KEN 36 The Royal Borough of Kensington ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. 1914. Vail & Co., Printers and Stationers, 170, Farringdon Road, E.C. iii. PUBLIC HEALTH DEPARTMENT STAFF. Chief Sanitary Inspector. George M. Pettit. Sanitary Inspectors. J. E. Bagshaw. E. J. Bennett. T. Cutting. H. Dawes. J. H. Fowles. A. E. Friend. G. W. McQuinn. N. Males. C. G. Sexton. J. Steward. Lady Sanitary Inspectors. Miss N. T. F. de Chaumont. Miss G. A. Looker. Health Visitors. Miss E. MacKay. Miss F. C. Hargrave. Miss W. H. E. Whitbread (Temporary). 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), A. Nonn, F. Chillcott, G. H. I. Harris. 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. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit the Aunual Report of the Medical Officer of Health, 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 Royal Borough during the year 1914. In August, 1914, owing to the outbreak of war, your Medical Officer of Health, Dr. J. E. Sandilands, was called away as a member of the Territorial Forces, to undertake active military medical duties in the field, and early in the autumn your Council appointed me as Acting Medical Officer of Health during Dr. Sandilands' absence. Other changes in the constitution of the staff of the Public Health Department, owing to the war, are the absence of Mr. McQuinn, Sanitary Inspector, who enlisted, with the Council's consent, on the 28th April, 1915; the absence of Mr. Wilson, Clerk in the Department, who enlisted on the 12th September, 1914; and the absence of Miss McKay, Health Visitor, from October, 1914, to April, 1915, to undertake military nursing in a war hospital. It has not been thought necessary to provide substitutes for Messrs. McQuinn and Wilson, nor for Miss McKay during her six months' period of absence. Notwithstanding the decrease of personnel, I am sure that the work of the Department has been carried on with its usual efficiency, and this result is largely to be attributed to the zeal and loyalty of the staff, and more especially to the unremitting attention of the Chief Sanitary Inspector, Mr. G. Pettit, to whose long experience and intimate acquaintance with all the Sanitary circumstances of the Borough I am greatly indebted in carrying out the duties of Acting Medical Officer of Health. I have the honour to be, Your obedient Servant, LOUIS C. PARKES. 21st June, 1915. vii. TABLE OF CONTENTS. A.—Vital Statistics. Page Population 3 Births 4 Deaths 6 „ From Zymotic Diseases 7 „ 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 Cerebro-Spinal Meningitis 17 Measles 18 Whooping Cough 18 Epidemic Diarrhcea 19 Tuberculosis 19 Cancer 27 C.—Food Supply. Milk Shops 33 Ice Cream Vendors 33 Places where Food is Sold 34 Bakehouses 34 Slaughter Houses 34 Unsound Food 35 Sale of Food and Drugs Acts 35 Cream Regulations, 1912 36 Water Supply 36 D.—Housing. Inhabited Houses 39 Council's Lodging Houses 39 Houses Let in Lodgings 39 Furnished Rooms 40 Common Lodging Houses 40 Housing (Inspection of District) Regulations 1910 41 Underground Rooms 41 Customs and Inland Revenue Acts 42 E.—Factories and Workshops. PAGE Women's Workshops 45 Home Work 46 Men's Workshops 48 Home Office Tables 51 F.—Sanitation. Dust Removal 55 Drainage Work 55 Nuisance from Smoke 55 Public Lavatories 55 Sanitary Inspection 55 Legal Proceedings 56 Disinfection 56 Cleansing Station 57 Rag Flock Act, 1911 58 Public Baths and Washhouses 58 Public Mortuary 58 Vaccination 59 G.—Appendix. Local Government Board Tables. Table I.—Vital Statistics, 1914 and Previous Years 63 Table II.—Infectious Diseases 64 Table III.—Causes of Death 65 Table IV.—Infantile Mortality 66 London County Council Summary. Table IX.—Proceedings during 1914 75 Other Statistical Tables. Table V.—Births and Deaths in Quinquennial Periods 67 Table VI.—Zymotic Deaths in Quinquennial Periods 68 Table VII.—Zymotic Death Rates in Quinquennial Periods 68 Table VIII.—Deaths, Sex, Age and Cause 69 Table X.--Work of Sanitary Inspectors 76 viii. SUMMARY OF STATISTICS, For the year 1914. Population (Estimated) 1 71,400. Area of Borough in Acres 2,291 Density of Population per Acre 75 Houses Inhabited 27,919 Persons per House 6.1 Number of Marriages 1,775 Number of Births 3,153 Birth Rate 18.4 Number of Deaths 2,289 Crude Death Rate 13.4 Standardised Death Rate 13.3 Infantile Mortality:— Deaths under 1 year 298 Infantile Deaths per 1,000 Births 95 Deaths from Phthisis 189 Phthisis Death Rate 1.10 Deaths from the Zymotic Diseases 134 Zymotic Death Rate 0.79 VITAL STATISTICS. 3 VITAL STATISTICS The Metropolitan Borough of Kensington covers an area of 2,291 acres, and is co-extetisive 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 £2,443,249. The product of a rate at one penny in the £ is £10,180 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 1914 is estimated to have numbered 171,400, 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 Estimsted Population, 1914. In private families. Inmates of Institutions. Totals. Families, tions. Cols. 1 2. 3. 4. 5. 6. 7. North Kensington 84,846 3,254 88,100 20,762 65 87,479 South Kensington 76,097 8,120 84,217 17,356 204 83,921 St. Charles 21,556 1,181 22,737 5,293 6 22,910 Golborne 25,190 377 25,567 6,006 8 25,411 Norland 20,578 614 21,187 5,052 21 20,702 Pembridge 17,527 1,082 18,609 4,411 30 18,456 Holland 18,992 1,271 20,268 4,437 42 20,236 Earl's Court 16,691 927 17,618 3,972 39 17,528 Queen's Gate 10,572 8,714 14,286 2,148 56 14,286 Redeliffe 18,109 992 19,101 4,255 33 19,187 Brampton 11,733 1,216 12,949 2,544 84 12,689 The Borough 160,943 11,374 172,317 38,118 269 171,400 The figures in the above Table 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 6 gives the number 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 1914. The natural increase in the population during the year by excess of births over deaths amounted to 864, the net estimated diminution being accounted for as in past years by the excess of emigration over immigration. 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. 4 Marriages.—The marriages celebrated during the year numbered 1,775. The number of marriages celebrated annually and the annual marriage rate since 1860 were given in the annual report for 1908, Appendix II., Table A, page 60. Births.- The number of births registered in the district was 3,003, but this figure does not include 150 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, 3,153. The birth-rate expressed as the number of births per 1,000 of the population was 18 4. Arranged as to sex and legitimacy the births were as follows:— Male. Female. Total. Legitimate 1,546 1,456 3,002 Illegitimate 87 64 151 Total 1,633 1,520 3,153 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 2,327 26.6 South Kensington 826 9.8 St. Charles 643 28.1 Golborne 844 33.2 Norland 552 26.7 Pembridge 288 15.6 Holland 209 10.3 Earl's Court 187 10.7 Queen's Gate 102 7.1 Redcliffe 204 10.6 Brompton 124 9.8 The Borough 3,153 18.4 The effects of social status on the birth-rate are illustrated by the fact that the rate for South Kensington is considerably 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. The births occurring every year in Kensington have fallen in round numbers from 4,500 in 1880, to 3,150 in the present year. The steady decline in the birth-rate is shown in Table V. Appendix, p. 67, where the number of births and the birth-rates both for London and Kensington are given for each quinquennial period since 1881. The figures for each year were given in the Annual Report for 1908. 5 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:— 1914. North Kensington. South Kensington. The Borough. Legitimate births per 1,000 married females aged 15-45 211 113 173 Illegitimate births per 1,000 unmarried and widowed females, 15-45 7 2 3 Legitimate and illegitimate births per 1,000 of total population 27 10 18 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. But 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 151, 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. 98 illegitimate births occurred in North Kensington and 53 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 3½ times higher than in South Kensington. Had no allowance been made for the excess of unmarried females in South Kensington, the rates calcuFated 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 3,003 live births registered as having occurred in Kensington, 2,712 or 90 per cent, were notified to the Medical Officer of Health. The unnotified births accordingly amounted to 291, or 10 per cent, of the number registered during the year. The subjoined figures show that 2,952 births in all were notified. Source of Notification. Number of Births Notified. Still Births. Live B.rths. Total Births. Midwives 47 1,559 1,606 Parents 10 502 512 Medical Practitioners 81 564 595 Other Persons 2 87 89 Births in the Borough 90 2,712 2,802 Institutions outside the Borough 6 144 150 Total 96 2,856 2,952 Of the notifications received 150 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. 6 Still Births.—The infants notified as still-born numbered 96. 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 40 out of the total number of still-born infants notified. One child was born dead from a twin pregnancy, and eight were born in wedlock of mothers employed in laundry work. In 29 cases the mother is known to have followed no occupation. Ten children were born from the first or second pregnancy, 16 from the sixth or some later conception, and 14 from intermediate pregnancies. A history of one previous miscarriage or still-birth was obtained in 4 cases and of two or more in 5 cases. The immediate cause of still-birth where detailed information was obtained, appears to nave been in 13 cases haemorrhage during pregnancy, and in 6 cases difficult labour. In 8 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 beycnd the scope of the enquiries undertaken by the Council's Health Visitors. Deaths.—The corrected number of deaths was 2,289. The crude death-rate was 13.4 and the standardised death-rate 13.3 per 1,000 living. To obtain the corrected number of deaths, which represents the true mortality among the population, it is necessary to add the deaths of Kensington "residents" occurring beyond the district to the number registered as actually taking place in the Borough, and to substract from the total thus arrived at the deaths of "non-residents" occurring in institutions or other places in Kensington. The following figures show how the corrected number of deaths given above has been obtained:— Total deaths registered in the Borough 2,624 Deaths of residents beyond the Borough 482 3,056 Deatho of non-residents within the Borough 767 Corrected number of deaths belonging to the Borough 2,289 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 13.4 to the standardised rate of 13.3 already given. Where comparisons are instituted between populations with a widely 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 138 14.9 1911 13.9 15.0 1912 13.3 13.6 1913 14.0 14.2 1914 13.4 14.4 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. 7 The number of deaths and the death-rates in Kensingon and London for each quinquennial period since 1881 will be found in Table V. Appendix, p. 67. 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 1,345 15.4 South Kensington 849 10.1 Unknown 95 — St. Charles 300 13.1 Golborne 383 403 15.1 19.5 Pembridge 259 14.0 Holland 224 1.11 Earl's Court 198 11.3 Queen's Gate 95 6.6 Redcliffe 222 11.6 Brompton 110 8.7 The Borough 2,289 13.4 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 Golborne and Norland in the North represent averages based on the combined experience of the good and bad areas which the figures embrace; and for this reason the Ward rates which are in themselves excessive can only be accepted as indicating the incidence of a very much heavier mortality on those streets and neighbourhoods where the inhabitants live in a state of social degradation. Causes of Death.—These are set out in detail in the Appendix. The following list shows certain causes of death which are important in themselves or from the fact that they contributed a considerable share to the total mortality for the year:— Number of Cause of Death. Deaths. Principal Zymotic (or epidemic) diseases 134 Epidemic influenza 31 Puerperal fever 4 Phthisis 189 Other tuberculous diseases 78 Cancer 253 Bronchitis 161 Pneumonia 155 Heart diseases 322 Bright's disease 72 Diseases and accidents of parturition 8 Premature birth 47 Accidents 63 Suicide 13 Old age 82 All other causes 677 2,289 The diseases described in the above list as the "principal zymotic diseases," are small-pox, measles, scarlet fever, diphtheria, whooping cough, enteric fever (including fever not otherwise defined) diarrhoea and enteritis. One fourth of the total number of deaths were registered as due diseases of the heart or the organs of respiration. Tuberculosis, a preventable disease, caused 267 deaths, of which 189 were due to tuberculosis of the lungs. It should also be noted that 8 cancer was the cause of 253 deaths, as compared with 189 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. 65, 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. 68, arranged in quinquennial periods since 1881. INFANTILE MORTALITY The deaths among infants under the age of one year numbered 298, the infantile mortality rate being equivalent to 95 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 61 111 105 1914 105 64 95 104 The difference between the infantile death-rates recorded in the various districts of the Borough is very marked, as will be seen from the following figures:— District. Deaths under one year Deaths under one year per 1,000 Births. North Kensington 245 105 South Kensington 53 64 St. Charles 47 73 Golborne 89 105 Norland 80 145 Pembridge 29 101 Holland 18 86 Earl's Court 14 75 Queen's Gate 3 29 Redcliffe 14 69 Brompton 4 32 The Borough 298 95 The figures in the second column of the Table show that the infantile death-rate in North Kensington was 41 in excess of that in South Kensington. The mortality in the Norland district, which contains Notting Dale, was equivalent to 145 deaths per 1,000 births. 9 Causes of Infantile Mortality.—In the following Table the deaths occurring in infants under the age of 12 months during the year 1914 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. 1912 1913 1914 Common infectious diseases 19 28 11 Diarrhœa (including enteritis, etc.) 32 62 47 Premature birth 60 55 47 Congenital defects (including injury at birth and atelectasis) 23 22 15 Wasting and debility 62 45 47 Tuberculous diseases 13 15 30 Syphilis 15 13 19 Bronchitis and pneumonia ... 40 79 37 Overlaying 4 6 5 Other causes 37 305 46 371 40 298 It will be noticed that as 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 84 deaths, or more than one-fourth of the total number, and here there is no doubt scope for preventive work. Forty-seven deaths were due to diarrhoea or enteritis. 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 67 took place in the first week, and 115—or less than one-third in the first four weeks of life. Premature birth and congenital defects accounted for 48 or nearly half the deaths occurring at this early period. Twenty-two children died of wasting or debility before the age of 14 days, and of this number a large proportion were no doubt either born prematurely or with some constitutional or physical defect. The conclusion suggested is that in the first three weeks of life 73 deaths occurred which were not preventable, in the sense that they took place in defective children whom no ordinary care could have saved. At this period, there were only 3 deaths from pneumonia and bronchitis and 2 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 14 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. A detailed analysis of the deaths in infants according to age and cause will be found in Table IV. in the Appendix. Illegitimacy.—Forty-one deaths occurred among illegitimate infants. The illegitimate births numbered 151. The mortality among the illegitimate was accordingly equivalent to a rate of 272 deaths per 1,000 births, as compared with a rate of 86 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 1914, 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 10 amongst the infants of mothers engaged in laundry work and other occupations, than it is amongst the infants of married women whose work is confined to the performance of household duties. These results are consistent with those obtained in former years. Artificial Feeding.—On the grounds that congenital debility is the predominating cause of death in the newly born, 67 infants who died before the age of seven days have been excluded from the figures in the Table that relate to methods of feeding. The records which were made of 121 deaths between the ages of 7 days and 12 months show that 49 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 first 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 1914 relate. They show that 92 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. Particulars Recorded Cases in which Particulars were Recorded. Survivors. Deaths. Number. Per Cent. Per Cent. Number. a. Occupation of Mother— Laundry work Charing, house-work (out) 55 4 5 8 Other occupations 34 3 4 7 No occupation 1,056 79 74 116 Totals 1,335 100 100 158 b. Mode of Feeding— Cow's milk 39 3 18 21 Breast and cow's milk 28 2 13 16 Breast and condensed milk 12 0.8 1 1 Breast and other foods 7 0.5 9 11 Condensed milk 13 0.9 5 6 Other artificial foods. 12 0.8 3 4 Total artificial 111 8 49 59 Breast alone 1,305 92 51 62 Totals 1,416 100 100 121 c. Number of Rooms in Tene- ment— 1 260 19 28 48 2 758 57 50 86 3 202 15 11 20 4 or more 117 9 11 20 Totals 1,337 100 100 174 Basement rooms only 152 11 14 25 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 14 per cent. for deaths, as against 11 per cent. for survivors. 11 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 three Health Visitors (an additional Visitor having been appointed in April for a period of 12 months), have been to the homes of 2,124 newly-born infants, and have paid 4,172 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 the ability to nurse and rear her children is good, a second visit may not be necessary. Where, as in the case of a first baby, the mother is in need of further advice, re-visits are paid according to the necessities of each case. Inquiries are also made in the homes of infants who die before the age of 12 months or who are notified as still-born. The information obtained in this way has been summarised in the tables dealing with the causes of infantile mortality, and has already been fully discussed. Necessitous mothers are referred to 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 305 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 A summary of the work of the Health Visitors, so far as it admits of tabulation, is given in the subjoined return. District. No, 1. No. 2. No. 3. 1, 2 and 3. Cases. 1st Visit. Re-Visit. 1st Visit. Re-Visit. 1st Visit. Re-Visit. 1st Visit. Re-Visit. Infants 1,091 641 555 793 478 614 2,124 2,048 Ophthalmia 38 134 8 22 7 25 53 181 Tuberculosis 17 27 5 2 5 1 27 30 Puerperal Fever 4 7 3 5 1 — 8 12 Deaths 151 61 69 28 35 15 255 104 Special 350 10 310 23 120 13 780 46 All Cases 1,651 880 950 873 646 668 3,247 2,421 Visits and Re-Visits 2,531 1,823 3,314 5,668 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. 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; 3 cases in all were notified in the Metropolis, and of this number one each occurred in the Cities of London and Westminster and the Port of London. DIPHTHERIA. During the year 190 cases of diphtheria were notified and of these 13 proved fatal. The seasonal incidence of diphtheria, with that of scarlet fever and enteric fever is illustrated by the subjoined Table:— Report for four weeks ended No. of Notifications. Diphtheria. Scarlet Fever. Enteric Fever. January 31 16 54 0 February 28 15 56 3 March 28 11 50 0 April 25 9 62 1 May 23 17 66 1 June 20 11 72 0 July 18 6 46 0 August 15 14 68 1 September 12 11 82 2 October 10 14 135 1 November 7 23 107 1 December 5 25 85 0 January 2, 1915 18 60 0 190 943 10 Anti-toxin was administered at the Council's expense to three diphtheria patients. 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 176 cases of suspected diphtheria were furnished free of charge to medical practitioners, the diphtheria bacillus being found in 27 of the specimens examined. This work is carried out at the Lister Institute and paid for by the Borough Council. In 23 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 1914 and in previous years:— Diphtheria in Kensington, 1901-1914. 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 1914 190 1.11 13 0.08 6.8 The disease in certain patients was severe in type, but the case fatality was below the average. The number of cases notified were 5 above the annual average of 185 cases during the ten years 1901—1910. SCARLET FEVER. During the year 943 cases of Scarlet Fever were notified, and of these 17 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 months of October and November. As in London and elsewhere the number of cases notified has been very excessive and more than 550 above the annual average for the ten years, 1901—1910. Scarlet Fever in Kensington, 1901-1914. Year. Cases notified. Case-rate per 1,000 of population. Deaths. Death-rate per 1,000 of population. Case-mortality per cent. 1901—1910 3,870 2.22 115 0.07 3.0 1911 227 1.32 3 0.02 1.3 1912 297 1.73 5 0.03 1.7 1913 552 3.21 3 0.02 0.5 1914 943 5 50 17 0.10 1.8 In 184 instances inquiry elicited a definite history of contact with persons suffering from Scarlet Fever. One hundred and fourteen cases were due to infection in schools; 43 were due to contact with persons recently discharged from hospital after an attack of Scarlet Fever; 9 arose from contact with "missed cases" or persons who had suffered from unrecognised attacks of the disease. In 16 cases the infection was derived from sources beyond the Borough. Twenty patients acquired the disease in hospital, and 24 from playmates outside school. Defects in the drainage system were found in 108 of the houses where Scarlet Fever occurred. ENTERIC FEVER. The number of cases of enteric fever notified during the year was only 10, the number of deaths being one. 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 1914 10 „ 1 Of the 10 patients notified, one had acquired the infection beyond the boundaries of the Borough. In two cases the disease was alleged to have followed the consumption of shell-fish, and in 7 cases no clue as to the source of infection could be obtained. 17 PUERPERAL FEVER. Six cases of puerperal fever were notified during the year, and of this number 4 proved fatal. One patient was confined in the infirmary; of the mothers confined in their homes, 3 were attended in the first instance by midwives and 2 by doctors. 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—Thirty-eight cases of ophthalmia in new-born infants were notified during the year, including 9 by midwives in accordance with the provisions of the Public Health (Ophthalmia Neonatorum) Regulations, 1914, which came into force in April, but 3 of these had been notified by medical practitioners, so that the new cases notified by midwives numbered 6. In addition to the notified cases of ophthalmia, 17 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. Epidemic Cerebro-spinal Meningitis.—Two patients—a female, aged 13, and a male, aged 2, were notified as suffering from cerebro-spinal meningitis, and both cases terminated fatally. NON NOTIFIABLE EPIDEMIC DISEASES. The immense cost which the community is called upon to bear in order that persons suffering from Scarlet Fever, Diphtheria, and certain other notifiable diseases may be removed from their homes and isolated in Hospital diverts in some measure the attention of the public from the very heavy mortality which results from epidemics of the diseases which are not notifiable. The part played by these two artificial classes of disease has accordingly been represented in the following Table of deaths occurring in the year 1914.th occurred: — Epidemic Diseases. Notifiable Deaths, 1914, Non-Notifiable Deaths, 1914 Diphtheria 13 Measles 15 Erysipelas 4 Whooping Cough 7 Scarlet Fever 17 Influenza 31 Enteric Fever 1 Diarrhœa 81 35 134 18 Non-notifiable Epidemic Diseases in 1914. Report for four weeks ended Number of Deaths. Measles. Whooping Cough. Influenza Diarrhcea & Enteritis. January 31 1 0 4 8 February 28 0 1 7 5 March 28 0 0 3 2 April 25 0 0 1 2 May 23 0 0 0 1 June 20 0 2 3 5 July 18 1 1 1 3 August 15 2 0 1 8 September 12 1 1 0 12 October 10 1 1 3 23 November 7 1 1 1 9 December 5 3 0 4 3 January 2, 1915 5 0 3 0 Total 15 7 31 81 Age at Death. Measles. Whooping Cough. Influenza. Diarrhœa & Enteritis. Under 1 year 3 3 0 47 Under 5 yenrs 15 6 1 66 5 to 15 years 0 1 0 0 15 to 65 years 0 0 15 7 65 years and upwards 0 0 15 8 Total 15 7 31 81 Fatal diarrhœa is seen to be a disease of infancy, increasing in prevalence in the late summer and early autumn. Deaths from measles and whooping cough occur in early childhood; influenza is chiefly fatal in old age and late middle life, the number of deaths showing a marked remission in the summer months. MEASLES. The deaths from Measles numbered 15, all 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 411 cases were notified; 72 additional cases were found in the homes visited, the total number of cases coming to the notice of the Public Health Department being 483. Out of this number only 81 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 Sirdar Road School, where 67 children were attacked, the Fox School, where 54 were attacked, and St. Mary Abbotts School contributed the next largest number, notifying 49 cases of measles during the year. The cases admitted to the hospitals of the Metropolitan Asylums Board numbered 8. WHOOPING COUGH. The deaths from whooping cough numbered 7, the number of cases brought to the notice of the Public Health Department by the schools being 165. In the homes visited 49 additional cases were discovered; the total number of cases dealt with by the Sanitary Inspectors being 214. An advisory leaflet was left with the mother of each family visited. The largest number of cases occurred in the Barlby Road School, where 35 children were attacked; Middle Row School, where 29 children were attacked; Wornington Road School contributed the next largest number, notifying 22 cases of whooping cough during the year. Of the cases visited only 34 had received medical treatment. The limitation of fatal whooping cough to young children was shown by the fact that 6 out of 7 deaths registered during the year, occurred in children under the age of 5 years. During the year 21 cases of whooping cough were admitted to the hospitals of the Metropolitan Asylums Board. 19 EPIDEMIC DIARRHCEA During the year diarrhoea and enteritis caused 81 deaths, as compared with 108 deaths from the same group of diseases in 1913. TUBERCULOSIS. The number of deaths from tuberculosis was 267, the crude and standardised death-rates being 1.56 per 1,000. The mortality in the years 1901-1914 from phthisis, other tuberculous diseases, and all forms of tuberculosis is expressed in the following Table as the number of deaths per 100,000 persons living in the periods to which the death-rates refer. Tuberculosis in Kensington, 1901-1914. 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 1914 189 110 78 46 267 156 Since 1900 the death-rate from tuberculosis has varied between extremes of 195 per 100,000 in 1904, and 109 in 1910, as compared with a rate of 156 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 1.10 per 1,000 living, and a standardised rate of 1.00. The deaths from other forms of tuberculosis numbered 78, and were equivalent to a death-rate of 0-5 per 1,000 of the population. The incidence of deaths from tuberculosis on the Wards in the Borough was as follows: — Deaths from Tuberculosis in Wards, 1906-1910 and 1914. District. Number of Deaths. Death-rate per 10,000 Pulmonary Tuberculosis. Other Forms. Pulmonary Tuberculosis. Other Forms. 1900-10 1914. 1914. 1905-10. 1914. 1914. North Kensington 623 138 53 12 16 6 South Kensington 252 45 22 6 5 3 St. Charles 125 30 10 11 13 4 Golborne 182 31 14 14 12 6 Norland 222 52 25 20 25 12 Pembridge 94 25 4 10 14 2 Holland 73 7 7 7 3 3 Earl's Court 65 11 8 7 6 5 Queen's Gate 26 8 1 4 6 1 Redcliffe 57 12 2 6 6 1 Brompton 31 7 4 5 6 3 Unknown — 6 3 — — — The Borough 875 189 78 10 11 5 20 The death-rate in North Kensington from phthisis was more than twice as great as the rate in the South, and the heaviest mortality in the North under both heads fell on the Ward of Norland. 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 tuberculosis: — Deaths from Tuberculosis in Age Periods. Age Periods. Under 5 years. 5 to 15 15 to 45. 45 and upward. Total. Number of Pulmonary Tuberculosis 5 3 111 70 189 Deaths from Other Forms of Tuberculosis 45 15 13 4 78 The bulk of the deaths from phthisis occurred to the number of 111 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 frcm Pulmonary Tuberculosis. Other Forms. Kensington Infirmary 78 28 Patient's Home 72 24 General or Children's Hospitals 13 17 Lunatic Asylums 8 2 Brompton Hospital 1 0 Other Institutions for the Sick 9 3 Other places beyond the Borough 8 4 Total 189 78 109, or considerably more than half the total deaths from consumption, and 50 or two-thirds of the deaths from other forms of tuberculosis occured 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 1,321, and have been classified in the following Table:— Number of Notifications. A. B. C. D. Total. Pulmonary Tuberculosis 682 0 158 214 1,054 Other Forms 193 3 26 45 267 Totals 875 3 174 259 1,321 21 Only 3 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 26 15 41 ... ... ... District Medical Officers 29 ... 29 ... ... ... Kensington Infirmary 180 49 229 93 3 96 Other Infirmaries 6 2 8 1 ... 1 Kensington Tuberculosis Dispensary 156 ... 156 33 ... 33 Other Dispensaries 2 ... 2 ... ... ... Lunatic Asylums 11 ... 11 3 ... 3 Metropolitan Asylums Board Hospitals and Homes 2 14 16 1 19 20 St. Mary's Hospital 14 ... 14 12 ... 12 Other Hospitals 27 2 29 28 ... 28 Other approved residential Sanatoriums 6 76 82 ... 4 4 Private Medical Practitioners 223 ... 223 22 ... 22 682 158 840 193 26 219 608, or nearly three-fourths of the notices certifying persons as suffering from consumption or notifying the admission of consumptives to residential institutions came from the Infirmary (229), the Tuberculosis Dispensary (156), and from private practitioners (223). Of the notifications of other forms of tuberculosis 197 out of a total of 219 came from the infirmary, hospitals or other institutions for the sick, and only 22 were received from private practitioners. Nearly half of the notifications of other forms of tuberculosis came from the Kensington Infirmary, and numbered ninety-six. Persons Notified.—During the year 653 persons were notified as suffering from consumption, and 207 as suffering from other forms of tuberculosis. In addition 134 fatal cases of tuberculosis in persons who had not been notified during the year 1914 were reported by the Registrar of Births and Deaths. The total number of cases reported to the Department in 1914 was accordingly 994. Cases of Tuberculosis Reported in 1914. Source of Information. Pulmonary Tuberculosis. Other Forms. All Forms. Total Cases. New Cases. Notified in previous years. Total New Cases. Cases. Notified in previous years. Total Cases. Notification Certificates 501 152 653 181 26 207 860 Death Certificates 29 66 95 35 4 39 134 Total 530 218 748 216 30 246 994 The new cases of consumption, that is to say, the cases notified in 1914, without having been notified in any previous year, numbered 501. Twenty-two deaths from consumption also occurred in persons who died unnotified. Non-pulmonary tuberculosis was also certified as the cause of death in 34 unnotified persons. 22 The year of primary notification in the case of previously notified persons who died in 1914 is shown in the following Table: — Deaths in 1914 of persons previously notified. Date of primary notification. Number of Deaths in 1914 Pulmonary Tuberculosis. Other Forms. 1904 2 - 1908 2 - 1910 6 — 1911 6 — 1912 22 — 1913 38 4 1914 91 39 Total deaths of persons previously notified 167 43 Of those who died from consumption in 1914, 38 had been known to the Department for more than 12 months, as compared with 30 persons dying in 1913, 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 exceeding 2 years in 14 cases, and in two cases exceeded 10 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 380 136 516 South Kensington 104 34 138 St. Charles 89 28 117 Golborne 130 46 176 Norland 111 51 162 Pembridge 50 11 61 Holland 27 8 35 Earl's Court 28 12 40 Queen's Gate 11 6 17 Redeliffe 27 4 31 Brompton 11 4 15 Unknown 17 11 28 The Borough 501 181 682 23 In its main features the distribution of the notified cases has been much the same as that of the deaths from tuberculosis. 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 5 4 45 28 44 36 54 72 42 49 39 33 20 30 249 252 B. Other Forms 50 30 31 26 7 16 4 5 2 5 — — 3 2 97 84 Total at ages for both sexes A. 9 73 80 126 91 72 50 501 B. 80 57 23 9 7 — 5 181 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 represen children who were examined in school or taken by their mothers to the tuberculosis dispensary, to hospitals or to private medical practitioners, but at the ages 25-45 there is a deficit in male notifications. 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 479 Lymphatic Glands other than the Mesenteric 71 Larger Joints and Bones above Wrist and Ankle 24 Vertebral Column (Spine) 12 Smaller Joints and Bones, Wrist, Ankle, Hand, Foot 7 Mesenteric Glands, Bowel, Peritoneum 54 Urinary Organs, Kidney, Bladder 5 Meninges of Brain 17 Skin 4 Other Parts 9 Total Cases 682 Interpreted, the above figures show that out of 203 persons notified as the subjects of nonpulmonary tuberculosis, 43 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: — 24 Home Accommodation of Patients previously unknown. Accommodation. l Room. 2 Rooms. 3 Rooms. 4 or more Rooms Common Lodging House. Homeless Cases in Infirmary. Asylum,&c. Total Cases. Cases of Phthisis 99 148 80 1J5 9 50 501 Other Cases 19 55 17 18 0 72 181 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 123 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 Patieni Cases of Tuberculosis. Pulmonary. Other Forms. One Room Three persons 28 2 Four persons 6 5 Five persons 4 3 More than five persons 2 1 Two Rooms Three persons 9 6 Four persons 18 11 Five persons 21 10 More than five persons 30 23 Source of Infection.—The source of infection in 208 cases appears to have been as follows. Source of Infection. Cases of Tuberculosis. Pulmonary. Other Forms. Contact with consumptive relative 116 48 „ „ friend 8 0 „ ,, fellow lodger 2 0 ,, „ fellow worker 4 0 Residence in infected house 30 0 Total 160 48 25 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. Artist 1 - 1 - Baker, Biscuit-maker 2 - 1 — Blacksmith 4 - - — Bootmaker 3 - 3 — Bricklayer 1 - — — Builder 3 - — — Canvasser — _ 1 — Carpenter 9 - — — Chaffcutter 1 - — — Charwoman 12 — 3 Chauffeur 4 — 1 — Clerk 16 2 5 — Coachman, carman, stableman, or wife of 13 1 6 1 Coach painter 1 — 1 — Compositor 3 — — — Cripple 1 — 1 — Domestic servant 5 40 1 9 Dressmaker, milliner, sempstress — 12 — 4 Electrician 1 — — — Engineer — — 1 — Errand boy 3 — 1 — Farmer 1 — — — Farrier 2 — 1 — Furniture porter 1 — 1 — Gas stoker 2 — 1 — Gunsmith 1 — — — Handyman 1 — 1 — Harness maker 2 — 1 — Hawker, general dealer, costermonger 10 4 5 3 House painter 5 — 5 — Infant 8 3 6 1 Insurance agent 1 — - - Iron driller 1 — — — Labourer 27 — 9 — Lampngrner 1 — 1 — Laundry work — 21 1 11 Living on own means 1 7 2 5 Lodging house keeper — 1 — — Medical student 2 — — — Milkman — — 2 — Musician 1 — 2 — Navvy 1 — — — Newsvendor 1 — 1 — Nun — 3 — 1 Nurse—asylum, hospital, monthly — 2 — 1 Paperhanger — — 1 — Pastry cook — — 1 — Persons in asylums, common lodging houses, etc. 10 15 1 1 Pianokey maker — — 1 — Plasterer 1 — 1 — Plumber 8 — — — Police constable 3 — — — Porter—coal, shop, railway, etc. 5 — 3 — Printer or printer's apprentice 3 — 1 — Publican, potman 3 — 1 — 26 Occupation of Consumptive Persons—continued. Occupation. Cases Deaths. Males. Females Males. Females. Sawyer 1 - 1 - School boy, girl (elementary) 34 21 1 2 School master, mistress 1 1 1 — Shop assistant, shop keeper 11 3 5 1 Soldier, or wife of 5 — 1 1 Son or daughter of artizan or labourer above school age 4 4 2 2 Steward — — 1 — Street singer 1 — — — Surveyor 1 — — — Tailor, tailoress 4 2 4 2 Tin plate woiker 1 — 1 — Tobacco manufacturer - 1 — — — Trunk maker — —- 1 — Tubeman — — 1 — Typist — 3 — 1 Unspecified occupations 3 6 4 13 Upholsterer 1 — 2 — Valet 1 — — - Waitress — 1 — 1 Watchmaker 1 — 1 — Wife or daughter of tradesman, artizan or labourer — 88 — 28 Totals 249 252 98 91 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. Work of the Lady Sanitary Inspectors.—For the purpose of making inquiries, offering assistance and giving advice, 592 first visits and 959 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, 110 first visits and 151 revisits were paid for inquiry into cases of tuberculosis other than pulmonary. 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 (pulmonary) 592 b. Subsequent visits 959 c. First visits to other cases of tuberculosis 110 d. Subsequent visits 151 Total visits paid during the year 1,812 II.—Provision for Home Treatment. Bedsteads and bedding lent 14 III.—Disinfection after Death or Removal to Hospital. Cases where bedding, etc., was disinfected by steam 194 Number of rooms disinfected 279 Number of rooms stripped 3 IV.—Children attending the elementary schools and notified to the Medical Officer (Education), London County Council, as living in contact with consumptive persons 239 V.—Specimens of Sputum from suspects examined bacteriologically by the Lister Institute at the expense of the Council 113 27 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 14 of the Council's beds were in use. In the following cases four new beds were supplied, and seven returned beds were lent again to fresh patients after disinfection: — 1. To E.F., sleeping with her daughter. 2. To W.S., sleeping with wife and child. 3. To E.B., sleeping with husband and child. 4. To F.B., sleeping with two sisters. 5. To J.S., sleeping with husband and child. 6. To M.G., sleeping with mother and sister. 7. To R.C., to sleep in shelter. 8. To F.T., sleeping with two brothers. 9. To S., sleeping with another. 10. To N.C., sleeping four in one bed. 11. To L.S., sleeping with two others. In three other cases additional bedding was lent to enable the family to use their second bedstead. The Tuberculosis Dispensary.—During the year 1914 consumptive persons residing in the Borough to the north of Kensington High Street received treatment at the Tuberculosis Dispensary, 119 Ladbroke Grove. The institution is under voluntary management, but the 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. 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 axe set apart with accommodation for some 60 consumptives, and from the notifications received it would appear that 180 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 78 deaths from phthisis occurred in the Infirmary during the year. The Insurance Committee.—During the year 93 insured consumptives were sent from Kensington by the Insurance Committee for the County of London to residential institutions for the treatment of consumption. Dispensary Scheme 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. The London County Council's scheme for sanatorium treatment for non-insured persons came into force in August last year. Particulars will be deferred till the next annual report. CANCER. Cancer caused 253 deaths, and of this number 229 occurred in persons over the age of 45 years. Carcinoma was the form of cancer to which 134 deaths were attributed; sarcoma was the assigned cause of 14 deaths; 105 deaths were certified as due to cancer or malignant disease without further definition. 28 The parts of the body which were affected in each case are shown in the following Table : — Deaths from Cancer, 1914. Parts Affected. Sex Total. Male. Female. Buccal Cavity, No. 39 9 5 14 Stomach, Liver, etc., No. 40 40 30 70 Peritoneum, Intestines, Rectum, No. 41 14 33 47 Female Genital Organs, No. 42 — 29 29 Breast, No. 43 — 46 46 Skin, No. 44 — — — Other and unspecified Organs, No. 45 26 21 47 Totals 89 164 253 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. 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 27 149 176 Tuberculosis 28 85 113 Enteric Fever 2 3 5 Gonorrhœa 1 3 4 Total 58 240 298 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. Three patients 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. 29 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 5 5 0 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. 33 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 22 applications for registration were received from persons who proposed to sell milk, and in each case the application was granted. The alterations made in the Register of Milk Purveyors during the year 1914 are summarised in the following Table:— The Register of Milk Purveyors. Class of Premises. Milkshops. General Stores. Restaurants. Totals. Transferred 10 5 0 0 15 Vacated and removed from Register 3 4 0 7 Premises added to Register 5 1 1 7 On Register December 31, 1913 124 43 34 201 On Register December 31, 1914 126 40 35 201 Increase + Decrease — +2 -3 +1 +0 - The inspection of dairies and milkshops made during the year numbered 1,089, 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 three 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. Ice Cream —At the end of the year 197 premises were shown in the Register of places within the Borough where ice cream is prepared or sold. Fifteen places have been added to the Register and 3 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 12. The trade is regulated under 34 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. 291 visits to ice cream premises have been made by the inspectors during the year. 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 1913 and 1914, 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. 31st, 1913 252 168 117 44 40 71 11 709 No added 4 8 2 0 4 1 3 22 Removed 2 1 1 1 0 1 0 6 On Register Dec. 31st, 1914 254 175 118 43 50 71 14 725 The inspections of the above premises during the year numbered 1,126, 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 8 Drains defective 4 Bedroom adjoins 1 Refuse deposited 3 Want of cleanliness 37 Defective ashpit accommodation 8 Other defects 19 Total number of defects found 81 Bakehouses. — There are 91 bakehouses in the Borough, and of this number 69 are underground. As a result of 470 inspections in the year 51 notices were served, the work required in 30 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. During the year a considerable number of pigs were killed in the slaughter house in the Walmer Road, and the license was renewed by the London County Council in October on the condition that the premises be not used for the purpose of slaughtering on more than 20 Sundays in the year, that slaughtering on Sundays be carried out in the forenoon only, that the licensee do inform the Council of the Royal Borough of Kensington on the previous day when he intends to slaughter animals on a Sunday, and that on week-days cattle be slaughtered only between the hours of 8 a.m. and 8 p.m. in the months of May, June, July, August and September, and between the hours of 8 a.m. and 6 p.m. during the remainder of the year. The slaughter house inspections for the year numbered 233. 35 Unsound Food.—The unsound food surrendered and destroyed during the year is shown in the following list:— June 23rd.—12 boxes of potatoes. November 14th.—2 pigs' carcases. „ „ 5 pigs' heads. 2 pigs' plucks. 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 702 samples, of which 54 (or 7 per cent.) were adulterated. Proceedings were taken against 16 persons for adulteration or other offences, the fines and costs inflicted amounting to £68 10s. 6d. The samples collected were as follows:— Samples Collected by the Sanitary Inspectors. Name of Sample. Number Taken. Number Adulterated. Milk 281 8 Cream 20 9 Preserved Cream 2 2 Butter 98 1 Cheese 20 1 Flour 10 ... Sausages 36 ... Arrowroot 8 ... Corn Flour 6 ... Oatmeal 6 ... Preserved Vegetables 5 4 Sweets 24 ... Potted Meats 24 1 Vinegar 34 3 Cocoa 6 ... Campthorated Oil 12 4 Milk of Sulphur 6 2 Pearl Barley 8 ... Spirits 76 11 Mustard 8 ... Bread 12 ... Total 702 54 Margarine and Butter Substitutes —Under Section 9 of the Margarine Act, 1887, and Section 7 (4) of the Sale of Food and Drugs Act, 1899, manufacturers and wholesale dealers in margarine and margarine cheese are required to register their premises with the local authority. By Section 1 (1) of the Butter and Margarine Act, 1907, these requirements were extended to butter factories and to the premises of wholesale dealers in milk-blended butter. The following premises in the Borough are registered in accordance with the requirements of the above Acts:— Lipton, Ltd 210, Portobello Road. „ 129, Brompton Road. E. C. Nicholls 19, Church Street. C. E. Webb & Sons 39-41, Brompton Road. Pearks, Ltd. 165, Portobello Road. Maypole Dairy Co., Ltd 196, Portobello Road. Home and Colonial Stores, Ltd. 136, Portobello Road. „ „ 20, Chepstow Mansions. „ „ 71, Notting Hill Gate. „ „ 171, Earl's Court Road. „ „ 98, Golborne Road. 36 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 additions of any other kind of preservative is prohibited. In all cases the Public Analyst examines milk and cream for preservatives. A list is appended: Milk and Cream not sold as Preserved Cream. Article. Number of Samples examined for the presence of a preservative. Number in which a preservative was reported to be pgesent. Milk 281 0 Cream 20 9 (1) Milk.—No preservatives were found in the samples of milk examined. (2) Cream.—In May, the President of the Local Government Board stated that the evidence at the present time available as to the influence on health of the addition of small quantities of preservatives being to some extent contradictory, he had decided to nominate a small expert committee to investigate anew the question. Whilst awaiting the result of this enquiry, which would not be of a lengthy character, he expressed the opinion that it is inadvisable that local authorities should institute proceedings except in cases where the amount of boric acid in the cream exceeds the amount declared on the label or where the amount so declared is clearly excessive. This Committee has apparently not yet been formed. In twenty samples of cream—not sold as preserved cream—9 contained preservatives (boric acid) varying from 12.142 grains to 33.096 grains per pound. Proceedings were taken in 3 cases under the Sale of Food and Drugs Acts, and penalties were inflicted to the amount of £ 10 and 10s. 6d. costs in two cases, and £2 and 10s. 6d. costs in the other. Preserved Cream.—Two samples were taken, both of which contained preservative, in the first case 16.856 grains of boric acid per pound, and in the other 14.875 grains. No action was taken in either case on account of tt e conditions of sale. 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. No complaints of the quality of the water supplied were received during the year under consideration. 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. 39 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 Collector's 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 1914 numbered 27,919. 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 are 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:— 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 113 were let and 7 were empty. Houses Let in Lodgings.—The number of houses let in lodgings on the Council's register at the end of the year was 2,071, as compared with 2,085 at the end of 1913, the difference being due to the addition of five houses and the removal of nineteen. 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. 40 The inspections and re-inspections of the registered lodging houses in the Borough numbered 8,245. Notices requiring the remedy of defects found were served in 1,007 instances, and 77 cases of overcrowding were abated. The owners of seven 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 2,071 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. The inspection of houses let in furnished lodgings during the year numbered 1,520. 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:— Common Lodging Houses. Ward. Name of Keeper. Address of Common Lodging House. No. of Lodgers, for which licensed in 1914. 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. 31, do. 53 ... 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 liedman, Emma 24, Peel Street 34 ... 34 „ Do. 22, do. Totals 401 272 673 41 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 3 Houses where underground rooms were closed by the Council 38 Houses where underground rooms were fit for habitation 95 Houses where underground rooms were not slept in 37 House where defects were remedied without Closing Orders 319 Defective houses vacated without Closing Orders and outstanding: (a). Vacated in 1913 2 (b). Vacated in 1912 12 Total houses under consideration in 1914 536 The 14 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 16, Russell Gardens Mews 1 7, Boundary Mews 1 2a, Admiral Mews 1 Total 14 Closing Orders.—During the year 61 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 3 Houses closed by Order of the Council 3 Houses rendered fit for habitation after the making of Closing Orders 3 Houses represented for the Closing of Underground Rooms 58 Houses where Underground Rooms were closed 38 Underground Rooms rendered fit for habitation after the making of Closing Orders 23 Underground Rooms.—Underground rooms in 170 houses were inspected during the year. In 95 houses, 127 underground rooms used habitually as sleeping places were inspected and found to be fit for habitation. In 58 houses 77 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 17 (7) of the Housing, Town Planning, etc., Act, 1909. Closing Orders prohibiting the use of 54 of these underground rooms as sleeping places were made by the Council. During the year 23 rooms closed have 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 have been determined. 42 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. Three houses were closed, and the use of underground rooms as sleeping places in 38 houses was prohibited by Closing Orders under Section 17 of the Housing, Town Planning, etc., Act 1909. Defects were remedied in 308 houses in response to notices served under the Public Health (London) Act, 1891, and in 11 houses in response to a notice served under Section 15 of the Houses, Town Planning, etc., Act, 1891. 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 1,550. 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 80 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 38 certificates were granted by the Medical Officer of Health during the year, in respect to 38 tenements in 18 houses containing a total number of 41 separate dwellings. FACTORIES AND WORKSHOPS. 45 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 1,745. 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 249, 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 1914 was eight hundred and seventy-four, 333 (mostly laundries) being in North Kensington, and 541 (mostly dressmakers) in South Kensington. During the year 9 workshops were added to the register and 7 were removed. "The subjoined Table summarises particulars of the 66 factories and 808 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. Miscel2 laneous. Total. No. on Register 64 200 69 333 391 9 141 541 874 No. of Rooms therein 107 635 105 847 732 29 209 970 1,817 "The number of persons employed varies with the period of the year, being, of course, greatest during the 'season': it exceeds 10,000. "The businesses carried on at the registered premises are set out in the subjoined list:— Trade or Business North Kensington. South Kensington. Total in the Borough. Art needlework 1 2 3 Blind-maker - 1 1 Blouse-maker 3 8 11 Boot header 1 - 1 ,, closer 2 - 2 Cigarette maker (Factory) - 1 1 Colour printer (Factory) 1 - 1 Corset maker 2 6 8 Cracker maker 1 - 1 Dressmaker and ladies' tailor 61 378 439 Dyer and cleaner (Factory) 2 2 4 Eyelet hole finisher (Factory) 1 - 1 Florist - 10 10 Furrier 1 8 9 Hair wash manufacturer 1 - 1 Hosier - 1 1 Lamp shade maker - 2 2 Laundry (workshop) 144 9 153 ,, (factory) 56 - 56 Machinist - 1 1 Mantle maker 1 4 5 Milliner 4 51 55 Outfitter - 4 4 Photographer 2 14 16 Pickle manufacturer 1 - 1 Printer (Factories) - 3 3 Silversmith - 1 1 Sweetmaker - 1 1 Tailor 41 4 45 Typist - 5 5 Tyre Maker - 1 1 Umbrella manufacturer 1 1 2 Upholsterer 1 14 15 Violin string manufacturer 1 - 1 Waistcoat maker 8 - 3 Wig maker 1 9 10 Total 333 541 874 46 "Routine inspections of the workshops shown on the above list were carried out during the year, and complaints from His Majesty's inspectors or anonymous sources received immediate attention." Ventilation.—In response to notices, additional means of ventilation were provided in 3 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—Two cases of overcrowding were dealt with during the year, as compared with 7 in the year 1913, and 9 in the year 1912. 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 28 sanitary conveniences attached to workshops were found and remedied. HOME WORK. An analysis of the outworkers registered, shows that 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 116 Outworkers in Domestic Workshops 32 Outworkers in their own Homes 216 Total number of Outworkers 364 The factories and workshops referred to in the above list are included in the Table which shows the trades carried on in the workshops on the Council's register. The nature of the work given out to the homeworkers in the 216 homes on the register is as follows:— Home Work. Nature of Work. No. of Premises. Tailoring 60 Ironing 30 Outfitting 23 Bootmaking 50 Dressmaking, Blousemaking 32 Shirt making 2 Waistcoat making 7 Upholstery 3 Millinery 2 Lace mending 2 Fur making 2 Embroidery 2 Artificial flowers 1 Total 216 In 10 instances in the course of inspection, addresses were found incorrectly given, or the outworker had left or given up work. 47 Condition of Homes Visited.—The following Table shows the circumstances of the 216 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 34 17 1 62 „ for work and as living rooms 111 15 - 126 „ for work and as bed and living rooms 29 8 1 38 Totals 174 40 2 216 The sanitary defects remedied in the 216 homes were as follows:— Rooms cleansed 2 W.C.'s found defective and remedied 1 Number of Defects remedied 3 On the whole the homeworkers, many of whom are women, belong to a respectable, thrifty class and keep their rooms in a clean and tidy state. Their homes compare favourably with those of the lower labouring classes, and instances of persons in great poverty carrying on work for an insufficient wage in insanitary surroundings are in Kensington practically unknown. The foreign outworkers are for the most employed in registered workshops which are regularly inspected, and the practice of letting out sittings in workshops, which leads to grave abuses in certain districts, does not prevail in the Borough of Kensington. After the outbreak of War in August, 1914, a certain number of foreign tailors disappeared, while other outworkers were abnormally busy with Army work. No case of infectious disease occurred in any workshop or home where Army work was carried on. Infectious Diseases.—Infectious disease occurred in 24 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:— Premises Visited. Number of Visits and Inspection. No. 1 District. No. 2 District. The Borough. Factories 17 13 30 Workshops 296 582 878 Outworkers' Premises 155 59 214 Other Workplaces 66 55 121 Total Inspections 534 709 1,248 Intimation Notices issued 28 89 67 Statutory Notices served 15 12 27 Summons issued ... ... ... 48 MENS WORKSHOPS. At the end of the year, the registered workshops at which men alone were employed numbered 937. The factories at which men alone were employed numbered 183. 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 183 factories. Trade or Business. Workshops. Factories. Total. Aerated water manufacturer — 4 4 Baker 78 13 91 Basket-maker 6 — 6 Blacksmith 38 1 39 Bootmaker 167 8 175 Builder 114 9 123 Cabinet-maker and Joiner 52 3 55 Carver and Gilder 9 — 9 Coach-builder 37 4 41 Cycle-maker 17 — 17 Electric Generating Works — 11 11 Firewood-manufacturer 12 2 14 French Polisher 2 — 2 Marble Mason 6 4 10 Printer 6 22 28 Saddler 19 — 19 Tailor 111 — 111 Trunk-maker 19 — 19 Umbrella-maker 5 — 5 Undertaker 10 — 10 Upholsterer 29 2 31 Watchmaker 45 3 48 Wig Maker 15 — 15 Sausage Maker — 16 16 Sundry businesses 140 81 221 Total 937 183 1,120 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. 49 FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK I.—Inspection. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 316 7 Workshops (including Workshop Laundries) 15,43 130 — Workplaces (other than Outworkers' premises included in part 3 of this Report) 121 8 — Total 1,980 145 — 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 59 59 — Want of ventilation 3 3 — — Overcrowding 2 2 - - Want of drainage of floors 5 5 - - Other Nuisances 60 56 - - Sanitary accommodation insufficient 4 4 - — unsuitable or defective 43 43 - - not separate for sexes 8 8 - — 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) 33 33 - - Other Offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) - - - - Total 217 213 - — 50 IV.-Registered Workshops. Workshops on the Register (s 131) at the end of the Year. Number. Important of shop, such as workshop bakehouses, may be merated here. Dressmakers and Ladies' Tailors' 455 Workshop Laundries 153 Workshop Bakehouses 78 Other Workshops 1,059 Total number of workshops on Register 1,745 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) 30 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 28 Reports (of action taken) sent \ to H. M. Inspectors 18 Other 1 Underground Bakehouses (s. 101):— In use at the end of the year 69 51 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 served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109. 110) Sending twice in the year. Sending once in the year Failing to keep or permit inspection of lists. Failing to send lists. Lists.* Outworkers Lists. Outworkers. Contractors Workmen. Contractors. Workmen. 1. 2. 3. 4. 5. 6 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. Wearing Apparel— making, etc. 82 143 676 3 ... 5 28 ... ... 3 3 ... 15 ... ... cleaning and washing 22 20 34 1 ... 4 8 ... ... 1 1 ... 9 ... ... Household linen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace, lace curtains and nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Curtains and furniture hangings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and Upholstery 4 1 10 ... ... ... ... ... ... ... ... ... ... ... ... 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. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Artificial flowers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 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 108 166 720 4 ... 9 36 ... ... 4 4 ... 24 ... ... * Two lists have been sub-divided according to class of home work. SANITARY WORK. 55 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, 451 new moveable ash-bins of galvanised iron have been provided during the year, and 106 fixed ash-pits of brick have been abolished under the powers conferred by Section 23 of the London County Council (General Powers) Act, 1904. A bi-weekly collection was instituted from April to October 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 80 house drains have been reconstructed under notices served by the Sanitary Inspectors. Nuisance from Smoke.-193observations of chimney shafts in the Borough were made, and notices were served in four 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 six public lavatories containing water-closets: one is for men only, and in five 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 fo; women at eleven railway stations in the Borough. The public-house urinals entered from the street and available to the public number 75. The public conveniences in the Borough have been regularly inspected during the year, those for women in stations and elsewhere having been kept under observation by the Lady Sanitary Inspectors. Sanitary Inspection. -A complete list of members of the staff of the Public Health Department will be found on the page following the title page of this report. For the purposes of sanitary inspection the Borough is divided into ten districts, one of which is allotted to each of the ten male sanitary inspectors, who carry out duties under the Public Health Act, the Housing Acts, 1890-1909, the Sale of Food and Drugs Acts, the Rag Flock Act, 1911. the London County Council General Powers Acts, and so far as men's workshops are concerned under the Factory and Workshop Act, 1901. 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 three 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. 76. 56 LEGAL PROCEEDINGS. Legal proceedings were instituted in 11 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. April 7th Municipal Permanent Investment Building Society, 62, King William Street Failure to carry out sanitary repairs at 412, Portobello Road Withdrawn, the works having been completed. April 21st Mrs. Blackburn, 14, Nevern Place Failure to provide water supply at 14, Nevern Place Withdrawn, the water supply having been reinstated. June 16th T. Crosson, 1, Hurstway Street Failure to comply with byelaws for Houses let in Lodgings at 56, Sirdar Road Order to execute work in 14 days. July 7th E. W. Bowes, 20, Kensal Road Failure to carry out certain sanitary requirements at Nos. 141, 143, 145, 147, 149 and 151, Barlby Road Withdrawn, the works having been completed. July 21st J. E. Keene, 6, Lonsdale Road, Barnes Failure to remedy damp state of walls and site and make sound the floor of ground floor slip room at 22, Archer Street Fined 50s. and an order to execute work in 14 days. Oct. 6th ... Mrs- M. A. Bryan, 348, Portobello Road Failure to repair drain at 348, Portobello Road Order to execute work in 14 days. DISINFECTION. Bedding is disinfected at the Council's disinfecting station at Wood Lane by exposure to sleam 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 1/2 per cent. solution of formic aldehyde (formalin 2 ounces to 1 gallon of water), and then sealed and fumigated with formalin vapour. 57 The following Table shows the number of disinfections carried out for various diseases during the year:— Disinfection, 1914. Nature of Infection. Rooms Disinfected. Premises Disinfected. Disinfections at Wood Lane. Scarlet Fever 1,023 899 928 Diphtheria 187 177 172 Enteric Fever 17 12 11 Measles 40 32 4 Consumption 279 249 194 Vermin 309 294 342 Other Diseases 124 83 118 Totals 1,979 1,746 1,769 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 1914 69 19 1 11 1,769 The following number of articles was dealt with at the Wood Lane Disinfecting Station during the year:— Articles disinfected only ... ... ... ... ... 22,022 Articles disinfected and washed free of charge 2,886 Total articles dealt with in 1914 ... ... 24,908 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 58 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. The superintendent was called up for Naval Service at the outbreak of the war, and a temporary man has been appointed in his place. 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 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 is 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 are responsible, and for the cleansing of such cases no charge is made. The following Table shows the work carried out at the station for the year 1914, since its opening on January 16th:— Children cleansed 788 Adults cleansed 32 Baths given 1,897 Verminous Rooms.—451 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, 299 beds were disinfested, 7 verminous beds were destroyed, and 139 dirty beds were cleansed. Rag Flock Act, 1911.-Three samples of rag flock were taken, analysed and reported on during the year. Two contained 10 parts of chlorine per 100,000, the limit set by the Regulations being 30 parts. The remaining sample contained 495 parts of chlorine, and was taken from a chair which was being remade, and no action was taken. PUBLIC BATHS AND WASHHOUSES The subjoined particulars set forth the use made of the Public Baths and Washhouses during 1914 and the three preceding years by washers and bathers:— Year. Washers. Bathers. 1911 71,241 153,981 1912 76,052 142,685 1913 74,757 157,383 1914 75,144 202,668 MORTUARY AND CHAPEL OF REST. During the year 242 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 12 3. At the request of the coroner (inquest cases):— Cases of sudden death 77 Cases of violent death 81 - 158 4. Brought in by the Police—Persons found dead 15 Accident cases 4 - 19 5. On account of death due to infectious disease 3 Total number of bodies received 242 59 In 127 of the above cases post mortem examinations were made under the coroner's warrant The number of bodies deposited in 1914 and the five preceding years, together with the number of inquests held and the number of post mortem examinations made in the Mortuary is shown in the following- Table:— Number of Bodies taken into the Mortuary. Year. No. of bodies received at the Mortuary. No. of bodies upon which Coroner's inquests were held. No. of bodies upon which post mortem examinations were made. 1909 263 181 110 1910 233 145 103 1911 261 177 118 1912 238 151 107 1913 239 151 132 1914 242 177 127 Unnecessary inconvenience having been caused by numerous applications from undertakers for the reception of bodies late at hight, 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 54 bodies were deposited in the Chapel of Rest, Avondale Park. Sixtyfour 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 1913. Out of a total number of 3,107 infants born 392 were not vaccinated on account of "conscientious objection" on the part of the parents, and 205 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 597 or to 19 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 2,194 or 71 per cent. of the total births, and 224 infants died before the operation of vaccination had been performed. APPENDIX. 63 APPENDIX. Local Government Board Tables I—IV. TABLE I. Vital Statistics of Whole District during 1914 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 births Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1909 178,160 3,187 3,381 19.5 2,770 16.0 692 371 879 112 2,449 14.1 1910 172,730 3,007 3,190 18.5 2,524 14.6 635 315 345 108 2,204 12.8 1911 172,300 3,037 3,223 18.7 2 712 15.7 722 399 435 135 2,389 13.9 1912 172,000 3,068 3,318 19.3 2.524 14.7 683 446 305 92 2,287 13.3 1913 171,700 3,173 3,335 19.4 2,614 15.2 695 490 371 111 2,409 14.0 1914 171,400 3,019 3,153 18.4 2,624 15.8 767 432 298 95 2,289 13.4 • Rates calculated per 1,000 of estimated population. Area of District in acres (exclusive of area covered by water) 2291 At Census of 191 Total population at all ages 172.317 Total families or separate occupiers 38,118 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 1914 has been estimated on the assumption that the rate of decrease has been reduced from 430 to 300 per annum. 64 TABLE II. Cases of Infectious Disease notified during the Year, 1914. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward. Total Cases Removed to Hospital. At all Ages. At Ages.—Years. St. Charles. Golborne. Norland. Pembridge. Holland. Earl's Court. Queen's Gate. Redcliffe. Brompton. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45 45 to 65. 65 and upwards. Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 190 4 55 85 22 21 3 ... 17 61 33 14 12 17 7 19 10 171 Erysipelas 162 3 3 10 16 42 66 22 26 49 24 24 6 5 11 11 6 54 Scarlet fever 943 16 197 589 85 52 5 ... 218 225 117 60 109 66 36 90 22 888 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 10 ... 1 1 3 4 1 ... 1 ... ... 1 1 1 3 2 1 6 Continued fever 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Puerperal fever 6 ... ... ... ... 6 ... ... 1 2 2 ... ... ... 1 ... ... 4 Cerebro-Spinal Meningitis 2 ... 1 1 ... ... ... ... 1 1 ... ... ... ... ... ... 2 Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... *Pulmonary Tuberculosis 501 ... 9 73 80 217 108 14 89 130 111 50 27 28 11 27 11 253 †Other forms of Tuberculosis 181 31 51 57 22 15 8 2 28 46 51 11 8 12 6 4 4 122 Ophthalmia Neonntorum 38 38 ... ... ... ... ... ... 12 6 11 2 3 2 ... 2 ... 1 Totals 2034 91 318 816 228 357 186 38 393 520 349 162 167 181 75 155 54 1501 • In 17 cases the Ward was unknown. In 11 „ „ „ „ 65 TABLE III. Causes of, and Ages at, Death during the Year 1914. 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 2,288 298 75 71 63 71 287 631 792 1,344 Uncertified 1 - - - - - - 1 - - Enteric Fever 1 ... ... ... ... ... ... ... ... 2 Small-pox ... ... ... ... ... ... ... ... ... ... Measles 15 3 5 7 ... ... ... ... ... 5 Scarlet Fever 17 2 3 4 8 ... ... ... ... ... Whooping-Cough 7 3 3 . . . 1 ... ... ... ... 7 Diphtheria, and Croup 14 2 1 8 2 ... ... ... ... 3 Influenza 31 ... 1 ... ... 3 6 6 15 1 Erysipelas 4 1 ... ... ... ... 1 2 ... 4 Phthisis (Pulmonary Tuberculosis) 189 1 ... 4 3 24 87 62 8 245 Tuberculous Meningitis 34 11 3 7 9 1 1 2 ... 18 Other tuberculous diseases 44 18 4 2 7 6 5 2 ... 30 Cancer, Malignant disease 253 1 1 1 1 3 17 113 116 180 Rheumatic Fever 8 ... ... ... 2 ... 3 3 ... ... Meningitis 11 4 2 3 2 ... ... ... ... 6 Organic Heart Disease 306 1 ... ... 8 3 29 101 164 161 Bronchitis 161 14 3 3 ... 1 7 38 95 120 Pneumonia (all forms) 155 23 19 12 2 6 22 41 30 72 Other diseases of Respiratory Organs 46 5 ... 2 2 ... 5 16 16 22 Diarrhoea and Enteritis 81 47 15 4 ... ... 2 5 8 71 Appendicitis and Typhlitis 15 ... ... 2 ... ... 2 4 6 2 Cirrhosis of Liver 35 ... ... ... ... ... 6 22 7 15 Alcoholism 4 ... ... ... ... ... 2 2 ... 2 Nephritis and Bright's Disease 79 1 1 3 2 1 9 33 29 43 Puerperal Fever 4 ... ... ... ... 1 3 ... ... 4 Other accidents and diseases of Pregnancy and Parturition 8 ... ... ... ... 2 6 ... ... 5 Congenital Debility and Malformation including Premature Birth 102 100 2 ... ... ... ... ... ... 47 Violent Deaths, excluding Suicide 63 12 4 4 4 2 12 8 17 26 Suicide 13 ... ... ... ... 1 5 4 3 1 Other Defined Diseases 586 49 8 5 10 15 56 166 277 252 Diseases ill-defined or unknown 3 ... ... ... ... ... ... 2 1 ... 2,289 298 75 71 63 71 287 632 792 1,344 66 TABLE IV. INFANT MORTALITY DURING THE YEAR 1914. 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. Certified 67 24 18 11 115 53 52 38 40 298 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... 1 ... 1 Measles ... ... ... ... ... ... ... 1 2 3 Scarlet Fever ... ... ... ... ... ... ... 2 ... 2 Whooping-cough ... ... ... ... ... 1 2 ... ... 8 Diphtheria and Croup ... ... ... ... ... ... ... ... 2 2 Erysipelas ... ... 1 ... 1 ... ... ... ... 1 Tuberculous Meningitis ... ... ... ... ... ... 2 4 5 11 Abdominal Tuberculosis ... ... ... ... ... 7 1 5 3 16 Other Tuberculous Diseases ... ... ... ... ... ... 1 .. 2 3 Meningitis (not Tuberculous) ... ... ... ... ... ... 2 2 ... 4 Convulsions 1 1 ... ... 2 ... 1 1 ... 4 Laryngitis ... ... ... ... ... 1 1 ... 1 3 Bronchitis 1 ... ... 1 2 2 5 2 3 14 Pneumonia (all forms) ... 1 1 1 3 2 7 6 5 23 Diarrhæa ... ... ... ... ... 6 2 ... 5 13 Enteritis ... 1 1 ... 2 6 12 9 5 34 Gastritis ... 2 ... ... 2 1 ... ... 1 4 Syphilis ... 3 ... 2 5 6 3 3 2 19 Rickets ... ... ... ... ... ... 1 ... ... 1 Suffocation, overlaying 1 ... 1 ... 2 2 1 ... ... 5 Injury at birth 7 ... ... ... 7 ... ... ... ... 7 Atelectasis 2 ... ... ... 2 ... ... ... ... 2 Congenital Malformation 4 ... 1 ... 5 ... 1 ... ... 6 Premature Birth 37 8 2 1 48 3 1 47 Atrophy, Debility, and Marasmus 9 13 4 3 29 10 6 1 1 47 Other causes 5 ... 2 3 10 6 8 1 3 23 67 24 13 11 115 53 52 38 40 298 Nett Births in the year legitimate, 3,002. illegitimate, 151. Nett Deaths in the year of legitimate infants, 257. illegitimate infants, 41. 67 TABLE V. Births and Deaths in Kensington ; Birth-rates and Death-rates ; and Infantile Mortality 1881-1914 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 2.287 13.6 13.3 305 91 92 1913 3,335 24.5 19.4 2,409 14.2 14.0 371 105 111 1914 3,153 24.3 18.4 2,289 14.4 13.4 298 104 95 Note 1.—The decennial rates for the years 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 68 TABLE VI. Deaths from the Principal Epidemic Diseases, 1881-1914. Period. Deaths from the Seven Principal Epidemic Diseases. Small-pox Measles. Scarlet Fever. Diphtheria WhoopingCough Enteric Fever. Diarrhæa and Enteritis (all ages). Diarrhæa. and Enteritis (under 2 years.) 1881-1885 107 326 153 96 427 115 — — 1886-1890 1 442 135 305 387 77 — — 1891-1895 9 297 152 306 312 92 678 — 1896-1900 0 448 105 249 262 87 874 1901-1910 18 579 115 212 432 86 1,110 — 1911 0 98 3 20 54 4 184 150 1912 0 27 5 5 25 4 70 36 1913 0 82 3 7 29 6 108 81 1914 0 15 17 13 7 1 81 62 TABLE VII. Death-rate in Kensington, per 1,000 persons living, from each of the Seven Principal Epidemic Diseases. 1881-1914. Period. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhæa and Enteritis (all ages). Diarrhæa and Enteritis (under 2 years). 1881-1885 0.13 0.39 0.19 0.12 0.52 0.17 1886-1890 0.00 0.53 0.16 0.37 0.47 0.10 — — 1891-1895 0.01 0.85 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 1914 0.00 0.09 0.10 0.08 0.04 0.00 0.47 0.36 69 TABLE VIII. Causes of Death at different periods of life in the Year 1914. CAUSES OF DEATH. Classification No. Totals— All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. Totals— Under 5 Years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards. Totals— Above 5 Years. Total M F M F M F M F M F Total M F M F M F M F M F M F Total I. GENERAL DISEASES. Enteric Fever 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 Measles 6 15 9 6 3 ... 2 3 4 3 9 6 15 ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 7 17 8 9 1 1 2 1 2 2 5 4 9 3 5 ... ... ... ... ... ... ... ... 3 5 8 Whooping-Cough 8 7 1 6 1 2 ... 3 ... ... 1 5 6 ... 1 ... ... ... ... ... ... ... ... ... 1 1 Croup 9 1 ... 1 ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 9A 13 5 8 1 1 1 ... 3 4 5 5 10 ... 2 ... ... ... 1 ... ... ... ... ... 3 3 Influenza 10 31 11 20 ... ... 1 ... ... ... 1 ... 1 ... ... 3 ... 3 3 2 4 2 13 10 20 30 Dysentery 14 5 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 1 ... 1 1 4 5 Erysipelas 18 4 ... 4 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... 1 ... 2 ... ... ... 3 3 Other epidemic diseases 19 2 2 ... 2 ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Pyæmia, septicæmia 20 9 5 4 ... ... ... ... ... ... ... ... ... ... ... 1 1 2 1 2 2 ... ... 5 4 9 Tetanus 24 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Actinomycosis 25 1 ... 1 ... ... ... ... ... ... ... ... .... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Pulmonary Tuberculosis 28AB 183 95 88 ... ... ... ... 3 ... 3 ... 3 1 2 13 10 45 42 32 29 3 ... 92 88 180 Acute Miliary Tuberculosis 29B 6 3 3 1 ... ... ... 1 ... 2 ... 2 ... ... ... 1 1 1 ... 1 ... ... 1 3 4 Tuberculous Meningitis 30 34 16 18 6 5 1 2 5 ... 12 9 21 4 5 ... 1 ... 1 ... 2 ... ... 4 9 13 Tuberculosis of Peritoneum, &c. 31AB 29 17 12 9 7 1 2 1 ... 11 9 20 ... 1 3 1 2 1 1 ... ... ... 6 3 9 Tuberculosis of Spinal Column 32 3 1 2 ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... 1 2 3 Tuberculosis of other organs 34 3 1 2 1 ... ... ... ... ... 1 ... 1 ... 1 ... ... ... 1 ... ... ... ... ... 2 2 Disseminated Tuberculosis 35 9 5 4 ... 1 ... 1 1 ... 1 2 3 2 1 1 ... ... 1 l ... ... ... 4 2 6 Rickets 36 2 1 1 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 1 Syphilis 37 29 12 17 8 11 2 1 1 ... 11 12 23 ... ... ... ... ... 1 1 3 ... 1 1 5 6 Cancer 39-45 253 89 164 1 ... 1 ... 1 ... 3 ... 3 1 ... 3 ... 5 12 36 77 41 75 86 164 250 Other tumours 46 3 1 2 ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 1 ... 1 ... 2 2 Rheumatic Fever 47 8 ... 8 ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 3 ... 3 ... ... ... 8 8 Chronic Rheumatism, &c. 48AB 4 1 3 ... ... ... ... ... ... ... ... ... ••• ... ... ... ... 1 1 ... 2 1 3 4 Gout 48C 5 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 ... 5 ... 5 Diabetes 50 16 7 9 ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 3 4 2 4 7 9 16 Exophthalmic goitre 51 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 2 2 Leueoeythæmia, &c. 53AB 6 3 3 ... ... ... ... ... ... ... ... ... ... l 2 ... ... l 2 ... ... 3 3 6 Carried forward 702 299 403 35 29 11 13 23 12 69 54 123 11 24 27 16 58 73 81 134 53 102 230 349 579 70 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 702 299 403 35 29 11 13 23 12 69 54 123 11 24 27 16 58 73 81 134 53 102 230 349 579 GENERAL DISEASES.-continued. Anæmia Chlorosis 54 9 7 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 2 ... 4 ... 7 2 9 Alcoholism 56 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... ... ... 4 4 Total for General Diseases 715 306 409 35 29 11 13 23 12 69 54 123 11 25 27 16 59 76 83 136 57 102 237 355 592 ii.-DISEASES OF THE NERVOUSSYSTEM AND OF THE ORGANS OF SPECIAL SENSE. Cerebral Spinal Fever 61A 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 Meningitis 61BC 10 8 2 3 1 ... 1 3 ... 7 2 9 1 ... ... ... ... ... ... ... ... ... 1 ... 1 Locomotor Ataxy 62 5 4 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 1 1 ... 4 1 5 Other Diseases of the Spinal Cord 63AB 10 4 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 3 3 4 6 10 Cerebral Hæmorrhage, Apoplexy 64 AE 90 41 49 ... ... ... ... ... ... ... ... . . . ... ... 1 ... 2 4 17 17 21 28 41 49 90 Softening of Brain 65 8 2 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... 4 2 6 8 Paralysis without specified cause 66AC 10 3 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 6 3 7 10 General Paralysis of the Insane 67 12 8 4 ... ... ... ... ... ... ... ... ... ... ... ... 1 3 2, 5 1 ... ... 8 4 12 Other forms of Mental Alienation 68 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Epilepsy 69 12 5 7 1 ... ... ... ... ... 1 ... 1 1 1 2 ... 3 2 1 ... ... 4 7 11 Infantile Convulsions under 5 years 71AB 6 4 2 3 1 1 ... ... ... 4 ... 6 ... ... ... ... ... ... ... ... ... ... ... ... ... Neuritis 73 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 2 Other Diseases of the Nervous System 74 AD 12 7 5 ... ... 2 ... ... 2 ... 2 1 ... ... ... 1 ... 1 4 2 1 5 5 10 Diseases of the Eyes and Aunexa 75 2 2 ... 1 ... ... ... 1 ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Mastoid Disease 76A 1 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Ears 76B 2 2 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Total for Diseases of the Nervous System, and of the Organs of Special Sense 184 93 91 10 2 4 2 4 ... 18 4 22 3 2 1 3 7 10 34 30 30 42 75 87 162 III.-DISEASES OF THE CIRCULATORY SYSTEM. Pericarditis 77 4 2 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 1 ... 2 2 4 Acute Endocarditis 78AC 8 4 4 ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... 3 ... ... 4 4 8 Valvular Disease 79A 108 40 68 ... ... ... ... ... ... ... ... ... 2 1 1 1 6 8 11 24 20 34 40 68 108 Fatty Degeneration of the Heart 79B 38 13 25 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 3 5 8 19 13 25 38 Carried forward 1057 458 599 45 31 15 15 27 12 87 58 145 17 28 30 22 74 96 134 198 116 197 371 541 912 71 TABLE VIII.—continued. CAUSES OF DEATH. Classification No. Totals— All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. TotalsUnder 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 1057 458 599 45 31 15 15 27 12 87 58 145 17 28 30 22 74 96 134 198 116 197 371 541 912 DISEASES OF THE CIRCULATORY SYSTEM-continued. Other Organic Disease of the Heart 79C 160 79 81 ... 1 ... ... ... ... ... 1 1 2 3 1 ... 6 6 35 23 35 48 79 80 159 Angina Pectoris 80 4 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 2 2 4 Arterial Sclerosis, &c. 81 AC 46 27 19 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 10 5 15 13 27 19 46 Cerebral Embolism and Thrombosis 82A 31 13 18 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 6 11 12 13 18 31 Other Embolism and Thrombosis 82B 4 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... 1 2 2 4 Diseases of the Veins 83 AD 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Other Diseases of the Circulatory System 85 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 1 2 Total for Diseases of the Circulatory System 406 184 222 ... 1 ... ... ... ... ... 1 1 5 4 3 3 16 18 67 68 93 128 184 221 405 IV.—DISEASES OF THE RESPIRATORY SYSTEM. Diseases of the Larynx 87AC 6 3 3 2 1 ... ... 1 1 3 2 5 ... 1 ... ... ... ... ... ... ... ... ... 1 1 Diseases of the Thyroid Body 88 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 2 Bronchitis 89 & 90 161 71 90 6 8 1 2 2 1 9 11 20 ... ... ... ... 5 2 18 20 39 56 62 79 141 Broncho-pneumonia 91 58 38 20 15 3 7 6 6 3 28 12 40 ... ... ... ... 2 1 3 3 5 4 10 8 18 Lobar-pneumonia 92A 22 14 8 ... 1 ... ... 1 ... 1 1 2 ... ... 2 ... 3 3 5 2 3 ... 13 7 20 Pneumonia (type not stated) 92B 75 43 32 3 1 2 4 2 ... 7 5 12 ... 2 2 ... 11 2 18 10 5 11 36 27 63 Pleurisy 93AB 7 5 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 2 ... ... 2 5 2 7 Pulmonary Congestion, &c. 94AD 18 10 8 1 1 ... ... ... ... 1 1 2 ... 1 ... ... 1 ... 3 1 5 5 9 7 16 Gangrene of Lung 95 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Asthma 96 7 2 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 3 1 1 2 5 7 Pulmonary Emphysema 97 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Fibroid Disease of Lung 98 A 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 1 2 Other Diseases of the Respiratory System 98 B 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 2 Total for Diseases of the Respiratory System 362 189 173 27 15 10 12 12 5 49 32 81 ... 4 4 3 25 9 53 42 58 83 140 141 281 V.—DISEASES OF THE DIGESTIVE SYSTEM. Diseases of the Mouth, &c. 99AD 1 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Carried forward 1668 773 895 73 47 25 27 39 17 137 91 228 19 35 35 25 107 113 237 276 238 355 636 804 1440 72 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 1668 773 895 73 47 25 27 39 17 187 91 228 19 35 35 25 107 113 237 276 236 355 636 804 1440 DISEASES OF THE DIGESTIVE SYSTEM- continued. Diseases of Pharynx 100 5 4 1 ... ... ... ... ... 1 ... 1 1 ... ... ... ... 1 ... 1 ... 2 ... 4 ... 4 Perforating Ulcer of Stomach 102 8 7 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 4 1 ... ... 7 1 8 Inflammation of Stomach 103A 10 4 6 3 1 ... ... ... ... 3 1 4 ... ... ... ... 1 ... ... ... ... 5 1 5 6 Other Diseases of the Stomach 103B 2 ... 2 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 1 ... 1 1 Diarrhœa and Enteritis 104 & 105 AH 81 46 35 32 15 7 8 2 2 41 25 66 ... ... ... ... ... 2 2 2 3 5 5 10 15 Appendicitis 108 15 7 8 ... ... ... ... 1 1 1 1 2 ... ... 1 ... 1 1 2 1 2 4 6 7 13 Hernia 109A 6 4 2 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 2 4 1 1 3 2 5 Intestinal Obstruction 109B 14 4 10 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 2 1 1 3 4 10 14 Other Diseases of the Intestines 110 5 1 4 ... ... ... 1 ... ... ... 1 1 ... ... ... 1 ... ... 1 ... ... 1 1 3 4 Hydatid of Liver 112 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 7 ... ... 1 ... 1 Cirrhosis of the Liver, &c. 113AC 35 21 14 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 15 1 3 4 21 14 35 Biliary Calculi 114 6 1 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 4 1 5 6 Other Diseases of the Liver 115 11 8 3 1 ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... 1 1 5 2 7 3 10 Peritonitis (cause unstated) 117 6 ... 6 ... ... ... ... ... 1 ... 1 1 ... 1 ...... 1 ... 2 ... 1 ... ... ... 5 5 Other Diseases of the Digestive System 118 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Total for Diseases of the Digestive System 207 109 98 38 17 7 9 3 5 48 31 79 ... 1 1 2 12 11 31 23 17 30 61 67 128 vi.—non-venereal diseases of the genito-urinary system and ANNEXA. Acute Nephritis 119 7 2 5 ... l ... l 2 1 2 3 5 ... ... ... ... ••• ... 2 ... ... ... 2 2 Bright's Disease, &c. 120AB 72 41 31 ... ... ... ... ... ... ... ... ... 1 1 1 4 5 22 9 14 15 41 31 72 Other Diseases of the Kidney 122AD 7 5 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 ... 2 ... 5 2 7 Calculi of the Urinary Passage 123 3 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... 2 1 3 Diseases of the Bladder 124 8 6 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 6 1 6 2 8 Diseases of the Urethra 125AB 7 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 ... 3 ... 7 ... 7 Diseases of the Prostate 126 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... ... ... 1 ... 1 ... 1 Uterine Tumour 129 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 2 Other Diseases of the Uterus 130 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Ovarian Cyst 131 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Other Diseases of the female genital organs 182 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... 3 3 Total for non-Venereal Diseases of the Genito Urinary System and Annexa 112 64 48 ... 1 ... 1 2 1 2 3 5 1 1 ... 1 5 11 30 16 26 16 62 45 107 Carried forward 1986 945 1041 110 65 32 37 44 23 186 125 311 20 37 36 28 124 135 298 315 281 401 759 916 1675 73 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 1986 945 1041 110 65 32 37 44 23 186 125 311 20 37 36 28 124 135 298 315 281 401 759 916 1675 VII.—THE PUERPERAL STATE. Accidents of Pregnancy 134AB 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... ... 4 4 Puerperal Hasmorrhage 135 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Puerperal Fever 137 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 ... ... ... ... ... 4 4 Puerperal Convulsions and Albuminuria 138 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... 3 3 Total for Diseases of the Puerperal State 12 ... 12 ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 9 ... ... ... ... ... 12 12 VIII.—DISEASES OF THE SKIN AND OF THE CELLULAR TISSUE. Senile Gangrene 142A 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 ... 4 4 Other Gangrene 142D I ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 1 Carbuncle 143 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 2 Phlegmon, Acute Abscess 144AB 7 3 4 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 2 ... 1 1 3 4 7 Diseases of the Integumentary System 145 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 2 Total for Diseases of the Skin and of the Cellular Tissue 16 3 13 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 2 3 1 6 3 13 16 IX.—DISEASES OF THE BONES AND OF THE ORGANS OF LOCOMOTION. 146 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... .. . ... ... ... ... ... ... ... 1 ... 1 X.—MALFORMATIONS. Congenital Malformation 150AD 6 5 1 5 1 ... ... ... ... 5 1 6 ... ... ... ... ... ... ... ... ... ... ... ... ... XI.—DISEASES OF EARLY INFANCY. Premature Birth 151A 47 26 21 26 21 ... ... ... ... 26 21 47 ... ... ... ... ... ... ... ... ... ... ... ... ... Infantile Atrophy, Debility, and Marasmus 151B 47 29 18 28 17 1 1 ... ... 29 18 47 ... ... ... ... ... ... ... ... ... ... ... ... ... Icterus Neonatorum 151C 1 ... 1 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast Milk 151E 1 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Umbilicus, &c. 152A 1 ... 1 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis 152B 2 ... 2 ... 2 ... ... ... ... ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Injuries at Birth 152C 7 5 2 5 2 ... ... ... ... 5 2 7 ... ... ... ... ... ... ... ... ... ... ... ... ... Cyanosis Neonatorum 152D 1 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Total for Diseases of Early Infancy 107 62 45 61 44 1 1 ... ... 62 45 107 ... ... ... ... ... ... ... ... ... ... ... ... ... Carried forward 2128 1016 1112 176 110 33 38 44 23 253 171 424 21 38 36 32 124 146 300 318 282 407 763 941 1704 74 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 2128 1016 1112 176 110 33 38 44 23 253 171 424 21 38 36 32 124 146 300 318 282 407 763 941 1704 XII.—OLD AGE. Old Age 154AB 82 27 55 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 55 27 55 82 XIII.—AFFECTIONS PRODUCED BY EXTERNAL CAUSES. Suicide by Poison. 155 5 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 2 ... ... 1 4 5 Suicide by Hanging 157 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Suicide by Drowning 158 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 2 Suicide by Firearms 159 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 Suicide by Cutting or Piercing Instruments 160 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Suicide by Crushing 162 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Other Suicide 163 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Other Acute Poisoning 165 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 1 2 Conglagration 166 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 2 Burns 167 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 2 Absorption of Deleterious Gases (Overlain, etc.) 168 10 7 8 4 3 ... ... ... ... 4 3 7 ... ... ... ... 1 ... 1 ... 1 ... 3 • * » 3 Accidental Drowning 169 4 2 2 ... 1 ... ... ... ... ... 1 1 1 ... ... ... ... ... 1 ... ... ... 2 1 3 Injury by Fall 172 22 16 ... ... ... ... ... ... ... 6 ... 6 ... ... ... ... 4 1 1 1 5 4 10 6 16 Injury by other Crushing (vehicles, railways, &c.) 175 15 10 ... ... ... ... ... ... 1 ... 1 1 2 ... ... 2 1 4 ... 1 2 10 4 14 Homicide 184 4 1 3 ... 3 1 ... ... ... 1 3 4 ... ... ... ... ... ... ... ... ... ... ... ... ... Other Violence 186 2 2 ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... 1 ... . . . ... ... ... 1 ... 1 Total for Affections produced by External Causes 76 48 28 5 7 4 ... 3 1 12 8 20 3 1 2 1 11 6 9 3 11 9 36 20 56 XIV.—ILL-DEFINED CAUSES. Heart Failure 189A 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 1 2 Cause not specified 189F 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Total for Ill-defined Causes 3 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 1 2 3 Grand Totals 2289 1092 1197 181 117 37 38 47 24 265 179 444 24 39 38 33 135 152 310 322 320 472 827 1018 1845 75 TABLE IX—PROCEEDINGS DURING 1914. PREMISES. NUMBER OF PLACES. Number of inspections 1914. Number of notices, 1914. Number of prosecutions, 1914. On register at end of 1913. Added in 1914. Removed in 1914, On register at end of 1914. Milk premises 201 7 7 201 1,089 9 0 Cowsheds 1 — — 1 42 — — Slaughter-houses 10 — — 10 233 1 — Other offensive trade premises Nil — — — — — — Ice cream premises 185 15 3 197 291 — — Registered houses let in lodgings 2,085 5 19 2,071 8,245 {(a)*74 {(a)*0 {(b)*933 {(b)*7 Total number of intimation notices served for all purposes, 2,104. * (a) For overcrowding. †(b) For other conditions. Overcrowding—1914. Number of dwelling rooms overcrowded 77 Number remedied 77 Number of Prosecutions 0 Underground rooms— Illegal occupations dealt with during year 7 Number of rooms closed 5 Insanitary houses— Number closed under the Public Health (London) Act, 1891 0 Number closed under the Housing of the Working Classes Act 3 Number of premises cleansed under Section 20 of L.C.C. (General Powers) Act, 1904 451 Shelters provided under sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year No shelter Revenue Acts— Number of houses for which applications for certificates were received during year 18 Number of tenements comprised therein 41 Number of tenements for which certificates were (a) granted 38 (b) refused 0 Number of prosecutions under By-laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, &c. — (b) For prevention of nuisance arising from offensive matter running out of any manufactory, etc. - (c) For the prevention of keeping of animals in such a manner as to be injurious to health 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 296 Total number of infectious bodies removed 3 76 TABLE X. Summary of the Work done by the Sanitary Inspectors during the Year 1914. description of work, etc. number of district. Grand Total. 1 2 3 4 5 6 7 8 9 10 Complaints received 205 88 83 98 138 91 140 93 100 75 1,111 House to House Inspections 271 55 65 88 78 88 361 307 32 205 1,550 Houses Inspected on Complaint 717 475 320 343 443 465 353 231 258 171 3,776 Re-inspections of Houses 564 672 1,174 1,165 877 1,595 1,018 1,068 963 917 10,013 Inspections of Lodging Houses (Unfurnished) 1,239 1,446 207 667 1,034 67 810 464 422 369 6,725 Inspections of Lodging Houses (Furnished) 36 — 924 226 — 333 1 — — — 1,520 Houses cleansed, &c. 177 186 113 197 87 88 309 107 104 107 1,475 Verminous Rooms cleansed 133 31 37 143 44 31 30 — 1 1 451 Dirty bedding cleansed 27 49 27 22 — 12 1 — 1 — 139 „ „ destroyed 3 1 — — — — — 2 1 7 Overcrowding abated 28 22 13 2 1 8 1 1 1 — 77 Underground Rooms, illegal occupation discontinued 2 10 - 1 - 10 7 3 4 3 40 House Drains re-constructed 4 7 17 10 3 21 4 4 3 7 80 Defective Drains repaired 35 24 17 5 4 28 16 9 13 7 158 House Drains cleansed 36 166 9 4 16 32 18 20 21 10 332 Water-closets constructed, repaired, &c. 131 31 52 80 51 81 54 43 41 85 649 „ supplied with water 32 116 — 62 47 7 50 6 32 25 377 „ new, provided — 3 — 6 1 4 9 — 22 — 45 Soil-pipes ventilated, repaired, &c. 5 22 3 9 4 14 7 15 16 3 98 ,, new, provided 4 7 1 11 2 9 4 — 9 8 55 Cisterns cleansed, covered, &c. 40 80 10 35 17 12 25 21 42 32 314 Yards, Areas paved, drained, repaired 34 28 71 41 20 32 31 12 23 15 307 Dustbins provided 61 62 45 57 13 25 28 32 91 37 451 Ashpits abolished 43 11 2 12 2 3 20 4 9 — 106 Accumulations of filth, &c., removed 46 37 5 2 2 27 43 20 20 13 215 Animals removed 5 6 5 1 9 1 10 1 — 11 49 Other Sanitary Work executed 27 540 168 81 48 47 122 42 48 91 1,214 Workshops &c., Inspections of 37 27 57 101 27 36 46 147 70 117 665 Factories, Inspections of 3 15 5 36 83 45 — 61 13 25 286 Bakehouses, Inspections of 50 65 25 79 64 40 18 29 48 52 470 Slaughter-houses, Inspections — 35 68 27 — 24 71 8 - — 233 „ „ Notices 1 — — — — - — 1 Dairies, &c., Inspections 151 74 82 125 210 112 30 102 108 95 1,089 „ Notices — — 3 3 — — 3 — 9 Ice Cream Vendors, premises, Inspections 56 35 24 46 30 47 7 20 19 7 291 „ „ „ Notices — — — — — — — Other Places where Food is prepared, Inspections of 203 256 57 140 104 23 71 48 88 136 1,126 Smoke observations 65 39 16 49 21 3 193 Nuisances from smoke observed 2 2 — — — — — 4 Mews, Inspections of 945 570 579 332 746 508 290 765 197 825 5,757 Other inspections 124 453 49 260 177 40 91 242 52 338 1,826 Notices issued { Written intimations 251 247 238 263 122 158 256 178 270 121 2,104 {Statutory 48 50 69 69 26 41 48 37 28 33 449 {Lodging House 139 136 117 166 88 22 169 52 89 29 1,007 {Removal of Manure 3 5 - 9 1 — — 2 20 Sanitary Works completed 873 1,439 595 781 371 492 789 340 503 456 6,639 Legal Proceedings—Number of summonses issued 8 — 1 — — 1 — — 1 — 11 INDEX. Page Adulteration of Food 35 Appendix 61 Area of the Borough 3 Baths and Washhouses 58 Births and Birth Rates 4 Births,Notificationof 5 Births and Birth Rates, Tables I. and V 63 & 67 Cancer 27 Cerebro-spinal Meningitis 17 Chapel of Rest for the Dead 59 Cleansing of Children and Verminous Persons 57 Common Lodging Houses 40 Consumption 19 Cow House 33 Cream Regulations, 1912 36 Customs and Inland Revenue Acts 42 Dairies and Milkshops 33 Deaths and Death Rates— In Districts 7 From Principal Causes 7 From Zymotic or Principal Epidemic Diseases 7&15 Among Infants 8 Deaths and Death Rates, Tables— 1909—1914 Table I. 63 Causes of at Ages, Summary, Table III. 65 Infantile Mortality, Table IV. 66 Causes of by Sexes at ages, Table VIII. 69 In Quinquennia, 1881—1910 Table V. 67 Principal Epidemic Diseases, Deaths from, Table VI. 68 Principal Epidemic Diseases Death Rates, Table VII. 68 Diarrhoea 19 Diphtheria 15 Disinfection 56 Drainage Work 55 Dust, Removal of 55 Enteric Fever 16 Enteritis and Diarrhœa 19 Factories and Workshops 45 Food Supply 83 Food, Adulteration of 35 Furnished Rooms 40 Health Visitors 11 & 55 Home Office Tables 49-51 Home Work 46 Houses let in Lodgings 39 Houses, Number Inhabited 39 Housing (Inspection of District) Regulations, 1910 41 Housing of Working Classes 39 Ice Cream Vendors 33 Illegitimate Births 5 Infantile Mortality 8 Infectious Diseases 15. Notification and Removal, Table II. 64 Inhabited Houses, Number of 39 Inspection, Sanitary 55 Inspectors, Work of, Summary, Table X. 76 Inquests 59 ii. Page Lavatories, Public 55 Legal Proceedings 56 Local Government Board Tables I.—IV 63-66 Lodging Houses— Common Lodging Houses 40 Houses Let in Lodgings 39 Provided by the Council 39 London County Council Summary of Work, Table IX. 75 Margarine 35 Marriages 4 Measles 18 Milkshops 33 Milk Supply 33 Mortuary 58 Notifiable Diseases 15 Notification of Births 5 Ophthalmia Neonatorum 17 Outworkers' Premises 46 Phthisic 19 Population 3 Distribution in Wards 3 Prosecutions 56 Public Health (Tuberculosis) Regulations 20 Public Health (Milk and Cream Regulations), 1912 36 Puerperal Fever 17 Rag Flock Act, 1911 58 Refuse, Removal of 55 Registered Lodging Houses 39 Sale of Food and Drugs Acts 35 Sanitary Inspection 55 Sanitary Inspectors' Work, Table X. 76 Scarlet Fever 16 Schools for Mothers 11 Slaughter House 34 Small Pox 15 Smoke Nuisances 55 Tuberculosis— Dispensary 27 Notification 20 Occupation of Persons Notified 25 Provision of Beds 27 Regulations 20 Site of Disease. 23 Typhoid Fever 16 Underground Rooms 41 Unsound Food 35 Vaccination 59 Verminous Persons, Articles and Rooms 58 Water Certificates 36 Water Supply 36 Whooping Cough 18 Workshops and Factories 45 Zymotic or Principal Epidemic Diseases 8 & 15 Deaths from in Quinquennial Periods, Table VI.68 Death Rates from in Quinquennial Periods, Table VII. 68