution or resolutions by the Council to the contrary notwithstanding, and that it be referred to the Public Health Committee to bring up a scheme for the provision by the Council of such a Cleansing Station." A resolution that the Council do affirm the principle that a Cleansing Station shall be provided for the Borough having been lost by 29 votes to 21, at a meeting of the Council on November 7th, 1911, it was held that the rescinding motion of July l6th had failed, in that it was not supported bv the two-thirds majority which would have been necessary to render it an effective resolution. Verminous Rooms-406 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 disinfested, 13 verminous beds were destroyed, and 124 dirty beds were cleansed. THE RAG FLOCK ACT, 1911. This Act came into operation on July 1st, 1912, and read in conjunction with the Regulations made under Section 1, prohibits the sale of flock manufactured from rags which contain more than 30 parts of chlorine in the form of chlo.rides in 100,000 parts of flock. The Chief Sanitary Inspector and the ten District Sanitary Inspectors have been appointed to exercise the various powers conferred by the Act in the manner prescribed by Sub-section 5 of Section 1. Fifty-seven premises in the Borough have been placed on the register of places where rag flock is used or likely to be used in various branches of upholstering work. Of this number only two firms are engaged in the making of new beds on an extensive scale. Thirty-one firms describe themselves as furniture dealers and upholsterers, and seventeen as cabinet makers and upholsterers. Seven are coach builders and state that horse hair only is used in their work. Only 17 firms in all admit that rag flock is used on their premises. Eight use shoddy and rugging; three use rugging only, and six use shoddy only. The rag flock used in the Borough comes from nine different wholesale sources, but 8 out of the 17 retail firms obtain their flock from the two makers of new beds already referred to, whose premises are in Kensington, and who supply flock wholesale to local traders. Two samples of shoddy were taken during the year, and contained respectively 6 and 14 parts of chlorine per 100,000. 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 1912 and the three preceding years by washers and bathers:— Year. Washers. Total attendances. 1909 70,472 127,607 1910 73,342 139,237 1911 71,241 153,981 1912 76,052 142,685 It is satisfactory to note that the number of washers exceeded 76,000. 72 MORTUARY AND CHAPEL OF REST. During the year 238 bodies were deposited at the Mortuary under the following circumstances:— 1. At the request of the relatives of the deceased 57 2. At the request of undertakers, mainly at the instance of the relieving officers 12 3. At the request of the coroner (inquest cases):— Cases of sudden death 80 Cases of violent death 71 151 4. Brought in by the Police—Persons found dead 9 Accident cases 9 18 5. On account of death due to infectious disease ... 0 Total number of bodies received ... 238 In 107 of the above cases post-mortem examinations were made under the coroner's warrant The number of bodies deposited in 1912 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 which Coroner's inquests were held. No. of bodies upon which post-mortem examinations were made. 1907 274 194 112 1908 251 174 107 1909 263 181 110 1910 233 145 103 1911 261 177 118 1912 238 151 107 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 40 bodies were deposited in the Chapel of Rest, Avondale Park. Seventynine bodies were deposited in the previous year. VACCINATION. Through 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 1911. Out of a total number of 3,039 infants born 283 were not vaccinated on account of conscientious objection on” the part of the parents, and 136 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 419 or to 14 Der cent. of the births registered as compared with losses of less than 7 per cent, in each of the five years 1904-1908. APPENDIX. 75 APPENDIX. Local Government Board Tables I—IV. TABLE I. Vital Statistics of Whole District during 1912 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 District Uncorrected Number. Nett. of Nonresidents registered in the District. of Residentsnot registered iu the District. Under 1Year 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 1907 174,020 3,288 3,428 19.7 2,824 16.2 704 351 433 126 2,471 14.2 1908 173,590 3,362 3,504 20.2 2,757 15.9 718 354 428 122 2,398 13.8 1909 173,160 3,187 3,381 19.5 2,770 16.0 692 371 379 112 2,449 14.1 1910 172,730 3,007 3,190 18.5 2,524 14.6 635 315 345 108 2,204 12.8 1911 172,300 3,037 3,223 18.7 2 712 15.7 722 399 435 135 2,889 13.9 1912 172,000 3,068 3,318 19.3 2,524 14.7 683 446 305 92 2,287 13.8 * 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 172,317 Number of inhabited houses Average number of persons per house Note.—In the Intercensal period, 1901-1910, the average annual decrease in the number of the Population amounted to 430. The Population for the year 1912 has been estimated on the assumption that the rate of decrease has been reduced from 430 to 300 per annum. 76 TABLE II. Cases of Infectious Disease notified during the Year, 1912. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward. Total Cases 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ......... ......... ... ......... ... ......... ... ... ... Diphtheria (including Membranous croup) 180 2 48 75 23 27 3 2 30 30 26 30 19 9 12 17 7 151 Erysipelas 116 1 6 6 16 21 48 18 17 33 21 9 10 4 13 7 2 43 Scarlet fever 297 2 92 154 31 18 ... ... 47 77 35 35 39 24 10 27 3 272 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 15 ... 1 2 4 6 2 ... 3 1 ... 1 2 1 1 1 5 11 Continued fever 2 ... 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... 1 1 Puerperal fever 8 ... ... ... ... 8 ... ... 1 2 2 2 ... ... ... 1 ... 5 Cerebro-Spinal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Pulmonary Tuberculosis 858 1 17 157 145 371 149 18 132 276 180 113 34 34 25 34 30 262 Ophthalmia Neonatorum 22 22 ... ... ... ... ... ... 4 9 5 1 2 ... 1 ... ... 9 Totals 1499 28 166 394 219 452 202 38 234 428 269 192 106 72 62 88 48 755 Isolation Hospital or Hospitals, Sanatoria, &c— One male and one female bed have been retained for consumptive patients by the Council in the Maitland Sanatorium, with the option of other beds when available. 77 TABLE III. Causes of, and Ages at, Death during the Year 1912. Causes of Death. Nett Deaths at the subjoined ages of “Residents” whether occurring 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 a»d under 65 years. 65 and upwards. All causes Certified 2,287 305 71 51 48 63 315 653 781 1,245 Uncertified — — — — — — - — — — Enteric Fever 4 ... ... ... ... ... 3 1 ... 2 Small-pox ... ... ... ... ... ... ... ... ... ... Measles 27 9 9 8 ... 1 ... ... ... 3 Scarlet Fever 5 ... ... 2 2 ... 1 ... ... ... Whooping-Cough 25 9 9 4 3 ... ... ... ... 2 Diphtheria, and Croup 5 1 ... 1 ... ... 1 ... 2 ... Influenza 28 ... ... ... ... 1 1 15 11 ... Erysipelas 5 1 ... ... ... ... 1 1 2 7 Phthisis (Pulmonary Tuberculosis) 179 ... 2 1 2 20 86 62 6 243 Tuberculous Meningitis 20 5 4 3 5 2 1 ... ... 11 Other tuberculous diseases 28 8 1 4 8 2 4 2 4 13 Cancer, Malignant disease 228 ... 1 ... ... 3 19 116 89 140 Rheumatic Fever 7 ... ... ... 1 2 1 3 ... 3 Meningitis 18 8 ... 3 ... 1 2 3 1 7 Organic Heart Disease 275 ... 2 ... 5 3 24 108 138 109 Bronchitis 209 17 3 3 1 1 11 50 128 205 Pneumonia (all forms) 161 23 20 9 4 2 20 39 44 79 Other diseases of Respiratory Organs 45 3 2 1 ... 1 9 15 14 22 Diarrhœa and Enteritis 70 32 4 4 5 2 2 8 13 32 Appendicitis and Typhlitis 12 ... ... ... 2 ... 3 6 1 ... Cirrhosis of Liver 16 ... ... ... ... ... 2 11 3 9 Alcoholism 5 ... ... ... ... ... 4 1 2 Nephritis and Bright's Disease 79 ... ... ... ... ... 17 26 36 34 Puerperal Fever 6 ... ... ... ... ... 6 ... ... 3 Other accidents and diseases of Pregnancy and Parturition 9 ... ... ... ... ... 9 ... ... 2 Congenital Debility and Malformation including Premature Birth 135 134 ... ... 1 ... ... ... ... 46 Violent Deaths, excluding Suicide 64 5 1 2 5 6 15 20 10 23 Suicide 13 ... ... ... ... 2 8 3 ... 1 Other Defined Diseases 604 48 12 5 9 14 65 169 282 246 Diseases ill-defined or unknown 5 2 1 1 ... ... ... ... 1 1 2,287 305 71 51 48 63 315 653 781 1,245 78 TABLE IV. INFANT MORTALITY DURING THE YEAR 1912. Deaths from stated Causes, in Weeks and Months, under One Year of Age. Cause of Death. Under 1 week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. All Causes. Certified 91 21 20 5 137 56 43 41 28 305 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 6 3 9 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... 1 2 1 5 9 Diphtheria and Croup ... ... ... ... ... ... ... 1 ... 1 Erysipelas ... ... ... ... ... 1 ... ... ... 1 Tuberculous Meningitis ... ... ... ... ... 1 1 1 2 5 Abdominal Tuberculosis ... ... ... ... ... 1 3 2 ... 6 Other Tuberculous Diseases ... ... ... ... ... ... 1 ... 1 2 Meningitis (not Tuberculous) ... ... ... ... ... 1 2 3 2 8 Convulsions 2 ... ... ... 2 ... 1 1 3 7 Laryngitis ... ... ... ... ... ... ... 2 ... 2 Bronchitis ... 1 ... ... 3 9 3 ... 2 17 Pneumonia (all forms) 1 1 ... ... 2 5 3 11 2 23 Diarrhœa 1 ... ... ... 1 1 4 3 1 10 Enteritis ... ... ... ... ... 3 9 4 6 22 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... 4 3 1 8 3 4 ... ... 15 Rickets ... ... ... ... ... ... ... 1 ... 1 Suffocation, overlaying ... ... 1 ... 1 2 1 ... ... 4 Injury at birth 5 ... ... ... 5 ... ... ... ... 5 Atelectasis 3 1 ... ... 4 1 1 ... ... 6 Congenital Malformation 3 1 3 2 9 2 1 ... ... 12 Premature Birth 49 8 6 ... 58 2 ... ... ... 60 Atrophy, Debility, and Marasmus 24 9 5 ... 38 19 3 2 ... 62 Other causes 3 1 2 ... 6 4 4 3 1 18 91 21 20 5 137 56 43 41 28 305 legitimate, 3,186. Nett Births in the year illegitimate, 182. legitimate infants, 240. Nett Deaths in the year of ( illegitimate infants, 65. 79 TABLE V. Births and Deaths in Kensington; Birth-rates and Death-rates; and Infantile Mortality 1881-1912 in London and Kensington. Period 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. London. Kensington. London. Kensington London. Kensington. 1881-1885 21,383 34.3 26.1 13,438 21.0 16.4 3,211 150 150 1886-1890 19,428 32.1 23.5 13,816 19.7 16.7 3,060 153 157 1891-1895 18,512 30.8 22.0 14,235 19.8 16.9 3,105 156 167 1896-1900 18,665 29.7 21.6 14,075 18.5 16.3 3,203 162 172 1901-1910 35,062 27.5 20.0 24,917 15.6 14.3 4,644 126 132 1911 3,223 24.8 18.7 2,389 15.0 13.9 435 129 185 1912 3,318 - 19.3 2,287 — 13.3 305 — 92 Note I.—The rates tor London are taken from the Registrar General's Annual Summary (pp. xx. and xxxv.) for the year 1911. The decennial rates for the year 1901-1910 have been obtained by halving the sum of the quinquennial rates shown in the Annual Summary on the same pages for the years 1901-1905 and 1906-1910. Note 2.—The method adopted for obtaining the rates for Kensington was fully explained in the footnote whichwas appended to the above Table in the Annual Report of the Medical Officer of Health for the year 1911. 80 TABLE VI. Deaths from the Principal Epidemic Diseases, 1881-1912. Period. Deaths from the Seven Principal Epidemic Diseases. Small-pox. Measles. Scarlet Fever. Diphtheria WhoopingCough Enteric Fever Diarrhœa and Enteritis (all ages). Diarrhœa. and Enteritis (under 2 years.) 1881-1885 107 326 153 96 427 115 — — 1886-1890 1 442 135 305 387 77 — — 1891-1895 9 297 152 306 312 92 678 — 1892-1900 0 448 105 249 262 87 874 — 1901-1910 13 579 115 212 432 86 1,110 — 1911 0 93 3 20 54 4 184 150 1912 0 27 5 5 25 4 70 36 TABLE VII. Death-rate in Kensington, per 1,000 persons living, from each of the Seven Principal Epidemic Diseases, 1881-1912. Period. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhœa and Enteritis (all ages). Diarrhœa and Enteritis (under 2 years). 1881-1885 0.13 0.39 0.19 0.12 0.52 0.17 — — 1886-1890 0.00 0.53 0.16 0.37 0.47 0.10 — — 1891-1895 0.01 0.35 0.18 0.36 0.37 0.12 0.81 — 1896-1900 0.00 0.52 0.12 0.29 0.30 0.11 1.01 — 1901-1910 0.01 0.33 0.07 0.12 0.25 0.05 0.64 — 1911 0.00 0.54 0.02 0.12 0.31 0.02 1.07 0.87 1912 0.00 0.16 0.03 0.03 0.15 0.02 0.41 0.21 TABLE VIII. Causes of Death at different periods of life in the Year 1912. 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 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... 1 ... ... 3 1 4 Measles 6 27 13 14 5 4 3 6 5 3 13 13 26 ... ... ... 1 ... ... ... ... ... ... ... 1 1 Scarlet Fever 7 5 3 2 ... ... ... ... 2 ... 2 ... 2 1 1 ... ... ... 1 ... ... ... ... 1 2 3 Whooping-Cough 8 25 18 7 7 2 6 3 3 1 16 6 22 2 1 ... ... ... ... ... ... ... ... 2 1 3 Diphtheria 9A 5 1 4 ... 1 ... ... ... 1 ... 2 2 ... ... ... ... 1 ... ... ... ... 2 1 2 3 Influenza 10 28 10 18 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 6 ... 2 9 10 18 28 Dysentery 14 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 ... ... ... 1 1 Erysipelas 18 5 3 2 ... 1 ... ... ... ... ... 1 1 ... ... ... ... 1 2 ... l 2 ... 3 1 4 Pyæmia, yepticsemia 20 8 4 4 ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 42 1 1 ... ... 4 4 8 Pulmonary Tuberculosis 28AB 176 98 78 ... ... 1 1 1 ... 2 1 3 1 ... 9 11 43 ... 40 2 3 3 96 77 173 Acute Phthisis 29A 2 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 21 ... ... 1 1 2 Acute Miliary Tuberculosis 29B 1 1 ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... 1 • • • ... ... 1 ... 1 Tuberculous Meningitis 30 20 14 6 3 2 4 ... 3 ... 10 2 12 2 3 1 1 1 ... ... ... ... ... 4 4 8 Tuberculosis of Peritoneum, &c. 31AB 11 8 3 5 1 ... ... 2 1 7 2 9 ... 1 ... ... 1 ... ... ... ... ... 1 1 2 Tuberculosis of Spinal Column 32 4 2 2 ... ... ... ... ... 1 ... 1 1 ... ... ... ... 1 ... 1 ... ... 1 2 1 3 Tuberculosis of Joints 33 1 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... Tuberculosis of other organs 34 6 1 2 ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... 1 1 4 2 6 Disseminated Tuberculosis 35 6 4 2 1 ... ... 1 .. ... 1 1 2 1 ... 1 ... ... 1 ... ... ... ... 3 1 4 Rickets 36 4 2 2 1 ... 1 ... ... ... 2 ... 2 ... ... ... ... ... ... ... 1 ... 1 ... 2 2 Syphilis 37 21 11 10 8 7 1 1 ... ... 9 8 17 ... ... ... ... 2 1 ... ... ... 1 2 2 4 Ophthalmia Neonatorum 38C 1 ... 1 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... 1 ... ... 31 ... ... ... ... Cancer 39-45 228 76 152 ... ... 1 ... ... ... 1 ... 1 ... ... 2 1 6 ... 36 80 ... 58 75 152 227 Other tumours 46 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 13 1 ... ... ... 1 ... 1 Rheumatic Fever 47 7 8 4 ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 1 2 1 ... 3 4 7 Chronic Rheumatism, &c. 48AB 8 1 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 2 4 1 7 8 Gout 48C 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 5 ... 3 ... 3 Diabetes 50 22 10 12 ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... 1 3 1 7 10 12 22 Leucocythaemia, &c. 53AB 5 4 1 ... ... ... ... 1 ... 1 ... 1 1 ... ... ... ... 2 1 1 1 ... 3 1 4 Carried forward 635 299 336 31 19 17 12 17 7 65 38 103 9 8 19 15 67 63 90 125 49 87 234 298 582 81 TABLE VIII.—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 635 299 336 31 19 17 12 17 7 65 38 103 9 8 19 15 67 63 90 125 49 87 234 298 532 GENERAL DISEASES.—continued. Anæmia Chlorosis 54 5 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 1 ... 1 4 5 Acromegaly 55D 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Alcoholism 56 5 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... ... ... 1 2 3 5 Opium Habit 59 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... l ... 1 ... 1 Total for General Diseases 647 303 344 31 19 17 12 17 7 65 38 103 9 8 19 15 69 66 90 129 51 88 238 306 544 II.—DISEASES OF THE NERVOUS SYSTEM AND OF THE ORGANS OF SPECIAL SENSE. Encephalitis 60 3 1 2 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 1 1 2 3 Meningitis 61BC 18 9 9 5 3 ... ... ... 3 5 6 11 ... ... ... 1 2 ... 1 2 1 ... 4 3 7 Locomotor Ataxy 62 6 4 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 2 ... ... 4 2 6 Other Diseases of the Spinal Cord 63AB 9 1 8 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 4 ... 3 1 8 9 Cerebral Hæmorrhage, Apoplexy 64AE 85 38 47 1 ... ... ... ... ... ... ... ... ... ... 1 1 2 3 17 24 17 19 37 47 84 Softening of Brain 65 11 4 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 3 5 4 7 11 Paralysis without specified cause 66AC 15 6 9 .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 5 6 6 9 15 General Paralysis of the Insane 67 16 13 3 ... ... ... ... ... ... ... ... ... ... ... 1 ... 7 2 5 1 ... ... 13 3 16 Other forms of Mental Alienation 68 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 ... ... ... 4 4 Epilepsy 69 19 10 9 ... ... ... ... ... ... ... ... ... 1 ... 2 ... 3 2 3 4 1 3 10 9 19 Infantile Convulsions under 5 years 71AB 14 6 8 5 2 .... 4 1 2 6 8 14 ... ... ... ... ... ... ... ... ... ... ... ... ... Chorea 72 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 Neuritis 73 4 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 1 ... ... ... 3 1 4 Other Diseases of the Nervous System 74AD 21 6 15 ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 1 3 1 2 10 6 14 20 Mastoid Disease 76 A 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 Other Diseases of the Ears 76B 2 ... 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 2 2 Total for Diseases of the Nervous System and of the Organs of Special Sense 229 103 126 11 6 ... 4 1 5 12 15 27 2 3 6 3 18 15 36 43 29 47 91 111 202 III.—DISEASES OF THE CIRCULATORY SYSTEM. Pericarditis 77 6 2 4 1 ... ... ... ... ... 1 ... 1 ... 2 ... ... ... 1 ... 1 1 ... 1 4 5 Acute Endocarditis 78AC 3 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... 1 2 3 Valvular Disease 79A 75 39 36 ... ... ... ... ... ... ... ... ... 1 ... 1 1 2 2 19 10 16 23 39 36 75 Fatty Degeneration of the Heart 79B 47 21 26 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 8 7 12 15 21 26 47 Carried forward 1007 469 538 43 25 17 16 18 12 78 53 131 12 13 26 19 90 89 154 191 109 173 391 485 876 TABLE VIII.—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 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 1007 469 538 43 25 17 16 18 12 78 53 131 12 13 26 19 90 89 154 191 109 173 391 485 876 DISEASES OF THE CIRCULATORY SYSTEM—continued. Other Organic Disease of the Heart 79C 153 68 85 ... ... 2 ... ... ... 2 ... 2 ... 4 ... 1 8 7 27 32 31 41 66 85 151 Angina Pectoris 80 11 6 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 3 2 6 5 11 Arterial Sclerosis, &c. 81 AC 41 21 20 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 6 9 13 10 21 20 41 Cerebral Embolism and Thrombosis 82A 21 6 15 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 , 1 3 14 6 15 21 Other Embolism and Thrombosis 82 B 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 2 Diseases of the Veins 83AD 3 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... 1 2 3 Diseases of the Lymphatic System 84 AB 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 365 167 198 2 1 2 ... ... ... 4 1 5 1 6 1 2 15 17 67 65 79 107 163 197 360 IV.—DISEASES OF THE RESPIRATORY SYSTEM. Diseases of the Nasal Fossæ 86 1 ... 1 ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... . . . ... ... ... ... ... ... Diseases of the Larynx 87AC 3 2 1 1 1 1 ... ... ... 2 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of the Thyroid Body 88 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Bronchitis 89 & 90 209 94 115 12 5 2 1 ... 3 14 9 23 1 ... ... 1 4 7 23 27 52 71 80 106 186 Broncho-pneumonia 91 55 29 26 8 6 8 3 ... 3 16 12 28 ... ... ... ... 1 ... 3 4 9 9 13 14 27 Lobar-pneumonia 92 A 26 14 12 ... ... 1 1 ... 2 1 3 4 ... ... ... ... 4 3 5 3 4 3 13 9 22 Pneumonia (type not stated) 92 B 80 51 29 4 5 5 2 ... ... 13 7 20 ... ... 1 1 7 5 20 4 7 12 38 22 60 Pleurisy 93AB 5 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ... ... 1 1 4 5 Pulmonary Congestion, &c. 94AD 19 7 12 ... 1 ... ... ... ... ... 1 1 ... ... 1 ... 2 3 2 2 2 6 7 11 18 Gangrene of the Lung 95 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Asthma 96 11 5 6 ... ... ... 1 ... ... ... 1 1 ... ... ... ... ... 1 3 2 2 2 5 5 10 Pulmonary Emphysema 97 3 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... 1 2 3 Fibroid Disease of Lung 98A 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Total tor Diseases of the Respiratory System 415 205 210 25 18 17 8 4 9 46 35 81 4 1 2 2 18 22 59 45 76 105 159 175 334 V.—DISEASES OF THE DIGESTIVE SYSTEM. Diseases ot the Mouth, &c. 99AD 4 1 3 1 ... ... 2 ... ... 1 2 3 ... ... ... ... ... ... ... ... ... 1 ... 1 1 Carried forward 1600 779 881 70 44 36 26 22 21 128 91 219 16 18 28 22 120 120 252 282 235 348 651 790 1441 83 84 TABLE VIII.—continued. CAUSES OF DEATH. Classification No. Totals— All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. Totals— Under Five 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 1660 779 881 70 44 36 26 22 21 128 91 219 16 18 28 22 120 120 252 282 235 348 651 790 1441 DISEASES OF THE DIGESTIVE SYSTEM—continued. Perforating Ulcer of Stomach 102 10 5 5 ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 3 2 1 ... 1 5 5 10 Inflammation of Stomach 103A 8 2 6 ... 1 ... 1 ... ... ... 2 2 ... ... ... ... ... ... 2 2 ... 2 2 4 6 Other Diseases of the Stomach 103B 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... 2 Diarrhœa and Enteritis l04 & 105 AH 70 26 44 l3 19 2 2 ... 4 15 25 40 2 3 ... 2 ... 2 2 6 7 6 11 19 30 Appendicitis 108 12 2 10 ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 2 1 5 ... 1 2 10 12 Hernia 109 A 8 3 5 ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... 1 2 1 ... 3 2 5 7 Intestinal Obstruction 109B 17 6 11 ... ... 1 ... ... ... 1 1 1 ... ... ... ... 2 2 4 2 5 5 11 l6 Other Diseases of the Intestines 110 4 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 2 2 4 Cirrhosis of the Liver, &c. 113AC 16 8 8 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 4 7 2 1 8 8 16 Biliary Calculi 114 5 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 2 2 3 5 Other Diseases of the Liver 115 17 9 8 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 5 4 3 3 9 8 17 Peritonitis (cause unstated) 117 4 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 1 1 2 4 Other Diseases of the Digestive System 118AB 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 2 Total for Diseases of the Digestive System 179 71 108 14 20 3 5 1 4 18 29 47 3 5 1 2 6 12 23 32 20 28 53 79 132 VI.—NON-VENEREAL DISEASES OF THE GEN1TO-URINARY SYSTEM AND ANNEXA. Acute Nephritis 119 4 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 ... 2 2 4 Bright's Disease, &c. 120AB 76 37 38 ... ... ... ... ... ... ... ... ... ... ... ... ... 6 10 l3 12 18 l6 37 38 75 Other Diseases of the Kidney 122 AD 6 2 4 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 1 2 ... 1 1 4 5 Diseases of the Bladder 124 8 6 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 5 2 6 2 8 Diseases of the Urethra 125 AB 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 ... 2 Diseases of the Prostate 126 8 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 ... 8 ... 8 Uterine Tumour 129 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... 1 ... 1 1 Other Diseases of the Uterus 130AB 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 2 Ovarian Cyst (Tumour) 131 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... 1 ... 1 1 Other Diseases of the Female Genital Organs 132AB 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 1 ... ... ... 3 3 Total for non-Yenereal Diseases of the Genito Urinary System and Annexa 110 57 53 1 ... ... ... ... ... 1 ... 1 ... ... ... 2 6 13 16 17 34 21 56 53 109 Carried forward 1945 906 1039 84 64 39 29 23 25 146 118 264 19 23 29 26 132 145 291 331 289 396 760 921 1681 85 TABLE VIII.—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 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 1945 906 1039 84 64 39 29 23 25 146 118 264 19 23 29 26 132 145 291 331 289 396 760 921 1681 VII.—THE PUERPERAL STATE. Accidents of Pregnancy 134AB 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... 3 3 Puerperal Hemorrhage 135 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Other Accidents of Childbirth 136 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 2 Puerperal Fever 137 6 ... 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 ... ... ... ... ... 6 6 Puerperal Convulsions 138C 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Phlegmasia Dolens and Embolism 139AB 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 2 Total for Diseases of the Puerperal State 15 ... 15 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 ... ... ... ... ... 15 VIII.—DISEASES OF THE SKIN AND OF THE CELLULAR TISSUE. 15 Senile Gangrene 142A 6 2 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 3 2 4 6 Gangrene of Mouth 142B 1 ... 1 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Carbuncle 143 3 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 2 1 3 Phlegmon, Acute Abscess 144AB 9 2 7 ... 1 ... 1 ... ... ... 2 ... ... ... ... ... ... ... 1 2 1 3 2 5 7 Diseases of the Integumentary System 145AD 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Total for Diseases of the Skin and oF the Cellular Tissue 20 7 13 ... 2 ... 1 ... ... ... 3 3 ... ... ... ... ... ... 3 3 4 7 7 10 17 IX.—DISEASES OF THE BONES AND OF THE ORGANS OF LOCOMOTION. 146-7 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 2 X.—MALFORMATIONS. Congenital Malformation 150AD 13 10 3 9 3 ... ... ... ... 9 3 12 1 ... ... ... ... ... ... ... ... ... 1 ... 1 XI.—DISEASES OF EARLY INFANCY. ... ... Premature Birth 151A 60 30 30 30 30 ... ... ... ... 30 30 60 ... ... ... ... ... ... ... ... ... ... ... ... ... Infantile Atrophy, Debility, and Marasmus 151B 59 27 32 27 32 ... ... ... ... 27 32 59 ... ... ... ... ... ... ... ... ... ... ... ... ... Icterus Neonatorum 151C 1 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast Milk 151E 2 2 ... 2 ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Umbilicus, &c 152A 2 2 ... 2 ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis 152B 6 4 2 4 2 ... ... ... ... 4 2 6 ... ... ... ... ... ... ... ... ... ... ... ... ... Injuries at Birth 152C 5 3 2 8 2 ... ... ... ... 3 2 5 ... ... ... ... ... ... ... ... ... ... ... ... ... Lack of Care 153 1 ... 1 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Total for Diseases of Early Infancy 136 69 67 69 67 ... ... ... ... 69 67 136 ... ... ... ... ... ... ... ... ... ... ... ... ... Carried forward 2131 992 1139 162 136 39 30 23 25 224 191 415 20 23 29 26 132 160 294 335 293 404 768 948 1716 86 TABLE VIII.—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 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 2131 992 1139 162 136 39 30 23 25 224 191 415 20 23 29 26 132 160 2 9 335 293 404 768 948 1716 XII.—OLD AGE. Old Age. 154AB 74 18 56 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 18 55 18 56 74 XIII.—AFFECTIONS PRODUCED BY EXTERNAL CAUSES. Suicide by Poison 155 4 2 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... ... ... ... ... 2 2 4 Suicide by Hanging 157 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... 3 ... 3 Suicide by Drowning 158 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Suicide by Firearms 159 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 2 Suicide by Cutting or Piercing Instruments ... 160 8 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... 1 2 3 Other Acute Poisoning 165 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Conflagration 166 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Burns 167 5 3 2 1 ... 1 ... ... 1 2 ... 3 ... ... ... ... ... 1 1 ... ... ... 1 1 2 Absorption ot Deleterious Gases (Overlain, etc.) 168 4 2 2 2 2 ... ... ... ... 2 2 4 ... ... ... ... ... ... ... ... ... ... ... ... ... Accidental Drowning 169 4 3 1 ... ... ... ... ... ... ... ... ... 2 ... ... ... 1 ... ... 1 ... ... 3 1 4 Injury by Fall 172 23 11 12 ... ... ... ... ... ... ... ... ... ... ... ... 3 1 1 7 4 3 4 11 12 23 Injury by Machines 174 2 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 2 ... 2 Injury by other Crushing (vehicles, railways, Asc.) 175 20 15 5 ... ... ... ... 1 ... 1 ... 1 3 ... 1 ... 6 3 4 ... ... 2 14 5 19 Injury by Animals 176 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Fractures (cause not specified) 185 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 1 2 Other Violence 186 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Total for Affections produced by External Causes 77 44 33 3 2 1 ... 1 1 5 3 8 5 ... 3 5 12 11 16 7 3 7 39 30 69 XIV.—ILL-DEFINED CAUSES. Heart Failure 189 A 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Other Hl-defined Causes 189BCD 3 2 1 1 ... .. 1 1 ... 2 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... Cause not specified 189F 1 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Total for Ill-defined Causes 5 4 1 2 ... ... 1 1 ... 3 1 4 ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Grand Totals 2287 1058 1229 167 138 40 31 25 26 232 195 427 25 23 32 31 144 171 310 343 315 466 826 1034 1860 87 TABLE IX—PROCEEDINGS DURING 1912. PREMISES. NUMBER OF PLACES. Number of inspections, 1912. Number of notices, 1912. Number of prosecutions. 1912. On register at end of 1911. Added in 1912. Removed in 1912. On register at end of 1912. Milk premises 196 16 8 204 1,362 19 1 Cowsheds 1 — — 1 45 — — Slaughter-houses 10 — — 10 268 — — Other offensive trade premises — — — — — — — Ice cream premises 173 67 69 171 184 14 — Registered houses let in lodgings 2,091 3 0 2,094 8,704 (a)*75 (b)†1161 (a)*0 (b)†10 Total number of intimation notices served for all purposes, 2,528. * (a) For overcrowding. f (4) For other conditions. Overcrowding—1912. Number of dwelling rooms overcrowded 113 Number remedied 113 Number of Prosecutions 0 Underground rooms— Illegal occupations dealt with during year 22 Number of rooms closed - Insanitary houses— Number closed under the Pubic Health (London) Act, 1891 0 Number closed under the Housing of the Working Classes Act 2 Number of premises cleansed under Section 20 of L.C.C. (General Powers) Act, 1904 406 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 58 Number of tenements comprised therein 169 Number of tenements for which certificates were (a) granted 152 (b) refused 0 Number of brosecutions under Bv-laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, &c. — (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 1 (d) As to paving of yards, etc., of dwelling houses 0 (e) In connection with the removal of offensive matter, etc. 3 (f) As to cesspools and privies, removal and disposal of refuse, etc. — (g) For securing the cleanliness of tanks, cisterns, etc. — (h) With respect to water closets, earth closets, etc. 0 (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 Managerre.it Acts Amendment (By-laws) Act, 1899) 0 M ortuaries— Total number of bodies removed 238 Total number of infectious bodies removed 0 88 TABLE X. Summary of the Work done by the Sanitary Inspectors during the Year 1912. description of work. etc. number of district. Grand Total. 1 2 8 4 5 6 7 8 9 10 Complaints received 205 156 68 116 125 131 177 117 206 109 1,410 House to House Inspections 146 118 101 228 227 5 238 423 36 343 1,865 Houses Inspected on Complaint 357 225 101 170 266 259 256 159 442 129 2,364 Re-inspections of Houses 757 656 1,235 1,363 1,681 1,552 895 1,090 1,418 867 11,514 Inspections of Lodging Houses (Unfurnished) 1,207 1,424 458 465 491 222 944 346 792 435 6,784 Inspections of Lodging Houses (Furnished) 118 3 1,082 194 — 520 3 — — — 1,920 Houses cleansed, &c. 115 365 265 87 85 51 446 72 188 60 1,734 Verminous Rooms cleansed 84 55 145 62 11 9 23 7 6 4 406 Dirty bedding cleansed 3 37 77 6 — — 1 — — — 124 ,. ,. destroyed — 3 7 1 — 1 1 — — — 13 Overcrowding abated 13 44 22 15 — 7 6 1 4 1 113 Underground Rooms, illegal occupation discontinued 4 5 1 — 4 — 6 1 1 — 22 House Drains re-constructed 13 21 9 13 8 6 15 7 11 2 105 Defective Drains repaired 25 18 19 7 5 36 13 12 27 11 173 House Drains cleansed 26 122 20 4 8 24 32 17 14 11 278 Water-closets constructed, repaired, &c. 160 35 84 76 68 41 87 36 87 54 731 „ supplied with water 9 164 1 60 74 3 78 17 62 14 482 new, provided 1 2 2 1 — 3 12 3 19 2 45 Soil-pipes ventilated, repaired, &c. 10 16 — 5 4 7 11 3 16 3 75 „ new, provided 10 9 5 2 3 5 7 1 23 1 66 Cisterns cleansed, covered, &c. 26 73 29 35 25 12 15 19 78 15 327 Yards, Areas paved, drained, repaired 42 35 111 31 35 41 51 15 60 5 426 Dustbins provided 80 110 91 56 125 22 30 23 75 40 652 Ashpits abolished 26 24 25 15 102 1 4 4 22 6 229 Accumulations of tilth, &c., removed 37 74 7 9 2 25 247 42 34 4 481 Animals removed 16 13 4 2 2 1 5 3 3 2 51 Other Sanitary Work executed 24 394 183 28 73 39 169 42 56 73 1,081 Workshops, &c., Inspections of 33 104 57 140 82 51 120 159 108 126 980 Factories, Inspections of 6 23 2 23 5 1 2 7 4 16 89 Bakehouses, Inspections of 67 78 21 91 63 46 55 22 109 55 607 Slaughter-houses, Inspections — 34 82 15 — 38 80 18 — 1 268 Dairies, &c., Inspections 144 87 107 121 167 201 72 99 256 107 1,362 „ Notices 3 — 5 — — 2 1 1 6 1 19 Ice Cream Vendors, premises, Inspections 19 29 22 44 12 17 17 4 18 2 184 „ „ „ Notices 1 3 3 2 1 1 2 — 1 — 14 Other Places where Food is prepared, Inspections of 188 221 58 137 88 29 120 69 180 139 1,229 Smoke observations 87 31 4 — — — 36 95 40 11 304 Nuisances from smoke observed 1 1 1 — — 1 — 1 1 6 Mews, Inspections of 980 675 537 477 663 674 349 929 695 881 6,860 Other inspections 49 406 81 116 187 75 83 344 128 141 1,610 Written intimations 267 324 307 256 258 175 248 161 411 121 2,528 Notices issued Statutory 34 81 67 38 53 48 37 49 71 37 515 Lodging Hous. 151 255 243 123 57 44 187 49 96 31 1,236 Removal of Manure 5 2 — — — 3 2 — — — 12 Sanitary Works completed 724 1,619 1,107 515 684 337 1,259 325 786 308 7,614 Legal Proceedings—Number of summonses issued 3 3 6 — 1 2 — 1 — — 16 89 TABLE XI. Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1911. (Vide page 72) DATE. Registration Sub-Districts comprised in Vaccination Officer's District Number of these Births duly entered in Columns 1, 2, 4, and 5 of the Vaccination Register (Birth List Sheets), tfiz : Number of these Births which are not entered in the Vaccination Register, on account, (as shown by Report Book) of Number of Births returned in Birth List Sheets. Column II. 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 1 ach of the Calendar Years. Column 1. Successfully Vaccinated. Insusceptible of Vaccination. Certificate of Conscientious Objection. Column V. Dead. Unvaccinated. Postponement by Medical Certificate. 1911. 1912. 1911. 1 2 3 4 6 7 8 9 19 12 13 1st Jan Kensington North 1,330 1,019 1 132 93 16 3 66 to Kensington Central 780 604 5 64 66 4 5 32 2,634 2,492 31st Dec. Kensington South 929 707 14 87 63 9 11 38 Total 3,039 2,330 20 283 222 29 19 136 90 TABLE XII. Name and Address of Keeper. Address of Houses Let in Furnished Rooms. 1 Number L Houses. Adkins, 42, Pottery Lane No. 42, Pottery Lane l Anthony, 38, Crescent Street Nos. 38 and 41, Crescent Street; No. 47, St. Katherines Road 3 Atkinson, 65, St. Katherines Road Nos. 6, 8, 19, 21, Crescent Street; Nos. 1 and 3, Sirdar Road 6 Barrs, 148, Portland Road Nos. 138, 140, 142, 148. Portland Road 4 Beadle, 24, Stebbing Street, Hammersmith Nos. 15 and 17, Crescent Street; No. 83, Princes Road 3 Brown, 160, Portland Road. No. 160, Portland Road 1 Burnell, 3, Darnley Road Nos. 4, 6, 8, Bangor Street 5 Byden, 12, St. Katherines Road Nos. 12 and 14, St. Katherines Road; Nos. 11 and 12, Bolton Road 4 Carter, 39, Sirdar Road No. 28, Bangor Street; Nos. 11 and 13, Crescent Street; Nos. 29, 31, 44, Sirdar Road 6 Cleveland, 172, Portland Road No. 172, Portland Road 1 Cook, 27, Sirdar Road Nos. 13 and 15, Sirdar Road 2 Crosson, 1, Hurstway Street Nos. 33, 42, 46, 48, 50, 52, 54, Sirdar Road 7 Culverweli, 6, Bangor Street No. 25, Sirdar Road 1 Doyle, 23a, Bolton Road Nos. 7, 23, 23a, Bolton Road 3 Goddard, 24, Stebbing Street, No. 40, Pottery Lane 1 smith *Hankins, 10, St. Anns Villas Nos. 12. 22, 24, 26, 32, 34, 36, 42, 29, 37, 39, Crescent Street (and Common Lodging Houses at Nos. 10, 28, 30. and 40, Crescent Street) 11 Heal, 52, Grove Road, Hounslow Nos. 19 and 20. Bolton Road 2 Hetherman, 1, St. Katherines Road Nos. 3, 5, 16, 18, 33, 35, 37, St. Katherines Road; No. 29, Kenley Street 8 Hunt, 13, Second Avenue, Paddington Nos. 2, 12, 19, Bangor Street; No. 4, Crescent Street; Nos. 17, 19, 21, Sirdar Road 7 Ivory, 25. Lonsdale Road Nos. 15, 17. 25, Lonsdale Road 3 James, 102, Princes Road No. 102, Princes Road 1 Lane, 70, St. Anns Road No. 70, St. Anns Road 1 Leary, 34, St. Katherines Road Nos. 32, 34, 38, St. Katherines Road 3 Legge, 227, Portland Road No. 227, Portland Road 1 Lineham, 178, Portland Road No. 178, Portland Road 1 *Madden, 96, Bramley Road Nos. 23, 25, 27, 29, 34, Blechynden Street; No. 125, Portland Road ; No. 11, Raymede Street; Nos. 57, 59, 61, Treverton Street (and Common Lodging House at No. 194, Kensal Road) 10 Mahoney, 49, St. Katherines Road No. 49, St. Katherines Road 1 Margetson, 59, St. Katherines Road Nos. 1, 2, 3, 4, Bolton Road ; Nos. 25, 27, 29, 31, 44, 57, St. Katherines Road 10 Marsh, 5, Bolton Road No. 5, Bolton Road 1 Moore, J., 93, Princes Road Nos. 7, 9, 13, 20, 22, St. Katherines Road ; No. 100, Princes Road 6 Moore, W., 110, Portland Road Nos. 108 and 110, Portland Road 2 Morris, 171, Portland Road No. 171, Portland Road 1 *Nagle, 46, Paddenswick Road, Hammersmith No. 9, Bangor Street (and Common Lodging Houses at Nos. 5 and 7, Bangor Street) 1 Nicols. 17, Peel Street No. 17, Peel Street 1 Parkes, 22, Talbot Grove Nos. 20, 24, 26, Talbot Grove 3 Pearce, 9, Bolton Road Nos. 9 and 10, Bolton Road 2 *Reynolds, C., 38, Bangor Street Nos. 36, 38, 37, Bangor Street; No. 68, St. Anns Road (and Common Lodging House at No. 35, Bangor Street) 4 Reynolds, D., 104, Princes Road No. 104, Princes Road 1 Riddler, 13, Talbot Grove Nos. 11, 13, 15, 17, Lockton Street 4 Rourke, 179, Portland Road ... Nos. 177 and 179, Portland Road 2 *Rusha, 16, Hume Road, Hammersmith Nos. 10, 11, 21, 23, 24, 25, 26, 29, 30, 32, Bangor Street; Nos. 14, 16, 18, Crescent Street (and Common Lodging Houses at Nos. 18 and 20, Bangor Street; Nos. 25, 27, 31, 33, Crescent Street; and Nos. 34, 36, 38, 40, Sirdar Road) 13 Salt, 270, Latimer Road No. 3, Bangor Street; No. 23, Sirdar Road 2 Saunders, 8, Bolton Road Nos. 8, 21, 22, Bolton Road 3 Simpson, 50, Hammersmith Road Nos. 31 and 33, Bangor Street 2 Slowe, 104, Portland Road Nos. 104 and 106. Portland Road 2 Strange, 165. Portland Road Nos. 112, 116, 157, 159, 163, Portland Road 5 Sutton, 44, St. Anns Road Nos. 32, 38, 40. St. Anns Road; No. 115, St. Katherines Road 4 Wallis, 2, St. Katherines Road Nos. 2 and 4, St. Katherines Road; Nos. 87 and 91, Princes Road 4 Warren, 16, Bolton Road Nos. 14, 15, 16, 17, Bolton Road 4 Watts, 33, Southam Street Nos. 22 and 33, Southam Street 2 Welch, 17, Bangor Street Nos. 13, 15, 17, Bangor Street 3 Wheelwright, 64, St. Anns Road No. 39, Bangor Street 1 Wigmore, 158, Portland Road Nos. 152, 154, 156, Portland Road 3 Williams, 34, Bangor Street Nos. 27 and 34, Bangor Street 2 Wilson, 30, Treverton Street No. 30, Treverton Street 1 Woodroff, 251a, Latimer Road, Hammersmith Nos. 19, 23, 25, Lockton Street 3 Total 187 * The five names marked with an asterisk are the names of persons letting furnished rooms who are also kteper- or common lodging houses. INDEX. Page Adulteration of Food 40 Appendix 75 Area of the Borough 3 Baths and Washhouses 71 Births and Birth Rates 4 Births, Notification of 5 Births and Birth Rates, Tables I. and V. 75 & 79 Cancer 34 Chapel of Rest for the Dead 72 Cleansing of Children and Verminous Persons 70 Common Lodging Houses 50 Consumption 21 Cow House 88 Cream Regulations, 1912 41 Customs and Inland Revenue Acts 53 Dairies and Milkshops 37 Deaths and Death Rates— In Districts 6 From Principal Causes 7 From Zymotic or Principal Epidemic Diseases 7 & 19 Among Infants 7 Deaths and Death Rates, Tables— 1907—1912 Table 1 75 Causes of at Ages, Summary, Table III 77 Infantile Mortality, Table IV 78 Causes of by Sexes at ages, Table VIII 81 In Quinquennia, 1881—1910 Table V 79 Principal Epidemic Diseases, Deaths from, Table VI 80 Principal Epidemic Diseases Death Rates, Table VII 80 Diarrhœa 21 Diphtheria 15 Disinfection 69 Drainage Work 67 Dust, Removal of 67 Enteric Fever 17 Enteritis and Diarrhœa 21 Factories and Workshops 57 Food Supply 37 Food, Adulteration of 40 Furnished Rooms 46 Health Visitors 11 Home Office Tables 61-64 Home Work 58 Houses let in Lodgings 46 Houses, Number Inhabited 45 Housing (Inspection of District) Regulations, 1910 50 Housing of Working Classes 45 Ice Cream Vendors 38 Illegitimate Births 5 Infantile Mortality 7 Infectious Diseases 15 Notification and Removal, Table II. 76 Inhabited Houses, Number of 45 Inspection, Sanitary 67 Inspectors, Work of, Summary, Table X. 88 Inquests 72 ii. Page Lavatories, Public 67 Legal Proceedings 68 Local Government Board Tables I.—IV 75-78 Lodging Houses— Common Lodging Houses 50 Houses Let in Lodgings 46 Provided by the Council 45 London County Council Summary of Work, Table IX 87 Margarine 41 Marriages 4 Measles 20 Milkshops 37 Milk Supply 37 Mortuary 72 Notifiable Diseases 15 Notification of Births 5 Ophthalmia Neonatorum 18 Outworkers' Premises 59 Phthisis 21 Places where Food is Sold 88 Poliomyelitis 18 Population 8 Distribution in Wards 8 Prosecutions 68 Public Health (Tuberculosis) Regulations, 1908-1911 22 & 23 Public Health (Milk and Cream Regulations), 1912 41 Puerperal Fever 17 Rag Flock Act, 1911 71 Refuse, Removal of— House Refuse 67 Trade Refuse 67 Registered Lodging Houses 46 Sale of Food and Drugs Acts 40 Sanitary Inspection 67 Sanitary Inspectors' Work, Table X 88 Scarlet Fever 16 Schools for Mothers 11 Slaughter Houses 39 Small Pox 15 Smoke Nuisances 67 Tuberculosis Dispensary 32 Tuberculosis of Lungs 21 Tuberculosis, Other Forms of 34 Tuberculosis Regulations, 1908 and 1911 22 & 23 Tuberculosis— Notification 24 Occupation of Persons Notified 29 Provision ot Beds 82 Sanatorium Treatment 33 Shelters 32 Typhoid Fever 17 Underground Rooms 53 Unsound Food 39 Vaccination Returns, Table XI 89 Verminous Persons, Articles and Rooms 71 Water Certificates 42 Water Supply 42 Whooping Cough 20 Workshops and Factories 57 Zymotic or Principal Epidemic Diseases 7 & 19 Deaths from in Quinquennial Periods, Table VI 80 Death Rates from in Quinquennial Perigcjia, Table VII 80