The Royal Borough of Kensington ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. 1913. Vail & Co., Printers and Stationers, 170, Farringdon Road, E.C. 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 (Infections 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. Staff of Cleansing Station. W. C. Webber (Superintendent), Mrs. Webber. 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 fifth 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 1913. Regulations prohibiting the use of certain underground rooms as sleeping places have been framed and approved by the Local Government Board. Provisional agreements have been made with the Kensington Tuberculosis Dispensary and the Brompton Hospital for the dispensary treatment of consumptive patients. A station has also been provided for the cleansing of school children and other persons who have become infested with vermin. The work of the Public Health Committee in securing these results has been exceptionally heavy, as has the work of the Public Health Department in the administration of the new Regulations and the new Tuberculosis Order. In these circumstances I desire to acknowledge the zeal and loyalty with which the staff have carried out their extended duties, and to thank the Committee and the Council for the consideration and support they have given to the Department throughout the year. I have the honour to be, Ladies and Gentlemen, Your obedient Servant, J. E. SANDILANDS, Medical Officer of Health. Public Health Department, Town Hall, Kensington, W. 14th May, 1914. vii. TABLE OF CONTENTS. A.—Vital Statistics. Page Population 3 Births 4 Deaths 6 „ from Zymotic Diseases 8 „ oF Infants 8 Infantile Mortality, Causes of 9 B.- Prevalence of Disease. Infectious Diseases 15 Small Pox 15 Diphtheria 15 Scarlet Fever 16 Enteric Fever 16 Puerperal Fever 17 Ophthalmia Neonatorum 17 Poliomyelitis 17 Measles 19 Whooping Cough 19 Epidemic Diarrhœa 19 Tuberculosis 22 Cancer 32 C.—Food Supply. Milk Shops 37 Ice Cream Vendors 38 Places where Food is Sold 38 Bakehouses 38 Slaughter Houses 38 Unsound Food 39 Sale of Food and Drugs Acts 39 Cream Regulations, 1912 40 Water Supply 40 D.—Housing. Inhabited Houses 45 Council's Lodging Houses 45 Houses Let in Lodgings 46 Furnished Rooms 46 Common Lodging Houses 47 Housing (Inspection of District) Regulations 1910 47 Underground Rooms 48 Customs and Inland Revenue Acts 50 E.—Factories and Workshops. Page Women's Workshops 58 Home Work 54 Men's Workshops 57 Home Office Tables 57 F.—Sanitation. Dust Removal 63 Drainage Work 63 Nuisance from Smoke 63 Public Lavatories 63 Sanitary Inspection 63 Legal Proceedings 64 Disinfection 65 Cleansing Station 66 Rag Flock act, 1911 66 Public Baths and Washhouses 66 Public Mortuary 67 Vaccination 67 G.—Appendix. Local Government Board Tables. Table I.—Vital Statistics, 1913 and Previous Years 71 Table II.—Infectious Diseases 72 Table III.—Causes of Death 73 Table IV.—Infantile Mortality 74 London County Council Summary. Table IX.—Proceedings during 1913 83 Other Statistical Tables. Table V.—Births and Deaths in Quinquennial Periods 75 Table VI.—Zymotic Deaths in Quinquennial Periods 76 Table VII.—Zymotic Death Rates in Quinquennial Periods 76 Table VIII.—Deaths, Sex, Age and Cause 77 Table X.--Work of Sanitary Inspectors 84 Tables XI. to XV.—Vital Statistics for Selected Streets 85, 86 Tables XVI. to XVIII.—Working Class Rents and Retail Prices 87 viii. SUMMARY OF STATISTICS, For the year 1913. Population (Estimated) 171,700. Area of Borough in Acres 2,291 Density of Population per Acre 75 Houses Inhabited 27,654 Persons per House 6.2 Number of Marriages 1,690 Number of Births 3,335 Birth Rate 19.4 Number of Deaths 2,409 Crude Death Rate 14.0 Standardised Death Rate 13.9 Infantile Mortality:— Deaths under 1 year 371 Infantile Deaths per 1,000 Births 111 Deaths from Phthisis 189 Phthisis Death Rate 1.10 Deaths from the Zymotic Diseases 235 Zymotic Death Rate 1.37 VITAL STATISTICS. 3 VITAL STATISTICS. The Metropolitan Borough of Kensington covers an area of 2,291 acres, and is co-extensive with the Civil Parish and Registration District of the same name. The Borough is 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 £2,430,143. The product of a rate at one penny in the £ is £9,476. In the comparison of vital statistics for different districts, those for Kensington are sometimes taken as representing the experience of a good class residential area. For the information of persons who are not familiar with local conditions, it may therefore be stated that it is only the figures for South Kensington which can be interpreted in the above mentioned sense. The northern half of the Borough touches the Harrow Road in the north and the Latimer Road on the east. In each of the four northern wards there are areas of extreme poverty, and the Golborne Ward may be taken as an example of a district in which practically the whole population consists of the working classes, and includes large numbers of semi-destitute persons who have no regular employment. 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 1913 is estimated to have numbered 171,700, and it is on this figure that the birth rate and the death rates for the year have been calculated. Census Population, 1911. Families or separate occupiers, Census 1911. Estimated Population, 1913. In private families. Inmates of Institutions. Totals. Families, Institutions. Cols. 1. 2. 3. 4. 5. 6. 7.  North Kensington 84,846 3,254 88,100 20,762 65 87,682 South Kensington 76,097 8,120 84,217 17,356 204 84,018 St. Charles 21,556 1,181 22,737 5,293 6 22,854 Golborne 25,190 377 25,567 6,006 8 25,462 Norland 20,573 614 21,187 5,052 21 20,860 Pembridge 17,527 1,082 18,609 4,411 30 18,506 Holland 18,992 1,271 20,263 4,437 42 20,245 Earl's Court 16,691 927 17,618 3,972 39 17,554 Queen's Gate 10,572 3,714 14,286 2,148 56 14,286 Redcliffe 18,109 992 19,101 4,255 33 19,159 Brompton 11,733 1,216 12,949 2,544 34 12,774 The Borough 160,943 11,374 172,317 38.118 269 171,700 The figures in the above Table, which w as not included in last year's report, show the number of private households or families and the number of persons living in such households in the Census year 1911 (vide cols. 5 and 2). Column (i gives the numbers of "institutions, large private establishments, etc." in each area, the number of inmates being shown in column 3. The last column shows the estimated populations for each area in the middle of the year 1913. The natural increase in the population during the year by excess of births over deaths amounted to 926, the net estimated diminution being accounted for as in past years by the excess of emigration over immigration. 4 The population for each ward has been calculated on the assumption that the rise or fall in the last intercensal period has continued at a slightly reduced rate. Marriages.—The marriages celebrated during the year numbered 1,690. 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 3,173, but this figure does not include 162 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, 3,335. The birth-rate expressed as the number of births per 1,000 of the population was 19.4 Arranged as to sex and legitimacy the births were as follows:— Male. Female. Total. Legitimate 1,608 1,564 3,172 Illegitimate 81 82 163 Total 1,689 1,646 3,335 Still births are not 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. Total Births. Birth-rate per 1,000 of the Population.  North Kensington 2,411 27 South Kensington 924 11 St. Charles 688 30 Golborne 830 33 Norland 609 29 Pembridge 284 15 Holland 250 12 Earl's Court 211 12 Queen's Gate 104 7 Redcliffe 237 12 Brompton 122 10 The Borough 3,335 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 four 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. 5 The births occurring every year in Kensington have fallen in round numbers from 4,500 in 1880, to 3,300 in the present year The steady decline in the birth-rate is shown in Table V. Appendix, p. 75, where the number of births and the birth-rates both for London and Kensington are given for cach 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 , from 3,190 in 1910 to 3,335 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. To estimate the effect of social status on the birth-rate in North and South Kensington, the female population of child-bearing age has been obtained for the two districts from the Registrar General District. Females, aged 15-45. Single. Married. Widowed.  North Kensington 24,259 13,021 10,549 689 South Kensington 36,662 28,976 6,755 931 The Borough 60,921 41,997 17,304 1,620 The legitimate birth rate, expressed as the number of legitimate births per 1,000 married females, aged 15 45 years, is shown in the following table:— 1918. North Kensington. South Kensington. The Borough.  Legitimate births per 1,000 married females aged 15-45 219 128 183 Illegitimate births per 1,000 unmarried and widowed females, 15-45 8 2 4 Legitimate and illegitimate births per 1,000 of total population 27 11 19 Calculated on the total population the birth rate in the South is only two-fifths of the rate in the North. If the births are shown in proportion to the married women of conceptive age the position in the South is improved, and the birth rate is increased to three-fifths of the rate for the northern half of the Borough. Hut even so there is still a wide discrepancy resulting from the fact that those who can best afford to bring up their children have the smallest families. Illegitimate Births. The illegitimate births numbered 163, and were equivalent to a rate of 9 per 10,000 persons living as compared with a rate of 9 for London in the year 1912. 105 illegitimate births occurred in North Kensington and 58 in South Kensington. Calculated on the unmarried and widowed female population the rate for North Kensington, as the figures in the above table show, was four times higher than in South Kensington. Had no allowance been made for the excess of unmarried females in South Kensington, the rates calculated on the total populations for North and South would have been as 12 to 7. 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. Out of the 3,173 live births registered as having occurred in Kensington, 2,856 or 90 per cent. were notified to the Medical Officer of Health. The unnotified births accordingly amounted to 317, or 10 per cent of the number registered during the year. The subjoined figures show that 3,110 births in all were notified, and that the notification certificates received from various sources numbered 3,127, and included 17 duplicates. 6 Source of Notification. Notifications received. Duplicate notifications. Number of Births Notified. Still Births. Live Births. Total Births. Midwives 1,561 5 36 1,520 1,556 Parents 726 7 23 696 719 Medical Practitioners 563 3 27 533 560 Other Persons 110 2 1 107 108 Births in the Borough 2,960 17 87 2,856 2,943 Institutions outside the Borough 167 — 5 162 167 Total 3,127 17 92 3,018 3,110 Of the notifications received 167 were forwarded by the London County Council, and related to infants born of Kensington mothers in Queen Charlotte's Hospital or other Institutions beyond the Borough. Still Births.-The infants notified as still-born numbered 92. Still-births are not registered, and it should be noted that they are accordingly not included in the numbers on which the birthrates for the Borough and the various wards have been calculated. Information could only be obtained in regard to 33 out of the total number of still-born infants notified. Eight were noted as illegitimate, two were born dead from two twin pregnancies, and four were born in wedlock of mothers employed in laundry work. In 18 cases the mother is known to have followed no occupation. Five children were born from the first or second pregnancy, 8 from the sixth or some later conception, and 11 from intermediate pregnancies. A history of one or more previous miscarriages or still-births was obtained in 7 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 5 cases haemorrhage during pregnancy, and in 4 cases difficult labour. In 7 cases labour and pregnancy, according to the mother's statement, were normal, and no cause for the still-birth could be assigned. The part played by syphilis as a cause of miscarriage and still-birth is beyond the scope of the inquiries undertaken by the Council's Health Visitors. Deaths.—The corrected number of deaths was 2,409. The crude death-rate was 14.0 and the standardised death-rate 13.9 per 1,000 living. To obtain the corrected number of deaths, which represents the true mortality among the population, it is necessary to add the deaths of Kensington "residents" occurring beyond the district to the number registered as actually taking place in the Borough, and to subtract from the total thus arrived at the deaths of "nonresidents" occurring in institutions or other places in Kensington. The following figures show how the corrected number of deaths given above has been obtained:— Total deaths registered in the Borough 2,614 Deaths of residents beyond the Borough 490 3,104 Deaths of non-residents within the Borough 695 Corrected number of deaths belonging to the Borough 2,409 The standardised death-rate is designed to represent the mortality that would have occurred had the age and sex distribution of the population in Kensington been the same as that of the population of the country as a whole in the Census year 1901. The age and sex composition of the population in Kensington is slightly in favour of a high mortality, and the effect of making allowance for these disturbing factors is to reduce the crude death-rate of 14.0 to the standardised rate of 13.9 already given. Where comparisons are instituted between populations with a widely 7 different age and sex composition the use of standardised 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 13.6 1913 14.0 - 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. 75. The number of deaths occurring in each year since the same date and the annual death-rates have been published in the Appendix of the Annual Reports for 1908 and previous years. The number of deaths at all ages with the corresponding death-rates in the Borough, in North and South Kensington and in the several Wards was as follows:— Districts. Number of Deaths. Crude Death-rate per 1,000 inhabitants.  North Kensington 1,526 17.0 South Kensington 825 10.0 Unknown 58 — St. Charles 330 14.0 Golborne 497 20.0 Norland 442 21.0 Pembridge 257 14.0 Holland 216 11.0 Earl's Court 233 13.0 Queen's Gate 89 6.0 Redcliffe 185 10.0 Brompton 102 8.0 The Borough 2,409 14.0 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-rates 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. 8 Causes of Death. These are set out in detail in the Appendix. The following list shows certain causes of death which arc 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 epidcmic) diseases 235 Epidcmic influenza 52 Puerperal fever 5 Phthisis 189 Other tuberculous diseases 51 Cancer 189 Bronchitis 219 Pneumonia 196 Heart diseases 284 Bright's disease 73 Diseases and accidents of parturition 5 Premature birth 55 Accidents 57 Suicide 17 Old age 85 All other causes 697 2.409 The diseases described in the above list as the "principal zymotic diseases," arc 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 240 deaths, of which 189 were due to tuberculosis of the lungs. It should also be noted that cancer was the cause of 189 deaths, as compared with 228 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. 73, 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. 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. 76, arranged in quinquennial periods since 1881. INFANTILE MORTALITY. The deaths among infants under the age of one year numbered 371, the infantile mortality rate being equivalent to 111 deaths per 1,000 births. The following Table shows a decline in the infantile death-rate from 172 in the quinquennium 1896-1900 to 120 in the years 1906-1910, and a decrease in the rate of 31 per cent. in North Kensington as compared with a decrease of 36 per cent. in South Kensington. Period. Deaths under one year per 1,000 Births. Kensington. North. South. The Borough London. 1896-1900 197 131 172 162 1901-1905 162 114 144 139 1906-1910 135 84 120 114 1911 148 103 135 129 1912 104 68 92 91 1913 131 61 111 — 9 The difference between the infantive 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 315 131 South Kensington 56 61 St. Charles 71 103 Golborne 123 148 Norland 94 154 Pembridge 27 95 Holland 23 92 Earl's Court 14 66 Queen's Gate 3 29 Redcliffe 7 30 Brompton 9 74 The Borough 371 111 The figures in the second column of the Table show that the infantile death-rate in North Kensington was twice as high as in South Kensington. The mortality in the Norland district, which contains Notting Dale, was equivalent to 154 deaths per 1,000 births, whilst the unsatisfactory social conditions prevailing in certain parts of the St. Charles ward are reflected by a rate which exceeded 103. Causes of Infantile Mortality.—In the following Table the deaths occurring in infants under the age of 12 months during the year 1913 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. 1911 1912 1913  Common infectious diseases 48 19 28 Diarrhœa (including enteritis, etc.) 123 32 62 Premature birth 41 60 55 Congenital defects (including injury at birth and atelectasis) 10 23 22 Wasting and debility 53 62 45 Tuberculous diseases 15 13 15 Syphilis 7 15 13 Bronchitis and pneumonia 63 40 79 Overlaying 4 4 6 Other causes 71 37 46 435 305 371 10 It will be noticed that in 1913, more than one-fifth 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 124 deaths, or more than one-third of the total number, and here there is no doubt scope for preventive work. Sixty-two deaths were due to diarrhœa or enteritis, diseases to which further reference will be made under the heading of " Epidemic Diarrhœa." 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 81 took place in the first week, and 124 or more than one-third in the first four weeks of life. Premature birth and congenital defects accounted for 61 or half the deaths occurring at this early period. Fifteen 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. Alt this period, there were only 6 deaths from pneumonia and bronchitis and four deaths from diarrhoea. 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 27 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 diseases, it is interesting to note that infants in the first half year are practically immune to measles, and that all the 17 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 three 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.—Fifty-six deaths occurred among illegitimate infants. The illegitimate births numbered 163. The mortality among the illegitimate was accordingly equivalent to a rate of 344 deaths per 1,000 births, as compared with a rate of 99 among those born in wedlock. 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 1913, 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. 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, 68 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 181 deaths between the ages of 7 days and 12 months, show that 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 1913 relate. They show that 94 per cent. were still being fed on the breast alone in their second or third week of life, but cannot be used for the purpose of comparison with the records of the deaths of infants at later ages. 11 Particulars Recorded. Cases in which Particulars were Recorded. Survivors. Deaths. Number. Per Cent. Per Cent. Number. a. Occupation of Mother— Laundry work 133 13 18 40 Charing, house-work (out) 36 3 6 14 Other occupations 29 3 7 16 No occupation 859 81 69 152 Totals 1,057 100 100 222 b. Mode of Feeding— Cow's milk 34 3 21 38 Breast and cow's milk 15 1 10 18 Breast and condensed milk 3 0.3 2 3 Breast and other foods 3 0.3 3 5 Condensed milk 7 1 6 11 Other artificial foods 4 0.4 3 6 Total artificial 66 6 45 81 Breast alone 1,010 94 55 100 Totals 1,076 100 100 181 c. Number of Rooms in Tene- ment— 1 237 23 22 47 2 566 56 61 127 3 148 15 9 19 4 or more 60 6 8 16 Totals 1,011 100 100 209 Basement rooms only 88 9 17 35 Housing.—The figures in the above table suggest that an infant's chance of surviving is not materially worse in a 1 or two room tenement than in a tenement containing 3 or 4 rooms. Basement rooms on the other hand appear to exert a distinctly prejudicial influence, the proportion of such tenements being 17 per cent. for deaths, as against 9 per cent. for survivors. 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 voluntary agencies. During the year the two Health Visitors have been to the homes of 1,874 newly-born infants, and have paid 3,894 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 the condition of its home. 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. 12 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 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 469 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 four "schools for mothers" maintained by voluntary contributions, at three of which 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 three 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 fourth 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 other schools to see any child whose progress is not satisfactory. At all four centres sewing classes are held and lectures on infant care are given. In three schools cooking classes have been organised. In a period of 12 months more than 800 mothers have attended the infant consultations at one or other of the four centres. The total number of dinners supplied to expectant or nursing mothers during the year amounted to 31,000. Special mention should also be made of the extension of the schemes by which children at any age under 5 years may now be brought to the "infant" consultations at the Bramley Road, Lancaster Road and Raymede Street Schools. 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 has undoubtedly played an important part as one of the direct causes of the recent decline in the infantile death-rate. Mention should also be made of the important services rendered to infants and young children during the past two years by the Baby Clinic in the Telford Road. The object of the Clinic is to provide free medical and surgical treatment for children from birth up to 5 years of age. During the year 1,210 children received treatment, the treatment being dental in 151 cases, and the attendances numbered 5,382. Arrangements have been made whereby children with skin troubles, discharging ears and other compaints requiring frequent skilled attention are treated daily by a trained nurse at the Clinic. As the results obtained have shown this daily attention has proved to be of the greatest value. Ninety-two minor operations mostly for the removal of tonsils and adenoids have also been performed. At tnree months 69 per cent. of the infants attending were breast, fed, as compared with 72 per cent. in 1909, and 75 per cent. in 1910 reported by the Health Visitors among infants of the same age. In 1911 at the age of 6 months, 68 per cent. were reported by the Health Visitors as breast fed. The figures for the Clinic are probably lower for the earlier age because it is the artifically fed who are more prone to sickness. In any case among the working classes there is no such thing as weaning to save trouble and allow the mother more freedom. Of the mothers who weaned their babies before the age of 3 months, 18 per cent. are reported to have found that their millk went when they got about. There is, however, no class in which women do not have the same experience, so that it would be by no means safe to assume that any considerable number of the poorer mothers lost their milk as the direct result of poverty. Twenty-five per cent. of the children attending the Clinic are reported as living in basements, as compared with the much smaller proportion of 9 to 17 per cent. reported in the years 1912 and 1913 by the Council's Health Visitors. The proportion of tenement houses with basements is probably greater in the neighbourhood of the Clinic than in the Borough as a whole, and as in . the case of the artificially fed, it is not improbable that these children from basements contribute more than their proper share to the sick rate for the Borough. 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. SMALL POX. No case of small pox occurred in Kensington during the year; 4 cases in all were notified in the Metropolis, and of this number 2 occurred in Poplar and 1 each in St. Marylebone and Southwark. DIPHTHERIA. Dunne the year 124 cases of diphtheria were notified and of these 7 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.  January25 9 28 1 February 22 4 25 1 March 22 11 27 0 April 19 10 9 0 May 17 10 30 1 June 14 9 26 1 July 12 5 29 6 August 9 5 45 3 September 6 4 32 1 October 4 21 49 3 November 1 8 69 7 November 29 18 95 1 January 3, 1914 (five weeks) 10 88 2 124 552 27 The increased prevalence of diphtheria in September and November coincided with the autumnal rise in the number of notifications throughout the country. The year was remarkable for the absence of epidemic outbreaks. Thus three, as the maximum number of cases occurring in the same elementary or private school in one calendar month, was only recorded in one instance. In three houses the occurrence of multiple cases was noted: in the first house three patients were notified; in each of the remaining two houses, two patients were notified. In no other private or tenement house or residential institution was more than one case reported. In one family 2 patients were notified, in another three; and these were the only two families in the Borough in which more than one case of diphtheria occurred. Anti-toxin was administered at the Council's expense to two diphtheria patients, and to two persons suspected to be suffering from diphtheria. The Council no longer pay for the preventive treatment of healthy contacts with anti-toxin, an alteration in procedure which appears to be fully justified by the rarity of multiple cases in infected households. Bacteriological reports on 105 cases of suspected diphtheria were furnished free of charge to medical practitioners, the diphtheria bacillus being found in 28 of the specimens examined. This work is carried out at the Lister Institute and paid for by the Borough Council. In 18 houses where diphtheria occurred, defects in the drainage system were reported and remedied at the instance of the sanitary inspector for the district. 16 The following Table shows the number of cases of diphtheria and the mortality during 1913 and in previous year:– Diphtheria in Kensington, 1901-1913. Year. Cases Notified. Case-rate per 1,000 of population. Deaths. Death-rate per 1,000 of population. Case-mortality per cent.  1901—1910 1,850 1.06 212 0.12 11.5 1911 212 1.23 20 0.12 9.4 1912 180 1.05 5 0.03 2.8 1913 124 0.72 7 0.04 5.6 The disease in certain patients was severe in type, but the case fatality was well below the average. The number of cases notified was less than in any year since 1900, amounting to 124, as compared with extremes of 125 in 1905, 234 in 1907, and the annual average of 185 cases during the ten years 1901—1910. SCARLET FEVER. During the year 552 cases of Scarlet Fever were notified, and of these only 3 proved fatal. The seasonal incidence of the disease which has already been shown with that of diphtheria, attained its maximum in Kensington as in the country as a whole during the month of November. As in London and elsewhere the number of cases notified has been excessive and more than 165 above the annual average for the 10 years, 1901—1910. The type of the disease was exceptionally mild, the case mortality being equivalent to only 5 deaths, as compared with an average of 30 deaths among every thousand cases in the last intercensal period. Scarlet Fever in Kensington, 1901-1913. 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 5 003 1.7 1913 552 3.21 3 0.02 0.5 In 193 instances inquiry elicited a definite history of contact with persons suffering from Scarlet Fever. Forty-seven cases were due to infection in schools; 18 were due to contact with persons recently discharged from hospital after an attack of Scarlet Fever; 11 arose from contact with "missed cases" or persons who had suffered from unrecognised attacks of the disease. In 8 cases the infection was derived from sources beyond the Borough. Nine patients acquired the disease in hospital, 12 from playmates outside school, and 11 from fellow lodgers. Thirteen cases occurred among the inmates of a convent school, and 4 in an orphanage. Defects in the drainage system were found in 30 of the houses where Scarlet Fever occurred. ENTERIC FEVER. The number of cases of enteric fever notified during the year was 27, the number of deaths being 6. 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 diminished prevalence of the disease during the last three years:— Decennium 1901—1910 Cases 529 Deaths 86 Average „ „ „ 53 „ 9 1911 „ 20 „ 4 1912 „ 15 „ 4 1913 „ 27 „ 6 17 Of the 27 patients notified, 15 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 11 cases no clue as to the source of infection could be obtained. PUERPERAL FEVER. Thirteen cases of puerperal fever were notified during the year, and of this number 5 proved fatal. Four patients were confined in hospital or in the infirmary; of the mothers confined in their homes, 5 were attended in the first instance by midwives and 4 by doctors; in two cases the infection followed a mis-carriage, and in three instances there was a history of laceration. In no instance did more than one case of puerperal fever occur in the practice of the same midwife or doctor during the year. 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.—Sixteen 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 12 cases One eye vision impaired—One eye vision normal 1 case Death during course of treatment 1 case Left the District and not traced 2 cases Total 16 cases Thus out of 13 infants who survived and whose subsequent history is known, 12 recovered with unimpaired vision in both eyes. In the 13th case the damage was limited to one eye, and did not result in total blindness. The two infants who left the district and could not be traced both suffered from mild attacks and probably recovered with unimpaired vision. In addition to the notified cases of ophthalmia, 5 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 four cases of this disease were notified in 1913. The parts paralysed in the several patients were in E.R., male, aged 3 years, left leg; in E.W.B., female, 4 years, left leg total paralysis, right leg partial; in L.P., male, 5 years, lower limbs; and in D.S., female, 10 months, both legs and abdomen. Of the four notified cases none died, and no deaths were certified as due to acute anterior poliomyelitis.. The homes of the patients were not verminous, except in the case of E.W.B., who was removed to hospital from rooms which were infested with bugs and fleas. In no case were animals kept on the premises. 18 Epidemic Cerebro-spinal Meningitis.—Three patients were notified as suffering from cerebro-spinal meningitis, which in one case terminated fatally. The patient who died was a woman aged 45, living in a house where no animals were kept, and where the rooms . were not infested with vermin. The diagnosis was confirmed by bacteriological examination. In the other two cases the diagnosis was probably erroneous. 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 lable of deaths occurring in the year 1913. Epidemic Diseases. Notifiable. Deaths, 1913. Non-Notifiable. Deaths, 1913 Diphtheria 7 Measles 82 Erysipelas 9 Who ping Cough 29 Scarlet Fever 3 Influenza 52 Enteric Fever 6 Diarrhœa 108 25 271 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 occurred :— Non-notifiable Epidemic Diseases in 1913. Report for four weeks ended Number of Deaths. Measles. Whooping Cough. Influenza Diarrhœa * & Enteritis. January 25 12 5 7 4 February 22 20 8 10 5 March 22 14 7 12 3 April 19 11 2 11 4 May 17 14 3 6 2 June 14 7 0 0 5 July 12 2 1 1 7 August 9 1 2 0 10 September 6 0 0 0 14 October 4 1 1 0 26 November 1 0 0 0 14 November 29 0 0 2 9 January 3, 1914 (five weeks) 0 0 8 5 Total 82 29 52 108 Age at Death. Measles. Whooping Cough. Influenza. Diarrhœa & Enteritis. Under 1 year 17 11 1 62 Under 5 years 79 28 2 81 5 to 15 years 3 1 0 1 15 to 65 years 0 0 21 16 65 years and upwards 0 0 29 10 Total 82 29 52 108 * Voluntarily notifiable, July to November, 1913. Fatal diarrhoea is seen to be a disease of infancy, increasing in prevalence in the late summer and eariy 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. 19 MEASLES. The deaths from Measles numbered 82 and with only three exceptions occurred in children under 5 years of age. 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 824 cases were notified; 174 additional cases were found in the homes visited, the total number of cases coming to the notice of the Public Health Department being 998. Out of this number only 115 had received medical advice before they were visited by the inspectors. A leaflet is left with the mother of each family attacked calling attention to the serious nature of the disease and insisting on precautions being taken to prevent the spread of infection. The largest number of cases occurred in the Barlby Road School, where 75 children were attacked ; St. Mary Abbotts School contributed the next largest number, notifying 58 cases of measles during the year. On 85 occasions classes in the elementary schools where measles had occurred were closed by order of the School Medical Officer for periods varying from 5 to 21 days. The schools in which one or more classes were closed numbered 24. The cases admitted to the hospitals of the Metropolitan Asylums Board numbered 264. WHOOPING COUGH. The deaths from whooping cough numbered 29; the number of cases brought to the notice of the Public Health Department by the schools being 303. In the homes visited 52 additional cases were discovered; the total number of cases dealt with by the Sanitary Inspectors being 35 An advisory leaflet was left with the mother of each family visited. The largest number of cases occurred in the Wornington Road School, where 41 children were attacked; St. Johns Norlands School contributed the next largest number, notifying 28 cases of whooping cough during the year. Of the cases visited only 14 had received medical treatment. The limitation of fatal whooping cough to young children was shown by the fact that 28 out of 29 deaths registered during the year, occurred in children under the age of 5 years. During the year 78 cases of whooping cough were admitted to the hospitals of the Metropolitan Asylums Board. EPIDEMIC DIARRHCEA. During the year diarrhoea and enteritis caused 108 deaths as compared with 70 deaths from the same group of diseases in 1912. The diseases in this group, which are commonly known as epidemic diarrhoea or zymotic enteritis, were made voluntarily notifiable by medical practitioners during the four months from July 12th to November 25th, and the notification fee was fixed at one shilling. The following Table shows the weekly incidence of the notified and fatal cases:— Period— Week ending. No. of Notifications. No. of Deaths June 14 — 0 „21 — 0 „ 28 — 2 July 5 — 1 „ 12 — 7 „ 19 11 1 „ 26 12 2 August 2 27 3 „ 9 24 4 „ 16 19 0 „ 23 42 2 „ 30 52 5 September 6 62 8 „ 13 50 7 „ 20 54 7 „ 27 50 7 October 4 44 4 „ 11 43 4 „ 18 33 2 „ 25 27 3 November 1 10 5 „ 8 2 2 „ 15 1 3 „ 22 4 1 „ 29 2 0 Totals 569 80 20 The first notable increase in the number of notifications began on August 16th, and was maintained until October 11th. The first sustained rise in the weekly mortality began one week later, on August 23rd, and came to an end about a fortnight earlier in the last week of September. The degree of correspondence in the weekly incidence accordingly affords some grounds for regarding the notified and fatal cases as belonging to the same aetiological group. The patients notified fell into the following age periods:— Age period in years Under 1. 1 to 2. 2 to 5. 5 to 15. 15 to 25. 25 to 45. 45 and upwards. Number of cases 184 154 85 30 23 60 33 The figures do not represent the true age incidence of diarrhoea, since young children are more likely to receive medical attention and so to be notified than older persons, who, except in severe or persistent cases, generally forego medical advice, and are content to purchase a diarrhoea mixture from the chemist. At the same time the notification of 83 cases between the ages of 15 to 45 has served to indicate the fact that epidemic diarrhoea is not confined to infants and young children except in a fatal form. The Table of deaths from non-notifiable diseases on p. 18, shows that whereas 81 deaths from diarrhoea and enteritis occurred in children under the age of 5 years, only 1 death occurred in the age period 5—15 years. As in the case of measles such figures illustrate the age of liability to death, without throwing any light on the question as to the age of greatest liability to attack. Children are more susceptible in both senses, but there is published evidence to show that adults also suffer in large numbers from non-fatal attacks, and that epidemic diarrhoea is not likely to be prevented by measures which are limited to the control of the disease in infants. In regard to of the patients notified no information was obtained. 1 he incidence or the remaining 547 cases on the houses invaded, which in nearly every instance contained more than one family, was as follows:— Cases per House. Number of Houses. Total Cases. 1 392 392 2 49 98 3 13 39 4 2 8 5 2 10 Totals 458 547 It has been suggested that summer diarrhoea is an infectious disease, spreading from the sick to the healthy, but the evidence in favour of this assumption afforded by the occurrence of more than one case in the same house, should not be pressed unduly As examples of non-infectious ailments which frequently attack several members of the same household, malaria and chillblains may be mentioned. In favour of case to case infection attention may be drawn to the following Table, which shows that when multiple cases occurred in the same house or household, an interval of 3 to 14 days elapsed in many instances between the primary and secondary case. Interval between First and Second Case, Number of days Less than 3. 3 to 7. 7 to 14. 14 to 28. 28 to 56. 56 and upwards. Number of instances 17 19 10 18 11 7 It will be understood that the intervals in the above Table do not represent minimum incubation periods, since the cases were nursed at home and remained infectious, if the disease is in fact infectious, throughout their illness. In 28 of the 66 houses in which multiple cases occurred, persons aged 5 years and upwards were attacked. On the assumption that the disease is infectious, the primary case might be expected to occur in the majority of instances in young children who suffer in greater numbers, and whose habits in such an ailment should render them a more effective source of infection. The histories of these 28 houses, however, shows that only 12 of the primary cases occurred in children under 5 years as against 16 primary cases in older persons. Of the primary cases in young children, 10 occurred in infants under 2 years of age; of those in older persons 10 occurred in patients aged 16 years and upwards. The following Table shows the proportion per cent. of 392 houses where single cases of diarrhoea occurred, and of 66 houses where multiple cases occurred in connection with which conditions presumably favourable to the origin and dissemination of diarrhoea were noted:— 21 A. 392 houses invaded by Single Cases. B. 06 houses invaded by Multiple Cases. Conditions noted. The Number per cent. of A.—392 houses. B.—66 houses. Fixed brick ashpit 6 11 Yard dirty 8 12 Yard hall-paved 32 49 Flies numerous 3 17 Yard unpaved 8 6 Dwelling in mews 4 3 Distance of ashpit or bin from house— Less than 5 feet 25 18 Less than 10 feet 47 39 In the B Class, comprising 66 houses invaded by multiple cases, the percentage of dwellings with fixed brick ashpits, half paved or dirty yards or many flies was notably higher than among the 392 houses where single cases of diarrhoea occurred. Flies were noted under the three heads, "Many," "Few," or "None": no numerical definition was attempted for these expressions, and no definition was attempted of the conditions of a yard which would justify the description " dirty." In these two particulars any bias in the mind of the observer would, therefore, have inevitably affected the reliability of the records. It is accordingly important to note that bias could not have existed when the records were made, since the comparison of the sanitary surroundings of multiple and single cases was not thought of until the end of the year. When the incidence of diarrhoea on a house is limited to one case, there is frequently an equal chance that the patient may have acquired the disease outside the premises or district in which he lives. When the incidence is multiple, the chances are against external infection and in favour of a common cause within the premises where the patients attacked reside together under the same roof. Flies and the brick ashpits in which they breed have been suggested as potential sources of infection when diarrhoea is prevalent. The fact that the proportion of houses containing many flies was five times as great, and the proportion with fixed brick ashpits twice as great in the B Class, may therefore be legitimately regarded as significant. The four last conditions named in the Table need not be discussed, as the figures do not suggest that they exert any influence in the production of multiple infections. The diet of the notified cases in children under 1 year of age is indicated in the following Table:— Diet. Under 7 months. 7-12 months. Under 1 year. Cow's Milk 33 26 59 Condensed Milk 12 17 29 Total Artificial 45 43 88 Breast alone 13 12 25 Total 58 55 113 The immunity of children taking no food except their mother's milk is shown by the small number of the breast fed among the infants who were attacked. And this immunity becomes more striking when account is taken of the fact that the number of breast fed babies is very large, and that more than 65 percent, of the infants who are born in Kensington and who survive are still at the breast between the ages of 5 and 7 months, and receiving no other food. Of the artificially fed in the normal population under the age of 7 months less than one-sixth are fed with condensed' milk. Of the artificially fed of the same age among those who suffered from diarrhoea, more than one-fourth had been fed with condensed milk, which has in a number of independent observations in different districts been found to increase the liability of infants to attack. 22 During the months of July, August and September an experimental daily collection of house refuse was instituted in the Southam Street area of the Golborne Ward between the canal and the Great Western Railway. The deaths from epidemic diarrhæa in this area between July 14th and October 15th numbered 10, as compared with 3 deaths during the same period in the preceding year. In the remainder of the Golborne Ward the deaths from epidemic diarrhæa also numbered 3 in 1912, and 10 in 1913 in the same three months under a system of weekly collection. Daily collection accordingly failed to prevent the increase in mortality from diarrhæa which was due to the greater heat in the summer months in 1913 as compared with 1912. TUBERCULOSIS The number of deaths from tuberculosis was 240, the crude and standardised death-rates being 1 40 per 1,000. The mortality in the years 1901-1913 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-rate? refer. Tuberculosis in Kensington, 1901-1913. 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 1913 189 110 51 30 240 140 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 140 in the year under consideration, and an average rate of 159 in the ten years 1901-1910. In the year under notice the deaths from phthisis (pulmonary tuberculosis) numbered 189, and corresponded to a crude death-rate of 110 per 1,000 living, and a standardised rate of 1.00. The deaths from other forms of tuberculosis numbered 51, and were equivalent to a death-rate of 0-3 per 1,000 of the population. The incidence of deaths from tuberculosis nn the Wards in the Borough was as follows:— Deaths from Tuberculosis in Wards, 1906-1910 and 1913. District. Number of Deaths. Death-rate per 10,000. Pulmonary Tuberculosis. Other Forms. Pulmonary Tuberculosis. Other Forms. 1906-10. 1913. 1913. 1906-10. 1913. 1913. North Kensington 623 130 38 12 15 4.3 South Kensington 252 52 13 6 6 1.5 St. Charfes 125 25 6 11 11 2.6 Golborne 182 44 11 14 17 4.3 Norland 222 41 14 20 20 6.7 Pembridge 94 20 7 10 11 3.8 Holland 73 14 1 7 7 0.5 Earl's Court 65 12 5 7 7 2.8 Queen's Gate 26 5 3 4 4 2.1 Redcliffe 57 10 3 6 5 1.6 Brompton 31 11 1 5 9 0.8 Unknown — 7 — — — — The Borough 875 189 51 10 11 3.0 23 The death-rates in North Kensington both from phthisis and other forms of tuberculosis were more than twice as great as the rates in the South, and the heaviest mortality in the North under both heads fell on the Wards of Golborne and Norland, which contain the largest proportion of persons in extreme poverty. A summary may be given here of the Table in the Appendix, which contains the number of persons dying in the successive age periods of life from tubercuolsis:— Deaths from Tuberculosis in Age Periods. Age Periods. Under 5 years. 5 to 15. 15 to 45 45 and upwards. Total. Number of Deaths from Pulmonary Tuberculosis 4 8 103 74 189 Other Forms of Tuberculosis 32 3 12 4 51 The bulk of the deaths from phthisis occurred to the number of 103 between the ages of 15 and 45 in the best working years of life. A large majority of the deaths from other forms of tuberculosis took place in children under the age of 5 years. The place at which death occurred affords some indication of the provision made in institutions for persons in the last stages of tuberculous disease:— Place of Death. Number of Deaths from Pulmonary Tuberculosis. Other Forms. Kensington Infirmary 66 18 Patient's Home 77 17 General or Children's Hospitals 5 7 Lunatic Asylums 10 2 Brompton Hospital 1 0 Other Institutions for the Sick 23 6 Other places beyond the Borough 7 1 Total 189 51 105, or considerably more than half the total deaths from consumption, and 33 or two-thirds of the deaths from other forms of tuberculosis occurred in institutions for the sick. Tuberculosis Regulations.—All previous Regulations in regard to the compulsory notification of consumption have now been superseded by the consolidating Order known as the Public Health (Tuberculosis) Regulations, 1912, which came into force on February 1st, 1913. By the new Order compulsory notification has been extended from consumption or tuberculosis of the lungs to all forms of tuberculosis. In addition to the primary certificate (on the form described in the Regulations as Form A), which every medical practitioner is required to send to the Medical Officer of Health on first becoming aware that a patient is suffering from tuberculosis, the following notifications are required, viz.: I. Weekly lists of cases of tuberculosis admitted to or discharged from Poor Law Infirmaries or Institutions, and from Sanatoriums which for the purpose of the Regulations mean residential institutions approved by the Local Government Board under the National Insurance Act, 1911, for the treatment of tuberculosis. Admissions are notified on Form C.; discharges on Form D. II. On Form B. School Medical Inspectors are required to furnish weekly lists of children examined in school and found to be suffering from tuberculosis. Notifications Received.—The notifications received during the year numbered 1,409, and tiave been classified in the following Table:— Number of Notifications. A. B. c. D. Before Feb. 1st. Total. Pulmonary Tuberculosis 747 7 104 116 162 1,136 Other Forms 216 14 18 25 0 273 Totals 963 21 122 141 162 1,409 24 The notifications received under the new Regulations on and after February 1st, numbered 1,247. Only 21 notifications were received on Form B. from School Medical Officers. The excess of discharges notified on Form D over admissions notified on Form C, has been due to the use of the primary certificate on Form A in certain institutions for notifying patients on admission, and to the neglect to include patients so notified in the weekly returns of admissions on Form C. The notifications on Form A of persons suffering from tuberculosis, and on Form C of patients admitted to residential institutions were received from the following sources:— Source of Notifications. Phthisis. Other forms of Tuberculosis. Form A. Form C. Total. Form A. Form C. Total. Brompton Hospital 17 13 30 ... ... ... District Medical Officers 30 ... 30 ... ... ... Kensington Infirmary 172 34 206 59 2 61 Other Infirmaries 2 3 5 1 ... 1 Kensington Tuberculosis Dispensary 172 ... 172 15 ... 15 Other Dispensaries 3 ... 3 ... ... ... Lunatic Asylums 12 ... 12 3 ... 3 Metropolitan Asylums Board Hospitals and Homes 5 8 13 27 16 43 West London Hospital 7 ... 7 5 ... 5 Other Hospitals 48 ... 48 66 ... 66 Other approved residential Sanatoriums 14 46 60 10 ... 10 Private Medical Practitioners 265 ... 265 30 ... 30 747 104 851 216 18 234 The notifications on 77 certificates from hospitals, 55 certificates from officers of Guardians, and 30 certificates from private practitioners, received before February 1st, under the old Regulations are not included in the above Table. Under the new Regulations 643, or three-fourths of the notices certifying persons as suffering from consumption or notifying the admission of consumptives to residential institutions came from the Infirmary (206), the Tuberculosis Dispensary (172), and from private practitioners (265). Of the notifications of other forms of tuberculosis 204 out of a total of 234 came from the infirmary, hospitals or other institutions for the sick, and only 30 were received from private practitioners. One-fourth of the notifications of other forms of tuberculosis came from the Kensington Infirmary, and numbered sixty-one. Persons Notified.—During the year 775 persons were notified as suffering from consumption, and 221 as suffering from other forms of tuberculosis. In addition 128 fatal cases of tuberculosis in persons who had not been notified during the year 1913 were reported by the Registrar of Births and Deaths. The total number of cases reported to the Department in 1913 was accordingly 1,124. Cases of Tuberculosis Reported in 1913. Source of Information. Pulmonary Tuberculosis. Other Forms. All Forms. Total Cases. New Cases. Notified in prev ious years Total Cases. New Cases. Notification Certificates 628 147 775 221 996 Death Certificates 22 77 99 29 128 Total 650 224 874 250 1124 25 The new cases of consumption, that is to say, the cases notified in 1913, without having been notified in any previous year, numbered 628. Twenty-two deaths from consumption also occurred in persons who died unnotified. The 221 notified cases of non-pulmonary tuberculosis, which was not made notifiable until February 1st, 1913, were necessarily new. Non-pulmonary tuberculosis was also certified as the cause of death in 29 unnotified persons. The year of primary notification in the case of previously notified persons who died in 1913 is shown in the following Table:— Deaths in 1913 of persons previously notified. Date of primary notification. Number of Deaths in 1913. Pulmonary Tuberculosis. Other Forms. 1905 1 — 1907 1 — 1908 2 — 1909 5 — 1910 4 — 1911 17 — 1912 47 — 1913 90 22 Total deaths of persons previously notified 167 22 Of those who died from consumption in 1913, 30 had been known to the Department for more than 12 months, as compared with 19 persons dying in 1912, who had also been known for the same period of time. The duration of the disease from the date of notification to the date of death exceeded 2 years in 13 cases, and in one case exceeded 7 years. The distribution of the new cases among the several districts in the Borough was as follows:— Distribution of Notified Cases. District. Number of New Cases. Pulmonary Tuberculosis. Other Forms. Total. All Forms. North Kensington 483 159 642 South Kensington 132 54 186 St. Charles 106 40 146 Golborne 182 46 228 Norland 133 57 190 Pembridge 62 16 78 Holland 26 11 37 Earl's Court 36 15 51 Queen's Gate 28 6 34 Redcliffe 25 14 39 Brompton 17 8 25 Unknown 13 8 21 The Borough 628 221 849 26 In its main features the distribution of the notified cases has been much the same as that of the deaths from tuberculosis. The difference between the Wards in the North and South is somewhat greater on account of the facilities afforded by the Talbot Road Dispensary for the diagnosis and notification of phthisis in large numbers of persons residing in the northern Wards. Without a subscriber's letter the same provision is not at present made at the Brompton Hospital in the South, and the death-rates, except in cases where the total number of deaths is too small, constitute a more reliable standard in the comparison of one Ward with another. Age and Sex of Persons Notified. Tuberculosis. Under 5 years. 5-15. 15-25. 25-35. 35-45. 45-55. 55 and upwards. Total. M F M F M F M F M F M F M F M F A. Pulmonary 16 10 65 58 26 66 59 89 50 61 41 37 25 25 282 346 13. Other Forms 33 30 44 47 22 14 5 13 2 6 0 4 1 0 107 114 Total at ages for both sexes A. 26 123 92 148 111 78 50 628 B. 63 91 36 18 8 4 1 221 The incidence of notification on the two sexes is important, but in pulmonary tuberculosis bears no resemblance to the incidence of the cases which actually occur. The notified males exceed the females up to the age of 15 years, and represent children who were examined in school or taken by their mothers to the tuberculosis dispensary, to hospitals or to private medical practitioners. Immediately after school age the order is reversed, and the number of males drops to less than half the number of females. At the ages 25-35 there is still a large deficit in male notifications, which in round numbers are to female notifications as 60 to 90 or 2 to 3. There is no such difference between the sexes in the returns of fatal phthisis (v. Appendix) and the explanation is that men at work will not seek medical advice until they are seriously ill, whilst women can generally find time to attend at a hospital in the usual afternoon hours. The provision of evening sessions at tuberculosis dispensaries would accordingly appear to be a measure of the first importance in securing treatment for male patients before they become incurable and a source of danger to others. Forms of Tuberculosis in Persons Notified. Site of Disease. Number of Cases. Lungs 628 Lymphatic Glands other than the Mesenteric 76 Larger Joints and Bones above Wrist and Ankle 45 Vertebral Column (Spine) 34 Smaller Joints and Bones, Wrist, Ankle, Hand, Foot 17 Mesenteric Glands, Bowel, Peritoneum 20 Urinary Organs, Kidney, Bladder 5 Meninges of Brain 15 Skin 5 Other Parts 4 Total Cases 849 Interpreted, the above figures show that out of 221 persons notified as the subjects of nonpulmonary tuberculosis, 96 were suffering from tuberculous conditions of the spine or other bones and joints, which frequently lead to partial or total crippling and disablement. In the following Table, showing the number of rooms occupied by tuberculous patients and their families, persons who died unnotified have been added to the new cases notified during the year. The number of rooms in the case of persons under treatment in institutions refers to their home accommodation before admission :— 27 Home Accommodation of Patients previously unknown. Accommodation. l Room. 2 Rooms. 3 Rooms. 4 or more Rooms. Common Lodging House. Unknown. Total Cases. Cases of Phthisis 140 201 83 153 14 59 650 Other Cases 21 44 28 29 0 128 250 In the case of consumption or pulmonary tuberculosis, the figures show that more than half the patients notified occupied tenements containing less than three rooms. The inquiries made also elicited the fact that in no less than 201 instances the consumptive patient occupied a one or two. room tenement, with more than one, and in certain cases with more than four other persons. # Rooms in Tenement Persons in Tenement, including Patient. Cases of Tuberculosis. Pulmonary. Other Forms. One Room Three persons Four persons Five persons More than five persons 27 9 3 2 4 2 1 4 Two Rooms Three persons Four persons Five persons More than five persons 32 31 32 60 6 5 7 19 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 700 persons are known to have lived with consumptive patients in tenements so small and crowded as to render it impossible for them to have escaped infection. In regard to patients suffering from other forms of tuberculosis, the inquiries have been incomplete, and the home accommodation noted in 122 cases only does not necessarily constitute a representative sample of the conditions under which the total number of 250 patients were housed. Source of Infection.—The source of infection in 146 cases appears to have been as follows'. Source of Infection. Cases of Tuberculosis. Pulmonary. Other Forms. Contact with consumptive relative 130 16 „ „ friend 5 0 „ „ fellow lodger 5 0 ,, ,, fellow worker 6 0 Residence in infected house 36 0 Total 182 16 Since January 1st, 1910, a register has been kept of the houses in the Borough where notified consumptives are known to have lived before and after the onset of their illness. In addition to the address of the patient on the date of notification, previous addresses have also been registered, but with a view to limiting the amount of labour involved, their number has generally been limited to one or two. At the end of the year 1,887 houses appeared in the register, which consists of cards, each 28 card representing a house. On 1,439 cards the name of one consumptive patient only had been entered; 450 cards bore the names of two or more consumptive patients. In analysing these 456 cards, 27 were rejected as containing insufficient information for the purpose of the analysis, and 8 as representing Common Lodging Houses which are not comparable to the other houses in the register. The number of consumptive persons who have resided in each house either before or during their illness is shown in the following Table:— Number of Notified Consumptives. 2 3 4 5 6 7 8 Total.2 to 8 1 Grand Total. Houses where information 20 3 4 0 0 0 0 27 0 27 was insufficient Common Lodging Houses 2 1 2 0 1 0 2 8 0 8 All other Houses 296 82 26 12 3 2 0 421 1431 1852 Grand Totals 318 86 32 12 4 2 2 456 1431 1887 In the next Table the circumstances are tabulated, which in 421 instances brought two or more consumptives either before or during their illness to reside under the same roof. Number of Notified Consumptives per House. 2 3 4 5 6 7 Total. Circumstances of Association. Number of Houses. 1. Membership of same family alone 153 29 7 2 0 1 192 2 Family and chance association — 23 11 5 1 1 41 3. Chance association alone 74 11 1 0 0 0 86 4. Infection from another family in same house or "House Infection" alone 69 15 2 2 0 0 88 5. House infection and chance association 0 4 5 3 2 0 14 4 & 5. Total house infections 69 19 7 5 2 0 102 2, 3 & 5. Total chance associations 74 38 17 8 3 1 141 1 to 5. Total number of houses 296 82 20 12 3 2 421 Among many points of interest in the above Table particular attention may be drawn to the figure which shows that in 141 instances the residence of two or more consumptives in the same house either before or after the onset of their illness, was due, not to the operation of cause and effect, but to nothing more than chance association; as for instance when two consumptives come to the same house who have both developed the disease before leaving their previous addresses. Under these circumstances it will be understood that in the 102 cases where the dates of onset and residence rendered house infection possible, the facts might with equal probability be explained by the chance association, which is known to have been the sole cause of a much larger number of examples of multiple invasion. In 84 cases of non-pulmonary tuberculosis a history was obtained of the feeding of the patient in infancy. Twenty-seven, or 32 per cent. of the patients had been fed on cow's milk alone or in conjunction with breast milk from the age of 3 months onwards, as compared with 25 per cent. of artificially fed infants at the same age in the general population. The difference is not great enough to be significant, but the records of other observers have shown that non-pulmonary tuberculosis in children is certainly more frequent among those who have been fed on cow's milk from an early age. 29 Occupation.—The occupation or status of the persons newly notified, and of those who died from consumption during the year was as follows:— Occupation of Consumptive Persons. Occupation. Cases. Deaths. Males. Females. Males. Females. Accountant - - 1 - Baker, Biscuit-maker 3 1 1 — Barman 1 - — — Bank messenger, picture palace attendant — - 4 — Bath chairman 1 - — — Blacksmith 1 - — — Bookbinder 1 - — — Bootmaker 4 - 2 — Brass finisher 1 - - — Bricklayer 2 - 3 — Brushmaker 1 - — — Butcher's boy 1 - 1 — Carpenter 1 - 1 — Cellarman — - 1 — Charwoman — 8 — 3 Chauffeur 3 — 2 — Clerk 6 8 4 1 Coachman, carman, stableman, or wife of 9 — 8 4 Coach painter 1 — — — Coffee roaster 1 — — — Colonial Civil Service — — 1 — Commercial traveller 1 — — — Compositor 1 — — — Cripple — 1 — — Crossing-sweeper 1 — — — Dental assistant 1 — — — Domestic servant 4 18 — 10 Dressmaker, milliner, sempstress — 10 — 2 Dyer — 1 — — Electrician 1 1 — — Engineer 1 — 1 — Errand boy 3 — — — Farrier 1 — — — Feather cleaner — 1 — — French polisher 1 — — — Fireman on railway — — 1 — Gas stoker 4 — — — Gardener — — 1 — Glazier 1 — — — Hairdresser 1 1 1 — Hawker, general dealer, costermonger 13 5 4 3 House painter 8 — 9 — Infant 11 14 1 2 Insurance agent 1 — 1 — Labourer 28 — 13 — Lamplighter 1 — 1 — Laundry work 1 32 — 2 Law student 3 — 1 — Living on own means — 6 2 6 Lodging house keeper — — — 1 Marine — — 1 — Mason — — 1 — Medical student — — 1 — Metal worker — — 1 — Milkman — — 1 — Carried forward 124 107 70 34 30 Occupation. Cases. Deaths. Males. Females. - Males. Females. Brought forward 124 107 70 34 Motor trimmer 1 - Musician 2 1 — - Newsvendor 2 — — - Nun — 1 — - Nurse—asylum, hospital, monthly — 3 — 1 Paperhanger 2 — 2 — Persons in asylums, common lodging houses, etc. 44 25 — — Pipemaker 1 — — — Plasterer 1 — 1 — Porter—coal, shop, railway, etc. 11 — 6 — Postman 1 — — — Printer or printer's apprentice 1 — 1 — Publican, potman 1 — 2 — Reader of plays — — 1 — Saddler 1 — 1 — Sailor, or wife of a 1 — 1 1 School boy, girl (elementary) 57 48 3 4 School master 1 — 1 1 Ship broker — — 1 — Shop assistant, shop keeper 2 3 2 2 Sign writer 1 — 1 — Slater 1 — 1 — Soldier, or wife of 1 — 3 1 Solicitor — — 1 — Son of artizan or labourer above school age 3 — — — Street singer 3 — 2 — Tailor, tailoress 7 6 2 1 Tortoise shell polisher 1 — 1 — Trunk maker — — 1 — Tubeman 1 — — — Typist — 1 — 1 University professor — — 1 — Unspecified occupations 5 29 1 2 Upholsterer 2 — — — Waiter, waitress 3 2 — — Watchmaker 1 — — — Wheelwright 1 — — — Wife or daughter of tradesman, artizan or labourer — 120 — 34 Totals 282 346 107 82 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 41 cases and 12 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 decrease in the death-rate of phthisis which has occurred in the last twenty years. 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. 31 Work of the Lady Sanitary Inspectors.—For the purpose of making inquiries, offering assistance and giving advice, 617 first visits and 821 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, 80 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 617 b. Subsequent visits 821 c. Visits after death 80 Total visits paid during the year 1,518 II.—Provision for Home Treatment. Bedsteads and bedding lent 6 III.—Patients or Contacts sent to Hospitals or other Institutions. a. To the Tuberculosis Dispensary 23 b. To the Brompton Hospital 2 c. To the Millfield Home, or Queen Mary's Hospital 12 d. To other hospitals or institutions 14 Total number sent to institutions 51 I V.—Disinfection after Death or Removal to Hospital. Cases where bedding, etc., was disinfected by steam179 Number of rooms disinfected 234 Number of rooms stripped 28 V.—Children attending the elementary schools and notified to the Medical Officer (Education), London County Council, as living in contact with consumptive persons 391 VI.—Specimens of Sputum from suspects examined bacteriologically by the Lister Institute at the expense of the Council 79 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. 144 sputum cups have been purchased by the Council during the year for the use of consumptives. The greater number of these cups have been distributed at the Tuberculosis Dispensary; the remainder have been taken to the homes of consumptive patients by the Lady Inspectors. For the purpose of preventing the spread of infection in families, additional bedsteads with bedding are provided by the Council free of charge, and offered to those who need them by the Lady Inspectors. At the end of the year 13 of the Council's beds were in use. In the following cases four new beds were supplied, and three returned beds were lent again to fresh patients after disinfection:— 1. To S.G., an advanced case sleeping with her daughter. 2. To F.L., an advanced case sleeping with wife and child. Bed returned on removal of F.L. to Home for dying. 3. To E.W., sleeping with husband and child. 4. To C.S., sleeping with husband and child. 5. To L.K., sleeping with husband and child. 6. To C.C., sleeping with wife and child. 7. To E.M., bedding only was lent to enable the family to use their second bedstead. In one case the bedding and bedstead lent by the Council in 1912 have now been bought by the parents of the patient. The Tuberculosis Dispensary.—During the year 1913, 219 consumptive persons residing in the Borough to the north of Kensington High Street received treatment at the Tuberculosis Dispensary in the Talbot Road. The institution is 'under voluntary management, but the 32 Committee includes members of the Borough Council and the Board of Guardians. Provision is made for the medical examination of contacts and the visiting of patients in their homes, both by the Medical Officers and by the Dispensary Nurses. Co-operation with the Public Health Department and various voluntary agencies has been secured by the weekly meeting of Case Committees, which are attended by representatives of voluntary societies and by the Council's Lady Inspectors or Medical Officer of Health. At the end of the year the arrangement under which the Dispensary in the Talbot Road served both Paddington and Kensington came to end. In future Paddington alone will be served by the Talbot Road Dispensary. The Borough of Kensington throughout the area lying north of the High Street will be provided for by the new Kensington Tuberculosis Dispensary which has been established under the Kensington members of the old combined committee, on new premises at 119, Ladbroke Grove. The Board of Guardians.—Important work is carried out by the Board of Guardians in the admission to the Infirmary of advanced and highly infectious cases of consumption. Wards are set apart with accommodation for some 60 consumptives, and from the notifications received it would appear that more than 170 phthisical patients were admitted from homes in Kensington during the year. That many of these patients were in the last and most infectious stages of the disease may be inferred from the fact that 66 deaths from phthisis occurred in the Infirmary during the year. The Insurance Committee. During the year 81 insured consumptives, of whom 51 were men and 30 women, were sent from Kensington by the Insurance Committee for the County of London to residential institutions for the treatment of consumption. Of those receiving residential treatmen five died in the institution to which they had been sent or shortly after their return home. Dispensary Schema of Council.- The Council's scheme for the Dispensary treatment of patients at the Brompton Hospital and the Kensington Tuberculosis Dispensary has been approved by the Local Government Board. Publications of the details will be deferred until the scheme in its final form has been approved by the London County Council and agreed to by the institutions concerned, and the Insurance Committee of the County of London. CANCER. Cancer caused 189 deaths, and of this number 168 occurred in persons over the age of 45 years. Carcinoma was the form of cancer to which 102 deaths were attributed; sarcoma was the assigned cause of 11 deaths; 76 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, 1913. Parts Affected. Sex. Total. Male. Female. Buccal Cavity, No. 39 11 0 11 Stomach, Liver, etc., No. 40 30 20 50 Peritoneum, Intestines, Rectum, No. 41 16 28 44 Female Genital Organs, No. 42 — 21 21 Breast, No. 43 — 27 27 Skin, No. 44 3 2 5 Other and unspecified Organs, No. 45 20 11 31 Totals 80 109 189 The numbers following the description of the parts affected refer to the classification of causes of death adopted by the Registrar General for use in England and Wales. 33 BACTERIOLOGICAL WORK. The following bacteriological work has been carried out in the Lister Institute at the Council's expense, with a view to assisting medical practitioners in the diagnosis of infectious ailments:— Disease Suspected. Number of Cases. Positive. Negative. Total. Diphtheria 28 77 105 Tuberculosis 17 62 79 Gonorrhoea 0 1 1 Other Diseases 1 1 2 Total 46 141 187 Included in the above Table is one negative result obtained from the examinations of a sample of milk which had caused violent attacks of diarrhoea in 3 adult members of the same household. TREATMENT OF DISEASE. Under Section 77 of the Public Health (London) Act, 1891, the Council may, with the sanction of the Local Government Board, provide or contract with any person to provide a temporary supply of medicines and medical assistance for the poorer inhabitants of their district. In pursuance of these powers and the Board's Anti-toxin Order, diphtheria anti-toxin is supplied by the Council free of charge, and a fee of 5s. is paid to any medical practitioner who administers the Council's antitoxin to a poor person suffering or suspected to be suffering from diphtheria. Two patients and two suspects were treated at the Council's expense during the year. An annual subscription of £5 5s. is also paid by the Council to the Kensington District Nursing Association in recognition of their services in rendering temporary medical assistance through their nurses to the sick poor, and particularly to infants suffering from ophthalmia. As a good deal of misapprehension exists in regard to the Council's powers to provide treatment, it should be noted first that the above powers are permissive and not obligatory, secondly that they can only be exercised with the sanction of the Board, and thirdly, that the assistance given can only be temporary. There are no powers under which the Council can provide and pay for permanent medical attendance upon poor patients in their homes, as for instance non-insured consumptives who are too ill to attend a dispensary. Full provision can, however, be made for such persons by the Guardians through the District Medical Officer in any case where the patient is destitute in the sense that he cannot pay for the treatment his case requires. Section 75 of the Public Health (London) Act, 1891, empowers the Council to provide hospitals or contract for the use of any part of a hospital for the inhabitants of their district. It is under this Section that the Council propose to contract with the Brompton Hospital and the North Kensington Dispensary for the dispensary treatment of non-insured consumptives, and already subscribe to the following institutions:— £ s. d. Brompton Hospital 10 10 0 West London Hospital 5 5 0 Kensington General Hospital 5 5 0 St. Mary's Hospital 5 5 0 Chelsea Hospital for Women 5 5 0 Paddington Green Children's Hospital 5 5 0 Kensington Dispensary and Children's Hospital 5 5 0 Kensington District Nursing Association 550 Kensal Gospel and Medical Mission 5 5 0 £52 10 0 The subscription to the Kensington District Nursing Association is paid under Section 77. THE FOOD SUPPLY. 37 THE FOOD SUPPLY. All premises in the Borough where food is sold or prepared for sale are 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 201 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 17 applications for registration were received from persons who proposed to sell milk, and in each case the application was granted. The names of two milk purveyors in general shops who were found to have resumed the sale of paraffin oil on their premises were removed from the register. The alterations made in the Register of Milk Purveyors during the year 1913 are summarised in the following Table:— The Register of Milk Purveyors. Class of Premises. Milkshops. General Stores. Restaurants. Totals. Transferred 8 2 1 11 Vacated and removed from Register 4 5 1 10 Premises added to Register 1 5 0 6 On Register December 31, 1912 127 43 35 205 On Register December 31, 1913 124 43 34 201 Increase + Decrease — -3 ±0 -1 -4 The inspection of dairies and milkshops made during the year numbered 1,295, and notices were served requiring the remedy of defects which were found on 9 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. In the absence of any ground for complaint the occupier's licence was renewed by the London County Council at the licensing sessions held in October. 38 Ice Cream. At the end of the year 185 premises were shown in the Register of places within the Borough where ice cream is prepared or sold. Thirty-three places have been added to the Register and 19 have been removed during the year, the net result being that the number of premises upon which ice cream is made has been increased by 14. 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. 556 visits to ice cream premises have been made by the inspectors during the year, and 18 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 1912 and 1913, 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, 1912 242 162 115 43 47 62 10 681 No. added 14 9 3 0 2 10 1 39 Removed 4312310 14 On Register Dec. 31st, 1913 252 168 117 41 46 71 11 706 The inspections of the above premises during the year numbered 1,316, 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 14 Drains defective 2 Gully within Food Store 2 Want of cleanliness 64 Defective ashpit accommodation 20 Other defects 39 Total number of defects found 142 Bakehouses. — There are 94 bakehouses in the Borough, and of this number 73 are underground. As the result of 511 inspections in the year 57 notices were served, the work required in 36 cases being the cleansing of walls and ceilings. 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 first half of the year a considerable number of pigs were killed in the slaughter house in the Walmer Road. The slaughter house inspections for the year numbered 275. 39 Unsound Food.—The unsound food surrendered and destroyed during the year is shown in the following list:— January 26th.—1 Pig's pluck with abscess in lung. February 5th.—1 Pig's carcase with tuberculosis of various glands and organs. February 5th.—2 Pig's heads with tuberculosis of submaxillary glands. August 21st.—1 Box of Bream, September 9th.—81 pecks of Plums. On April 18th, 50 lbs. of rotten tomatoes exposed for sale on a barrow were seized. The vendor was prosecuted, and a penalty of 15s. or seven days' imprisonment was inflicted. SALE OF FOOD AND DRUGS ACTS Each of the ten Sanitary Inspectors is appointed as an inspector under the above Acts, and is instructed to take samples in any place in the Borough which is not within his own sanitary district. During the year the Inspectors collected 698 samples, of which 48 (or 7 per cent.) were adulterated. Proceedings were taken against 14 persons for adulteration or other offences, the fines and costs inflicted amounting to £15 3s. 6d. The samples collected were as follows:— Samples Collected by the Sanitary Inspectors. Name of Sample. Number Taken. Number Adulterated Milk 269 6 Cream 6 3 Butter 102 — Cheese 8 ... Pepper 6 ... Brawn 9 5 Flour 19 ... Rice 6 6 Sausages 30 8 Arrowroot 14 ... Corn Flour 18 ... Oatmeal 8 ... Linseed 12 1 Coffee 6 ... Preserved Vegetables 4 3 Sweets 24 ... Potted Meats 26 2 Vinegar 42 1 Mustard 20 ... Spirits 56 13 Bread 12 — Lard 1 ... Total 698 48 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, J.td. 165, Portobello Road. 40 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. 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 additions of boric acid, borax or peroxide 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. On November 5th, 1912, proceedings were instituted against the vendor of a sample of cream which contained 22 grains or more than ¼ percent. of boric acid per pound. The sample had been taken before the Cream Regulations came into force, and the summons taken out under Section 3 of the Sale of Food and Drugs Act, 1875, was for having sold an article of food mixed with a material so as to render such article injurious to health. The Bench inflicted a penalty of £5, and the defendant appealed to Quarter Sessions, where judgment was given confirming the conviction. The Deputy-Chairman agreed to state a special case, but the appellant has now given notice that he does not intend to proceed to the High Court, and the case is at an end. Before issuing the new Regulations the Board published a report by Dr. J. M. Hamill, one of their medical inspectors, on preservatives in cream. On the first page of the report attention is drawn to the recommendation of the Departmental Committee that the amount of boric acid in cream should not exceed ¼ per cent, or 17-5 grains per pound, and further that the amount of boric acid present should be declared by a label on the vessel containing the cream. On this recommendation the Council have always acted, and where the ¼ percent, limit has been exceeded, proceedings have been instituted, whether the amount of boric acid present has been declared or not. It is, moreover, difficult to see what other course the Council can adopt until the recommendation of the Departmental Committee has been modified by an equally authoritative finding. There is, according to Dr. Hamill, a preponderance of opinion that boric acid in amounts such as may commonly be found in food, cannot safely be regarded as incapable of exerting a deleterious action upon health. On the other hand so small an amount as 0-25 per cent, is not sufficient to keep cream sweet in the hotter months of the year, and as a concession to trade necessities as they exist at present, Dr. Hamill recommends an increase in the limit to 0-4 per cent, during the months of May to October inclusive. The report is not endorsed by the Local Government Board, except in so far as it has been published by them, and it could not in any case be regarded as an authoritative modification of the views of the Departmental Committee. The Committee considered the maximum amount that could be permitted with safety. Dr. Hamill has dealt with the minimum quantity which will keep cream sweet in the summer and has given no finding on the all important question as to whether cream containing the specific proportion of boric acid suggested, namely 0-4 per cent., is or is not injurious. The standard of the Departmental Committee has been disregarded without being overthrown, and the Board have repeatedly been urged by the Council to end a position which is impossible, both for traders and for local authorities, by making a statutory limit, if they intend, as traders believe, to permit the addition of boric acid to cream in amounts not exceeding 0-5 per cent, throughout the year. The Council's request has so far not been granted, and in the absence of a statutory limit it has not been found practicable to administer the Regulations. WATER SUPPLY. A summary of the sources of the water taken from the Thames to supply Kensington will be found in the Annual Report for 1912 on page 42. Between March 15th and 17th, and again between March 22nd to 24th, the water supplied to certain districts in Kensington and other parts of London was noticed to have a disagreeable fishy or oily taste, and samples were taken by the inspectors of the Water Board at a house in Kensington Square at the request of the Public Health Department. The Board's director of Water Examination ascertained that the tainting of the water had been due to the excessive growth of a species of harmless algae on certain filter beds, which were at once closed, with the result that no further complaints have been received. 41 On April 8th the Council received a report from the Superintendent of the Baths stating that during the past two months the water supplied had been of a very bad colour, and the attention of the Board was called to the report. On the receipt of the 9th Research Report of Dr. Houston, the Director of Water Examination, the attention of the Council was called by their Medical Officer of Health to Dr. Houston's opinion that filtration without storage would almost certainly fail to render the filtered Thames water innocuous. Extracts were also quoted from a report received on October 28th, 1912, in which Dr. Houston had stated that certain works were suffering from the non-availability of adequately stored water. Under these circumstances it was suggested that the Council should inform the Board that so long as this system of inadequate storage at certain works continued they would not be in a position to express themselves as satisfied with the London water supply. The suggestion was adopted, and in July a letter was received from the Board stating that the matter was receiving the most urgent attention of the responsible committees. Water Supply to New Houses.—During the year 15 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. The number of inhabited and empty dwellings or tenements in the Borough in the Census year 1911 was as follows:— District. Dwellings or Tenement. Inhabited. Uninhabited. Dwellings. Separately Occupied Tenements. Institutions St. Charles and Golborne (= North) 11,299 14 203 Norland and Pembridge (= Central) 9,463 51 413 North Kensington (=North and Central) 20,762 65 616 South Kensington (=South) 17,356 204 1,474 The Borough 38,118 269 2,090 The figure 38,118 used in the above Table to represent separately occupied tenements is the figure which represents in the Census returns the number of families or households separately occupying their own homes. Each set of one or more rooms occupied by a separate family in a house let in lodgings has accordingly been shown in the first column of the table as a separate dwelling or tenement. In the Rate Collectors' returns a house let in lodgings and occupied by members of more than one family is reckoned as a single house, and computed on this basis the inhabited houses in the Borough in 1913 numbered 27,654. In both returns a self-contained tenement or flat as distinct from a set of rooms in a lodging house has been reckoned separately as an inhabited house or dwelling. The second column of the Table shows the number of institutions and large private establishments used as dwellings in the Borough, and the third column gives the number of uninhabited dwellings. It is not possible to estimate how many of the total number of uninhabited dwellings a.re available for the working classes, but from inquiries which have been made the number of vacant and available rooms in North Kensington is known, and exceeds 1,000. Lodgings provided by the Council.—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 8/- Totals 120 2/6 to 8/- The above tenements provided by the Council are all within the Borough. At the end of the year 114 were let and 6 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 2,093, as compared with 2,102 at the end of 1912, the difference being due- to the addition of three houses and the removal of twelve. 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 occupied by members of more than one family. The inspections and re-inspections of the registered lodging houses in the Borough numbered 7,470. Notices requiring the remedy of defects found were served in 900 instances, and 58 cases of overcrowding were abated. The owners of six lodging houses were summoned for breaches of the lodging house bye-laws, or failure to carry out sanitary works required by the inspectors. Furnished Rooms. —Of the 2,094 lodging houses on the Council's Register, 187 were in 1912 let in furnished rooms, the rent charged being at the rate of 1s. 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 the Appendix of the Annual Report for 1912, which on page 47 contains a summary showing the streets in which such houses are situated, and the number of such houses in each street. The following figures show the number of houses let in furnished rooms at 1s. per night in the different parts of the Borough:— Norland Ward 143 St. Charles Ward 17 Pembridge Ward 24 Golborne Ward 2 Holland Ward 1 Other Wards 0 Total 187 Notting Dale Special Area in the Norland Ward 103 In 70 of the above 187 houses, unfurnished as well as furnished rooms were being let in 1912, the remaining 117 houses being let furnished throughout. Of the three houses added to the register in 1913, one in Sirdar Road was let in furnished lodgings throughout. The other two were situated in Kensal Road and were let in unfurnished lodgings, with the exception in each case of one furnished room on the top floor. The inspections of houses let in furnished lodgings during the year numbered 1,591. In the Notting Dale area alone 79 notices requiring dirty bedding to be cleansed were served, and 1 bed was destroyed. In the same district 77 verminous rooms were dealt with, and 157 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 houses are situated in the Norland Ward:— 47 Common Lodging Houses. Ward. Name of Keeper. Address of Common Lodging House. No. of Lodgers, for which licensed in 1913. 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 ... 54 „ Do. 30, do. „ Do. 40, do. ... 25 25 „ Rusha, Alfred 25, do. ... 57 57 „ Do. 27, do. „ Do. 81, 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 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 reform in the neighbourhood where the common lodging houses are situated. The inspection of common lodging houses is carried out by the inspectors of the London County Council, who exercise effective control under a system of annual licensing. If a house is not kept in conformity with the bye-laws, the renewal of the licence can be refused, and in this way the necessity for resorting to the cumbersome procedure of prosecution for each offence as it arises is avoided. The adoption of a similar system of annual licensing would materially strengthen the hands of the Sanitary Inspectors in dealing with the worst class of houses let in furnished lodgings, and special powers for the control of such houses are urgently needed. Housing (Inspection of District) Regulations, 1910.—By these regulations the Local Government Board have prescribed 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. The ten District Sanitary Inspectors and the Chief Sanitary Inspector have been designated by the Council 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 statements show the work of the year under the Regulations in the tabular form required by the Board:— Houses closed by Order of the Council 15 Houses where underground rooms were closed by the Council 52 Houses where underground rooms were fit for habitation 49 Houses where the underground rooms were not slept in 29 Houses where defects were remedied without Closing Orders 35 Defective houses vacated without Closing Orders and outstanding: (a). Vacated in 1913 2 (b). Vacated in 1912 15 Total houses under consideration in 1913 197 48 The 17 houses vacated without Closing Orders and outstanding at the end of the year were situated as follows:— 1, 2, 4—6, Lion Mews 5 2-—6 and 8, Dunworth Mews 6 7, 10 and 12, Colville Square Mews 3 16, Russell Gardens Mews 1 7, Boundary Mews 1 2a, Admiral Mews 1 Total 17 Of the total number of houses under consideration, 168 were recommended for early inspection for the first time in the course of the year 1913, and may be classified as follows:— Mews dwellings 22 Houses recommended for the inspection of underground rooms 130 Other houses 16 168 General Character of Defects.—Of the above 22 mews dwellings the greater number presented structural defects which permitted the access of effluvia from the stable beneath to the dwelling rooms above. In a number of cases structural alterations for improving the ventilation and lighting of w.c. apartments were required, and similar defects were remedied in six additional mews dwellings which had been vacated in 1912, without Closing Orders, pending the completion of the works required by the Council. In 9 three-room cottages dampness was remedied by the insertion of damp proof courses, and other necessary works were carried out. Defects found on the other premises dealt with during the year have been described in the following paragraphs which relate to Closing Orders and to underground rooms. Closing Orders.—During the year 59 houses were represented by the Medical Officer of Health with a view to Closing Orders being made. The following tabular statement represents the action taken, and the results which were obtained:— Houses represented as unfit for habitation 7 Houses closed by Order of the Council 15 Houses rendered fit for habitation after the making of Closing Orders 5 Houses represented for the Closing of Underground Rooms 52 Houses where Underground Rooms were closed 52 Underground Rooms rendered fit for habitation after the making of Closing Orders 8 Of the 15 houses closed, 8 were represented in 1912, and 7 in 1913, hence the discrepancy in the above statement between the number closed and the number represented in the year to which the figures relate. In each case the houses closed contained from 8 to 10 rooms, and were let or had been let in lodgings of one, two, or three rooms to several families. The seven houses reported in 1913 were verminous, and as regards all woodwork, plaster and internal fittings, so dilapidated as to be totally unfit for habitation. The lodgers evicted by the Council's Order were of the lowest type, and had in some measure been themselves responsible for the filthy and dilapidated state of the houses. The eight houses represented in 1912 were also lodging houses, which had been left empty and insufficiently protected against trespassers. Roughs in the neighbourhood removed the greater part of the internal woodwork, and through holes in the main roof rain found its way into the top floor rooms, and in some cases even into the rooms below the top story. Extensive works being required to render the houses habitable, the Council ordered them to be closed. At the end of the year the Council had determined the Closing Orders in respect to 5 houses which had been rendered fit for human habitation. One mews dwelling was closed during the year by an Order from the Magistrates under the Public Health (London) Act, 1891, the owner having failed to carry out sanitary repairs which had been required by the Sanitary Inspector for the district, for the abatement of nuisances. No Demolition Orders were made by the Council. Underground Rooms.—Underground rooms in 130 houses were inspected during the year. In 49 houses, 72 underground rooms used habitually as sleeping places were inspected and found to be fit for habitation. In 52 houses 56 rooms used as bedrooms were inspected and found to be unfit for habitation in that they did not comply with the Council's Regulations under Section 49 17 (7) of the Housing, Town Planning, etc., Act, 1909. Closing Orders prohibiting the use of these 50 underground rqoms as sleeping places were accordingly made by the Council. At the end of the year 8 of the rooms closed had been altered by the raising or enlargement of the windows, or the execution of other works so as to comply with the Regulations, and in these cases the Council's Closing Orders were determined. Regulations for Underground Rooms.—Section 17 (7) of the Housing, Town Planning, etc., Act, 1909, prohibits the use as a sleeping place of any underground room which does not comply with such regulations as may be made by the Local Authority with the consent of the Local Government Board for secimng proper ventilation and lighting and protection "against dampness, effluvia, or exhalation." The Regulations made by the Council for the purposes mentioned were sanctioned by the Local Government Board in February, 1913. For securing adequate light and ventilation they provide that the superficial area of the window or windows of an underground room shall be not less than one-tenth of the floor space, and further that a portion of the window or windows not less in extent than one-twelfth of the area of the floor shall be so situated as to admit unobstructed light at an angle of 30 degrees. Obstructions to light to be within the scope of the Regulations must, however, be within a distance of 10 feet from the window of the underground room. The obstruction which requires consideration in 99 per cent, of cases is the area wall adjoining the footway outside front basement rooms facing the street. In such a room, having found the width of the window, and the area of the floor, the lowest point on the window pane at which unobstructed light should be capable of entering at an angle of 30 degrees can be determined. This lowest point on the window pane may be conveniently described as the point "X." The greater the distance of the point X below the surface of the adjoining footway the greater must be the distance between the window and the area wall, or in other words the wider must be the area required by the Regulations. When the position of the point X on the window pane has been ascertained, the width of the adjoining area required by the Regulations can be determined by multiplying the vertical distance of the point X below the footway by 1-73205 or the square root of 3, which is the co-tangent of an angle of 30 degrees. The results to be obtained by this method are shown in the following Table, in which the figures in Column I. represent the distance of X below the top of the area coping on the footway, and in Column II. the width of the area required:— Col. I. Inches. Col. II. Ft. In. Col. I. Inches. Col. II. Ft. In. 14 2 0 44 6 4 15 2 2 45 6 6 16 2 4 46 6 8 17 2 5 47 6 9 18 2 7 48 6 11 19 2 9 49 7 1 20 2 11 50 7 3 21 3 0 51 7 4 22 3 2 52 7 6 23 3 4 53 7 8 24 3 6 54 7 10 25 3 7 55 7 11 26 3 9 56 8 1 27 3 11 57 8 3 28 4 0 58 8 4 29 4 2 59 8 6 30 4 4 60 8 8 31 4 6 61 8 10 32 4 7 62 8 11 33 4 9 63 9 1 34 4 11 64 9 3 35 5 1 65 9 5 36 5 2 66 9 6 37 5 4 67 9 8 38 5 6 68 9 10 39 5 8 69 10 0 40 5 9 70 10 1 41 5 11 71 10 3 42 6 1 72 10 5 43 6 2 50 The conclusions arrived at in the use of the above Table are expressed by reporting that the area adjoining an underground room is too narrow by 1, 2 or 3 ft. as the case may be, and the use of this formula has led owners of houses to feel they are being required to set back a footway with which they cannot interfere. If, however, it were thought desirable, the report on an area as 2 ft. too narrow could be converted by inspection of the figures in the same Table into a report stating that the point X, and consequently the top of the window were too low in relation to the footway by 13 inches. The terms used would then bring home the fault to the room and its window, and would no longer suggest the setting back of a public road. Procedure for the Remedy of Defects.—In the case of houses or underground rooms represented with a view to Closing Orders being made, the owners concerned are afforded the opportunity of appearing before the Housing Sub-Committee before the action to be taken is decided upon. Fifteen houses were closed, and the use of underground rooms as sleeping places in 52 houses was prohibited by Closing Orders under Section 17 of the Housing, Town Planning, etc., Act, 1909. Defects were remedied in 21 houses in response to notices served under the Public Health (London) Act, 1891, in 13 houses as the result of negotiations without the service of statutory notices, and in 1 house in response to a notice service under Section 15 of the Housing, Town Planning, etc., Act, 1891. In two cases premises were vacated after the service of notices under the Public Health Act, and no works were carried out. 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, routine house to house inspections have been made during the year for the purpose of detecting and securing the remedy of sanitary defects. Excluding the inspections of registered lodging houses for the purpose of enforcing the lodging house bye-laws, the total number of house to house inspections proper amounted to 2,339. Water Supply in Lodging Houses.—In response to notices served under the London County Council General Powers Act, 1907, an additional supply of water was provided in 57 lodging houses above the level of the ground floor. In the greater number of cases in addition to the water tap a sink was also supplied. Customs and Inland Revenue Acts,—Under these Acts 152 certificates were granted by the Medical Officer of Health during the year, in respect to 152 tenements in 77 houses containing a total number of 168 separate dwellings. FACTORIES AND WORKSHOPS. 53 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 1,751. 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. The factories in the Borough number 240, and are inspected and regulated by H.M. Inspectors under the Home Office. The Sanitary Inspectors of the Borough Council are, however, required to ensure the provision of suitable and sufficient sanitary conveniences in factories as well as in workshops. WOMEN'S WORKSHOPS Report of Lady inspectors.—"The number of workshops and factories at which female labour was employed at the end of 1913 was eight hundred and seventy-two, 328 (mostly laundries) being in North Kensington, and 544 (mostly dressmakers) in South Kensington. During the year 60 workshops were added to the register and 64 were removed. "The subjoined Table summarises particulars of the 67 factories and 805 workshops on the register at the end of the year in North Kensington and South Kensington respectively. Workshops, etc. North Kensington. South Kensington. Total for Whole Borough Dressmakers. Laundries. Miscellaneous. Total. Dressmakers. Laundries. Miscellaneous. Total. No. on Register 60 201 67 328 390 9 145 544 872 No. of Rooms therein 102 635 102 839 729 29 215 973 1,812 "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 Book-binder (Factory) 1 - 1 Boot beader 1 - 1 „ closer 2 - 2 Cigarette maker (Factory) - 1 1 Colour printer (Factory) 1 - 1 Corset maker 2 6 8 Cracker maker 1 - 1 Dressmaker and ladies' tailor 57 378 435 Dyer and cleaner (Factory) 2 2 4 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) 145 9 154 „ (factory) 56 - 56 Machinist - 1 1 Mantle maker 1 4 5 Milliner 4 56 60 Outfitter - 3 3 Photographer 2 14 16 Pickle manufacturer 1 - 1 Printer (Factories) - 3 3 Silversmith - 1 1 Sweetmaker - 1 1 Tailor 38 5 43 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 328 544 872 54 "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 ttention" Ventilation—In response to notices, additional means of ventilation were provided in 26 of the workrooms visited. Whilst a very marked improvement in the ventilation of workshops has been effected in the last twelve 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.—Seven cases of overcrowding were dealt with during the year, as compared with 9 in the year 1912, and 11 in the year 1911. 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 47 sanitary conveniences in factories or workshops were found and remedied. HOME WORK. The return made to the Home Office on "Home Work" is based on figures which show that 803 addresses and names of outworkers were received on the lists sent in by the employers residing in this Borough, and that of these 530 were forwarded to the Councils of the respective districts in which they were situated; the remaining 273 being in Kensington. These 273 names and addresses, together with 392 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 332 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 132 Outworkers in Domestic Workshops 30 Outworkers in their own Homes 170 Total number of Outworkers 332 The factories and workshops referred to in the above list are included in the Table which shows the trades carried on in the factories and workshops on the Council's register. 55 The nature of the work given out to the home workers in the 170 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 2 Fur making 1 Embroidery 3 Artificial flower making 1 Total 170 In 17 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 170 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 33 7 4 44 „ for work and as living rooms 68 9 0 77 „ for work and as bed and living rooms 35 14 0 49 Totals 136 30 4 170 The sanitary defects remedied in the 170 homes were as follows:— Rooms cleansed 4 W.C.'s found defective and remedied 3 Number of Defects remedied 7 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 56 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 to any extent in the Borough of Kensington. Infectious Diseases.—Infectious disease occurred in 16 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. 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. 1918 North Kensington. South Kensington. Total for Borough. Dressmakers Laundries. Miscellaneous Total Dressmakers Laundries. Miscellaneous Total. 1. Workshop inspections, No. of 102 189 218 509 654 10 225 889 1398 2. „ re-inspections ,, 12 18 20 50 148 — 47 190 240 3. Workrooms inspected ,, 114 575 248 937 1004 28 252 1284 2221 4. ,, measured „ 16 - 8 24 65 - 5 70 94 5. „ cards distributed, No. of 13 - - 13 77 - 5 82 95 6. Workshops, &c., newly discovered and reported to H.M. Inspector 2 — - 2 37 — 14 51 58 7. Workshops, &c., reported by H.M. Inspector 18 2 12 27 44 — 18 57 84 8. Workshops, &c., newly registered 9 — 9 18 85 — 7 42 60 9. Workshops, &c., removed from register. 12 9 4 25 26 4 9 39 64 10. Domestic workshops and workplaces inspected 36 37 53 126 9 - 57 66 192 11. Sanitary defects remedied:- (a) Additional means of ventilation provided 1 - 3 4 20 - 2 22 26 (b) Booms cleansed and whitened 1 21 1 23 12 — 3 15 38 (c) Overcrowding abated 1 - - 1 6 — — 6 7 (d) Sanitary conveniences; defects remedied 3 4 5 12 25 — 10 35 47 (e) Miscellaneous defects remedied - 13 — 18 7 — 4 11 24 12. Written intimations issued 8 10 4 17 47 1 18 61 78 18. Statutory notices issued — - — — 15 - 4 19 19 57 MEN'S WORKSHOPS. At the end of the year, the registered workshops at which men alone were employed numbered 945. The factories at which men alone were employed numbered 173. It should be noted that by Section 157, the provisions of the Factory and Workshop Act, 1901, relating to temperature, 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 factories and 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 and in the 173 factories. Trade or Business. Workshops. Factories. Total. Aerated water manufacturer — 4 4 Baker 80 14 94 Basket-maker 6 — 6 Blacksmith 42 1 43 Bootmaker 158 7 165 Builder 112 9 121 Cabinet-maker and Joiner 49 3 52 Carver and Gilder 9 — 9 Coach-builder 42 3 45 Cycle-maker 23 — 23 Electric Generating Works — 11 11 Firewood-manufacturer 12 1 13 French Polisher 2 — 2 Marble Mason 5 5 10 Printer 5 23 28 Saddler 20 — 20 Tailor 112 — 112 Trunk-maker 20 — 20 Umbrella-maker 5 — 5 Undertaker 11 1 12 Upholsterer 30 2 32 Watchmaker 43 3 46 Wig Maker 15 — 15 Sausage Maker — 15 15 Sundry businesses 144 71 215 Total 945 173 1,118 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. 58 FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. I.—Inspection. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 344 34 — Workshops (including Workshop Laundries) 2,234 143 — Workplaces (other than Outworkers' premises included in part 3 of this Report) 137 31 — Total 2,715 208 — II.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:— Want of cleanliness 86 86 _ Want of ventilation 29 29 - - Overcrowding 7 7 - - Want of drainage of floors - - - - Other Nuisances 65 65 3 - Sanitary accommodation insufficient 8 8 - - unsuitable or defective 80 80 - - not separate for sexes 6 6 - - 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) 42 42 - - Other Offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) - - - - Total 323 323 3 - 59 III.—Home Work. NATURE OF WORK.* OUTWORKERS' LISTS. SECTION 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Lists received from Employers. Notices Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110) Sending twice in the year. Sending once in the year. served on Occupiers as to keeping or sending lists. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers Outworkers. Contractors. Workmen. Lists. Contractors Workmen. 1. 2. 3. 4. 5. 6. 8. 9. 10. 11. 12. 13. 14. 15. 16. Wearing Apparel— making, etc. *86 159 544 4 ... 6 38 ... ... 5 5 ... 16 ... ... cleaning and washing 26 19 55 1 ... 1 12 ... ... ... ... ... ... ... ... Household linen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace, lace curtains and nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Curtains and furniture hangings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and Upholstery 4 1 6 1 ... 2 ... ... ... ... ... ... ... ... ... Electro Plate ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... File making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brass and brass articles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fur pulling ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cables and Chains ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anchors and Grapnels ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cart Gear ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Locks, Latches and Keys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, etc. ... 6 ... ... ... ... ... ... ... ... ... ... ... ... ... Artificial flowers ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... Nets, other than wire nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tents ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sacks ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Racquet and tennis balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper, etc., boxes, paper bags ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brush making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pea picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather sorting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carding, etc., of buttons, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stuffed Toys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Basket making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chocolates and sweetmeats ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cosaques, Christmas crackers, Christmas stockings, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Textile weaving ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 116 187 607 6 9 50 ... ... 5 5 ... 16 ... ... "Two lists have been sub-divided according to class of home work. 60 IV.—Registered Workshops. Workshops on the Register (s. 131) at the end of the Year. Number. Important classes of workshops, such as. workshop bakehouses, may be enumerated here Dressmakers and Ladies' Tailors' 150 Workshop Laundries 154 Workshop Bakehouses 80 Other Workshops 1,067 Total number of workshops on Register 1,751 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) 58 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 81 Reports (of action taken) sent to H.M. Inspectors 24 Other 3 Underground Bakehouses (s. 101):— In use at the end of the year 73 SANITARY WORK. 63 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, 733 new moveable ash-bins of galvanised iron have been provided during the year, and 193 fixed ash-pits of brick have been abolished under the powers conferred by Section 23 of the London County Council (General Powers) Act, 1904. During an experimental period of three months from July to October, house refuse was removed daily in that part of the Golborne Ward which lies north of the Great Western Railway, and a bi-weekly collection is to be instituted from April to October in 1914 throughout the Borough. 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 98 house drains have been reconstructed under notices served by the Sanitary Inspectors. Nuisance from Smoke.—301 observations of chimney shafts in the Borough were made, and notices were served in three 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. A report was submitted to the Public Health Committee drawing their attention to the need of public accommodation for both sexes in the neighbourhood of the Earl's Court Road, midway between the Fulham Road and Kensington High Street, and the matter is now receiving the consideration of the Works Committee. 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 three of the schools for mothers. A summary of the work of the sanitary inspectors will be found in Table X., Appendix, p. 84. 64 LEGAL PROCEEDINGS. Legal proceedings were instituted in 16 cases, particulars of which are summarised in the following lists:— Legal Proceedings under the Public Health (London) Act, 1891, Metropolis Local Management Act and Housing, Town Planning, etc., Act, 1909. Date. Name and Address of Defendant. Offence. Result. Jan. 7th H. Hobbs, Blenheim Lodge Failure to carry out sanitary repairs at 30, 1 field Road Withdrawn, the works having been completed Jan. 21st M. Squires, 118, Draycott Avenue Failure to remove manure from 12, Thurloe Place Mews Fined 20s. Feb. 11th T. Doggett Failure to execute sanitary repairs at 25, Powis Terrace Withdrawn, the works having been completed Mar. 18th Ladbroke Hall, Ltd. Failure to carry out sanitary repairs at Ladbroke Hall „ „ „ A. Buckmaster, 100, Seymour Place Failure to carry out sanitary repairs at 224, Walmer Road „ „ „ J. Minnis, 25, Lonsdale Road Failure to carry out sanitary repairs at 20, Earl's Court Gardens „ „ April 15th L. Smith, 114, Portobello Road Failure to cleanse kitchen and contents at 114, Portobello Road Fined 5s. May 6th A. Braine and four other lodgers at 78, Southam Street Failure to leave 78, Southam Street after notice of Closing Order by the Council Orders to quit within 14 days. „ J. Gardner, 270, Kilburn Lane Sale of unsound tomatoes Fined 15s. or seven days. June 17th E. Bowes, 20, Kensal Road Failure to provide ashbin at 14, Admiral Place Withdrawn, bin having been provided. July 15th P. Hetherman, 85, Princes Road Failure to clear choked water closet at 94, Bramley Road Summons withdrawn, the work having been carried out. July 29th The Owner of No. 8, Boundary Mews Failure to carry out sanitary rerepairs at 8, Boundary Mews Closing Order made. Oct. 7th M. Abrahamson Failure to provide w.c. in workshop at 59, Sussex Place Fined 20s. Dec. 2nd S. Preddy, 343, London Road Failure to cleanse and limewash rooms at 41, Yeoman's Row Summons withdrawn on payment of 10s. 6d. costs, the works having been completed. 65 Date. Name and Address of Defendant. Offence. Result. Dec. 2nd W. Buckmaster, 106, Seymour Place Failure to execute sanitary repairs at 1, Runcorn Place Fined 20s. „ H. Hoffman, 83, Princes Road Failure to carry out sanitary repairs at 83, Princes Road Fined 20s. 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 ½ per cent. solution of formic aldehyde (formalin 2 ounces to 1 gallon of water), and then sealed and fumigated with formalin vapour. The following Table shows the number of disinfections carried out for various diseases during the year:— Disinfection, 1913. Nature of Infection. Rooms Disinfected. Premises Disinfected. Disinfections at Wood Lane. Scarlet Fever 612 522 538 Diphtheria 146 135 129 Enteric Fever 25 24 28 Measles 146 84 3 Consumption 234 212 179 Vermin 34 27 37 Other Diseases 87 64 69 Totals 1284 1068 983 Year. Weight of Articles sent from Premises. Number of Disinfections at Wood Lane. 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 1913 - 38 15 0 8 983 66 The following number of articles was dealt with at the Wood Lane Disinfecting Station during the year:— Articles disinfected only 14,416 Articles disinfected and washed free of charge 2,590 Total articles dealt with in 1913 17,006 CLEANSING STATION. In November 1913, the Council took over for use as a station for the cleansing of verminous persons the Casual Wards in Mary Place at an annual rent of £80. For more than a year the Metropolitan Asylums Board have had no occasion to accommodate casuals in the wards, and it is not likely that the wards will again be required for this purpose. In the receiving rooms six baths are provided, three on the ground floor and three on the first floor. The Council have installed in the wards adjoining the bath room on the ground floor a machine for disinfection by steam at a temperature of 212 degrees F. under atmospheric pressure. The cost of the machine was £80, and the cylindrical disinfecting chamber is 5 ft. in length with a diameter of 2 feet. The station has been staffed by the appointment of a married couple who reside on the premises. The husband receives 20s. a week as superintendent of the station, and is responsible for the working of the disinfector and the bathing of adult males. The wife receives 15s. a week and is required to bathe females and children. Under a contract with the Education Authority the Borough Council have agreed to receive verminous children sent to the station by the school nurses from the elementary schools. For the use of the station and its equipment the Borough Council are to receive payment at the rate of 2s. for each child cleansed. Technically in accordance with the provisions of the Childrens' Act, 1908, children sent from the elementary schools are cleansed by the school nurse in the employ of the London County Council, who attends at the station for the purpose, and is responsible under her employers for the effective use of the apparatus provided. In practice the actual work of bathing and disinfecting garments will be carried out by the Borough Council's servants under the supervision of the school nurse. For adults and children not sent from the elementary schools the superintendent and his wife will be responsible, and for the cleansing of such cases no charge will be made. At the end of the year the equipment of the station was approaching completion, but verminous persons were not admitted until the elementary schools re-opened after the Xmas holidays. Verminous Rooms.—271 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, 73 beds were disinfested, 4 verminous beds were destroyed, and 107 dirty beds were cleansed. Rag Flock Act, 1911.—Four samples of rag flock were taken, analysed and reported on during the year. One contained 36 parts of chlorine per 100,000, the limit set by the Regulations being 30 parts, but the excess was so small that no action was taken beyond the sending of a caution to the vendor. The other three samples in each case contained less than thirty parts of chlorine, and complied with the statutory standard. 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 1913 and the three preceding years by washers and bathers:— Year. Washers. Bathers. 1910 73,342 139,237 1911 71,241 153,981 1912 76,052 142,685 1913 74,757 157,383 67 MORTUARY AND CHAPEL OF REST. During the year 239 bodies were deposited at the Mortuary under the following circumstances:— 1. At the request of the relatives of the deceased 50 2. At the request of undertakers, mainly at the instance of the relieving officers 15 3. At the request of the coroner (inquest cases):- Cases of sudden death 82 Cases of violent death 69 151 4. Brought in by the Police—Persons found dead 14 Accident cases 9 23 5. On account of death due to infectious disease ... 0 Total number of bodies received ... 239 In 132 of the above cases post mortem examinations were made under the coroner's warrant. The number of bodies deposited in 1913 and the five preceding years, together with the number of inquests held and the number of post-mortem examinations made in the Mortuary is si own 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. 1908 251 174 107 1909 263 181 110 1910 233 145 103 1911 261 177 118 1912 238 151 107 1913 239 151 132 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 64 bodies were deposited in the Chapel of Rest, Avondale Park. Forty bodies were deposited in the previous year. VACCINATION. Through the courtesy of Mr. Hinton, the vaccination officer, I am able to publish the following summary of the official returns respecting the vaccination of children whose births were registered in 1912. Out of a total number of 3,116 infants born 337 were not vaccinated on account of "conscientious objection" on the part of the parents, and 204 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 541 or to 17 per cent. of the births registered as compared with losses of less than 7 per cent. in each of the five years 1904-1908. The number successfully vaccinated amounted to 2,289 or 73 per cent. of the total births, and 207 infants died before the operation of vaccination had been performed. APPENDIX. 71 APPENDIX. Local Government Board Tables I.—IV. TABLE I. Vital Statistics of Whole District during 1913 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 Residents not registered in the District. Under 1 Year of Age At all Ages. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1908 178,590 3,862 3,504 20.2 2,757 15.9 718 854 428 122 2,398 18.8 1909 178,160 3,187 3,881 19.5 2,770 16.0 692 371 879 112 2,449 14.1 1910 172,780 3,007 3,190 18.5 2,524 14.6 635 815 845 108 2,204 12.8 1911 172,800 8,037 8,223 18.7 2 712 15.7 722 399 435 185 2,389 13.9 1912 172,000 3,068 3,818 19.3 2,524 14.7 683 446 305 92 2,287 18.8 1918 171,700 3,173 3,335 19.4 2,614 15.2 695 490 871 111 2,409 14.0 * 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 172,817 Number of inhabited bouses 38 387 Average number of persons per bouse 4.5 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 1913 has been estimated on the assumption that the rate of decrease has been reduced from 430 to 300 per annum. 72 TABLE II. Cases of Infectious Disease notified during the Year, 1913. Notifiable Disease. Number of Cases Notified. Tolal Casas Notified in each Ward. Total Cases Removed to Hospital. At all Ages. At Ages.—Years. St. Charles. Golborne. Norland. Pembridge. Holland. Earl's Court. yueen 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) 124 5 41 50 18 *9 ... ... 22 42 18 12 7 10 8 10 5 116 Erysipelas 112 2 5 4 17 81 86 17 14 88 15 18 11 7 8 6 5 44 Scarlet fever 552 8 109 887 54 87 6 1 128 122 88 67 57 87 22 18 18 516 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 27 ... ... 5 9 10 8 ... 4 2 2 1 4 6 2 2 4 21 Continued fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 18 ... ... ... 6 7 ... ... 2 2 2 1 1 2 ... 8 ... 10 Cerebro-Spinal Meningitis 3 ... ... ... 1 1 1 ... 2 ... . . . ... ... ... 1 ... ... 1 Poliomyelitis 4 1 2 1 ... ... ... ... 1 1 ... ... 1 ... 1 ... ... 2 *Pulmonary Tuberculosis 628 6 20 128 92 259 110 18 106 182 188 62 26 86 28 25 17 295 †Other forms of Tuberculosis 221 16 47 91 86 26 5 ... 40 46 57 16 11 15 6 14 8 128 Ophthalmia Neonatorum 17 17 ... ... ... ... ... ... 8 6 4 2 1 ... 1 ... ... ... Totals 1701 55 224 617 228 880 161 86 822 486 814 174 119 118 72 78 52 1188 • In 13 cases the Ward was not known, † In 8 ,, ,, ,, ,, 73 TABLE III. Causes of, and Ages at, Death during the Year 1913. 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 and under 65 years. 65 and upwards. All causes Certified 2,409 371 132 90 52 68 295 581 820 1,215 Uncertified - - - - - - - - - Enteric Fever 6 ... ... ... ... 1 8 2 ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... Measles 82 17 29 88 8 ... ... ... ... 2 Scarlet Fever 8 • • • ... 2 1 ... ... ... ... ... Whooping-Cough 29 11 8 9 1 ... ... ... ... 8 Diphtheria, and Croup 7 . . . 1 2 4 ... ... ... ... 1 Influenza 52 1 1 ... ... ... 4 17 29 ... Erysipelas 9 1 1 ... ... I 1 2 8 6 Phthisis (Pulmonary Tuberculosis) 189 8 1 ... 8 17 86 63 11 228 Tuberculous Meningitis 22 8 5 8 3 3 ... ... ... 18 Other tuberculous diseases ... 29 9 5 2 ... 5 4 2 2 19 Cancer, Malignant disease ... 189 ... ... 1 1 2 17 86 82 149 Rheumatic Fever ... 5 . . . ... ... 1 1 ... 8 ... 1 Meningitis ... 14 4 2 8 1 8 ... 1 ... 7 Organic Heart Disease 266 1 ... ... 2 8 84 78 148 150 Bronchitis ... 219 26 12 5 1 1 9 47 118 155 Pneumonia (all forms) 196 58 85 16 8 3 19 38 84 78 Other diseases of Respiratory Organs 55 5 1 2 ... 1 4 14 28 24 Diarrhoea and Enteritis 108 62 19 ... 1 8 5 8 10 43 Appendicitis and Typhlitis 19 ... ... 1 ... 5 3 4 6 8 Cirrhosis of Liver 82 ... ... ... ... ... 7 17 8 10 Alcoholism 9 ... ... ... ... ... 8 5 1 6 Nephritis and Bright's Disease 79 ... ... ... 3 1 18 26 36 32 Puerperal Fever 5 ... ... ... ... 1 4 ... ... 2 Other accidents and diseases of Pregnancy and Parturition 5 ... ... ... ... 2 3 ... ... 8 Congenital Debility and Malformation including Premature Birth 118 116 2 ... ... ... ... ... ... 24 Violeut Deaths, excluding Suicide 57 8 1 1 8 1 8 15 15 20 Suicide 17 . . . ... ... ... 1 5 10 1 1 Other Defined Diseases 582 51 8 5 11 8 61 150 288 288 Diseases ill-defined or unknown 6 ... 1 ... ... ... 2 8 ... 1 2,409 871 132 90 52 68 295 581 820 1,215 74 TABLE IV. INFANT MORTALITY DURING THE YEAR 1913. Nett Deaths from stated Causes, at Various Ages, under One Year of Age. Cause of Death. Under 1 week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. All Causes. Certifed 81 15 14 14 124 50 78 66 58 871 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... • • • ... • • • Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 5 12 17 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... 1 1 1 ... 3 6 11 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... •• ... ... ... ... ... ... 1 1 Tuberculous Meningitis ... ... ... ... ... ... 1 1 1 8 Abdominal Tuberculosis ... ... ... ... ... 2 1 8 1 7 Other Tuberculous Diseases ... ... ... ... ... 1 2 1 1 5 Meningitis (not Tuberculous) ... ... ... ... ... ... 2 1 1 4 Convulsions 1 1 ... ... 2 1 2 2 8 10 Laryngitis ... ... ... ... ... ... ... 1 ... 1 Bronchitis ... 1 1 1 8 7 4 4 8 26 Pneumonia (all forms) 1 8 ... 1 5 7 10 19 12 53 Diarrhœa ... ... ... . . . • • • 2 14 7 2 25 Enteritis 1 ... 8 1 5 1 13 18 5 87 Gastritis ... 1 ... 1 2 8 1 ... ... 6 Syphilis ... • • • ... 1 1 4 7 1 ... 18 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlaying ... ... ... ... ... 6 ... ... ... 6 Injury at birth 2 ... ... ... 2 ... ... ... ... 2 Atelectasis 4 1 ... ... 5 ... ... ... ... 5 Congenital Malformation 7 2 1 1 11 2 1 1 ... 15 Premature Birth 45 3 1 1 50 3 2 ... ... 55 Atrophy, Debility, and Marasmus 12 8 8 2 25 9 7 l 8 45 Other causes 8 ... ... 4 12 1 6 3 2 24 81 15 14 14 124 50 73 66 58 371 legitimate, 3,172. Nett'Births in the year illegitimate, 168. legitimate infants, 315. Nett Deaths in the year of illegitimate infants, 56. 75 TABLE V. Births and Deaths in Kensington; Birth-rates and Death-rates ; and Infantile Mortality 1881-1913 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 13.9 435 129 135 1912 3,318 24.5 19.3 2287 13.6 13.3 305 91 92 1913 3,335 24.5 19.4 2,409 14.2 14.0 371 105 111 Note 1.—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 which was appended to the above Table in the Annual Report of the Medical Officer of Health for the year 1911. 76 TABLE VI. Deaths from the Principal Epidemic Diseases, 1881-1913. Period. Deaths from the Seven Principal Epidemic Diseases. Small-pox. Measles. Scarlet Fever. Diphtheria WhoopingCough Enteric Fever. 1881-1885 107 326 158 96 427 115 1886-1890 1 442 185 305 387 77 1891-1895 9 297 152 306 312 92 1896-1900 0 448 105 249 262 87 1901-1910 18 579 115 212 482 86 1911 0 93 8 20 54 4 1912 0 27 5 5 25 4 1913 0 82 8 7 29 6 TABLE VII. Death-rate in Kensington, per 1,000 persons living, from each of the Seven Principal Epidemic Diseases, 1881-1913. Period. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhœa and Enteritis (all ages). Diarrhœa and Enteritis (under 2 years). 1881-1885 0.18 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 1913 0.00 0.48 0.02 0.04 0.17 0.03 0.63 0.47 77 TABLE VIII. Causes of Death at different periods of life in the Year 1913. 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 Tot al I. GENERAL DISEASES. Enteric Fever 1 6 4 2 ... ... ... ... ... ... ... ... ... ... 1 ... 2 1 1 1 ... ... 4 2 6 Measles 6 82 43 39 10 7 11 18 21 12 42 37 79 1 2 ... ... ... ... ... ... ... 1 2 3 Scarlet Fever 7 3 2 1 ... ... ... ... 2 ... 2 ... 2 ... 1 ... ... ... ... ... ... ... ... ... 1 1 Whooping-Cough 8 29 11 18 3 8 4 4 4 5 11 17 28 ... 1 ... ... ... ... ... ... ... ... ... 1 1 Diphtheria 9A 7 1 6 ... ... ... 1 1 1 1 2 3 ... 4 ... ... ... ... ... ... ... ... 4 4 Influenza 10 52 18 34 1 ... ... 1 ... ... 1 1 2 ... ... ... ... 2 2 5 12 10 19 17 33 50 Dysentery 14 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 Erysipelas 18 9 4 5 1 ... ... 1 ... ... 1 1 2 ... ... ... 1 1 ... 1 1 1 2 3 4 7 Pyaemia, Septicaemia 20 1 1 ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Tetanus 24 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Pulmonary Tuberculosis 28AB 183 107 76 ... ... 1 ... ... ... 1 ... 1 3 3 6 11 56 30 35 27 6 5 106 76 182 Acute Phthisis 29A 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Acute Miliary Tuberculosis 29B 5 1 4 1 2 ... ... ... ... l 2 3 ... 2 ... ... ... ... ... ... ... ... ... 2 2 Tuberculous Meningitis 30 22 9 13 3 2 3 5 3 7 9 16 ... ... 2 l ... ... ... ... ... ... 2 4 6 Tuberculosis of Peritoneum, &c. 31AB 13 7 6 4 3 1 ... 1 ... 6 3 9 ... ... ... 1 1 1 ... 1 ... ... 1 3 4 Tuberculosis of Spinal Column 32 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 Tuberculosis of Joints 33 2 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 ... 2 Tuberculosis of other organs 34 6 2 4 ... ... ... ... ... ... ... 1 1 ... ... 1 ... 1 ... ... 1 ... 2 2 3 5 Disseminated Tuberculosis 35 7 5 2 2 ... 3 1 ... ... 5 1 6 ... ... ... 1 ... ... ... ... ... ... ... 1 1 Syphilis 37 20 7 13 5 8 ... 3 1 ... 6 11 17 ... ... ... ... 1 1 ... ... ... 1 1 2 3 Cancer 39-45 189 80 109 ... ... ... ... ... 1 ... 1 1 1 ... 1 l 3 14 43 43 32 50 80 108 188 Other tumours 46 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Bheumatic Fever 47 5 3 2 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 2 ... ... 3 2 5 Chronic Rheumatism, &c. 48AB 9 1 8 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 1 5 1 8 9 Gout 48C 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 1 2 Diabetes 50 23 10 13 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 4 3 5 8 10 13 23 Exophthalmic goitre 51 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 2 Leucocythsemia, &c. 53AB 4 1 3 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 1 ... 1 3 4 Carried forward 686 322 364 27 31 22 32 36 23 85 86 171 6 17 14 18 70 53 90 97 57 98 237 278 515 78 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 686 322 364 27 31 22 32 36 23 85 86 171 6 17 14 18 70 53 90 97 57 93 237 278 515 GENERAL DISEASES.—continued. Anæmia Chlorosis 54 8 3 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 2 2 1 3 5 8 Alcoholism 56 9 3 6 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... 5 ... 1 3 6 9 Total for General Diseases 703 328 375 27 31 22 32 36 23 85 86 171 6 17 14 18 73 55 91 104 59 95 243 289 532 II.—DISEASES OF THE NERVOUS SYSTEM AND OF THE ORGANS OF SPECIAL SENSE. Encephalitis 60 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 2 2 Cerebral Spinal Fever 61A 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Meningitis 61BC 13 6 7 3 1 ... 2 1 2 4 5 9 1 ... 1 2 ... ... ... ... ... ... 2 2 4 Locomotor Ataxy 62 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Other Diseases of the Spinal Cord 63AB 10 4 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 3 1 2 4 6 10 Cerebral Hæmorrhage, Apoplexy 64AE 84 36 48 2 ... ... ... 1 ... 3 ... 3 ... ... ... ... 2 2 10 17 21 29 33 48 81 Softening of Brain 65 11 2 9 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 7 2 9 11 Paralysis without specified cause 66 AC 10 5 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 2 5 5 5 10 General Paralysis of the Insane 67 13 8 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 6 5 2 ... ... ... 8 5 13 Other forms of Mental Alienation 68 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 ... 2 Epilepsy 69 13 8 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 4 4 4 ... ... 1 8 5 13 Convulsions 70 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 Infantile Convulsions under 5 years 71AB 13 8 5 7 3 1 2 ... ... 8 5 13 ... ... ... ... ... ... ... ... ... ... ... ... Neuritis 73 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... 3 3 Other Diseases of the Nervous System 74AD 8 4 4 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 2 3 4 4 8 Mastoid Disease 76A 3 2 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 2 1 3 Other Diseases of the Ears 76B 2 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... 1 1 2 Total for Diseases of the Nervous System, and of the Organs of Special Sense 190 86 104 12 4 1 4 2 2 15 10 25 2 2 2 3 14 14 25 27 28 48 71 94 165 III.—DISEASES OF THE CIRCULATORY SYSTEM. Pericarditis 77 3 3 ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... 2 ... ... ... ... 2 ... 2 Acute Endocarditis 78AC 5 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... l 1 1 1 ... 1 2, 3 5 Valvular Disease 79A 62 32 30 ... ... ... ... ... ... ... ... ... ... 1 4 3 2 4 13 5 13 17 32 30 62 Fatty Degeneration of the Heart 79 B 45 12 33 ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 5 4 4 5 24 12 33 45 Carried forward 1008 463 545 39 35 24 36 38 25 101 96 197 8 20 21 24 94 79 134 141 105 185 362 449 811 79 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 1008 463 545 39 35 24 36 38 25 101 96 197 8 20 21 24 94 79 134 141 105 185 362 449 811 DISEASES OF THE CIRCULATORY SYSTEM—continued. Other Organic Disease of the Heart 79 C 159 76 83 ... 1 ... ... ... ... ... 1 1 ... ... ... ... 10 11 27 20 39 50 76 82 158 Angina Pectoris 80 10 6 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 1 2 2 6 4 10 Arterial Sclerosis, &c. 81 AC 57 82 25 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 16 7 14 16 32 25 57 Cerebral Embolism and Tbrombosis 82A 23 6 17 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 7 1 10 6 17 23 Other Embolism and Thrombosis 82B 8 3 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 2 2 3 5 8 Diseases of the Veins 83 AD 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 ... 4 4 Diseases of the Lymphatic System ... 84 AB 3 1 2 ... 1 ... ... ... ... ... 1 1 1 ... ••• ... ... ... ... 1 ... ... 1 1 2 Total for Diseases of the Circulatory System ... 379 173 206 ... 2 1 ... ... ... 1 2 3 1 2 5 3 19 25 71 50 76 124 172 204 376 IV.—DISEASES OF THE RESPIRATORY SYSTEM. ... Diseases of the Larynx 87AC 5 3 2 1 1 1 ... 1 1 3 2 5 ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of the Thyroia Body 88 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... 3 3 Bronchitis 89 & 90 219 95 124 15 11 6 6 3 2 24 19 43 ... 1 ... ... 5 4 25 22 41 77 71 105 176 Broncho-pneumonia 91 99 46 53 23 16 12 13 5 5 40 84 74 ... ... ... ... ... 3 8 5 3 11 6 19 25 Lobar-pneumonia 92 A 22 10 12 2 2 ... ... 1 ... 3 2 5 ... ... 1 ... 1 1 5 4 ... 5 7 10 17 Pneumonia (type not stated) 92B 75 42 33 5 5 6 4 5 ... 16 9 25 1 2 1 1 11 3 8 8 5 10 26 24 50 Pleurisy 93AB 6 1 5 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 2 ... 2 1 5 6 Pulmonary Congestion, &c. 94AD 25 11 14 1 2 ... ... ... ... 1 9 3 ... ... ... ... 2 ... 4 ... 4 12 10 12 22 Asthma 96 13 6 7 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 4 2 1 5 6 7 13 Fibroid Disease of Lung 98 A 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... 3 8 Total for Diseases of the Respiratory System 470 214 256 47 37 25 23 15 8 87 68 155 1 3 3 2 20 12 49 45 54 126 127 188 315 V.—DISEASES OF THE DIGESTIVE SYSTEM. ... Diseases of the Mouth, &c. 99AD 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... 3 ... 3 Carried forward 1745 804 941 86 74 49 59 53 83 188 166 354 10 24 24 26 126 106 237 226 219 393 616 775 1391 80 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 1745 804 941 86 74 49 59 53 33 188 166 354 10 24 24 26 126 106 237 226 219 393 616 775 1391 DISEASES OF THE DIGESTIVE SYSTEM - continued. Diseases of Pharynx 100 4 3 1 ... ... 1 ... 1 ... 2 ... 2 ... ... ... ... ... ... ... 1 1 ... 1 1 2 Diseases of (Esophagus 101 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Perforating Ulcer of Stomach 102 9 5 4 ... ... ... ... ... ... ... ... ... ... ... ... 2 3 1 1 1 1 ... 5 4 9 Inflammation of Stomach 103A 13 6 7 3 3 ... ... ... ... 3 3 6 ... ... ... ... ... 1 ... 1 3 2 3 4 7 Other Diseases of the Stomach 103B 5 4 1 2 1 ... ... ... ... 2 1 3 ... ... ... ... ... ... 1 ... 1 ... 2 ... 2 Diarrhœa and Enteritis 104 & 105AH 108 55 53 33 29 11 ... ... ... 44 37 81 ... ... 1 2 4 1 2 6 4 6 11 16 27 Appendicitis 108 19 8 11 1 ... ... ... 1 ... 1 ... 1 ... ... 3 2 1 3 2 2 2 4 7 11 18 Hernia 109A 7 2 5 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 3 ... 2 1 5 6 Intestinal Obstruction 109B 13 2 11 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... 1 ... 3 2 6 2 10 12 Other Diseases of the Intestines 110 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 3 ... 3 Cirrhosis of the Liver, &c. 113AC 32 15 17 ... ... ... ... ... ... ... . . . ... ... ... ... ... 3 4 10 7 2 6 l5 17 32 Biliary Calculi 114 4 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 2 2 4 Other Diseases of the Liver 115 11 4 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 1 4 4 7 11 Diseases of the Spleen 116 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Peritonitis (cause unstated) 117 2 1 1 ... ... ... ... ... 1 ... 1 1 ... ... 1 ... ... ... ... ... ... ... 1 ... 1 Total for Diseases of the Digestive System 235 114 121 39 34 12 8 2 1 53 43 96 1 1 5 6 12 11 21 28 22 32 61 78 139 VI.—NON-VENEREAL DISEASES OF THE GENITO-URINARY SYSTEM AND ANNEXA. Acute Nephritis 119 6 2 4 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... 4 ... ... ... ... 2 4 6 Bright's Disease, &c. 120AB 73 36 37 ... ... ... ... ... ... ... ... ... 1 ... 1 ... 4 5 14 12 16 20 36 37 73 Other Diseases of the Kidney 122AD 4 4 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 2 ... 4 ... 4 Calculi of the Urinary Passage 123 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Diseases of the Bladder 124 13 9 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 1 5 2 9 4 13 Diseases of the Urethra 125 AB 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Diseases of the Prostate 126 5 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 ... 5 ... 5 Uterine Hæmorrhage 128 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Uterine Tumour 129 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 2 Total for non-Venereal Diseases of the Genito Urinary System and Annexa 106 57 49 ... ... ... ... ... ... ... ... ... 4 ... 1 ... 6 11 18 16 28 22 57 49 106 Carried forward 2083 972 1111 125 108 61 67 55 34 241 209 450 15 25 30 32 144 128 275 270 267 447 731 902 1633 TABLE VIII.—continued. CAUSES OF DEATH. Classification No. Totals— All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. T otals— Under 5 Years. 5 and under 15 years 15 and under 25 years. 25 and under 45 years 45 and under 65 years 65 years and upwards. T otals— Above 5 Yeats. 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 2088 972 1111 125 108 61 67 55 34 241 209 450 15 25 30 32 144 128 275 270 267 447 731 902 1633 VII.—THE PUERPERAL STATE. ... Accidents of Pregnancy 134 AB 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 Other Accidents of Childbirth 136 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... 3 3 Puerperal Fever 137 5 ... 6 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 4 ... ... ... ... ... 5 5 Puerperal Convulsions 1380 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 Total for Diseases of the Puerperal State 10 ... 10 ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 7 ... ... ... ... ... 10 10 VIII.—DISEASES OF THE SKIN AND OF THE CELLULAR TISSUE. ... Senile Gangrene 142A 7 3 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 2 2 3 4 7 Gangrene of Mouth 112 B 2 ... 2 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 2 2 Phlegmon, Acute Abscess 144 AB 6 2 4 ... 1 ... ... ... ... 1 1 ... ... ... ... 1 ... ... 1 1 2 2 3 5 Total for Diseases of the Skin and of the Cellular Tissue 15 5 10 ... 1 ... ... ... ... 1 1 ... 1 ... 1 1 ... 1 3 3 4 5 9 14 IX.—DISEASES OF THE BONES AND OF THE ORGANS OF LOCOMOTION. 146 7 2 5 1 1 ... ... ... ... 1 1 2 1 2 ... ... ... ... ... 1 ... 1 1 4 5 X.—MALFORMATIONS. Congenital Malformation 150AD 15 11 4 11 4 ... ... ... ... 11 4 15 ... ... ... ... ... ... ... ... ... ... ... ... XI.—DISEASES OF EARLY INFANCY. ... Premature Birth 151A 55 30 25 30 25 ... ... ... ... 30 25 55 ... ... ... ... ... ... ... ... ... ... ... ... Infantile Atrophy, Debility, and Marasmus 151B 43 28 15 26 15 2 ... ... 98 15 43 ... ... ... ... ... ... ... ... ... ... ... ... ... Icterus Neonatorum 151C 1 1 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast Milk 151E 4 1 3 1 3 ... ... ... ... 1 3 4 ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Umbilicus, &c 152 A 1 1 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis 152B 5 3 2 3 2 ... ... ... ... 3 2 5 ... ... ... ... ... ... ... ... ... ... ... ... Injuries at Birth 152C 2 2 ... 2 ... ... ... ... ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Lack of Care 153 3 1 64 2 1 2 ... ... ... ... 1 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... Total for Diseases of Early Infancy 114 50 62 50 2 ... ... ... 64 50 114 ... ... ... ... ... ... ... ... ... ... ...... ... ... Carried forward 2244 1054 1190 199 164 63 67 55 34 317 265 582 16 28 30 36 145 135 276 274 270 452 737 925 1662 81 82 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. S 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 2244 1054 1190 199 164 63 67 55 34 317 265 582 16 28 30 36 145 135 276 274 270 452 787 925 1662 XII.—OLD AGE. Old Age 154AB 85 29 56 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 28 54 29 56 85 XIII.—AFFECTIONS PRODUCED BY EXTERNAL CAUSES. Suicide by Poison 155 4 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... 1 1 3 4 Suicide by Asphyxia 156 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Suicide by Hanging 157 5 4 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 1 ... ... 4 1 5 Suicide by Drowning 158 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 1 2 Suicide by Cutting or Piercing Instruments 160 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Suicide by jumping from high place 161 8 1 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... 1 2 3 Suicide by Crushing 162 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Other Acute Poisoning 165 8 3 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 2 ... ... ... 3 ... 3 Burns 167 3 1 2 ... ... ... 1 ... ... ... 1 1 1 ... ... ... ... ... ... ... ... 1 1 1 2 Absorption of Deleterious Gases (Overlain, etc.) 168 7 4 3 4 3 ... ... ... ... 4 8 7 ... ... ... ... ... ... ... ... ... ... ... ... ... Accidental Drowning 169 8 6 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 3 ... 3 ... 6 2 8 Injury by Fall 172 20 10 10 ... 1 ... ... ... ... ... 1 1 1 ... ... ... 4 ... 2 3 3 6 10 9 19 Injury by other Crushing (vehicles, railways, &c.) 175 15 8 7 ... ... ... ... 1 ... 1 ... 1 3 2 ... ... 1 2 3 1 ... 2 7 7 14 Homicide 184 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Total for Affections proaucea by External Causes 74 41 33 4 4 ... 1 1 ... 5 5 10 6 2 ... 2 7 6 17 8 6 10 36 28 64 XIV.—ILL-DEFINED CAUSES. ... Heart Failure 189A 4 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... ... 1 3 4 Other Ill-defined Causes 189BCD 1 1 ... ... • •• 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Cause not specified 189F 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Total for Ill-defined Causes 6 2 4 ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... 2 1 2 ... ... 1 4 5 Grand Totals 2409 1126 1283 203 168 64 68 56 34 323 270 593 22 30 30 38 152 143 295 286 304 516 803 10131816 83 TABLE IX—PROCEEDINGS DURING 1913. PREMISES. NUMBER OF PLACES. Number of inspections, 1913. Number of notices, 1913. Number of prosecutions, 1913. On register at end of 1912. Added in 1913. Removed in 1913. On register at end of 1913. Milk premises 205 6 10 201 1,295 9 0 Cowsheds 1 — — 1 45 — Slaughter-houses 10 — — 10 275 1 — Other offensive trade premises Nil — — — — — — Ice cream premises 171 33 19 185 556 18 — Registered houses let in lodgings 2,102 3 12 2,093 7,470 (a) *58 (a)*0 (b)+842 (b)+6 Total number of intimation notices served for all purposes, 2,536. * (a) For overcrowding. † (4) For other conditions. Overcrowding—1913. 111 Number of dwelling rooms overcrowded Number remedied 111 Number of Prosecutions 0 Underground rooms— 76 Illegal occupations dealt with during year Number of rooms closed 56 Insanitary houses— Number closed under the Public Health (London) Act, 1891 1 Number closed under the Housing of the Working Classes Act 15 Number of premises cleansed under Section 20 of L.C.C. (General Powers) Act, 1904 271 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 certificites were received during year 77 Number of tenements comprised therein 168 Number of tenements for which certificates were (a) granted 152 (b) refused 0 Ntimber of prosecutions under By-laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, &c. — (y) 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 0 (d) As to paving of yards, etc., of dwelling houses 0 (e) In connection with the removal of offensive matter, etc. 0 (f) As to cesspools and privies, removal and disposal of refuse, etc. — (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 Management Acts Amendment (By-laws) Act, 1899) 0 Mortuaries— Total number of bodies removed 303 Tctal number of infectious bodies removed 0 84 TABLE X. Summary of the Work done by the Sanitary Inspectors during the Year 1913. DESCRIPTION OF WORK, Etc. number of district. Grand Total. 1 2 3 4 5 6 7 8 9 10 Complaints received 226 156 88 112 145 168 126 107 241 68 1,437 House to House Inspections 343 162 118 149 260 141 166 450 41 509 2,339 Houses Inspected on Complaint 592 325 244 338 423 460 209 201 442 108 3,342 Re-inspections of Houses 1,010 947 1,504 1,300 1,532 1,351 781 1.059 1,328 878 11,690 Inspections of Lodging Houses (Unfurnished) 858 1,410 285 571 516 77 784 311 741 326 5,879 Inspections of Lodging Houses (Furnished) 60 7 860 174 — 487 3 — — 1,591 Houses cleansed, &c. 124 333 157 97 90 43 231 94 177 58 1,404 Verminous Rooms cleansed 43 41i 77 66 25 5 11 — 2 1 271 Dirty bedding cleansed 1 15 79 6 — 4 2 — — — 107 „ ,, destroyed — — 1 — — 2 — — — 1 4 Overcrowding abated 21 59 8 2 1 8 8 1 2 1 111 Underground Rooms, illegal occupation discontinued 6 7 — 1 1 — 2 3 — 20 House Drains re-constructed 11 20 19 8 10 12 4 1 9 4 98 Defective Drains repaired 23 18 29 5 8 13 11 15 26 21 169 House Drains cleansed 39 137 15 4 7 25 8 34 20 20 309 Water-closets constructed, repaired, &c. 140 49 69 62 99 53 39 32 78 67 688 „ supplied with water 16 91 3 42 99 1 35 17 38 12 354 „ new, provided — 2 1 5 — 4 5 1 30 3 51 Soil-pipes ventilated, repaired, &c. 6 29 2 5 2 14 4 2 25 8 97 „ new, provided 7 11 1 3 3 11 5 13 5 59 Cisterns cleansed, covered, &c. 32 86 16 18 17 4 15 8 71 18 285 Yards, Areas paved, drained, repaired 62 44 69 24 48 36 19 11 48 14 375 Dustbins provided 88 111 98 71 117 71 27 33 89 28 733 Ashpits abolished 28 23 21 8 64 4 18 1 25 1 193 Accumulations of filth, &c., removed 43 37 12 8 — 17 53 16 41 6 233 Animals removed 5 8 5 1 2 — — 2 — 9 32 Other Sanitary Work executed 22 422 144 54 109 59 142 32 96 58 1,138 Workshops &c., Inspections of 31 80 30 146 61 39 73 164 110 112 846 Factories, Inspections of 15 20 16 44 28 33 17 42 21 51 282 Bakehouses, Inspections of 48 65 20 73 67 23 42 19 103 51 511 Slaughter-houses, Inspections — 32 104 26 — 29 69 15 — — 275 „ „ Notices — — 1 — — — — — — — 1 Dairies, &c., Inspections 155 62 97 112 247 108 35 96 264 119 1,295 „ Notices 2 1 — — — — — 1 3 2 9 Ice Cream Vendors, premises, Inspections 81 72 34 81 37 96 39 26 71 19 556 „ „ „ Notices — 3 — 3 1 4 3 2 1 1 18 Other Places where Food is prepared, Inspections of 205 239 69 128 142 33 96 67 188 149 1,316 Smoke observations 74 18 — 6 — — 42 91 57 13 301 Nuisances from smoke observed 1 1 — — — — — 1 — 3 Mews, Inspections of 892 646 636 446 737 503 339 873 673 943 6,688 Other inspections 78 331 71 179 160 45 88 263 155 218 1,588 Notices issued Written intimations 291 339 309 274 250 188 151 149 448 137 2,536 Statutory 56 77 74 58 60 37 23 36 67 25 513 Lodging House 103 134 191 100 77 63 114 23 74 21 900 . Removal of Manure 1 1 — — 1 7 7 — — — 17 Sanitary Works completed 717 1,543 826 490 702 386 637 302 793 335 6,731 Legal Proceedings—Number of summonses issued 1 2 3 1 3 1 — — 2 3 16 85 SELECTED STREETS IN NORLAND WARD. TABLE XI.—Deaths in Males and Females and Place of Death, 1913. Number of Deaths Place of Death. Streets. Male. Female. Total. Home. Kensington Infirmary. Hospitals and Places beyond the Borough. Bangor Street 16 25 41 9 20 12 Crescent Street 8 18 26 4 14 8 Kenley Street 6 3 9 2 3 4 Portland Road 19 17 36 17 13 6 St. Katherine's Road 20 13 33 12 14 7 Sirdar Road. 13 15 28 12 12 4 Total Selected Streets 82 91 173 56 76 41 TABLE XII.—Population in 1911 and Deaths in 1913 at Age Periods. Age Period. Under 5 years. 5-15. 15-25. '25-45. 45-65. 65 and upwards. All Ages. Male. Female. Population 630 1,013 758 1,767 1,021 225 5,414 2,618 2,796 Deaths . 78 5 3 24 45 18 173 82 91 TABLE XIII.—Infantile Mortality, Births and Deaths in Legitimate and Illegitimate Infants under the age of 1 year. Births. Deaths under 1 year. Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. Bangor Street 30 3 33 4 0 4 Crescent Street 13 1 14 2 0 2 Kenley Street 21 1 22 0 0 0 Portland Road 54 3 57 12 1 13 St. Katherine's Road 43 8 51 6 4 10 Sirdar Road 29 3 32 6 2 8 Total Selected Streets 190 19 209 30 7 37 86 TABLE XIV.—Causes of Death, 1913. Cause of Death. Bangor Street. Crescent Street. Keoley Street. Portland Road St. Katberine's Road. Sirdar Road. Total. Measles 8 3 1 — 3 5 20 Whooping Cough 2 — — 4 1 2 9 Pulmonary Tuberculosis 5 5 1 4 6 2 23 Other Tubercular Diseases 1 1 1 1 — — 4 Syphilis 4 — — 1 2 — 7 Diseases of Nervous System 2 1 1 1 2 1 8 Heart Diseases 3 1 — — — 4 8 Bronchitis 2 3 — 3 1 2 11 Pneumonia 3 3 2 9 6 — 23 Diarrhoea and Enteritis 1 — — 1 3 3 8 Other Respiratory Diseases — — 1 — 3 1 5 Bright's Disease 1 1 — 1 — — 3 Cancer 3 2 — 2 — — 7 Senile Decay 1 — — 1 2 — 4 Premature Birth — — — — 1 3 4 Accident 1 3 — 1 1 — 6 Suicide — — — 1 — — 1 Other Causes 4 3 2 6 2 5 22 41 26 9 36 33 28 173 TABLE XV.—Legitimate and Illegitimate Births in 1913 per 1,000 Females aged 15-45 in Census Population 1911. Married Females, aged 15-45 814 Unmarried and Widowed Females, aged 15-45 532 Legitimate Births per 1,000 Married Females 233 Illegitimate Births per 1,000 Unmarried and Widowed 36 87 WORKING-CLASS RENTS AND RETAIL PRICES. BOARD OF TRADE ENQUIRY. TABLE XVI.—Index Numbers showing Comparison with London Districts in 1912 (London—Middle Zone — 100). Weekly Rents. Food. Coal. Coal and Food. Rent Rent, Coal and Food. Weekly Rents. 2 Rooms. 3 Rooms. Inner Zone 99 102 99 116 102 6/6 8/3 Middle Zone 100 100 100 100 100 5/6 7/3 West 100 100 100 106 101 5/9 7/6 Kensington — — — 106 — 6/0 7/6 Outer Zone 101 96 100 87 97 — 6/6 * Kensington is a sub division of the West District of the Middle Zone. TABLE XVII.—Percentage Difference in Rents and Prices and Actual Difference in Weekly Rents between 1905 and 1912. Food. Coal. Coal and Fuel. Rent. Rent, Coal and Food. Weekly Rents. 2 Rooms. 3 Rooms. Inner Zone + 11 + 17 + 12 — 6 + 8 - 6d. - 6d. Middle Zone + 11 + 16 + 12 - 4 + 9 - 6d. - 3d. West + 10 + 18 + 11 - 2 + 8 - 3d. - 3d. Kensington — — — - 2 — - 3d. Nil Outer Zone + 10 + 14 + 10 - 2 + 8 — Nil Increase = + Decrease = — Note.—The Rents for the above Enquiry were obtained with the assistance of the Council's Sanitary Inspectors in the Kensington District, and the Board have supplied the Public Health Department with a copy of their Report. The rise in the price of clothing, including boots, "has not been much less for the same quality of article than for food, coal and rent combined" (p. xiii ), and is, therefore, about 9 per cent. TABLE XVIII.— Weekly Budget in 1905 and in 1912 of man and wife with one child, earning, say, 30s., spending from 22s. to 24s. on food, coal, rent and clothes, and residing in Kensington. 1905, 1912. Increase ( + ) Decrease (-) £ s. d. £ s. d. Per cent.* Per week. S. d Food and Coal 14 5 16 0 + 11 + I 7 Rent, two Rooms 6 0 5 9 — 4 — 3 Clothes and Boots 2 0¾ 2 3 + 9 + 2¼ Total cost 1 2 5¾ 1 4 0 + 7 + l 6¼ * Note.—The only figures in the above Table taken from the Report of the Board of Trade are those representing the percentage increases in the cost of food, coal, clothes and rent. INDEX. Page Adulteration of Food 89 Anterior Poliomyelitis 17 Appendix 71 Area of the Borough 8 Baths and Washhouses 66 Births and Birth Rates 4 Births, Notification of 5 Births and Birth Rates, Tables I. and V 71 & 75 Cancer 82 Cerebro-spinal Meningitis 18 Chapel of Rest for the Dead 67 Cleansing of Children and Verminous Persons 66 Common Lodging Houses 47 Consumption 22 Cow House 87 Cream Regulations, 1912 40 Customs and Inland Revenue Acts 50 Dairies and Milkshops 87 Deaths and Death Rates— In Districts 7 From Principal Causes 8 From Zymotic or Principal Epidemic Diseases 8&15 Among Infants 8 Deaths and Death Rates, Tables— 1908—1918 Table 1 71 Causes of at Ages, Summary, Table III 78 Infantile Mortality, Table IV 74 Causes of by Sexes at ages, Table VIII 77 In Quinquennia, 1881—1910 Table V 75 Principal Epidemic Diseases, Deaths from, Table VI 76 Principal Epidemic Diseases Death Rates, Table VII 76 Diarrhœa 19 Diphtheria 15 Disinfection 65 Drainage Work 68 Dust, Removal of 68 Enteric Fever l6 Enteritis and Diarrhœa 19 Factories and Workshops 58 Food Supply 87 Food, Adulteration of 89 Furnished Rooms 46 Health Visitors 11 & 68 Home Office Tables 58-60 Home Work 54 Houses let in Lodgings 46 Houses, Number Inhabited 45 Housing (Inspection of District) Regulations, 1910 47 Housing of Working Classes 45 Ice Cream Vendors 88 Illegitimate Births 5 Infantile Mortality 8 Infectious Diseases 15 Notification and Removal, Table II. 72 Inhabited Houses, Number of 45 Inspection, Sanitary 68 Inspectors, Work of, Summary, Table X. 84 Inquests 67 ii. Page Lavatories, Public 68 Legal Proceedings 64 Local Government Board Tables I.—IV 71-74 Lodging Houses— Common Lodging Houses 47 Houses Let in Lodgings 46 Provided by the Council 45 London County Council Summary of Work, Table IX. 83 Margarine 39 Marriages 4 Measles 19 Milkshops 37 Milk Supply 37 Mortuary 67 Notifiable Diseases 15 Notification of Births 5 Ophthalmia Neonatorum 17 Outworkers' Premises 54 Phthisis 22 Poliomyelitis 17 Population 3 Distribution in Wards 3 Prosecutions 64 Public Health (Tuberculosis) Regulations 23 Public Health (Milk and Cream Regulations), 1912 40 Puerperal Fever 17 Rag Flock Act, 1911 66 Refuse, Removal of 63 Registered Lodging Houses 46 Sale of Food and Drugs Acts 39 Sanitary Inspection 63 Sanitary Inspectors' Work, Table X. 84 Scarlet Fever 16 Schools for Mothers 12 Slaughter Houses 38 Small Pox 15 Smoke Nuisancs 63 Tuberculosis— Dispensary 31 Notification 23 Occupation of Persons Notified 29 Provision of Beds 31 Regulations 23 Site of Disease 26 Typhoid Fever 17 Underground Rooms 48 Unsound Food 39 Vaccination 67 'Verminous Persons, Articles and Rooms 66 Water Certificates 41 Water Supply 40 & 50 Whooping Cough 19 Workshops and Factories 53 Zymotic or Principal Epidemic Diseases 8 & 15 Deaths from in Quinquennial Periods, Table VI. 76 Death Rates from in Quinquennial Periods, Table VII. 76