LCC 3 London County Council ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE ADMINISTRATIVE COUNTY OF LONDON. 1894. (Ordered by the Council to be printed.) TABLE OF CONTENTS. Statistics— PAGE Population 5 Marriages5 Marriages of minors in London, 1894 6 Births 6 Deaths 7 London mortality in the four years 1891-94, compared with the decennium 1881-90 10 Average "Life Capital" of the population of London 12 Infant mortality 13 Deaths from several classes of disease 13 Principal zymotic diseases 14 Smallpox and vaccination 15 London vaccination returns 20 Measles 20 Scarlet fever 22 Hospital accommodation 25 Scarlet fever and elementary schools 25 Diphtheria 27 Hospital accommodation 30 Diphtheria and elementary schools 30 Whooping cough 32 Typhus 33 Enteric fever 34 Diarrhœa 37 Cholera 38 Erysipelas 40 Puerperal fever 40 Influenza, bronchitis and pneumonia 41 Phthisis 42 Cancer 43 Anthrax 43 Meteorology 44 Administration— Dairies, cowsheds and milkshops 45 Offensive trades 45 Trade nuisances 45 Nuisances 47 Smoke nuisances 47 Removal of offensive matter 47 Removal of house refuse 48 Regent's and Grand Junction canals 49 Private mews 50 Combined drainage 50 Housing of the working classes 51 Proceedings in respect of houses represented as unfit for human habitation 52 Customs and Inland Revenue Acts, 1890 and 1891 53 Workmen's trains 53 Houses let in lodgings 54 Common lodging houses 55 Underground rooms 55 Workshops 55 Bakehouses 57 Unsound food 61 The manufacture and sale of ice creams 61 Disinfection and destruction of infected articles and provision of shelters 61 Hospital provision for infectious disease 63 Spread of disease by vagrants 63 Mortuaries 64 Water supply 64 Constant water supply 65 Amendment of regulations as to water fittings 65 The London Equalisation of Rates Act, 1894 66 Sanitary condition and administration of districts 68 Medical officers of health and sanitary inspectors 68 The London Building Act, 1894 68 Metropolis Management (Plumstead and Hackney) Act, 1893 70 4 Appendices— I—Report on an outbreak of scarlet fever at Blackheath, 1894. II.—Memorandum on the distribution of enteric fever in 1894 considered in relation to water supply. III.—Report of the medical officer on anthrax in London. IV.—Report by the medical officer submitting summary of reports by Dr. Young on the collection and disposal of house refuse by London sanitary authorities. V.—Report of the medical officer on the sanitary condition of bakehouses. VI.—Disinfection and destruction of infected articles. VII.—Report on the sanitary condition and administration of Deptford. VIII.—Report on the sanitary condition and administration of Whitechapel. IX.—Report on the sanitary condition and administration of Mile-end Old-town. X.—Report on the sanitary condition and administration of Bethnal-green. XI.—Report of the medical officer of health submitting a return showing particulars as to sanitary inspectors in the several districts of the Administrative County of London. LIST OF DIAGRAMS. to face page Diagram I.—Marriages, 1851-94 5 ,, II.—Births, 1851-94 5 „ III.—Deaths, 1841-94 7 „ IV.—Smallpox, 1841-94 15 „ V.—Smallpox and vaccination, 1894 19 „ VI.—Measles, 1841-94 20 „ VII.—Scarlet fever, 1859-94 22 „ VIII.—Scarlet fever : admissions to and deaths in hospitals of Metropolitan Asylums Board, per cent. of total cases and deaths in London 22 „ IX.—Scarlet fever at various age-periods, 1894 26 „ X.—Diphtheria and croup, 1859-94 28 XI.—Diphtheria: admissions to and deaths in hospitals of Metropolitan Asylums Board, per cent, of total cases and deaths in London 28 „ XII.—Diphtheria at various age-periods, 1894 30 „ XIII.—Whooping cough, 1841-94 32 „ XIV.—Typhus, 1869-94 32 „ XV.—Enteric fever, 1869-94 37 „ XVI.—Diarrhœa in relation to mean temperature (summer quarter) 1841-94 37 Chart showing incidence of phthisis mortality on the several sanitary districts of London in 1894 42 Diagram I Marriages. Mean Marriage rate 1851-94 18.97 Administrative County of London. REPORT OF THE MEDICAL OFFICER OF HEALTH. 1894. STATISTICS. Population. The population of the administrative county of London, estimated to the middle of 1894, was 4,370,135, this estimate being based on the assumption that the rate of increase between the census years 1881 and 1891 has been since maintained. The estimated population of each of the 43 sanitary districts comprised in the administrative county is shown in the following table— Santary District. Estimated Population, 1894. Sanitary District Estimated population, 1894. Sanitary District. Estimated population, 1894. Paddington 121,583 St. Giles 38,144 St. George, Southwark 60,060 Kensington 167,350 St. Martin-in-the-Fields 13,783 Newington 118,512 Hammersmith 105,696 Strand 23,179 St. Olave, Southwark 12,984 Fulham 110,993 Holborn 32,438 Bermondsey 84,053 Chelsea 99,052 Clerkenwell 65,312 Rotherhithe 40,365 St. George, Hanoversquare 75,033 St. Luke 41,168 Lambeth 282,574 City of London 34,832 Battersea 161,558 Westminster 54,414 Shoreditch 123,186 Wandsworth 179,518 St. James, Westminster 23,571 Bethnal-green 129,840 Camberwell 248,893 Marylebone 138,554 Whitechapel 75,498 Greenwich 173,128 Hampstead 75,443 St. George-in-the-East... 45,360 Lee 38,172 St. Pancras 233,739 Limehouse 57,000 Lewisham 100,872 Islington 331,900 Mile-end Old-town 108,242 Woolwich 42,309 Stoke Newington 34,172 Poplar 170,217 Plumstead 59,233 Hackney 211,493 St. Saviour, Southwark 26,712 Marriages. There were 36,902 marriages in the registration county of London in 1894, giving an annual rate of persons married of 17.0 per 1,000 living. The marriage rate since 1870 has been as follows— 1871 19.5 1872 19.9 1873 19.8 1874 19.4 1875 19.6 1876 19.2 1877 18.7 1878 18.5 1879 18.0 1880 18 . 1881 18.1 1882 18.4 1883 18.1 1884 17.9 1885 17.4 1886 17.2 1887 16.9 1888 16.9 1889 17.1 1890 17.6 1891 17.7 1892 17.4 1893 17.2 1894 17.0 The accompanying diagram (I.) shows the marriage rate in each year since 1850 in relation to the mean of the period 1851-94. In the year 1894, 4.69 per cent. of the men and 16'80 per cent. of the women who were married were under 21 years of age. The proportions in preceding periods are shown in the following table; the proportions in England are also given for the purpose of comparison— In the year 1894, 4.69 per cent. of the men and 16'80 per cent. of the women who were married were under 21 years of age. The proportions in preceding periods are shown in the following table; the proportions in England are also given for the purpose of comparison— Marriaqes of minors per cent. of total marriages. London. England. Males. Females. Males. Females. 1851-60 2.77 11.95 5.70 17.99 1861-70 3.56 14.56 6.82 20.37 1871-80 4.71 16.90 7.96 22.03 1881-90 5.53 18.91 6.81 20.75 1891 4.86 17.45 5.90 19.01 1892 5.15 17.67 5.87 18.76 1893 4.75 16.80 5.59 18.08 6 In the annual report for the year 1893 a table is published showing the number of minors married in each of the registration districts of London in the years 1885-93. The following table gives similar information for the year 1894— Marriages of minors in London, 1894. Registration districts. Males. Females. Registration districts. Males. Females. London 1,729 6,198 Shoreditch 75 210 Paddington 32 136 Bethnal-green 130 375 Kensington 54 171 Whitechapel 16 66 Fulham 65 254 St. George-in-the-East 33 71 Chelsea 40 120 Stepney 18 83 St. George, Hanover-square 21 118 Mile-end Old-town 93 379 Westminster 10 60 Poplar 79 275 Marylebone 51 166 St. Saviour, Southwark... 296 819 Hampstead 8 42 St. Olave, Southwark 44 144 Pancras 89 314 Lambeth 68 324 Islington 93 370 Wandsworth 91 348 Hackney 62 266 Camberwell 52 215 St. Giles 7 67 Greenwich 47 181 Strand 12 41 Lewisham 17 53 Holborn 77 296 Woolwich 38 176 London City 11 58 Births. The number of births registered in the administrative county during 1894 was 130,970, being 30.1 births per 1,000 persons living. Since 1870 the birth-rate in each year per 1,000 living has been as follows— 1871 34.5 1872 35.6 1873 35.3 1874 35.6 1875 35.4 1876 35.9 1877 35.6 1878 35.5 1879 35.5 1880 35.3 1881 34.7 1882 34.5 1883 34.5 1884 34.3 1885 33.4 1886 33.4 1887 32.9 1888 32.1 1889 31.9 1890 30.7 1891 31.9 1892 30.9 1893 30.9 1894 30.1 It will thus be seen that the decline in the London birth rate, which has been apparent in recent years, is still continued. That this decline is not peculiar to London will be seen by a comparison of the figures relating to England and Wales— Birth rates per 1,000 living—England and Wales. 1871 35.0 1872 35.6 1873 35.4 1874 36.0 1875 35.4 1876 36.3 1877 36.0 1878 35.6 1879 34.7 1880 34.2 1881 33.9 1882 33.8 1883 33.5 1884 33.6 1885 32.9 1886 32.8 1887 31.9 1888 31.2 1889 81.1 1890 30.2 1891 31.4 1892 30.5 1893 30.8 1894 29.6 It is interesting to note in connection with this general decline in the birth rate that, in addition to a declining marriage rate, the mean age at marriage in England and Wales has been steadily rising since the year 1873. The accompanying diagram (II.) shows the London birth rate in each year in relation to the mean of the period 1851-94. The birth rate in 1894 in each of the London sanitary districts is shown in the following table— For the purpose of more exact comparison between one and another district the births should, in view of the difference of the age and sex distribution of the several populations, be considered in relation to the number of women at the child-bearing period of life. For practical purposes this may be reckoned as including the ages 15 to 45, the rates shown in the last column of the table are thus obtained. Sanitary District. Births. Birth rate per 1,000 living. Births per 100 females aged 15-45. Paddington 2,837 23.4 7.04 Kensington 3,673 22.0 6.20 Hammersmith 2,901 27.5 10.17 Fulham 3,763 34.0 13.00 Chelsea 2,700 27.3 10.09 St. George, Hanover-square 1,501 20.1 5.73 Westminster 1,235 22.8 8.54 St. James 464 19.7 6.80 Diagram III Deaths (All causes) 7 Sanitary District. Marylebone Hampstead Pancras Islington Stoke Newington Hackney St. Giles St. Martin-in-the-Fields Strand Holborn Clerkenwell St. Luke London City Shoreditch Bethnal-green Whitechapel St. George-in-the-East Limehouse Mile-end Old-town Poplar St. Saviour, Southwark St. George, Southwark Newington St. Olave Bermondsey Rotherhithe Lambeth Battersea Wandsworth Camberwell Greenwich Lee Lewisham Woolwich Plumstead London Births. 4,304 1,472 6,967 9,500 757 6,073 1,069 233 547 832 2,180 1,879 525 4,332 4,636 3,178 1,877 1,906 4,042 5,800 770 2,071 4,201 431 3,095 1,353 9,231 5,024 4,423 7,382 5,374 794 2,457 1,271 1,910 130,970 Birth rate per 1,000 living. 31.2 19.6 29.9 28.7 22.2 28.8 28.1 17.0 23.7 25.7 33.5 45.8 15.1 35.3 35.8 42.2 41.5 33.5 37.5 34.2 28.9 34.6 35.6 33.3 36.9 33.6 32.8 31.2 24.7 29.7 31.1 20.9 24.4 30.1 32.3 30.1 Births per 100 females aged 15—45. 9.94 5.36 11.54 10.86 7.31 10.78 9.91 5.81 8.61 10.17 13.73 18.86 5.69 14.82 15.44 18.00 18.17 14.96 15.72 15.54 13.01 14.50 15.04 14.14 16.32 15.71 12.57 13.07 8.44 11.86 12.95 6.80 8.28 14.94 14.39 11.35 In 1894, therefore, the district of St. Luke had the highest birth rate per 1,000 living, 45.8, and the City the lowest, 15.1. Deaths. During 1894, 75,705 deaths were registered in the administrative county of London, giving a death rate of 17.4 per 1,000 living. Since the year 1870 the London death rate has been as follows— 1871 24.6 1872 21.5 1873 22.4 1874 22.4 1875 23.6 1876 21.9 1877 21.6 1878 23.1 1879 22.6 1880 21.7 1881 21.3 1882 21.5 1883 20.8 1884 20.9 1885 20.4 1886 20.6 1887 20.3 1888 19.3 1889 18.4 1890 21.4 1891 21.0† 1892 20.3† 1893 20.9† 1894 17 . 4† Reference to Diagram III. shows that the death rate of 1894 has been lower than the death rate of any year since 1841. It has in fact been lower in 1894 than that of any year since "civil registration " was instituted. In view of this circumstance it is desirable to ascertain the effect on the death rates of London of the changes which have occurred in the age and sex distribution of the population since that date. This effect may be approximately ascertained by assuming a constant rate of mortality at the several age periods 0-, 5-, 10-, 15-, &c., and by applying these rates to the populations as enumerated at these age groups at each census from 1841 onwards. By adopting as a standard the rates of mortality for England and Wales obtaining at each age-period in the decennium 1881-90, and applying these rates to the London population at similar age periods as enumerated at the censuses of 1841,1851, 1861, 1871, 1881 and 1891, the following death rates per 1,000 living at all ages are obtained— Year. Death rate. 1841 17.51 1851 18.02 1861 18.26 1871 18.35 1881 18.28 1891 17.96 t These death rates are fully corrected for deaths in institutions, i.e., by the exclusion of deaths of persons not belonging to but occurring in institutions situated within Loudon, and by the Inclusion of deaths of persons belonging to London but occurring in institutions situated outside London. 8 The differences observed in these rates are, therefore, solely due to differences in the age and sex distribution of the population, since the rates of mortality operating on the groups of population at various ages have been assumed to be constant. It will thus be seen that from 1841 to a point between 1861 and 1881 the age and sex distribution of the population had been so changing as to act prejudicially upon the death rates, while from this point to the year 1891 a reversal of this process has taken place, the changing age and sex distribution of the population tending gradually to diminish the death rates. If the age and sex distribution of the population shown by the censuses of 1891,1881, 1871, &c., be regarded as constant for the periods 1886-94. 1876-85, 1866-75, &c., respectively, it will be seen that the constitution of the population as regards age and sex in the period 1886-94 was more favourable to the death-rate than the constitution of the population of any of the other periods under consideration, except that of 1836-45. Assuming that the age and sex distribution of the population for each period under consideration had been identical with that of the period 1886-94, the approximate effect on the death rates may be shown as follows— Period. Mean death rate. Excess per cent. over mean death rate of 1886-94. Amount of this excess due to difference of age and sex distribution (compared with 1886-94). 1846-55 25.10 24.6 0.4 1856-65 23.56 17.0 2.0 1866-75 23.62 17.3 2.5 1876-85 21.58 7.1 1.8 1886-94 20.14 — — It will thus be seen that the excess of the mean death rates in the periods previous to 1886-94 shown in the table is only in trifling degree due to differences of age and sex distribution. The following table has been prepared for the purpose of comparing the death rate of the registration County of London with that of other English towns having populations of more than 200,000 persons at the census of 1891. It will be seen that three of these towns in the ten years 1884-93, and five of these towns in 1894, had a lower death rate than that of London. All Causes. Population estimated to the middle of 1894. Death rate per 1,000 living. Population estimated to the middle of 1894. Death rate per 1,000 living. 1884-93. 1894. 1884-93. 1894. London 4,349.166 20.4 17.8* West Ham 238,184 19.3 16.2 Manchester 520,211 26.2 20.4 Bristol 226,578 19.5 17.3 Liverpool 507,230 26.0 23.8 Bradford 223,985 20.5 17.0 Birmingham 492,301 21.0 18.6 Nottingham 223,584 20.4 17.2 Leeds 388,761 21.8 17.9 Hull 212,679 20.2 17.4 Sheffield 338,316 22.1 17.8 Salford 205,828 24.9 21.0 Again the death rate of London in the ten years 1884-93 and the year 1894 was lower than the corresponding death rate for each of the undermentioned foreign cities— All Causes. Death rate per 1,000 living. Death rate per 1,000 living. 1884-93. 1894. 1884-93. 1894. London 20.4 17.8* St. Petersburg 29.8 31.4 Paris 23.3 20.3 Berlin 22.3 18.2 Brussels 21.5 18.1 Vienna 25.1 22.8 Amsterdam 22.4 18.3 Rome 24.7 19.4 Copenhagen 21.8 18.7 New York 25.5 21.1 Stockholm 21.2 18.3 In 1885 the Registrar-General began to distribute the deaths from all causes and from certain zymotic diseases, occurring in institutions, to the sanitary districts to which thev belong and death rates corrected in this sense can therefore be obtained for each of the years 1885-94. For the purpose of a more precise statement, it is necessary to have regard to the age and sex distribution of the several populations, and to correct each crude death rate by the proper factor; the following table is thus obtained— *Including deaths of Londoners in the Metropolitan Workhouses, Hospitals, and Lunatic Asylums, situated outside Registration London, but excluding deaths of persons not belonging to London occurring in the Highgate Smallpox Hospital, in the London Fever Hospital, in the Middlesex County Lunatic Asylum at Wandsworth, and in the Metropolitan Asylums Board Hospitals within registration London. 9 Crude and Corrected Death Rates* per 1,000 persons living in Sanitary Districts of London. Sanitary area. Standard death rate. Factor for correction for age and sex distribution. Crude death rate, 1894. Corrected death rate 1894. Comparative mortality figure, 1894. [London 1,000.] Crude death rate 1885-93. Corrected death rate 1885-93. Comparative mortality figure. 1885-93. [London 1,000.] England and Wales 19.15 — — — — — — — London 17.96 1.06626 174 186 1,000 20.1 21.4 1,000 Battersea 17.80 1.07584 16.0 17.2 925 — — — Bermondsey 18.10 1.05801 20.7 21.9 1,177 22.6 23.9 1,117 Bethnal-green 18-39 1.04133 20.4 21.2 1,140 23.5 24.5 1,145 Camberwell 18.10 1.05801 16.3 17.2 925 18.7 19.8 925 Chelsea 17.95 1.06685 16.4 17.5 941 20.9 22.3 1,042 Clerkenwell 17.28 1.10822 19.1 21.2 1,140 23.5 26.0 1,215 Fulham 18.27 1.04817 17.1 17.9 962 — — — Greenwich 18.63 1.02791 17.2 17.7 952 19.7 20.2 944 Hackney 18.30 1.04645 15.4 16.1 866 — — — Hammersmith 18.05 1.06094 16.2 17.2 925 — — — Hampstead 16.63 1.15153 10.6 12.2 656 12.5 14.4 673 Holborn 17.62 1.08683 20.4 22.2 1,194 25.7 27.9 1,304 Islington 17.90 1.06983 15.9 17.0 914 18.5 19.8 925 Kensington 17.38 1.10184 15.9 17.5 941 17.2 19.0 888 Lambeth 18.24 1.04989 17.2 18.1 973 19.9 20.9 977 Lee 17.67 1.08376 12.4 13.4 720 — — — Lewisham 17.92 1.06864 13.6 14.5 780 14.5 15.5 724 Limehouse 17.59 1.08869 24.7 26.9 1,446 26.0 28.3 1,322 City of London 16.65 1.15015 19.5 22.4 1,204 22.3 26.2 1,224 Mile-end Old-town 18.58 1.03068 21.1 21.7 1,167 21.3 22.0 1,028 Newington 18.32 1.04531 20.0 20.9 1,124 22.5 23.5 1,098 Paddington 17.72 1.08070 15.1 16.3 876 16.9 18.3 855 Plumstead 19.09 1.00314 12.5 12.5 672 — — — Poplar 18.49 1.03569 19.0 19.7 1,059 21.2 22.0 1,028 Rotherhithe 18.49 1.03569 19.0 19.7 1,059 21.9 22.7 1,061 St. George, Hanover-square 17.34 1.10438 14.5 16.0 860 17.0 18.8 879 St. George-in-the-East 18.43 1.03907 26.4 27.4 1,473 29.8 31.0 1,449 St. George, Southwark 17.35 1.10375 23.1 25.5 1,371 26.1 28.8 1,346 St. Giles 17.27 1.10886 19.9 22.1 1,188 24.4 27.1 1,266 St. James 17.16 1.11597 16.7 18.6 1,000 19.2 21.4 1,000 St. Luke 17.72 1.08070 23.5 25.4 1,366 27.2 29.4 1,374 St. Martin-in-the-Fields 15.74 1.21665 19.4 23.6 1,269 21.4 26.0 1,215 St. Marylebone 17.82 1.07464 19.3 20.7 1,113 21.2 22.8 1,065 St. Olave 18.42 1.03963 20.7 21.5 1,156 23.5 24.4 1,140 St. Pancras 17.89 1.07043 18.3 19.6 1,054 20.8 22.3 1,042 St. Saviour 18.29 1.04702 21.0 22.0 1,183 25.9 27.1 1,266 Shoreditch 18.45 1.03794 19.9 20.7 1,113 23.3 24.2 1,131 Stoke Newington 17.85 1.07283 9.8 10.5 565 — — — Strand 16.24 1.17919 22.7 26.8 1,441 25.5 30.1 1,407 Wandsworth 17.93 1.06804 12.4 13.2 710 — — — Westminster 16.94 1.13046 18.3 20.7 1,113 22.3 25.2 1,178 Whitechapel 17.74 1.07948 21.4 23.1 1,242 23.1 24.9 1,164 Woolwich 16.99 1.12713 17.8 20.1 1,081 20.7 23.3 1,089 The death rates of Battersea, Wandsworth, Hammersmith, Fulham, Stoke Newington, Hackney, Lee, and Plumstead cannot be given for the period 1885—93, as during some portion of this period Battersea was combined with Wandsworth, Hammersmith with Fulham, Stoke Newington with Hackney, and Lee with Plumstead; the death rates of the combined areas for this period, however, are shown in the following table— Sanitary area. Standard death rate. Factor for correction for age and sex distribution. Crude death rate 1885-93. Corrected death rate 1885-93. Comparative mortality figure, 1885-93. [London 1,000.] Wandsworth (combined with Battersea) 17.86 1.07223 16.7 17.9 836 Fulham (combined with Hammersmith) 18.-15 1.05510 19.3 20.4 953 Hackney (combined with Stoke Newington) 18.23 1.05047 17.4 18.3 855 Plumstead (combined with Lee) 18.51 1.03458 15.3 15.8 738 The "factors for correction " in the above tables are calculated upon the age and sex distribution of the population enumerated in the district at the time when the last census was taken. This * All death-rates in this report relating to London Sanitary Districts are fully corrected for institutions (see footnote (†), page 7). [2] 10 population did not include persons resident in poor law institutions belonging to the district but situated beyond its limits. If such persons were included in the population the "factors for correction " would in some instances be slightly modified. London mortality in the four years 1891-4 compared with the decennium 1881-90. A valuable application of the Manchester Life tables in a comparison of the mortality in Manchester in 1891-3 with that of 1881-90, is shown in a recent report on the Health of Greater Manchester, 1891-3, by Dr. Tatham, the late medical officer of health. In my last annual report a life table based on the mortality figures for London in the decade 1881-90 was published ; it is now, therefore, possible by means of this life table to institute a similar comparison of the London mortality in the four years 1891-4 and that of the decade 1881-90. The mean death rates in London at the several age periods in 1881-90 and 1891-4 are shown in the following table— Age period. males. Females. Mean death rate 1881-90. Mean death rate 1891-94. Difference per cent. Mean death rate 1881-90. Mean death rate 1891-94. Difference per cent. 0— 73.09 70.87 — 3.0 63.26 60.96 — 3.6 5— 5.93 5.46 7.9 5.-82 5.72 1.7 10— 2.92 2.63 — 9.9 2.89 2.66 — 8.0 15— 4.05 3.90 — 3.7 3.58 3.32 — 7.3 20— 5.44 5.06 — 7.0 4.40 4.01 — 8.9 25— 8.65 8.08 — 6.6 6.82 6.33 — 7.2 35— 14.96 15.23 + 1.8 11.42 11.41 — 0.1 45— 23.87 24.61 + 3.1 17.23 17.53 + 1.7 55— 41.33 43.15 + 4.4 30.77 32.44 + 5.4 65— 77.97 80.58 + 3.3 63.28 65.80 + 4.0 75— 155.93 156.05 + 0.1 134.28 136.60 + 1.7 85 and upwards 297.63 288.41 — 3.1 264.77 260.67 — 1.5 All ages 22.10 21.53 — 2.6 18.83 18.46 — 2.0 It will thus be seen that whereas the mortality of males and females at all ages has declined in the period 1891-4, that of males aged 35-85 and of females aged 45-85 has actually increased, the decline in the death-rate at "all ages" being almost exclusively due to a decline in mortality at the early age periods. These figures do not give more than an approximate indication of the nett gain or loss to the community, and it is in arriving at a more accurate result in this respect that a life table is especially useful. The following example of an extreme case may show this more clearly. Assume that in a certain community 800 deaths occur in one year, and that 400 of these deaths occur among persons aged 0-25, whose mean future lifetime is, say, 30 years, and that the remaining 400 deaths occur among persons aged 25 and upwards, whose mean future lifetime is, say, 15 years, then these 800 deaths will represent a total of 18,000 years of " life capital" lost to the community, for— (400 X 30) + (400 X 15)= 18,000. Now suppose that 700 deaths occur in the same community in the following year, and that 600 of these deaths occur among persons aged 0-25, and the remaining 100 among persons aged 25 and upwards, then the loss of life capital to the community will be (600 X 30) + (100 X 15) = 19,500 years. Thus, while there is a saving of 100 lives in the second year compared with the first, there is an actual loss to the community of 1,500 years of " life capital." It is therefore apparent that the actual number of lives saved in any period is an unreliable measure of progress, and that the value of each life gained or lost must be considered in order to arrive at more accurate conclusions. The following table shows the mean future lifetime of males and females in certain groups of ages. These figures have been calculated* from the figures in the Ex and Qx columns of the life table for London, 1881-90, published in my last annual report. * The future lifetime of lx persons is Qx, and the mean expectation of life of each of these persons is Qx/lx The future lifetime of Px persons living at all ages between x and x + 1 is Qx- Px/2, the mean expectation of life of each being Qx/ Px-½. The future lifetime of Px + Px + 1 + Px + n _ 1 persons living at all ages between x and z + n is and their mean expectation of life equals- This formula ha9 been used for the age group 0—5 years, Px being taken as the geometrical mean of lx and lx + i, i.t. except in the case of the age period 0—1 ; in this case the mean number living at all ages between 0 and 1 has been deduced from the recorded proportion of deaths under 3 months, 3 months to 6 months, and 6 months and under montns. In the case of the age period 5—10. the mean expectation of life has been assumed to equal the arithmetical mean of the expectations of life at the precise ages 5 and 10, and similarly in the case of succeeding age periods. 11 Table I. Mean future lifetime of males and females in groups of ajes (calculated from London life tables, 1881-90). Age groups. Males. Females. Age groups. Males. Females. Years. Years. Years. Years. 0— 49.06 52.69 35— 24.19 27.24 5— 48.94 52.68 45— 18.15 20.57 10— 45.05 48.80 55— 12.95 14.56 15— 40.79 44.55 65— 8.89 9.78 20— 36.70 40.39 75- 6.35 6.74 25— 31.04 34.51 85 and upwards 2.75 2.85 By comparing the mean deaths occurring at each age period in 1891-4 with the deaths which would have occurred at these age periods if the death rates of 1881-90 had still been maintained, the differences between the two sets of figures will be the number of lives gained or lost at each age period by fluctuations of mortality, and by applying to these differences the figures in the preceding table the actual gain or loss may be expressed in " life capital." The result of this process is shown in the following table— Table II. Age groups. Deaths calculated according to mean rates 1881-90. Mean deaths occurring in the four years 1891-4. Mean annual gain (+) or loss (—) of lives in the four years 1891-4 by fluctuations of mortality. Mean annual gain (+) or loss (—) of "life capital" in four years 1891-4 by fluctuations of mortality. Males. 0— 18,541 17,978 + 563 +27,621 5— 1,363 1,255 + 108 + 5,286 10— 613 552 + 61 + 2,748 15— 814 783 + 31 + 1,264 20— 1,074 1,000 + 74 + 2,716 25— 2,937 2,743 + 194 + 6,022 35— 3,748 3,816 — 68 — 1,645 45— 4,204 4,334 — 130 — 2,359 55— 4,154 4,337 — 183 — 2,370 65— 3,999 4,133 — 134 — 1,191 75— 2,232 2,234 — 2 — 13 85 and upwards 457 443 + 14 + 38 All ages 44,136 43,608 + 528 +38,117 Females. 0— 16,241 15,650 + 591 +31,139 5— 1,352 1,328 + 24 + 1,264 10— 618 568 + 50 + 2,440 15— 799 741 + 58 + 2,584 20— 1,049 956 + 93 + 3,756 25— 2,664 2,471 + 193 + 6,660 35— 3,177 3,174 + 3 + 82 45— 3,426 3,486 — 60 — 1,234 55— 3,844 4,052 — 208 — 3,028 65— 4,656 4,842 — 186 — 1,819 75— 3,430 3,489 — 59 — 398 85 and upwards 974 959 + 15 + 43 All ages 42,230 41,716 + 514 +41,489 Total 86,366 85,324 + 1,042 + 79,606 This table shows, therefore, that during the period 1891-4, as compared with the decennium 1881-90, there has been a mean annual saving of 1,042 lives, and that this represents 79,606 years of "life capital" annually saved to the community. The actual gain to the community is therefore greater than appears from the number of lives saved, and this is apparent when the great saving of life at the earlier ages shown in the table is considered. 12 Average Life Capital of the Population of London. The mean future lifetime at certain age groups, shown in Table I., may also be conveniently utilised to calculate the average life capital or mean future lifetime of each member of the population. If the mean population living in the period 1891-4 be calculated for each age group, and applied to the " future lifetimes " shown in Table I. for the same age groups, the total " life capital " of the population may be ascertained. The following table shows the mean population of the period 1891-4 at certain age groups for males and females, and the total life capital of the population at each age group and at all ages— Table III. Estimated Mean Population and Life Capital of London in the period 1891-4. Males. Females. Age groups. Population. Life capital. Age groups. Population. Life capital. 0— 253,673 12,445,197 0— 256,730 13,527,104 5— 229,849 11,248,810 5— 232,261 12,235,509 10— 209,838 9,453,202 10— 213,876 10,437,149 15— 200,880 8,193,895 15— 223,236 9,945,164 20— 197,508 7,248,544 20— 238,446 9,630,834 25— 339,530 10,539,011 25— 390,543 13,477,639 35— 250,529 6,060,297 35— 278,204 7,578,277 45— 176,141 3,196,959 45— 198,846 4,090,262 55— 100,504 1,301,527 55— 124,924 1,818,893 65— 51,289 455,959 65— 73,585 719,661 75— 14,316 90,907 75— 25,541 172,146 85 and upwards 1,536 4,224 85 and upwards 3,679 10,485 All ages 2,025,593 70,238,532 All ages 2,259,871 83,643,123 The above table shows therefore that the total "life capital" of the 2,025,593 males and 2,259,871 females estimated as the mean numbers living in the period 1891-4 was 70,238,532 and 83,643,123 years respectively. Assuming the age and sex constitution remains the same as at the 1891 census enumeration, and the death rates at the several ages as in the decennium 1881-90, it appears that an estimated population of 4,285,464 persons in London represents a total " life capital" of 153,881,655 years, the mean future lifetime of each person being 153,881,655/4,285,464 = 35.91 years. The mean population living in any year represents accurately the number of years of life expended by the population in that year. The proportion of the "life capital" of the population expended in one year may therefore be shown; for the number of years of life expended in one year by the mean population of London in 1891-4, out of a total "life capital" of 153,881,655, would be equal to the total mean population, viz., 4,285,464 or 2.785 per cent. The result of these calculations is shown in the following table— Average " life capital " of the London population and proportion per cent. of "life capital" expended per annum. Average life capital of the population. Proportion per cent. of " life capital" expended per annum. Years. Years. Males 34.68 2.884 Females 37.01 2.702 Persons 35.91 2.785 The following table shows the results obtained by Dr. Tatham in the case of the city of Manchester— Average life capital of tne population. Proportion percent. of "'life capital" expended per annum. Years. Years. Males 31.63 3.161 Females 33.37 2.997 Persons 32.53 3.074 Infant mortality. The deaths of children under 1 year of age in London during 1894 numbered 18,667, being in the proportion of 143 deaths per 1,000 births. In 1891 the proportion was 153, in 1892, 154, and in 1893, 163 deaths per 1,000 births. 13 The infant mortality in London may be compared with that in other English towns having more than 200,000 inhabitants by reference to the following table— 1884-93. 1894. 1884-93. 1894. London 154 143* West Ham 155 138 Manchester 185 160 Bristol 145 150 Liverpool 187 179 Bradford 171 145 Birmingham 172 163 Nottingham 170 174 Leeds 177 155 Hull 165 142 Sheffield 176 157 Salford 190 174 London had therefore in 1894 a lower rate than any of these towns except West Ham and Hull, and in the preceding ten years a lower rate than any except Bristol. Bristol and Nottingham are the only towns in this group which show a higher rate in 1894 than the average of the preceding ten years. The infant mortality m the several London districts in 1894 was as follows— Sanitary district. Deaths under one year of age. Deaths under one year of age per 1,000 births Sanitary district. Deaths under one year of age. Deaths under one year of age per 1,000 births. Paddington 388 137 Bethnal-green 699 151 Kensington 637 173 Wliitechapel 491 154 Hammersmith 426 147 St. George-in-the-East 347 185 Fulham 561 149 Limehouse 331 174 Chelsea 354 131 Mile-end Old-town 629 156 St. George, Hanover-square 172 115 Poplar 887 153 Westminster 170 138 St. Saviour, Soutliwark 112 145 St. James 67 144 St. George, Southwark 385 186 Marvlebone 558 130 Newington 664 158 Hampstead 167 113 St. Olave 55 128 Pancras 1,012 145 Bermondsey 451 146 Islington 1,232 130 Rotherhithe 218 161 Stoke Newington 65 86 Lambeth 1,225 133 Hackney 769 127 Battersea 734 146 St. Giles 141 132 Wandsworth 506 114 St. Martin-in-the-Fields 49 210 Camberwell 1,096 148 Strand 98 179 Greenwich 743 138 Holborn 150 180 Lee 75 94 Clerkenwell 316 145 Lewisham 325 132 St. Luke 232 123 Woolwich 173 136 London, City of 84 160 Plumstead 179 94 Shoreditch 694 160 London 18,667 143† Deaths from several classes of disease. The deaths from the several classes of disease registered in the registration county of London (including the lunatic asylums and hospitals for infectious disease belonging to the county) are given by the Registrar-General in the Annual Summary of Births, Deaths and Causes of Death, and the following table has been prepared from the figures contained in the summary relating to the year 1894— 1894. Corrected annual average 1884-93. Zymotic diseases 13,435 14,561.9 Parasitic „ 59 104.0 Dietetic „ 526 470.1 Constitutional diseases 15,474 17,084.6 Developmental „ 5.107 5,433.7 Nervous „ 8,107 9,849.8 Diseases of organs of special sense 162 136.8 Circulatory diseases 6,041 6,875.9 Respiratory „ 14,641 19,374.1 Diseases of the Digestive system 4,404 4,833.4 „ „ Lymphatic „ 119 112.2 „ „ Urinary „ 2,056 2,224.2 „ „ Generative „ 523 530.9 „ „ Locomotive „ 310 371.1 ,, ,, Integumentary system 263 298.7 Violence (accident) 2,624 2,707.5 Violence (other than accident) 523 492.9 Other causes 2,665 3,237.2 All causes 77,039 88,699.0 The deaths therefore in 1894 were below the average of the preceding ten years in each class of disease, except the dietetic, diseases of organs of special sense, diseases of the lymphatic system, and violence other than accident. * See footnote (*), page 8. † See footnote (†), page 7. 14 Principal Zymotic Diseases. The number of deaths in London from the principal zymotic diseases, viz.: smallpox, measles; scarlet fever, diphtheria, whooping cough, fever, and diarrhoea, during 1894 was 11,513, giving a death rate of 2.64 per 1,000 living, compared with 3.04 in 1893, 2.8 in 1892, and 2.3 in 1891. In the period 1884-93 the London death rate from the principal zymotic diseases was lower than that of the other English towns having a population of more than 200,000 except Birmingham, Bristol, Bradford, Nottingham, and Hull; but in 1894 was higher than that of any except Liverpool, West Ham, and Salford, thus— Death rates per 1,000 living. 1884-93. 1894. 1884-93. 1894. London 2.85 2.66* West Ham 3.43 3.19 Manchester 3.51 2.38 Bristol 2.10 2.04 Liverpool 3.69 3.41 Bradford 2.45 1.76 Birmingham 2.83 2.50 Nottingham 2.68 2.33 Leeds 2.95 2.00 Hull 2.55 1.76 Sheffield 3.42 2.27 Salford 4.44 3.25 The death rate from the first six of these principal zymotic diseases, viz.: smallpox, measles, scarlet fever, diphtheria, whooping cough and fever, was in London, in 1884-93, higher than in Paris, Brussels, Amsterdam, Berlin, and Vienna, and lower than in Copenhagen, Stockholm, St. Petersburg, Rome, and New York, thus— Death rates per 1,000 living. 1884-93. 1894. 1884-93. 1894. London 2.12 2.24* St. Petersburg 3.06 3.49 Paris 1.96 1.35 Berlin 1.88 1.50 Brussels 1.17 .95 Vienna 1.80 2.12 Amsterdam 1.61 .84 Rome 2.34 1.08 Copenhagen 2.13 1.90 New York 2.53 2.16 Stockholm 2.73 2.05 The death rates from the principal zymotic diseases in the several sanitary districts of London in 1894 and the period 1885-93 is shown in the following table. It will be seen that the district of St. George-in-the-East had the highest mortality, and the district of Stoke Newington the lowest mortality in 1894. Sanitary district. Deaths in 1894. Death rate pec 1,000 living. Sanitary district. Deaths in 1894. Death rate per 1,000 living. 1894. 1885—93. 1894. 1885—93. Paddington 289 2.38 2'03 Shoreditch 350 2.85 3.75 Kensington 349 2.09 2.08 Bethnal-green 457 3.53 3.78 Hammersmith 256 2.43 3.15 Whitechapel 231 3.07 2.98 Fulham 425 3.84 St. George-in-the-East 224 4.95 4.62 Chelsea 224 2.27 2.72 Limehouse 214 4.29 4.22 St. George, Hanover. square 105 1.40 1.70 Mile-end Old-town 439 4.07 3.34 Poplar 549 3.23 3.11 Westminster 108 1.99 2.57 St. Saviour, Southwark 87 3.27 3.27 St. James 52 2.21 1.87 St. George, Southwark 217 3.62 3.74 Marylebone 328 2.37 2.25 Newington 327 2.77 3.15 Hampstead 104 1.38 1.32 St. Olave 36 2.78 2.89 Pancras 510 2.19 2.69 Bermondsey 279 3.33 3.20 Islington 847 2.56 2.70 Rotherhithe 134 3.33 3.15 Stoke Newington 29 .85 2.52 Lambeth 676 2.40 2.66 Hackney 554 2.63 Battersea 493 3.06 2.54 St. Giles 78 2.05 2.62 Wandsworth 317 1.77 St. Martin . in . the Fields 27 1.96 1.98 Camberwell 687 2.77 2.63 Greenwich 540 3.13 2.74 Strand 62 2.68 2.49 Lewisbam 200 1.99 1.62 Holborn 81 2.50 2.92 Woolwich 110 2.61 2.02 Clerkenwell 174 2.67 3.62 Lee 64 1.68 1.95 St. Luke 87 2.12 3.78 Plumstead 124 2.10 London, City of 39 1.12 1.49 London 11,513 2.64 2.75+ * See footnote (*), page 8. † See footnote (†), page 7, DiaararnIV 15 Smallpox and vaccination. Smallpox caused one death in London in 1889, three in 1890, eight in 1891, 29 in 1892, and 186 in 1893. In 1894 the number of deaths fell to 89. The death rate from smallpox in London in successive periods has been as follows— Smallpox death rate Smallpox death rate Period. per 1,000 living. Period. per 1,000 living. 1851.60 0.28 1891 0.00* 1861-70 0.28 1892 0.01* 1871-80 0.46 1893 0.04* 1881-90 0.14 1894 0.02* The death rate in each year since 184-0 in relation to the mean of the period 1841-94 is shown in diagram IV. During the complete years in which the notification of infectious diseases has been obligatory, the number of cases of smallpox notified to the medical officers of health in London has been as follows— Year. Cases notified. Year. Cases notified. 1890 60 1893 2,815 1891 114 1894 1,193 1892 425 It will thus be seen that the number of cases notified in 1894, although less than 50 per cent, of the number notified in 1893, was yet considerably in excess of the average number of notifications of the period 1890-4. Compared with the large towns in England having more than 200,000 inhabitants. London had in the period 1884-93 a higher death rate from smallpox than any of the towns except Sheffield and AVest Ham, and in 1894 a higher death rate than Leeds, Sheffield, Nottingham, Hull and Salford. Smallpox—Death rates per 1,000 living. Towns. 1884-93. 1894. Towns. 1884-93. 1894. London .07 .02† West Ham .47 .21 Manchester .03 .04 Bristol .03 .07 Liverpool .04 .04 Bradford .06 .12 Birmingham .04 .35 Nottingham .01 .01 Leeds .01 .01 Hull .03 .01 Sheffield .24 .00 Salford .01 .01 In comparing the death rate from smallpox in London with the death rates in the following foreign cities it will be seen that in 1894 the London rate was exceeded by the rates of Paris, Brussels, St. Petersburg and New York, while in 1884-93 it was exceeded by those of Brussels, St. Petersburg, Vienna and Rome. Smallpox—Death rates per 1,000 living. [####]Towns. 1884-93. 1894. Towns. 1884-93. 1894. London .07 02† St. Petersburg .14 .10 Paris .07 .07 Berlin .00 .00 Brussels .18 .04 Vienna .19 .01 Amsterdam .00 .01 Rome .37 .00 Copenhagen .00 .00 New York .03 .08 Stockholm .00 — The cases notified in London were distributed throughout the year as follows— No. of week. Week ending. No. of cases notified. No. of week. Week ending. No. of cases notified. No. of week. Week ending. No. of cases notified. 1 6 January 14 19 12 May 53 37 15 September 20 2 13 15 20 19 „ 32 38 22 ,, 20 3 20 8 21 26 „ 61 39 29 ,, 15 4 27 13 22 2 June 48 40 6 October 13 5 3 February 12 23 9 „ 31 41 13 „ 9 6 10 „ 15 24 16 ,, 39 42 20 „ 8 7 17 „ 16 25 23 „ 19 43 27 „ 8 8 24 „ 18 26 30 „ 15 44 3 November 9 9 3 March 14 27 7 July 28 45 10 ,, 11 10 10 „ 21 28 14 ,, 10 46 17 ,, 3 11 17 „ 7 29 21 „ 13 47 24 ,, 2 12 24 „ 16 30 28 ,, 143 48 1 December 4 13 31 „ 16 31 4 August 58 49 8 „ 9 14 7 April 25 32 11 ,, 22 50 15 ,, 3 15 14 ,, 32 33 18 „ 46 51 22 ,, 3 16 21 „ 41 34 25 „ 27 52 29 ,, 2 17 28 „ 25 35 1 September 51 18 5 May 36 36 8 ,, 14 * See footnote (†), page 7. •† Bee footnote (*), page 8. 16 The following table shows the distribution of smallpox throughout the year in the several sanitary districts— Sanitary district. Four weeks ended Jan. 27. Feb. 24. Mar. 24. Apr. 21. May 19. June 16. July 14. Aug. 11. Sept 8. Oct. 6. Nov. 3. Dec. 1. Dec. 29. Paddington 3 1 1 1 ... 2 ... 6 3 1 6 4 ... Kensington 7 1 1 1 1 ... ... 1 ... 6 ... ... ... Hammersmith 2 3 4 ... ... ... ... 1 ... ... ... ... ... Fulham ... 12 6 4 ... 3 ... 8 5 2 ... ... Chelsea 1 2 1 1 2 2 2 1 ... ... 2 ... ... St. George, Hanover-squa ... ... ... ... ... 4 ... 2 4 1 ... ... ... Westminster ... ... ... 1 ... ... ... ... ... ... ... ... ... St. James ... ... 1 ... ... 1 ... 1 ... ... ... ... ... Marylebone ... 1 ... 2 2 ... 6 156 90 22 11 7 11 Hampstead ... ... 2 2 ... 10 2 ... ... 1 1 Pancras 2 1 4 7 15 20 8 17 7 10 4 2 ... Islington ... ... 4 15 23 24 4 5 4 4 ... 1 ... Stoke Newington ... ... 1 ... 1 ... 1 ... ... ... ... ... ... Hackney 2 l 1 11 10 9 1 1 ... ... ... ... ... St. Giles ... ... 1 1 3 ... ... 2 ... ... ... ... ... St. Martin-in-the-Fields ... ... ... 1 ... ... ... ... ... ... ... ... ... Strand ... ... ... 1 1 3 ... ... ... ... ... ... ... Holborn ... ... ... ... ... 1 2 1 3 1 ... ... ... Clerkenwell 1 l 2 1 1 ... ... ... 1 ... ... ... ... St. Luke 2 ... 1 3 4 ... 2 2 2 ... ... ... ... London, City of ... ... ... ... ... ... ... 1 ... ... ... ... ... Shoreditch ... l 3 5 4 4 6 2 1 l 1 1 ... Bethnal Green 1 2 3 2 10 34 19 9 3 l 1 ... ... Whitechapel ... 1 ... 2 ... 2 ... 3 ... ... 1 1 1 St. George-in-the-East ... ... ... 1 1 ... 2 ... ... l ... ... ... Limehouse 2 ... 1 1 4 1 ... ... ... ... ... ... ... Mile-end Old-town 4 5 4 3 11 18 ... ... ... ... ... ... ... Poplar 10 5 7 20 34 21 8 2 2 1 ... ... 2 St. Saviour, Southwark 1 ... ... ... ... ... ... ... ... 1 ... ... ... St. George Southwark ... ... ... 1 2 1 ... ... ... 2 ... ... 1 Newington ... ... ... 5 ... 8 1 ... 1 ... ... ... ... St. Olave ... ... ... ... ... ... ... ... ... ... ... ... ... Bermondsey i 1 1 3 1 ... 1 ... ... ... ... ... ... Rotherhithe ... ... ... ... ... 1 l ... 1 ... 2 2 ... Lambeth ... 1 2 5 5 4 l 5 1 2 ... ... ... Battersea 2 l ... 1 ... 1 ... 2 3 1 1 ... ... Wandsworth 1 ... 1 1 ... ... ... ... ... ... ... ... ... Camberwell ... ... ... 4 4 1 l 3 ... 2 ... 1 ... Greenwich 6 6 1 1 3 3 l ... 1 3 ... ... ... Lewisham 1 2 ... ... ... 1 l ... 1 ... 2 ... ... Woolwich ... 3 1 1 3 2 ... 1 ... 3 ... ... ... Lee ... 7 1 1 ... ... ... ... ... ... ... ... ... Plumstead 1 3 4 2 1 5 4 2 ... ... ... ... ... Port of London ... ... 1 3 ... 1 ... ... ... ... 1 ... 1 Total 50 61 58 114 146 179 72 236 138 68 34 20 17 Smallpox, therefore, although less prevalent in London during 1894 than in the preceding year, was widely distributed over the county, the small district of St. Olave alone being able to claim that not a single case was known to have occurred within its area. The disease was, moreover, distributed over the whole year, but an especially large number of cases (143) was notified in the week ending the 28th July. This exceptional number was due mainly to a serious prevalence of the disease in the district of Marylebone. The very complete measures taken by the sanitary and vaccination authorities of Marylebone, and the opportunities afforded by the Metropolitan Asylums Board for the isolation of the sick proved adequate for the limitation of the extension of the disease. Some of the eastern districts, notably Bethnal-green and Poplar, suffered somewhat heavily in May and June, and the occurrence of smallpox in West Ham was probably associated with this circumstance. In many instances, mild, and at the time unrecognised, cases of smallpox served as centres for the infection of numerous persons. The reports of the medical officers of health of the several districts supply the following information— Paddington—The source of infection of the cases occurring in the first and second quarter was not apparent; of the cases occurring in the third quarter one came from an invaded house in the East-end; of the cases in the fourth quarter there was evidence of the infection of two in other parts of London, and three others appeared to be secondary to cases previously notified. Kensington—A group of cases of smallpox occurred in Kensington due to exposure of the first patient to infection in Shoreditch. The Shoreditch case was not recognised as smallpox 17 until the occurrence of the Kensington cases led the medical officer of health of that district to direct the attention of his colleague in Shoreditch to the case in the latter district. The history of this occurrence briefly told is as follows—In Shoreditch a married woman suffered from smallpox, at first unrecognised ; she was attended by her mother, a resident in Kensington, who sickened in that district, and who was in turn nursed by two other married daughters, both of whom were attacked. The son of one of these daughters and the husband of the other were later attacked, and subsequently a friend who had lived in another house, but who bad been in contact with two of the infected women. The inmates of this house were re-vaccinated, and no further case occurred, Fulham—In the beginning of February two cases of smallpox occurred in different houses in the Margravine ward. The source of infection of these cases was not apparent, but on February 12th a district visitor directed attention to several cases of illness in a house in Greyhound-road. These persons, it was found, had recently suffered from smallpox. The first case was a man who, in the latter part of the previous December, had been employed at the Nottingham Borough Smallpox Hospital in Basford, and who, though strongly advised by the medical superintendent to be re-vaccinated, had positively refused. On the ground floor lived a brother and sister, who kept a small sweetstuff shop, both of whom were suffering from smallpox, the girl attending to the shop with the disease upon her. In the basement was a man and his wife; the former had been attacked about four days previously, and the latter had just recovered from smallpox. Eleven cases of smallpox were due to infection from this house. The report contains a useful table showing the relation of these and other cases of smallpox to each other whenever the connection could be established. Marylebone—In the six months ending June 30th, only five cases of smallpox had been notified, but the medical officer of health reports that " in July, however, a fatal case occurred in Portland Town, under circumstances which, in the first place, absolutely precluded removal to hospital, and in the second place, gave unusual facilities for its dissemination. An outbreak of almost unprecedented character occurred in the immediate locality of the case mentioned, the remote effects of which are even now experienced. This outbreak commenced on July 3rd, when four cases were notified, and during the seven days from the 23rd to the 31st, no less than 139 cases from a limited area were removed to hospital. After that date scattered cases only were reported until August 10th, when there was a smaller but still a serious burst in and around Nightingale-street. The cause of this was satisfactorily traced to infection derived from Portland Town, which had smouldered in Nightingale-street. In other words, cases in Nightingale-street that had not been reported were found to have existed from July 25th up to August 11th. By the end of August 71 cases had been reported in connection with this second outbreak. After August, smallpox declined. In September there were 26 cases; in October, 10; in November, 11 ; and in December, 10. . . . Hence, of the 299 cases reported during the year, the majority of these were derived from the large outbreak in Portland Town and the subsidiary outbreak in Nightingale-street, and they fell for the most part in the months of July and August. The deaths from smallpox amounted to 29, or about 10 per cent. of the attacks The influence of vaccination and vaccination in modifying or preventing attacks, and in diminishing mortality, was strikingly shown. An inspection of the schools also proved that there was a large number of scholars in the affected areas who had either never been vaccinated or had not been efficiently vaccinated. In the Portland Town outbreak a local office was temporarily used as a centre to which messages could be sent, and at which the inspectors and the medical officer of health were in more or less constant attendance. Similarly, in the Nightingale-street outbreak, a local administrative centre was established at the Stone-yard. The facilities which this system gave were so great that the experiment in similar circumstances will certainly be repeated. It was also found useful to employ special medical aid in visiting from house to house, so as to discover cases which would otherwise be unreported. Dr. Carter, who undertook this duty, did as a fact discover a few cases which, had they been neglected, might have formed fresh centres. The great lesson, however, which these outbreaks teach, is the absolute necessity for prompt removal to hospital. The very fact that the outbreaks were due to cases kept at home proves the services which the admirable ambulance organization of the Asylums Board confers on the metropolis, and shows clearly that if every case of smallpox was early diagnosed and removed no spread of the disease would be possible. The officers of the sanitary and disinfecting departments worked well and for long hours, and they were thanked by the vestry for their services. The guardians also rendered most efficient help in giving facilities for re-vaccination and in appointing special officers to aid the public vaccinator, Dr. Greenwood, whose personal assistance was most valuable, and who for a time may be said to have lived in the affected area." St. Giles—Whereas in the preceding year nearly one-third of the cases were removed from the casual and receiving wards of the workhouse and the common lodging houses, in 1894 not a single case was notified from them. St. Luke—The source of infection in three instances was a child who was suffering from a rash, which at the time was erroneously thought to be chicken-pox, and no precautions were therefore taken to prevent the spread of the disease. Shoreditch—The report of the medical officer of health contains a well-arranged table giving the particulars of cases of smallpox in the district and their relation to each other. Special reference is made in the report to a group of cases due, in the first instance, to the attack by smallpox of a pawnbroker's assistant, whose illness, owing to its mildnesa, had escaped observation. This case was followed by the attack of three other assistants, two of [3] 18 whom returned to their homes. No further cases in the parish resulted, but the last two assistants affected some eight or nine other persons elsewhere. Bethnal-green—The medical officer of health gives account of an outbreak of smallpox having origin in two cases of smallpox, which were not reported, remaining in a house in Pollard-street. Nine cases occurred in the neighbourhood, and twenty others from within a radius of half-a-mile, most of which were presumably due to the unreported cases. Mile-end Old-town—Cases occurred from January to June, apparently the continuation of a slight epidemic prevalence of the disease which was experienced in the preceding year. A lodging-house in Mile-end-road " was responsible for five cases." The cases were generally mild, but four deaths from smallpox occurred in the year. Each of these persons was unvaccinated. In connection with these occurrences of smallpox, reference is made to the great use of the shelter which had been provided. Poplar—There was increase of smallpox during 1894 in Poplar, Bromley and Bow, the source of infection of a large number of the cases being unknown. Lewisham— The medical officer of health writes, " I have been allowed by the Board to use the Hither-green Fever Hospital as an isolation hospital in smallpox cases, as it is now no longer used as a hospital. Thus, in all cases of smallpox, the friends of the patient, or all of those who have been in contact with him, can be isolated till they are proved not to havecontracted the disease. This, however, can only be done with their free consent, but so far I have found them very willing to avail themselves of the opportunity. Lee (Charlton)—Eleven cases of smallpox occurred, having their origin in one case in which the nature of the malady was not recognised. The following table shows the number of cases of smallpox notified and the deaths attributed to smallpox belonging to the several sanitary disticts in 1894, together with the case rate in that year and the death rate in 1894 and in the period 1885-93 — Sanitary district. Smallpox. Cases, 1894. Case rate per 1,000 living, 1894. Deaths, 1894. Death rates per 1,000 living. 1894. 1885-93. Paddington 28 .23 3 .020 .017 Kensington 18 .11 — — .026 Hammersmith 10 .09 — — .022 Fulham 40 .36 3 .027 Chelsea 14 .14 — — 009 St. George, Hanover-square 11 .15 1 .013 .021 Westminster 1 .02 — — .018 St. James 3 .13 1 .043 .013 Marylebone 308 223 29 .210 .027 Hampstead 18 .24 3 .040 023 Pancras 97 .42 8 .034 .038 Islington 84 .25 3 .009 .049 Stoke Newington 3 .09 — — . 046 Hackney 36 .17 1 .005 St. Giles 7 .18 1 .026 .065 St. Martin-in-the-Fields 1 .07 — — .044 Strand 5 .22 — — 021 Holborn 8 .25 — — .026 Clerkenwell 7 .11 — — 043 St. Luke 16 .39 1 .024 .036 London, City of 1 .03 — — .028 Shoreditch 29 .24 2 .016 .039 Bethnal-green 85 .66 5 .039 030 Whitechapel 11 15 — — .030 St. George-in-the-East 5 .11 — — .044 Limehouse 9 .16 1 .018 .071 Mile-end Old-town 45 .42 4 .037 .049 Poplar 112 .66 10 .059 .068 St. Saviour, Southwark 2 .08 — — .045 St. George, Southwark 7 .12 — — .084 Newington 15 .13 2 .017 .073 St. Olave — — — .018 Bermondsey 8 .10 1 .012 .077 Rotherhithe 7 17 — — 115 Lambeth 26 .09 1 .004 .040 Battersea 12 .07 2 .012 .020 Wandsworth 3 .02 — — Camberwell 16 .06 2 .008 .087 Greenwich 25 14 — — .066 Lewisham 8 .08 — — .025 Woolwich 14 .33 1 .024 .050 Lee 9 .24 2 .053 .021 Plumstead 22 .37 2 .034 Port of London 7 — — — — London 1,193 27 89 .020* .042* * See footnote (†), page 7, Smallpox & Vaccination, 1894. 19 The deaths attributed to "cowpox and vaccination" in 1894 numbered nine, being slightly below the corrected annual average of the preceding ten years. The report of the Statistical Committee of the Metropolitan Asylums Board for 1894 supplies the following figures, showing the state as to vaccination of the patients suffering from smallpox admitted into the institutions of the Board during the year. Smallpox and vaccination. Age period. Vaccinated. No evidence as to* vaccination. Vaccination cicatrices absent. Admissions. Deathp. Admissions. Deaths. Admissions. Deaths. 0— — — — — 17 7 1— — — — — 17 6 2— 2 — 1 — 11 3 3— — — — — 11 3 4— 3 — 1 — 23 10 5— 1 — 1 — 20 4 6— 7 — — — 12 1 7— 5 — 2 — 17 — 8— 8 — 1 — 13 2 9— 8 — 1 — 9 — 10— 14 — 2 — 8 1 11— 11 — 4 — 12 — 12— 25 — 3 — 8 2 13— 20 — 1 — 6 — 14— 32 — 3 1 8 — 15— 144 2 9 — 24 2 20— 162 7 11 4 14 5 25— 108 7† 5 — 8 4½ 30— 91 8 5 — 5 1 35— 55 4 3 1 4 2 40— 75 5 6 — 4 2 50 and upwards 26 5 9 2 1 1 All ages 797 38 68 8 252 56 It will be observed that 797 vaccinated persons and 252 persons without vaccination cicatrices were admitted into the hospitals of the managers, and in considering these numbers, relative proportions of the vaccinated and unvaccinated populations of London have to be borne in mind. It will scarcely be claimed that the lamentable neglect of vaccination in recent years has yet raised the unvaccinated population to 22 per cent. of the total population, a result which would be necessary if we are to assume that the unvaccinated population has not contributed more proportionately to these hospital admissions than the vaccinated populations. Again it will be observed that the cases admitted at the earlier ages consist much more largely of patients without cicatrices than of vaccinated patients, and that the case mortality of the former has been considerably greater than that of the vaccinated. Reference to diagram V. will enable the mortality of patients above and below 15 years of age to be considered in relation to their state as to vaccination. Since 1880 the Registrar-general has classified the deaths from smallpox under three heads, viz., "vaccinated." "unvaccinated," and " no statement." The totals of the 14 vears, 1881-94, are as follows— Smallpox deaths, London—1881-94. Age-period. All ages. 0-1 1-5 5-20 20-40 40-60 60-80 80 and upwards Vaccinated 1,261 22 32 227 721 221 35 3 Unvaccinated 1,998 323 478 662 411 105 18 1 No statement 1,880 240 224 453 656 244 60 3 The following table, in which the number of deaths at each age-period is expressed as a percentage of the total deaths from smallpox at " all ages," more clearly indicates the relative ageincidence of this disease in the three classes under consideration— "All ages" taken as 100. Age period. All ages. 0-1 1-5 5-20 20-40 40-60 60-80 80 and upwards Vaccinated 100 1.7 2.5 18.0 57.2 17.5 2.8 0.2 Unvaccinated 100 16.2 23.9 33.1 20.6 5.3 0.9 0.1 No statement 100 12.8 11.9 24.1 34.9 13.0 3.2 0.2 " Vaccinated" and " No statement" combined. "Vaccinated" and "No statement" 100 8.3 8.1 21.7 43.8 14.8 3.1 0.2 Unvaccinated 100 16.2 23.9 33.1 20.6 5.3 0.9 0.1 * These cases include cases stated to have been vaccinated, but bearing no visible evidence of the operation, and also those in which no statement was made, but the nature of the eruption or other cause prevented any observation of the marks, if any existed, †Two deaths occurred among patients admitted during 1893. 20 The above tables show a marked difference in the age-incidence of the disease between the vaccinated and unvaccinated, a difference which is still conspicuous if the " vaccinated " and " no statement " figures are combined. I have referred in my previous reports to the large increase in recent years in the number of children appearing in the vaccination returns as " not finally accounted for" ; the following table shows the proportion of children born in London stated in the returns of the Local Goverment Board as " not finally accounted for " during several years to the year 1892:— London Vaccination Returns. Children not finally accounted for (including cases postponed) per cent. of total births. Children not finally accounted for (including cases postponed) per cent. of total births. 1881 5.7 1887 9.0 1882 6.6 1888 7.4 1883 6.8 1889 11.6 1884 6.8 1890 13.9 1885 7.0 1891 16.4 1886 7.8 1892 18.4 The following table gives similar information for each of the metropolitan unions for the years 1881.93, inclusive— Metropolitan Unions. 1881. 1882. 1883. 1884. 1885. 1886. 1887. 1883. 1989. 1890. 1891. 1892. 1893. Bethnal.green 5.5 7.1 6.1 8.0 8.6 11.1 13.5 16.0 25.1 30.6 38.2 53.1 54.8 Camberwell 5.2 6.0 6.4 7.0 6.8 8.4 9.4 8.4 12.5 14.0 17.4 15.5 132. Chelsea 5.1 6.7 5.2 5.1 5.0 5.6 7.2 4.8 6.0 6.3 16.7 12.1 11.8 Fulham 5.4 4.1 3.8 4.2 4.5 4.5 4.6 5.5 6.0 6.7 5.8 6.5 9.5 St. George, Hanover-square 2.3 4.4 3.1 2.9 4.6 4.3 4.6 4.5 4.0 3.6 3.7 3.4 3.5 St. George-in-the-East 4.2 4.3 4.7 3.7 4.8 5.3 6.7 7.9 6.5 7.9 8.6 9.4 10.8 St. Giles and St. George 11.6 9.9 11.4 11.6 11.1 12.2 14.1 17.7 22.5 17.8 13.6 18.1 19.3 Greenwich 6.6 7.8 10.2 10.4 11.1 11.4 9.6 10.1 11.5 32.3 19.4 9.8 7.1 Hackney 4.6 6.7 6.2 6.5 9.3 9.3 8.9 12.1 18.5 26.0 40.6 49.5 52.8 Hampstead 3.1 4.0 5.1 4.2 3.8 4.0 5.0 5.6 5.1 6.3 7.1 6.9 6.7 Holborn 6.2 7.6 8.5 9.7 8.1 7.7 8.7 10.3 11.3 12.4 12.7 14.2 14.2 Islington 8.2 8.0 8.4 8.0 8.0 7.8 8.1 9.8 9.5 9.2 10.8 12.4 12.8 Kensington 3.9 5.4 4.6 4.9 5.5 6.5 7.0 6.9 7.5 7.6 9.6 10.3 9.2 Lambeth 7.6 8.3 8.5 8.6 8.6 9.4 11.1 12.6 13.3 14.3 16.0 19.6 19.9 Lewisham 3.2 4.1 4.8 4.2 5.2 5.0 6.5 5.9 6.6 6.3 6.2 6.6 6.8 City of London 2.9 2.9 2.4 3.9 7.4 8.0 8.0 9.0 9.2 10.3 8.8 9.3 9.3 Marylebone 5.1 6.8 5.5 7.3 5.4 4.6 4.7 4.9 8.1 7.7 13.4 16.9 24.8 Mile.end Old.town 7.5 8.8 9.8 8.7 8.8 9.7 11.3 14.4 16.6 26.5 49.9 58.8 43.5 St. Olave 4.1 5.9 10.0 7.3 8.0 9.0 17.7 15.0 15.4 14.8 15.3 15.8 16.5 Paddington 7.7 9.2 8.8 8.2 8.8 10.1 8.4 11.3 12.7 11.6 17.7 12.6 10.0 St. Pancras 6.3 5.7 4.0 5.2 6.1 6.9 8.7 11.5 13.2 15.1 15.6 15.7 15.8 Poplar 4.4 4.0 3.6 3.8 3.0 4.9 5.7 16.9 15.1 19.5 19.6 23.6 23.1 St. Saviour 5.7 6.7 6.0 8.7 9.1 13.1 18.9 17.1 12.4 11.6 12.4 12.7 14.9 Shoreditch 10.3 12.0 7.6 6.5 5.6 6.3 5.6 3.7 5.5 9.3 8.8 10.8 16.2 Stepney 6.2 4.8 2.3 3.7 4.1 5.9 5.3 6.5 8.8 12.0 19.0 22.7 26.2 Strand 7.2 8.3 7.6 9.3 8.9 8.5 9.7 10.0 16.2 7.1 12.2 15.4 12.6 Wandsworth and Clapham 5.4 7.1 9.0 8.2 9.1 9.7 10.6 11.5 12.1 12.9 14.7 18.5 12.2 Westminster 4.8 5.7 6.1 5.7 6.6 8.5 8.5 4.1 12.8 13.2 17.0 23.0 28.0 Whitechapel 1.4 1.6 1.6 1.4 1.5 1.8 1.7 2.1 2.8 2.7 4.1 4.4 5.3 Woolwich 1.9 1.4 1.5 1.6 1.8 2.2 2.2 2.9 3.5 3.7 3.6 3.7 3.5 Measles. The deaths from measles in London in 1894 numbered 3,303, or nearly twice the number of deaths which occurred from that cause in 1893. The death rates per 1,000 living in 1894 and previous periods have been as follows— 1851-60 0.53 1891 0.43* 1861-70 0.58 1892 0.79* 1871-80 0.51 1893 0.38* 1881-90 0.64 1894 0.76* The death rate in each year since 1840, in relation to the mean of the period 1841-94, is shown in diagram VI. If the London death rate be compared with those of other large towns in England having more than 200,000 inhabitants, it will be seen that London had in the period 1884-93 a higher death rate than all these towns except Manchester, Liverpool and Salford, and in 1894 had a higher death rate than all except West Ham. *See footnote (†), page 7. Diagram VI Measles. 21 Measles—Death rates per 1,000 living. 1884-93. 1894. 1884-93. 1894. London 0.61 0.76* West Ham 0.55 0.96 Manchester 0.81 0.43 Bristol 0.54 0.50 Liverpool 0.89 0.59 Bradford 0.50 0.51 Birmingham 0.53 0.67 Nottingham 0.48 0.60 Leeds 0.55 0.75 Hull 0.44 0.43 Sheffield 0.53 0.49 Salford 0.84 0.71 Compared with the undermentioned foreign cities the death rate in London from measles has been in excess of the majority both in the period 1884-93 and in the year 1894— Measles—Death rates per 1,000 living. 1884-93. 1894. 1884-93. 1894. London .61 .76* St. Petersburg .73 .96 Paris .52 .41 Berlin .22 .20 Brussels .35 .24 Vienna .54 .60 Amsterdam .50 .18 Rome .62 .28 Copenhagen .49 .41 New York ... .42 .30 Stockholm .54 .52 The greatest incidence of measles in London has, in 1894, been upon the eastern districts, and upon those of the southern districts of London having a population containing many poor. The increase in the year has naturally led to the further discussion of the value of notification of measles as a means of limiting the extension of the disease. It will be recollected that the London School Board in 1892 addressed a letter to the Council expressing the opinion that such notification should be made compulsory in London, and that, after communication with the Local Government Board, the Council resolved to postpone discussion of the question until that Board had completed an enquiry which it had undertaken with a view to ascertaining the value of notification of measles in urban communities. It may be expected that such inquiry will include an investigation into the results obtained by certain authorities who have limited their requirement of notification to the first case occurring in a house or family. In view of the information contained in the reports of London medical officers of health as to the diffusion of measles by school attendance, there is need of some system which will give better opportunity for the exclusion from school of children living in infected houses. The chief points referred to in the reports of the medical officers of health are as follows— Kensington—The medical officer of health in discussing the effects of epidemic prevalence of disease on school attendance says, " It is surprising to what an extent the attendance in the infants' department of elementary schools is reduced during the currency of an epidemic of measles. In one large school in this parish during the three weeks ended June 2nd the absentees were 50 per cent. of the children, viz., 260 out of an average number of 523 on the roll. But not all the children were absent on account of being ill with measles, some having been kept from school owing to the infection in the houses wherein they resided, and some, of course, from other causes." In discussing the question of hospital provision he expresses the opinion that many lives might be saved were it practicable to isolate in hospital children suffering from measles, " especially such as live in overcrowded houses tainted with foul air, and under conditions which preclude the care so necessary in the nursing and management of measles." He refers to the requirement of the London School Board that children living in infected houses shall not attend the Board's schools, and to his suggestion made in 1890 that a circular letter informing parents of this requirement should be sent to the parents of pupils, a course, he says, which was not adopted. " Such a communication, if systematically made at the beginning of an epidemic of any infectious disorder, would probably be the means of saving many lives ; it would certainly have the effect of checking the spread of measles in the only practicable way short of closing schools." Fulham—The medical officer of health referring to the prevalence of measles in the district during the year says that " the epidemic began in the southern part of the parish, among the children attending the Langford-road Board School, which was, at the request of the sanitary authority, closed from March 1st to March 28th with apparently good effect to the district served by it." In discussing the question of notification of measles, he estimates that the deaths in Fulham from this cause, some 160 in number must have represented 4,000 cases, and says the results of notification in other communities do not seem, in the absence of isolation hospitals, to be commensurate with the heavy outlay incurred. But he refers to a modified system of notification by which the first attack in every house only is notified, and states his opinion that this, at any rate, would have the effect of impressing parents with a sense of the serious nature of the disease, and would give better control over the attendance at school of children from infected houses. Commenting on the heavy mortality among children unfavourably circumstanced, he expresses the hope that some hospital provision for such cases will before long be provided. *See footnote (*), page 8. 22 Westminster—The medical officer of health mentions the notification of 227 cases of measles up to the 1st April, 1894, when the vestry decided to abandon notification.* Hampstead—The medical officer of health reports that measles was epidemic in Town and Kilburn wards, being chiefly spread by the agency of schools. Poplar—Arrangements were made for the registrars of death to give immediate notice of death from measles to the medical officer of health in order that the premises and clothing might be disinfected. Plumstead—A card, prepared by the medical officer of health, giving advice as to the precautionary measures to be adopted in the event of occurrence of measles, was left at every house. Wandsworth (Clapham)—Efforts were made to prevent the attendance at school of children from invaded families in all cases which became known to the medical officer of health, who expresses the opinion that the great advantage of notification of the disease would be the ability to adopt this course universally. The measles death rate in each sanitary district in 1894 and in the period 1885-90 is shown in the following table— Sanitary district. Deal ha in 1894. Death rate per 1,000 living. Sanitary district. Deaths in 1894. Death rate per 1,000 living. 1894. 1885-93. 1894. 1885-93. Paddington 66 .54 .41 Whitechapel 66 .88 .70 Kensington 111 .67 .48 St. George-in-theEast 49 1.08 1.08 Hammersmith 71 .67 .70 Fulham 161 1.45 Limehouse 93 1.64 103 Chelsea 70 .71 .59 Mile-end Old-town 157 1.45 .68 St. George, Hanoversquare 31 .41 .33 Poplar 214 1.25 .67 St. Saviour, Southwark 46 1.73 .87 Westminster 35 .64 .57 St. James 13 .55 .48 St. George, Southwark 80 1.34 .87 Marylebone 88 .64 .57 Hampstead 31 .41 .23 Newington 103 .87 .69 Pancras 95 .41 .63 St. Olave 19 1.47 .69 Islington 204, .62 .62 Bermondsey 79 .94 .75 Stoke Newington 2 .06 .48 Rotherhithe 41 1.02 .63 Hackney 186 .88 Lambeth 181 .64 .53 St. Giles 15 .39 .67 Battersea 151 .94 .52 St. Martin-in-theFields 9 .65 .44 Wandsworth 75 .42 Camberwell 186 .75 .55 Strand 16 .69 .63 Greenwich 144 .83 .60 Holborn 23 .71 .70 Lewisham 51 .51 .28 Clerkenwell 49 .75 .94 Woolwich 39 .92 .51 St. Luke 14 .34 .99 Lee 11 .29 .45 London, City of 3 .09 .29 Plumstead 21 .36 Shoreditch 69 .56 .85 London 3,303 .761 '61‡ Bethnal-green 135 1.04 .89 Scarlet Fever. The cases of scarlet fever notified in London in 1894 numbered 18,495 compared with 36,953 in the previous year. The number of deaths registered from this cause in 1894 was 961, giving a death rate of 0.22 per 1,000 living, and a case mortality of 5.2 per cent. The London rates in 1894 and previous periods are shown in the following table— Period. Death rate per 1,000 living. Case rate per 1,000 living. Case mortality per cent. 1861-70 113 —† - 1871-80 0.60 —† - 1881-90 0.33 —† - 1891 0.14‡ 2.7 5.1 1892 0.27‡ 6.4 4.3 1893 0.37‡ 8.6 4.3 1894 0.22‡ 4.2 5.2 Diagram VII. shows the London scarlet fever death rate in each year since 1858 in relation to the mean of the period 1859-94. * The resolution of a Sanitary Authority requiring the notification would only have validity if subsequently confirmed by the Local Government Board. In this matter the Local Government Board did not confirm the acticn of the Vestry, †The Infectious Diseases (Notification) Act only came into force in 1889. ‡See footnote (†), page 7. DiagramVII Scarlet Fever. Diagram VIII Scarlet Fever. 23 The scarlet fever death-rate of London can be compared with that of other large English towns having a population of more than 200,000 inhabitants by reference to the following table— Scarlet fever—Death rates per 1,000 living. Ten years, 1884-93. 1894. Ten years, 1884-93. 1894. London 26 .22+ West Ham .27 .15 Manchester .43 .22 Bristol .27 .07 Liverpool .49 .45 Bradford .31 .32 Birmingham .20 .15 Nottingham .17 .23 Leeds .43 .13 Hull .19 .18 Sheffield .58 .12 Salford .57 .55 In the period 1884-93, therefore, the London rate was lower than that of any of these towns except Birmingham, Nottingham, and Hull, and in 1894 was only exceeded by those of Liverpool, Bradford, Nottingham, and Salford. If the London death rate of scarlet fever be compared with the death rates of the following ten foreign cities, it will be seen that in 1884-93 the London rate was exceeded by that of only three of these cities, while in 1894 it was exceeded bv six— Scarlet fever—Death rates per 1,000 living. 1884-93. 1894. 1884-93. 1894. London 26 .22† St. Petersburg .66 .59 Paris .09 .06 Berlin .21 .26 Brussels .05 .05 Vienna .20 .31 Amsterdam .20 .04 Rome .05 .02 Copenhagen .24 .67 New York .50 .27 Stockholm .80 .36 In the following table will be found the age distribution of the cases of scarlet fever which were notified during the year, and the case mortality at each age. As in 1893 the greatest incidence of the disease was upon males and females between four and five years of age ; but it may be said that the greatest incidence of death was on males between one and two years, and on females between three and four years of age, whereas, in the preceding year, the greatest incidence of death was on males between three and four years, and on females between two and three years of age. The statistics of 1891, however, show no practical difference between the death rates of males at the several ages, 1, 2 and 3. So again the statistics of that year show no practical difference between the death rates of females at the ages one and two. While the case rates at " all ages " of males and females are practically equal, the male death rate at " all ages " is somewhat higher than that of females. The highest case mortality was among males between one and two years of age, and among females under one vear. * Scarlet fever, 1894. Age period. Males. Females. Cases. Deaths. Case mortality per cent. Rates per 100,000 living. Cases. Deaths. Case mortality per cent. Rates per 100,000 living. Cases. Deaths. Cases. Deaths. All ages. 8,737 491 56 425 24 9,703 483 50 423 21 0— 177 26 14.7 318 47 141 26 18.4 249 46 1— 393 78 19.8 788 156 419 70 16.7 832 139 2— 663 81 12.2 1,27 1 155 665 74 11.1 1,269 141 3— 832 78 9.4 1,646 154 877 82 9.4 1,695 159 4— 821 72 8.8 1,670 146 932 56 6.0 1,888 113 5— 3,551 120 3.4 1,522 51 3,865 126 3.3 1,640 53 10— 1,386 19 1.4 651 9 1,661 27 1.6 765 12 15— 438 6 1.4 215 3 516 6 1.2 228 3 20— 221 5 2.3 110 2 263 8 3.0 109 3 25— 198 5 2.5 57 1 274 6 2.2 69 2 35— 38 1 2.6 15 — 62 2 3.2 22 1 45— 14 — — 8 — 17 — — 8 — 55 and upwards. 5 — — 3 — 11 — — 5 — * In the preparation of this table, the question whether the persons, who were attacked and who died, belonged to London is disregarded, the percentage being calculated on the number of cases notified in London, and the number of deaths occurring in London and the institutions belonging to London. Inasmuch as the age of the patient is not in all cases recorded in the notification certificate, it has been necessary to distribute such cases among the various ages proportionat ely. †See footnote (*), page 8. 24 It has already been pointed out that the scarlet fever case mortality of 1894 was 5.2 per cent. whereas in the preceding year it was 4.3 per cent. The case mortality at "all ages" may be affected by more than one circumstance. There was for instance, in 1893, a considerable prevalence of the disease at the end of the year, and hence an excessive number of deaths was registered in the first two weeks of 1894, which even when dealing with the large figures London supplies, naturally increases the apparent case mortality of 1894 when this is calculated upon the number of cases notified and the number of deaths registered in that year. Again the age and sex distribution of cases in a year is another factor which, it will be seen from the preceding table, must needs affect the case mortality at " all ages." Thus, if the age distribution of the cases in 1894 had been the same as in 1893, the case mortality at "all ages" cæteris paribus would have been 4.9 instead of 5.28, and if further correction could be made for the number of deaths registered in the first two weeks of 1894, among attacks notified in 1893, the case mortality at " all ages in 1894 would no doubt be still further reduced. Beyond this is another modifying element which deserves to be taken into consideration. The figures which are now supplied by the system of notification of infectious diseases in force in London are sufficiently large to justify inquiry whether the case mortality of the disease is the same at all periods of the year with a view to the elimination of influence, if any, of season. For this purpose the following table has been prepared and the cases notified during 1894 have been cast into months. The deaths have been dealt with in a similar manner, except that each month's deaths begin a week later than each month's cases, so as to associate the deaths more closely with the cases to which they belong. The approximate case mortality of each month can therefore be seen— Scarlet fever case mortalitxj, 1894. Month. No. of weeks. Cases. Deaths. Case mortality per cent. Mean case mortality taken as 100. January 5 2,039 105 5.15 101 February 4 1,420 80 5.63 110 March 4 1,414 75 5.30 104 April 4 1,631 112 6.87 135 May 5 1,850 96 5.19 102 June 4 1,437 73 5.08 100 July 4 1,517 87 5.73 112 August 5 1,545 76 4.92 96 September 4 1,450 57 3.93 77 October 5 1,809 66 3.65 72 November 4 1,278 59 4.62 91 December 4 1,050 55 5.24 103 The above table shows that the case mortality of this year was above the mean at the beginning and end of the year, and below the mean in the late summer and early autumn months. With a view to obtaining more trustworthy results a similar table has been prepared based on the cases and deaths occurring in the years 1891-94. Scarlet fever case mortality, 1891-94. Month. Cases. Deaths. Case mortality per cent. Mean case mortality taken as 100. January 5,470 339 6.20 136 February 4,568 259 5.67 124 March 5,051 285 5.64 123 April 5,682 317 5.58 122 May 7,107 321 4.52 99 June 7,833 374 4.77 104 July 8,849 379 4.28 94 August 9,698 436 4.50 98 September 11,032 380 3.44 75 October 11,590 385 3.32 73 November 10,630 449 4.22 92 December 6,322 366 5.79 127 This table exhibits a decided tendency of the case mortality to be at its maximum at the beginning of the year, to fall to a minimum in September and October, and then to increase in successive months until the maximum is again reached. This " seasonal " variation in case mortality is matter of considerable interest, and not least for the reason that the months of greatest prevalence of disease are not the months of greatest case mortality. In view of what has been shown as to the effect on the case mortality at "all ages " of the season of the year, it is necessary to determine whether this seasonal variation may not be itself dependent on differences in the age and sex distribution of the cases notified. 25 It will be seen from the table relating to 1894 (page 24) that the scarlet fever case mortality reached its maximum in April and its minimum in October, the case mortality in the former month being nearly twice as great as that in the latter. In order to ascertain whether the difference in the case mortality of the disease in these two months was due to differences in the age and sex distribution of the cases, I have prepared the following table, showing for each sex at several age periods what would have been the deaths had the case mortality been in April and in October the same for each age and sex as actually occurred over the whole vear 1894. It thus appears that had the case mortality at each age and for each sex been the same in each of these months as in the whole of 1894 the number of deaths occurring among the 1,631 cases of both sexes notified in April would have been 85*52, giving a case mortality at " all ages" of 5 24 per cent.; similarly among the 1,809 cases of both sexes notified in October, the deaths would have been 96.73, and the case mortality 5.35 per cent. It is therefore apparent that the difference between the actual case mortalities in the two months in question, viz., a difference between 6'87 and 3.65 (the case mortalities shown in the table for 1894) is not explicable on the ground of a difference in the age and sex distribution of the cases notified. It is obvious, therefore, that as the case mortality varies at different periods of the year, the "seasonal " distribution of the cases notified must influence the case mortality at " all ages " calculated on the figures for the whole year. Thus in 1893 a much larger proportion of the cases in that year occurred in the late summer and autumn months than in 1894, a circumstance that would tend to make the case mortality of 1893 lower than that of 1894. In point of fact, it may be stated that if correction be made for all the causes of variation pointed out, the " all ages" case mortalities of 1893 and 1894 become practically identical. The subject evidently needs farther investigation, but the inquiry already made points to the following conclusions— (a) That after due correction for differences in the age and sex distribution of the cases notified, the case mortality of scarlet fever varies to a considerable extent at different periods of the year. (b) That in comparing the case mortality at " all ages" of one year with another due correction must be made for— (1) Differences in the age and sex distribution of the cases notified, and (2) Differences in the " seasonal" distribution of the disease. Hospital accommodation. It will be seen by reference to diagram VIII. that the percentage of cases notified in London admitted to the hospitals of the Board was higher than that of any preceding year, the number of cases admitted during the year being 11,598 or 62.9 per cent. of the total cases notified, and the number of deaths occurring in these hospitals being 717 or 74.6 per cent. of the total deaths registered in London from this disease. Scarlet fever and elementary schools. In my last report I discussed the subject of the part played by elementary schools in the dissemination of scarlet fever, and showed that a marked decrease in the number of cases notified occurred in 1892 and 1893 at a time which corresponded with the summer holiday of the children attending London School Board schools, and that there was a marked increase in the number of cases notified at a time which corresponded with the re-opening of these schools at the close of the holidays, due allowance being made for a period of incubation and for a little delay in notification. Also I showed that this decrease was especially marked in the case of children at the school age period of life. With a view to learning whether the experience of the year 1894 points in the same direction as that of the two preceding years, the notified cases in each week of the year have been divided into three age groups, viz., children under three years of age, children from 3 to 13, and persons above 13 years of age. [4] Scarlet fever in April and in October, 1894, Age period. April. October. Male. Females. Males. Females. Cases. Estimated deaths. Cases. Estimated deaths. Cases. Estimated deaths. Cases. Estimated deaths. All ages. 742 41.11 889 44.41 907 50.02 902 46.71 0— 11 1.62 15 2.76 15 2.21 19 3.50 1— 33 6.53 34 5.68 38 7.52 45 7.52 2— 60 7.32 64 7.10 63 7.69 64 7.10 3— 66 6.20 81 7.61 80 7.52 77 7.24 4— 75 6.60 83 4.98 89 7.83 83 4.98 5— 272 9.25 361 11.91 411 13.97 369 1218 10— 119 1.67 151 2.42 143 2 00 159 2.54 15— 57 .80 44 .53 32 .45 35 .42 20— 19 .44 18 .54 18 .41 20 .60 25— 22 .55 34 .75 15 .37 24 .53 35— 5 13 4 .13 2 .05 3 .10 45— 3 — — — 1 — 1 — 55 and upwards. — — — — — — 3 — 26 The London School Board's schools generally closed on the 26th July, i.e., at the end of the 30th week of the year, and generally re-opened on the 27th August, i.e., at the beginning of the 35th week of the year. The effect, therefore, of the closing might be expected to be manifested in a reduction of the number of cases notified in the 32nd week, and the effect of re-opening to be manifested by an increase in the number of cases notified in the 36th week. Comparison of diagram IX. relating to 1894, with similar diagrams published in my last report relating to 1892 and 1893, shows that these changes are less marked in the year 1894. The year 1894 was characterized by irregularity in the behaviour of the disease in successive weeks and by the absence of the increase usual in the latter part of the year. There was decrease in the 30th and 31st weeks which was accentuated during the period 32nd—36th week, no very obvious increase occurring until the 37th week. The diagram undoubtedly shows diminished scarlet fever prevalence in the four weeks which might be expected to be influenced by closure of the School Board's schools, but the decrease began two weeks earlier and was continued one week later than would be explicable on this hypothesis alone. Whether this difference between the behaviour of scarlet fever in 1892 and 1893 on the one hand, and 1894 on the other, is due to irregularity in the behaviour of the disease in 1894, or to closure of some other schools than those of the School Board and at some other times than those of the Board, I am unable to say, for I have no information as to the date of closing of any other elementary schools than those of the Board. The following figures enable comparison to be made between the number of cases notified in three periods of four weeks, viz., in the 28th-31st weeks, in the 32nd-35th weeks, and in the 36th-39th weeks. Notified cases—Ages. Increase or decrease per cent. 0—3 3—13 13 and above. 0—3 3—13 13 and above. Four weeks preceding holiday influence (28th—31st week) 204 1,026 220 — — — Four weeks of holiday influence (32nd—35th week) 189 808 181 —7.4 —21.2 —17.7 Four weeks following holiday influence (36th—39th week) 176 1,079 175 —6.9 +33.5 —3.3 It will be seen that at each age there was decrease in the number of cases in the second period, but that this decrease was most manifest in children at the school age. Again, while there was decrease in the third period among infants under 3 years and among persons over 13 years of age, the number of cases among children at the school age increased 33'5 per cent. These figures accord with a hypothesis that the interruption of school operations was responsible for some part of the decrease in the second period of cases among children at school age, and that the increase of cases among these children in the third period was largely due to the re-opening of the schools. The experience of the years 1892-4 satisfies me that this hypothesis is correct. The reports of a few medical officers of health make reference to the occurrence of cases of scarlet fever in houses shortly after the return from hospital of an antecedent case. Thus the medical officer of health of Fulham states that in twenty-four instances the disease recurred in the family within seven days of the return to it of a patient. The medical officer of the Bow district of Poplar mentions one case in which the return of a child after 14 weeks' absence in hospital was shortly followed by the appearance of scarlatina in another child of the family. A similar experience was noted after shorter absence both in Camberwell and in Kidbrooke. The report relating to Shoreditch comments on the absence of the occurrence of such cases in that district. In the districts of St. George, Hanover-square, and Westminster, there were prosecutions for neglect to notify cases of scarlet fever, and in Whitechapel and Bethnal-green for wilful exposure of infectious persons. Only two references are made in the annual reports to outbreaks of any magnitude. The former of these occurred in Plumstead among the pupils of the Slade Board School " causing quite an epidemic in the neighbourhood," the latter in the Shooter's-hill-road, Greenwich. Inasmuch as the latter outbreak involved more than one district, I investigated its circumstances. In my inquiry I was cordially assisted by the medical officers of health of Greenwich and Kidbrooke, in whose districts the exceptional prevalence of disease was manifested, and who freely placed at my disposal the information they themselves obtained. The investigation clearly pointed to the milk distributed from a particular farm in Kidbrooke, as the cause of this outbreak, and there was no reason for thinking that the milk had become infected by human agency. Among the cows supplying the milk were certain animals having ulcerated teats. Effort was made, by inquiry as to the circumstances of the distribution of the milk from these and other cows, to learn whether there was reason for associating the milk of the former with the cases of scarlatina occurring among the consumers of milk from the farm ; but the evidence was conflicting, and it was impossible to arrive at any conclusion. Appended is a report on this subject which I presented to the Public Health Committee. (See Appendix I.) In the several sanitary districts the case rate ranged between 1.5 per 1,000 in St. Martin-inthe-Fields and 8.2 per 1,000 in Rotherhithe, and the death rate between .0 in Holborn and .58 in Limehouse. Diagram IX. Notified Cases. Scarlet Fever, 1894. 27 The following table shows the number of cases and deaths and the case and death rates of each district in 1893 and in the period 1885-92— Sanitary district. Cases, 1894. Case rate per 1,000, 1894. Deaths, 1894. Death rates per 1,000. 1894. 1885-93. Paddington 288 2.4 14 .12 .14 Kensington 385 2.3 22 .13 .17 Hammersmith 330 3.1 14 .13 .22 Fulham 535 4.8 33 .30 Chelsea 318 3.2 16 .16 .18 St. George, Hanover-square 257 3.4 11 .15 .16 Westminster 142 2.6 7 .13 .25 St. James 59 2.5 3 13 .17 Marylebone 560 4.1 40 .29 .19 Hampstead 232 3.1 10 .13 11 Pancras 1,274 5.5 51 .22 .20 Islington 1,512 4.6 69 .21 .17 Stoke Newington 92 2.7 6 .18 .24 Hackney 1,030 4.9 57 .27 St. Giles 87 2.3 2 .05 .18 St. Martin-in-the-Fields 21 1.5 1 .07 .21 Strand 56 2.4 1 .04 .20 Holborn 80 2.5 — — .26 Clerkenwell 223 3.4 10 15 .30 St. Luke 124 3.0 10 .24 .37 London, City of 80 2.3 9 .26 .17 Shoreditch 486 4.0 28 .23 .31 Bethnal-green 512 4.0 27 .21 .44 Whitechapel 269 3.6 23 .31 .27 St. George-in-the-East 219 4.8 18 .40 .39 Limehouse 376 6.6 33 .58 .43 Mile-end Old-town 578 5.4 37 .34 .38 Poplar 799 4.7 40 .23 .33 St. Saviour, Southwark 103 3.9 6 .23 .36 St. George, Southwark 287 4.8 17 .28 .44 Newington 549 4.6 19 .16 35 St. Olave 34 2.6 4 .31 .34 Bermondsey 391 4.7 23 .27 .35 Rotherhithe 330 8.2 15 .37 .28 Lambeth 1,173 4.2 64 .23 .24 Battersea 834 5.2 32 .20 .19 Wandsworth 674 3.8 20 .11 Camberwell 933 3.8 46 .19 .24 Greenwich 1,053 6.1 59 .34 .20 Lewisham 313 3.1 12 .12 .10 Woolwich 238 5.6 22 .52 .12 Lee 180 4.7 7 .18 .17 Plumstead 461 7.8 23 .39 Port of London 18 — — — London 18,495 4.2 961 .22‡ .24+ Diphtheria. The cases of diphtheria* notified in London in 1894 numbered 11,204, compared with 13,712 in 1893, and 8,368 in 1892. The number of deaths registered from this cause in 1894 was 2,642, compared with 3,197 in 1893, and 1,859 in 1892. The figures quoted for 1894 give a death rate of 0'61 per 1,000 living:, and a case mortality of 23'6 per cent. The diphtheria rates in 1894 and in previous periods are shown in the following table— Period. Death rate per 1,000 living. Case rate per 1,000 living. Case mortality per cent. 1861-70 0.18 —† — 1871-80 0.12 —† — 1881-90 0.26 —† — 1891 0.31‡ 1.5 22.5 1892 0.44‡ 2.0 22.2 1893 0.74‡ 3.2 23.3 1894 0.61‡ 2.6 23.6 *Unless otherwise stated, cases of "Diphtheria" include "Membranous Croup." † The Infectious Diseases (Notification) Act only came into force in 1889. ‡See footnote (†) page 7. 28 The death rate in each year since 1858 in relation to the mean of the period 1859-94 is shown in diagram X., the dotted line in the diagram also showing the death rate in relation to the mean of diphtheria and croup. If the London death rate from diphtheria be compared with those of other English towns having a population of more than 200,000 inhabitants, it will be seen that London in the period 1884-93 had a higher rate than that of any of these towns except Salford, which it equalled, and that in 1894 London had a higher rate than any of these towns except West Ham. Diphtheria—Death rates per 1,000 living. Ten years, 1884-93. 1894. ... ... Ten years, 1884-93. 1894. London 0.35 0.61§ West Ham 0.28 0.80 Manchester 0.23 0.28 Bristol 0.11 0.21 Liverpool 0.316 0.19 Bradford 0.06 0.08 Birmingham 0.13 0.15 Nottingham 0.10 0.08 Leeds 0.08 0.19 Hull 0.08 0.14 Sheffield 0.11 0.20 Salford 0.35 0.31 The following table enables comparison to be made between the diphtheria death rate of London in 1884-93 and 1894 and the corresponding diphtheria death rates in ten foreign cities— Diphtheria—Death rates per 1,000 living. 1884-93. 1894. 1884-93. 1894. London .35 .61§ St. Petersburg .49 1.02* Paris .69* .42* Berlin 1.00 .80 Brussels .13 .24* Vienna .66† 1.11 Amsterdam .38 .22 Rome .41 .09 Copenhagen .82 .66 New York 1.02 1.20 Stockholm .97* .93* The year 1894 is characterised by a marked decrease in the death rate from diphtheria after continued increase in three successive years. The following table shows that in 1894 the disease has especially attacked males and females at the younger ages; also that there has been a greater incidence on females than on males if the totals at " all ages " be considered, but that up to two years of age males have suffered more heavily than females, and that after this age the greater incidence has been on females. This is especially marked when 20 years of age is reached, a result probably due to the fact that the care of the sick is usually undertaken by women. The death rate of males at " all ages " and up to two years of age has also been greater than that of females, but females have at subsequent ages generally suffered a heavier mortality than males. So, again, the case mortality has been greater in the case of males than in the case of females at " all ages, but not at each of the several ages. ‡Diphtheria, 1894. Age period. Males. Fenjales. Cases. Deaths. Case mortality per cent. Rates per 100,000 living. Cases. Deaths. Case mortality per cent. Rates per 100,000 living. Cases. Deaths. Cases. Deaths. All ages. 4,987 1,287 25.8 243 63 6,203 1,431 23.1 270 62 0— 166 93 56.0 298 167 115 67 58.3 203 118 1— 380 226 59.5 762 453 353 207 58.6 701 411 2 448 199 44.4 859 381 477 241 50.5 910 460 3— 587 238 40.5 1,161 471 605 227 37.5 1,169 439 4— 520 164 31.5 1,058 334 548 200 36.5 1,110 405 5— 1,510 280 18.5 647 120 1,830 395 21.6 776 168 10— 535 45 8.4 251 21 749 47 6.3 345 22 15— 259 10 3.9 127 5 377 11 2.9 166 5 20— 177 8 4.5 88 4 367 9 2.5 152 4 25— 253 6 2.4 73 2 477 14 2.9 120 4 35— 94 6 6.4 37 2 189 6. 3.2 67 2 45— 33 7 21.2 18 4 80 3 3.7 40 1 55 and upwards. 25 5 20.0 15 3 36 4 11.1 16 2 I have already shown (page 24) that the case mortality of scarlet fever is greatest at the beginning of the year, and that it gradually declines until the later summer and early autumn months are reached, subsequently increasing again. *Including croup. †Including croup, 1891-94. § See footnote (*) page 8. ‡See footnote (*) page 23. Diagram X Diphtheria & Croup. Diagram XI Diphtheria. 29 An examination of the statistics relating to diphtheria shows that the case mortality of diphtheria is subject to similar seasonal variations. Tables for this purpose have been prepared in the same manner as those relating to scarlatina, namely, to the notifications of each month are applied the deaths registered in a month beginning a week later. The following figures are in this manner obtained. The rates of 1891-94 are obviously more reliable, inasmuch as they are calculated on larger figures. Diphtheria, 1894. Oases. Deaths. Case mortality per cent. Mean case mortality taken as 100. January 1,102 276 25.05 107 February 826 208 25.18 108 March 794 223 28.09 120 April 924 221 23.92 102 May 1,100 219 19.91 85 June 832 186 22.36 95 July 830 187 22.53 96 August 955 233 24.40 104 September 900 239 26.56 113 October 1,216 258 21.22 91 November 920 199 21.63 92 December 791 172 21.74 93 1891-94. Cases. Deaths. Case mortality per cent. Mean case mortality taken as 100. January 2,577 656 25.46 110 February 2,458 621 25.26 109 March 2,633 684 25.98 113 April 2,691 634 23.56 102 May 3,200 696 21.75 94 June 3,111 703 22.60 98 July 3,158 706 22.36 97 August 3,528 804 22.79 99 September 4,001 870 21.74 94 October 4,337 889 20.50 89 November 4,189 959 22.89 99 December 3,252 819 25.18 109 It will be seen from these tables that the seasonal variations in the case mortality of diphtheria, although proportionately less than the seasonal variations shown in the case mortality of scarlet fever, are yet of a character sufficiently marked to suggest some definite cause or causes for their occurrence. With a view to ascertaining whether the age and sex distribution of the cases notified is responsible in any degree for the differences exhibited by the figures, I have selected the three months of 31 arch, May and October, in the year 1894, for comparison in this respect. The following table shows the actual age and sex distribution of the cases notified in each of these three months with the deaths in each instance, which would have occurred had the case mortality for each age and sex been the same in each of the three months as for the whole year 1894. Diphtheria in March, May awl October, 1894. Age period. • March, 1894. May, 1894. October, 1894. Males. Females. Males. Females. Males. Females. Cases. Estimated deaths. Cases. Estimated deaths. Cases. Estimated deaths. Cases. Estimated deaths. Cases. Estimated deaths. Cases. Estimated deaths. All ages. 369 95.27 425 101.31 507 124.91 593 133.63 559 14383 657 144.33 0— 12 6.72 9 5.25 17 9.52 13 7.58 22 12.32 12 7.00 1— 24 14.28 24 14.06 29 17.26 38 22.27 41 24.40 32 18.75 2— 34 15.10 36 18.18 48 21.31 40 . 20.20 46 20.42 53 26.77 3— 47 1904 45 16.88 54 21.87 58 21.75 62 2511 50 18.75 4— 47 14.81 38 13.87 56 17.64 45 1643 58 18.27 49 17.89 5— 94 17.39 124 26.78 150 27.75 164 35.42 188 34.78 206 44.50 10— 53 4.45 48 3.02 58 4.87 82 5.17 53 4.45 90 5.67 15 — 16 .62 23 .67 33 1.29 34 .99 25 .98 37 1.07 20— 17 .77 20 .50 14 .63 42 105 17 .77 45 113 25— 13 .31 34 .99 25 .60 45 1.31 35 .84 51 1.48 35— 5 .32 14 .45 18 115 20 .64 7 .45 18 .58 45— 5 1.06 6 .22 2 .42 7 .26 3 .64 11 .41 55 and upwards. 2 .40 4 .44 3 .60 5 .56 2 .40 3 .33 30 The case mortality per cent., at "all ages" and both sexes, therefore, assuming the same case mortality at each age-period in each of the three months as was observed for the whole year, works out as follows— March 24 76 per cent. May 23.50 „ October 23.70 „ The variation shown in these estimated case mortalities is solely due to differences in the age and sex distribution of the cases notified, but that these differences are obviously insufficient to account for the variation in the actual case mortality shown for each of the three months (i.e., March, 28-09, May, 19*91, and October, 21-22) will be seen more clearly by applying to the actual case mortalities a factor, calculated from the estimated case mortalities, for the approximate correction of differences of The result ot these calculations is shown in the following table— Month. Recorded case mortality per cent. Factor for correction for age and sex distribution. Case mortality per cent. (corrected for age and sex distribution). March, 1894 28.09 .98102 27.56 May, 1894 19.91 1.03362 20.58 October, 1894 21.22 1.02489 21.75 Hospital accommodation. During 1894 3,666 cases of diphtheria were admitted into the hospitals of the Metropolitan Asylums Board, or 32.8 per cent. of the cases notified. The proportion of the total deaths from diphtheria which occurred in these hospitals was 39.2 per cent., a greater proportion than in any previous year, as will be seen by reference to diagram XI. Diphtheria and elementary schools. In my last report I discussed the relation of school attendance to an increased incidence of death from diphtheria on the school age period of life since the Elementary Education Act came into force, and I stated my reasons for thinking that the aggregation of children in schools played an important part in the dissemination of diphtheria in London. It may be recollected that the notification statistics of the year ] 893 showed that when school operations were suspended by the summer holidays there was a notable diminution in the prevalence of diphtheria at " all ages," and especially among children at the school age period of life, and that a marked increase followed the re-assembling of children at the conclusion of the holidays. With a view to learning whether the experience of 1894 affords similar evidence, the cases of diphtheria in that year have been cast into weeks, and grouped into three periods of four weeks, corresponding with the four weeks immediately before the effect of the summer holidays would be manifested, the four weeks during which this effect would be manifested, and the four subsequent weeks. The number of cases notified in these periods is shown in the following table— Notified cases. Increase or decrease per cent. 0—3 3-13 13 and upwards. 0—3 3—13 13 and upwards. The four weeks preceding effect of holiday 136 476 195 — — — The four weeks during which the effect of the holiday would be manifested 151 362 203 + 11.0 —239 +4.1 The four subsequent weeks 135 523 225 —10.6 + 44.5 + 10.8 It will be seen that the number of attacks among children under three years of age was decreased in the third period of four weeks, and reference to diagram XII., shows that the August depression of the curve, showing attacks in children at this age, occurs somewhat later than the depression in the curve showing attacks in children from 3-13, in a way to suggest that the attacks in children at the earlier age were due to infection from the older children, and that the decrease in the attacks of the former was due to diminished opportunities of infection from the latter. This behaviour of diphtheria in children at the two ages was also manifested in 1893. The year 1894, therefore, teaches the same lesson as the preceding year, so that the attention of medical officers of health and of school authorities should be especially directed to a study of the conditions required to lessen as far as possible the opportunity which school attendance affords for the communication of this disease from one child to another. In many of the annual reports of London medical officers of health relating to the year 1894, opinions are expressed as to the circumstances that have contributed to diphtheria prevalence. In particular instances defects in the sanitary condition of houses are referred to. In the report relating to Poplar and Bromley the medical officer of health notes that the Isle of Dogs, which is the dampest part of the district, suffered the least, and that North Bromley and Bow suffered most, his opinion being that the greater prevalence "was due to the inadequacy of the County Council's main sewers which run through these sub-divisions." In the annual report relating to Hackney account is given of the Notified Cases. Diphtheria,1894. DiagramXII. 31 occurrence of cases of diphtheria in a workshop, the use of a speaking tube being apparently one of the means of the disease being communicated. The relation of diphtheria to school attendance is discussed in several of the reports, the report of the medical officer of health of Fulham containing the following statement— " Comparing 1894 with 1893 it may be noticed that although the disease was much more prevalent in 1894, the increased prevalence of the disease was entirely among children between the age of 3 and 10, 203 cases of children of that age having been notified in 1894, against 182 in 1893, and there were 175 cases among children attending school in 1894, against 99 in 1893, the increase in the number of cases among children under 15 attending schofil being 76 per cent., and among children under 15 not attending school 32 per cent." In discussing the special incidence of diphtheria on particular schools Mr. Jackson states that "in the Sherbrooke-road School, between June 12th and August 7th, when the holidays commenced, 20 of the children attending school were notified as suffering from diphtheria while the disease was, comparatively speaking, absent during that time from the three adjacent schools—Munster-road, Lillie-road, and St. Thomas's—which draw a large number of their children from the same district as does Sherbrook-road School. Again, at the end of the year several children in the infants' department of St. Thomas's School contracted the disease, 10 cases being notified between November 27th and December 7th, when the department was [closed by the managers at my request, until after the Christmas vacation, and since then until now the school has been free from the disease." Among the statistics relating to diphtheria in the reports of the medical officers of health is an interesting analysis of the statistics of deaths due to throat disease by the health officer of St. Pancras, who shows that in the decennium 1881—90, increase of deaths from diphtheria had been compensated by decrease in deaths from other throat diseases. This compensation, however, was not maintained during the recent prevalence. In several reports the opinion is expressed that there would be advantage if a laboratory were provided in London for the bacterial examination of material from cases of suspected diphtheria. The following table shows for each of the London districts (a)the number of cases and the case ratf in 1894, (6) the number of deaths and the death rate in 1894, (c) the death rate in the period 1885—93. Sanitary district. Cases, 1894. Case rate per 1,000 living, 1894. Deaths, 1894. Death rate per 1,000 living. 1894. 1885-93. Paddington 383 3.2 93 .77 .35 Kensington 279 1.7 77 .46 .32 Hammersmith 189 1.8 50 .47 .38 Fulham 344 3.1 105 .95 Chelsea 251 2.5 52 .53 .33 St. George, Hanover-square 106 1.4 19 .25 .32 Westminster 73 1.3 26 .48 .37 St. James 42 1.8 15 .64 .18 Marylebone 287 2.1 73 .53 .24 Hampstead 99 1.3 19 .25 .26 Pancras 511 2.2 118 .51 .37 Islington 882 2.7 221 .67 .35 Stoke Newington 54 1.6 5 .15 .40 Hackney 581 2.8 122 .58 St. Giles 43 1.1 14 .37 .36 St. Martin-in-the-Fields 17 1.2 6 .44 .30 Strand 29 1.3 9 .39 .30 Holborn 72 2.2 20 .62 .35 Clerkenwell 162 2.5 34 .52 .40 St. Luke 64 1.6 15 .37 .38 London, City of 43 1.2 6 .17 .28 Shoreditch 302 2.5 75 .61 .42 Bethnal-green 559 4.3 133 1.03 .56 Whitechapel 181 2.4 46 .61 .47 St. George-in-the-East 206 4.6 51 1.13 .57 Limehouse 194 3.4 51 .90 .46 Mile-end Old-town 347 3.2 82 .76 .38 Poplar 692 4.1 108 .64 .38 St. Saviour, Southwark 90 3.4 20 .75 .35 St. George, Southwark 185 3.1 49 .82 .33 Newington 325 2.8 61 .52 .35 St. Olave 28 2.2 3 .23 .28 Bermondsey 268 3.2 66 .79 .30 Rotherhithe 150 3.7 31 .77 .27 Lambeth 624 2.2 141 .50 .40 Battersea 505 3.1 116 .72 .33 Wandsworth 354 2.0 80 .45 Camberwell 718 2.9 192 .77 .29 Greenwich 578 3.3 132 .76 .34 Lewisham 167 1.7 35 .35 .25 Woolwich 49 1.2 14 .33 .11 Lee 46 1.2 21 .55 .33 Plumstead 120 2.0 36 .61 Port of London 5 — — — — London 11,204 2.6 2.642 .61* .36* *Sec footnote (†) page 7. 32 Whooping cough. The deaths attributed to whooping cough numbered 2,116 in 1894, compared with 2,327 in 1893. The death rates from this disease in 1894, and previous periods, were as follows— Period. Death rate per 1,000 living. Period. Death rate per 1,000 living. 1851-60 0.88 1891 0.68* 1861-70 0.88 1892 0.58* 1871-80 0.81 1893 0.54* 1881-90 0.69 1894 0.49* It will be observed that these figures show a progressive decline in the death rate from this disease during recent years. The death rate of each year since 1840 in relation to the mean of the period 1841-94 is shown in diagram XIII. The London death rate compared with the death rates of the large towns of England having more than 200,000 population was, in the period 1884-93, greater than the death rates of all those towns except Liverpool, West Ham, and Salford, but in 1894 was exceeded by the death rates of Manchester, Liverpool, Sheffield, Bristol, Nottingham and Salford. Whooping cough—Death rates per 1,000 living. Ten years, 1884-93. 1894. Ten years, 1884-93. 1894. London 0.66 0.48† West Ham 0.74 0.43 Manchester 0.64 0.55 Bristol 0.51 0.78 Liverpool 0.67 0.55 Bradford 0.46 0.30 Birmingham 0.60 0.44 Nottingham 0.52 0.53 Leeds 0.45 0.34 Hull 0.38 0.38 Sheffield 0.55 0.71 Salford 0.72 0.68 The following table shows that the whooping cough death rate of London was in excess of that of each of the undermentioned foreign cities both in the period 1884.93 and in the year 1894— Whooping cough—Death rates per 1,000 living. 1884-93. 1894. 1884-93. 1894. London 66 .48+ St. Petersburg .23 .33 Paris .18 .10 Berlin .32 .20 Brussels .21 .24 Vienna .12 .04 Amsterdam .39 .30 Rome .09 .09 Copenhagen .46 .09 New York .30 .14 Stockholm .26 .16 The death rates of each sanitary district in 1894, and the mean death rates of the period 1885-93 are shown in the following table— Sanitary district. Deaths in 1894. Death rate per 1,000 living. Sanitary district. Deaths in 1894. Death rate per 1,000 living. 1894. 1885-93. 1894. 1885-93. Paddington 45 .37 .45 Shoreditch 93 .76 .91 Kensington 58 .35 .47 Bethnal-green 70 .54 .87 Hammersmith 59 .56 .67 Whitechapel 52 .69 .50 Fulham 60 .54 St. George-in-the-East 41 .91 .70 .Chelsea 38 .38 .69 Limehouse 27 .47 .103 St. George, Hanoversquare 21 .28 .33 Mile-end Old-town 74 .69 .81 Poplar 77 .45 .75 Westminster 21 .39 .58 St. Saviour, Southwark 9 .34 .70 St. James 7 .30 .44 St. George, Southwark 27 .45 .96 Marylebone 40 .29 .49 Newington 75 .63 .80 Hampstead 26 .35 .30 St. Olave .7 .54 .49 Pancras 115 .49 .63 Bermondsey 51 .61 .78 Islington 195 .59 .65 Rotherhithe 13 .32 .72 Stoke Newington 8 .23 .57 Lambeth 109 .39 .64 Hackney 68 .32 Battetsea 75 .47 .65 St. Giles 27 .71 .53 Wandsworth 55 .31 St. Martin - in - the Fields 5 .36 .38 Camberwell 137 .55 .67 Greenwich 112 .65 .67 Strand 21 .91 .54 Lewisham 57 .57 .43 Holborn 21 .65 .70 Woolwich 12 .28 .55 Clerkenwell 38 .58 .75 Lee 11 .29 .47 St. Luke 18 .44 .79 Plumstead 30 .51 London, City of 11 .32 .31 London 2,116 .49* .64* *See footnote (†) page 7. *See footnote (*) page 8. DiagramXIIL Whooping Cough. DiagrarnXIV Typhus Fever. 33 Typhus. During the year 1894, 21 cases of typhus were notified, and 5 deaths from this cause were registered in London. The death rates from this disease per 1,000 living in 1894, and in previous periods, were as follows— 1871-80 .055 1892 .003* 1881-90 .008 1893 .001* 1891 .002* 1894 .001* The death rate of each year since 1868 in relation to the mean of the period 1869-94 is shown in diagram XIV. I made inquiry of the several medical officers of health as to the cases of typhus notified in London during 1894, and the following information was obtained— January.—No cases of typhus fever were notified or removed to hospital during this month. February.—Two cases from the same address in Plumstead were notified on February 20th, but the illness proved in each instance to be haemorrhagic smallpox. March.—Two cases from a house in Greenwich were notified as enteric fever on March 7th, and two more cases from the same house on March 8th. Three of the patients were removed to the South Eastern Hospital of the Metropolitan Asylums Board, and the illness from which they were suffering was found to be typhus. On the 7th March a lad, aged 13, living in Lambeth., was certified to be suffering from typhus, and he was removed to the South Eastern Hospital on the following day. The diagnosis was not, however, confirmed. The patient died, and the cause of death was certified as septic meningitis. On the 28th March a girl, aged 4, living in North Woolwich, was certified to be suffering from typhus. The mother of this child was notified to Dr. Sanders, the medical officer of health of West Ham, as a case of typhus, but Dr. Sanders only received the information after the woman's death. Dr. Sanders informs me that he learnt that the woman, her husband, and three children lived in one small room, and that their circumstances were extremely impoverished. The child was removed to the Eastern Hospital at Homerton, where the diagnosis of typhus was not confirmed. April.—On the 5th April a case was notified as typhus in Lambeth. The patient was removed to the South Eastern Hospital, where the diagnosis was not confirmed. On the 10th April an infant, 10 months old, living in Bethnal-green, was certified to be suffering from typhus. On being removed to hospital the child was found to have measles. May.—On the 10th May a case was notified in Chelsea. The patient, a child aged 4, was removed to hospital, and there found to be suffering from measles. On the 18th May a man, 23 years of age, living in St. Pancras, was certified to be suffeiing from typhus. The case proved, however, to be one of smallpox. June.—On June 18th a child, aged 2½ living in Bethnal-green, was certified to be suffering from typhus, and was removed to hospital. It was there found that the illness was measles. On June 23rd a case was notified, that of a boy, aged 7, living in Lambeth, who was removed to hospital. His illness was there found to be acute ulcerative endocarditis. July.—On July 4th a case was notified in Camberwell. The patient, who was a woman aged 24, was not removed to hospital. There seems to have been some doubt as to the nature of her illness. On July 23rd another case was notified in Camberwell. The patient, who was not removed to hospital, was a woman, aged 32 ; her child had died of " scarlet fever " a few days previously. The mother died on July 23rd. No other suspected case of typhus fever was notified in this neighbourhood. August.—No case of typhus was notified during this month. September.—On September 12th a man, aged 51, living in Bermondsey, was certified to be suffering from typhus. He began to be ill on the 6th September, was removed to the South Eastern Hospital on the 12th, and died there on the 19th September. The man had been resident for nine years in the house from which he was removed ; he was an Italian, and an ice-cream vendor by trade, and was in the habit of visiting friends in Leather-lane, Holborn. It was not, however, known that any case of typhus had occurred among these friends, nor indeed could any source of infection be traced. October.—On October 19th a girl, aged 14, living in Islington, was removed to the South Eastern Hospital, her illness being supposed to be typhus fever. It was found that the patient was the subject of an attack of enteric fever. On October 30th a man, aged 31, and his son, aged 7, were removed from a house in Rotherhitlie to the South Eastern Hospital. The cases were notified as typhus, and the diagnosis was confirmed at the hospital. The man and his family had been suffering from great want for the last 12 months. The man worked as a casual labourer at Butler's-wharf. He and his family had been residing for 7 weeks in the house they occupied at the time the illness commenced. No source of infection could be traced. On Oct. 30th a man, aged 30, living in Marylebone, was certified to be suffering from typhus; he had been working at an establishment in Oxford-street, and two of his fellow-workmen were taken ill at about the same time that he was. These two men * See footnote (†), page 7. [5] 34 were regarded as suffering from enteric fever. The Marylebone patient was removed to the Middlesex Hospital. November.—On the 10th Nov. a woman was removed from the St. Giles Infirmary to the South Eastern Hospital, the case being notified as typhus. Her illness was found, however, to be enteric fever. On the 14th Nov. a male inmate of the Kensington Infirmary was certified to be suffering from typhus. The patient was a hawker by trade, his age was 17 ; he began to be ill on Nov. 5th, and was taken to the infirmary on Nov. 10th. He had lived in Notting-hill for three years, but had only been in the house where he was taken ill for one week. No source of infection could be traced. December.—On Dec. 15th a case of typhus was notified from the same street in Rotherhithe from which came the two cases referred to above as having occurred in October. The patient, a boy aged 12, had only been resident in the street for a few days, but he had lived for some time in the neighbourhood. The boy had never been quite well since an attack of measles a few months previously. No source of infection could be traced as the cause of his attack of illness in December. He was not removed to hospital. On Dec. 22nd a young man, aged 20, was removed from Limehouse to the Homerton Hospital, certified to be suffering from typhus. The patient died on Dec. 28th, and his death was certified to have been due to leucocythtemia. On Dec. 27th a girl, aged 9, living in Bermondsey, was certified to be suffering from typhus. The case, however, was subsequently regarded as one of enteric fever. The total number of cases notified as typhus was 21, 13 of these appear to have been notified in error; of the remaining 8, 3 were removed to one or other of the hospitals of the Metropolitan Asylums Board, where the diagnosis was confirmed. There were, moreover, 3 cases diagnosed as typhus after admission to the South Eastern Hospital which were not originally notified as cases of that disease. Enteric 1- ever. The cases of enteric fever notified in London during the year 1894 numbered 3,375, and the deaths belonging to London 610, compared with 3,681 cases and 677 deaths in 1893. The rates in 1894 and previous periods were as follows— Period. Death rate per 1,000. Case rate per 1,000. Case mortality per cent. 1871-80 0.24 - - 1881-90 0.19 — — 1891 0.12* 0.8 15.6 1892 0.10* 0.6 17.2 1893 0.16* 0.9 18.4 1894 0.14* 0.8 18.1 The year 1894, compared with the year 1893, is therefore characterised by a slightly lower death rate, case rate, and case mortality. The death rate from enteric fever in each year since 1868, in relation to the mean of the period 1869-94, is shown in diagram XV. The following table shows that in 1891, males in London suffered more heavily both in respect of cases and deaths than females, and that this is manifested at almost all age periods. The case mortality of males was also greater than that of females, a difference which is manifested at the majority of age periods. †Enteric fever, 1894. Age period. Males. Females. Cases. Deaths. Case mortality per cent. Rate per 100,000 living. Cases. Deaths. Case mortality per cent. Rates per 100,000 living. Cases. Deaths. Cases. Deaths. All ages. 1,876 368 19.6 91 18 1,484 262 17.7 65 11 0— 3 1 16.5 38 6 2 16.8 36 5 1— 11 2 10 — 2— 20 2 20 4 3— 25 6 27 4 4— 38 5 36 6 5— 219 21 9.6 94 9 178 16 9.0 76 7 10— 285 26 9.1 134 12 209 30 14.4 96 14 15— 263 38 14.4 129 19 182 31 17.0 80 14 20— 274 56 20.4 137 28 228 38 16.7 94 16 25— 433 111 25.6 126 32 345 68 19.7 87 17 35— 190 58 30.5 75 23 151 29 19.2 53 10 45— 85 26 30.6 48 15 54 18 33.3 27 9 55 and upwards. 30 16 53.3 18 9 42 18 42.9 18 8 * See footnote (†), page 7. † see footnote (*), page 23. 35 The distribution of cases of enteric fever throughout the year was characterised by an increase of prevalence in the 49th, 50th and 51st weeks. Previous experience of the distribution of cases of this disease in London during the period 1890-3 shows that this behaviour of the disease in 1894 was exceptional, and further inquiry shows that the increase was not due to any special local prevalence, but was manifested over a large area of the county. I have therefore made inquiry as to the water supply of the houses invaded in London with the result that it was found that this exceptional increase was observable in the population supplied by all the London water companies except the East London and the Kent companies. Study of the results of chemical examination of the waters supplied by the London water companies, and which are published by these companies, shows an intimate relation between the condition of the waters as supplied and the condition as to flood of the rivers from which these waters are derived. Certain notable floods in November materially altered the condition of the waters supplied, at a time when there is reason to suppose that some new factor in the causation of enteric fever in London must have come into operation. Inquiry as to the behaviour of enteric fever in populations in the vicinity of the county gives indication of some difference of behaviour of this disease in the population supplied by water from the Thames and Lea, and in the population otherwise supplied, the population supplied from these rivers, experiencing an increase of disease in the 49th, 50th and 51st week, corresponding with that experienced in London. The hypothesis of water-borne contagion appears better able than any other to afford explanation of the increase of disease in the weeks in question. In a memorandum which was presented to a committee of the Council, and which is appended to this report, the subject is considered in more detail. (See Appendix II.) The only considerable local outbreak of enteric fever in 1894 is discussed in the report of the medical officer of health of Lambeth. The circumstances of this outbreak, briefly told, are as follows. Between the 10th March and 21st April 49 persons living in Lambeth and in adjoining districts were attacked with enteric fever, 45 of whom received their milk from the same dairy. The dairy received its milk from three sources—(a) an amount averaging from 20 to 25 churns a day from a large proprietary farm; (b) a less amount from a firm of dealers at Salisbury, who supplied milk from several stations on the South Western line, and from one station on the London, Chatham and Dover Railway ; (c) some three or four churns a day from certain Brixton sheds. The milk from (a), the proprietary farm, was distributed in an area which was practically free from disease, the milk from (c), the Brixton sheds, was supplied to customers as nursery milk, the addresses of families thus supplied being recorded, and these persons also remained immune. As to the milk supplied by the Salisbury dealer, Dr. Verdon says, " On inquiry it was ascertained that many dairies in Lambeth, in whose area of distribution no typhoid was found, had also obtained consignments from this dealer, some from one station and some from another. In fact, milk from all stations was in daily consumption in Lambeth." No dairy, however, other than the dairy in question, "had among its customers a succession of typhoid cases." On this evidence, Dr. Verdon says, "it is unreasonable to suppose that milk from this source, the Salisbury dealers, was per se infective." In discussing the cause of the outbreak, Dr. Verdon states that in the Lambeth dairy was a tank, the water of which was used for washing carts and trucks, and which contained a quantity of filth, no doubt thus introduced. His assumption was that milk was rendered infective in the dairy. The chief point of interest in the report is that the supply of milk from the proprietary farm and the Salisbury dealers was stopped from April 3rd to April 7th, and that " within 10 days of interference taking place with the course of business at the dairy, a period admissible for cases already infected to declare themselves, the epidemic completely and totally collapsed, leaving only two belated cases to follow 10 days afterwards." In the reports of the medical officers of health instances are given of infection communicated from person to person, the attendant circumstances often being such that the scrupulous cleanliness requisite in the care of the sick was wanting. Thus, in Kensington, the medical officer of health reports that four cases occurred in one overcrowded house, three of them being due to contact with the sick. The medical officer of health of Hackney shows with much exactness the relations existing between the several cases in a series which extended from September, 1893, into May, 1894, and which occurred in several houses in two streets, infection evidently being communicated from one person to another. Again, of six persons attacked by enteric fever in St. Olave four were nurses. In several of the reports the possibility that oysters might be concerned in the causation of the disease is discussed. Thus, references to this subject are found in the reports relating to Paddington, Marylebone, Hampstead, Strand, Wandsworth (Claphamand Putney) and Deptford. With this subject the possibility of infection being conveyed by watercress is also considered. The medical officer of health of Marylebone analyses the circumstances of 64 cases of enteric fever in that district, and states that ten ate of both oysters and watercress, eight ate watercress but no oysters, and four ate oysters alone. "Some of the cases," he says, "may therefore have been through oysters or watercress, but the numbers consuming one or both are not sufficiently striking to base general conclusions on." The medical officer of health of Clapham says," In some of the cases reported here it was found that the patients had eaten oysters, as indeed was most likely, but I did not attach much importance to the few instances discovered." His colleague, discussing the cases which occurred in the sub-district of Putney writes, "This disease was unusually prevalent over London during the last quarter of the year, affecting to a great extent the upper classes of society. It has, I think, been undoubtedly shown that many cases were the result of eating oysters. Of the three fatal cases which occurred in this sub-district one of them at least was, in my opinion, due to this cause. It was the case of a temperate man and careful living man. No sanitary defects were found in the house. He was not a water drinker. About ten days before the symptoms appeared, on going up to market in the morning he partook freely of oysters, and by a process of exclusion I am driven to conclude that this was the only probable source of 36 infection." The medical officer of health of Hampstead states as the result of his inquiries, "It is certain that typhoid fever was epidemic in London during the close of the year, and most of our cases occurred at that time. No satisfactory explanation of the outbreak was arrived at, but there was some reason for thinking that the consumption of oysters that had been fattened in the estuaries of rivers, to the water of which typhoid material had access, had been a cause of the infection." The medical officer of health of the Strand district, in discussing 15 cases notified in the district, states that "no less than seven were persons employed in hotels and restaurants, one of them being also an oyster merchant." The evidence which is supplied by the inquiries made by medical officers of health in London does not do more than establish the fact that, antecedent to attack by enteric fever, certain of the sufferers had eaten oysters. There is, however, no information as to the proportion of persons in the general population who are in the habit of eating oysters. More precise evidence, tending to incriminate oysters as a cause of enteric fever, comes from Connecticut, where in October, 1894, were attacked, subsequent to a supper at the Wesleyan College, residents in the college and visitors not so resident, who were present at the supper and ate oysters, and these to the exclusion of other persons at the supper who did not ear oysters. Beyond this, oysters from the same source were sent elsewhere, and enteric fever followed their consumption. Lastly, the oysters, it was found, had been laid down in a creek where they were exposed to the drainage from a house in which cases of enteric fever had occurred.* Other suggestions as to the cause of enteric fever in London are made in the reports of medical officers of health. In Plumstead the drinking of water from a canal, used in the arsenal for engines, was thought by the medical officer of health to be the cause of a case of enteric fever. The medical officer of health of the Strand district writes, " It is also possible that the floods in the Thames in late autumn, by washing down the deposits in its bed, together with the contents of numerous cesspools on its bank may have exercised some influence on the disease," and the medical officer of health of St. George, Hanover-square writes, " Of the 65 cases of enteric fever, no fewer than 29 were certified in "November and December, and only 14 in the three previous months, when the seasonal prevalence of "that disease usually takes place, and on investigation I find this is usually the case as is shown by "the following table—" Cases of enteric fever (St. George, Hanover-square). Year. August, September and October. November and December. No. of cases. Average per month. No. of cases. Average per month. 1891 6 2.0 12 6.0 1892 15 5.0 15 7.5 1893 16 5.3 18 9.0 1894 14 4.7 29 14.5 "This follows upon the delivery of insufficiently filtered Thames water when the river is in flood, "which was especially noticeable last year, the samples taken in November being very bad indeed. "Some cases of this disease in London and elsewhere were believed to have been traced to the con"sumption of sewage-polluted oysters, but this cause would apply equally to September and October." The following table shows the case rates and death rates per 1,000 in each of the several sanitary districts in 1894, and the death rates per 1,000 in the period 1885-93,— Sanitary District. Cases, 1894. Case rate per 1,000, 1894. Deaths, 1894. Death rates per 1,000. 1894. 1885-93. Paddington 71 .6 19 .16 .13 Kensington 87 .5 21 .13 .10 Hammersmith 54 .5 15 .14 .14 Fulham 38 .3 5 .05 Chelsea 92 .9 14 .14 .14 St. George, Hanover-square 66 .9 12 .16 .11 Westminster 46 .8 5 .09 .10 St. James 24 1.0 8 .34 .14 Marylebone 151 1.1 23 .17 .12 Hampstead 49 .7 6 .08 .10 St. Pancras 200 .9 38 .16 .14 Islington 267 .8 36 .11 .14 Stoke Newington 16 .5 3 .09 .18 Hackney 195 .9 38 .18 St. Giles 34 .9 8 .21 .19 St. Martin-in-the-Fields 15 1.1 2 .15 .12 * The "Oyster Epidemic," or Typhoid Fever at Wesleyan University, by W. H. Conn, Ph.D., Professor of Biology, Wesleyan University, Middletown, Connecticut. (Medical Record of New York, December 15th, 1894.) 37 Sanitary District. Cases, 1894. Case rate per 1,000, 1894. Deaths, 1894. Death rates per 1,000. 1894. 1885-93. Strand 15 .6 7 .30 .20 Holborn 29 .9 7 .22 .18 Clerkenwell 66 1.0 8 .12 .14 St. Luke 15 .4 3 .07 .15 London, City of 31 .9 6 17 .10 Shoreditch 80 .7 12 .10 .16 Bethnal-green 146 1.1 27 .21 .17 Whitechapel 36 .5 10 .13 .12 St. George-in-the-East 62 1.3 6 13 .16 Limehouse 45 .8 8 .14 .21 Mile-end Old-town 79 .7 13 .12 .20 Poplar 212 1.2 31 .18 .20 St. Saviour, Southwark 8 .3 2 .08 .11 St. George, Southwark 29 .5 5 .08 .11 Newington 86 .7 14 .12 .13 St. Olave, 6 .5 — — .14 Bermondsey 51 .6 16 .19 .12 Rotherhithe 25 .6 2 .05 .20 Lambeth 257 .9 46 .16 .12 Battersea 136 .8 28 .17 .12 Wandsworth 131 .7 21 .12 Camberwell 127 .5 22 .09 .12 Greenwich 164 .9 32 .19 .16 Lewisham 61 .6 16 .16 .10 Woolwich 13 .3 6 .14 .13 Lee 24 .6 3 .08 .7 tead 23 .4 6 .10 Port of London 13 — — — — London 3.375 .8 610 .14+ .14+ DiarrhŒa. The deaths in London attributed to diarrhoea and dysentery in the year 1894 numbered 1,77-4, as compared with 3,445 in 1893. The death rates per 1,000 living in 1894, and previous periods, have been as follows— 1851-60 1.03 1891 0.58† 1861-70 1.04 1892 0.60† 1871-80 0.95 1893 0.80† 1881-90 0.75 1894 0.40† The diarrhœal death rate of each year since 1840 in relation to the mean death rate of the period 1841-94 is shown in diagram XVI. The mean temperature of the summer of each year in relation to the mean of the period 1841-94 is also shown. The age distribution of the deaths from this disease registered in London (excluding Penge) in 1894 was as follows—* Under 1 year. 1-5. 5-20. 20-10. 40-60. 60-80. 80 and upwards. 1,327 267 10 14 31 103 28 In each of the English towns having a population of more than 200.000 inhabitants death rate from diarrhœa was lower in 1894 than in the period 1884-93. In the period 1884-93 the death rate from this disease was in London lower than in any of these towns except Bristol, and in 1894 lower than in any of these towns except Bristol and Bradford. Ten years, 1884-93. 1894. Ten years, 1884-93. 1894. London .73 .42* West Ham .86 .45 Manchester 1.09 .67 Bristol .51 .31 Liverpool 1.10 1.00 Bradford .88 .30 Birmingham 1.18 .52 Nottingham 1.09 .60 Leeds 1.16 .45 Hull 1.18 .43 Sheffield 1.18 .56 Salford 1.51 .68 * See footnote (*), page 8. †See footnote (f), page 7. 38 The death rates in the several sanitary districts in London, in 1894 and the period 1885-93, art shown in the following table. It will be observed that the death rates of 1894- have, in the eastern districts, been generally higher than in the other districts of London, and that the highest death rate, both in 1894 and in the period 1885-93, was that of the district of St. George-in-the-East. Sanitary district. Deaths, 1894. Death rate per 1,000 living. Sanitary district. Deaths, 1894. Death rate per 1,000 living. 1891. 1885—93. 1894. 1885—93. Paddington 49 .40 .52 Shoreditch 70 .57 1.0 Kensington 57 .33 .51 Bethnal-green 60 .46 .80 Hammersmith 47 .46 1.01 Whitechapel 34 .45 .88 Fulham 57 .51 St. George-in-the-East 59 1.30 1.67 Chelsea 33 .34 .77 Limehouse 31 .54 .97 St. George, Hanoversquare 10 .14 .41 Mile-end Old-town 70 .65 .85 Poplar 68 .41 .69 Westminster 14 .26 .67 St. Saviour, Southwark 4 .14 .83 St. James 5 .21 .44 St. George, Southwark 39 .65 .93 Marylebone 35 .24 .62 Newington 53 .45 .73 Hampstead 8 .11 .29 St. Olave 3 .23 .88 Pancras 84 .36 .67 Bermondsey 42 .51 .80 Islington 119 .35 .69 Rotherhithe 32 .80 .91 Stoke Ne wing ton 5 .14 1.59 Lambeth 134 .43 .67 Hackney 82 .39 Battersea 88 .54 .69 St. Giles 11 .29 .62 Wandsworth 64 .35 St. Martin-in-theFields 4 .29 .44 Camberwell 101 .41 .66 Greenwich 60 .35 .68 Strand 8 .35 .61 Lewisham 29 .28 .43 Holborn 10 .30 .71 Woolwich 16 .40 .53 Clerkenwell 35 .55 1.02 Lee 8 .21 .43 St. Luke 26 .64 1.03 Plumstead 6 .10 London, City of 4 .11 .30 London 1,774 .40* .71* In view of the occurrence of localised outbreaks of cholera in England in 1893, and in order to obtain early knowledge of any local prevalence of diarrhœal disease, the Local Government Board in July, 1894, suggested to sanitary authorities the desirableness of requiring, during the quarter ending September, the notification of cases of diarrhoea in their districts. The following letter was addressed to London sanitary authorities with this object— Local Government Board, Whitehall, Sir, July 16th, 1894. I am directed by the Local Government Board to state that cholera, from which certain parts of Europe has never been entirely free since the summer of 1892, again shows some signs of recrudescence on the Continent. In the late summer and autumn months of 1892 and 1893 the disease reached our shores. In 1892 it failed to extend to any persons beyond those arriving in our midst from abroad, but last year it led to a number of localised outbreaks which, happily, were of trivial extent compared with previous cholera visitations to this country. In those localities where cholera made some headway it was found that there had been antecedent diarrhoea, generally quite excessive in amount, often choleraic in type; the existence of this unusual diarrhoea being only discovered when diarrhoea was under section 7 of the Infectious Diseases (Notification) Act, 1889, added to the diseases notifiable under that statute. But notification of diarrhoea was rarely, if ever, adopted until after the advent of cholera, when the information to be derived from it could not be utilised to prevent that disease from gaining a footing whilst in its least recognisable form. Under these circumstances the Local Government Board have thought it advisable to remind sanitary authorities that the utmost vigilance should be exercised within their respective districts to control any diarrhoea which may be suspicious, either in character or in amount, during the present and forthcoming season, and, with view of facilitating action in this direction, the Board would give favourable consideration to any applications that may be addressed to them for their approval to add diarrhoea to the list of notifiable diseases until the termination of the current quarter. In making any such application each sanitary authority will doubtless consider how far it may be desirable, in the first instance at least, to limit notification of diarrhœa to attacks occurring over one year of age. I am, Sir, Your obedient servant, (Signed) Hugh Owen, Secretary. Notification of diarrhoea was, as the result of this communication, required by the sanitary authorities of St. George Hanover-square and St. Giles. The number of cases notified in these districts was 101 and 98, respectively. Notification was also required in the district of Whitechapel, but it does not appear that the District, Board obtained the confirmation of its resolution by the Local Government Board. In the first two districts the requirement was limited to persons over one year and in the last to persons over two years of age. Cholera. In 1894 32 deaths were registered, the cause of which was attributed to "cholera" or "choleraic diarrhœa." This number is less than the number in any year since 1841 included under this heading or that of "cholera" or "simple cholera" in the returns of the Registrar-General. In 1894 the methods of dealing with suspected cases of cholera, which had been put in force in * See footnote (†), page 7. 39 the preceding year, were again adopted. I communicated with medical officers of health in London, informing them that I was authorised to send material to Dr. Klein in cases where bacteriological examination was desirable, and systematic investigation was again made into the history and symptoms of persons notified as suffering from cholera or choleraic diarrhoea, and of persons whose deaths were registered as due to these causes during the period between July and November. In making these inquiries it was found necessary in three cases to submit material to Dr. Klein, but in each instance the bacteriological examination gave a negative result. These three cases were— (i.) C. N. This man was between 50 and 60 years of age, and was hall porter at the Egyptian Hall, Piccadilly. He had been to Brighton, returning to London about a week before the commencement of his illness. On August 7th he drank some "sour milk"; on the 8th diarrhoea and vomiting set in. At 5 p.m. on the 9th he was admitted to St. George's Hospital, and was then blue and cold. He complained of cramps, and his voice was husky. Diarrhoea ceased for a time after admission, but returned on the morning of the 10th; the stools were "milky." The man died at noon on the 10th August. Dr. Rolleston, who made the post-mortem examination, found some congestion of the lower coils of the ilium. Dr. Klein found bacillus coli and proteus vulgaris in the material submitted to him, but no comma bacilli. (ii.) R. P., æt. 47, an ornamental metal worker, lived at Eversleigh-street, Battersea, and worked in Hatton-garden. On August 14th, slight diarrhoea commenced. Patient went to work, however, on this and the following day, and was in good health and spirits on the evening of the 15th. He ate some hake for supper. Early in the morning of the 16th purging, vomiting, and cramps set in. The evacuations were like rice water, and the cramps severe. Dr. Kempster, the medical officer of health, saw the patient at 5 p.m., and found him collapsed and blue with subnormal temperature and marked aphonia. Death occurred the same evening. A post-mortem examination was made, and the small intestine was found to be slightly reddened and congested. Dr. Klein found that no comma bacilli were present in the material examined by him. (iii.) C.B., œt. 62, birch-broom maker, lived at Cowpers-row, Brixton-hill. On the morning of August 23rd, abdominal pain commenced, and was followed later by diarrhoea and vomiting. On the 24th, pain and vomiting continued. On the 25th, the patient complained of cramp in the legs ; he became collapsed, and died the same night. This man had been to Ramsgate on August 6th, but had not since that date been out of London. Some congestion of the lower part of the small intestine was found on making a post-mortem examination ; the intestinal contents were bile stained. Dr. Klein's cultivations "revealed the existence of bacillus coli, but no commas of any kind." Dr. Klein, in commenting on these cases, noted that the Battersea case was the only one in which "to the unaided eye the intestine presented appearances like cholera." He adds, with reference to this case, that" under the microscope the abundance of detached epithelium and the presence in and between of rows, streaks and clumps of one kind of bacteria suggested cholera, but these bacteria were not the cholera commas, culture proved them to be bacillus coli." The medical officer of health of the Port of London thus reports on the steps taken by the Port Sanitary Authority in connection with cholera during the year :— As naturally anticipated, some few cases of cholera and choleraic diarrhoea were dealt with at Gravesend. Brief details of such cases are of interest. On the 27th July, the s.s. " Acme," of London, from St. Petersburg, arrived at Gravesend. While lying at St. Petersburg eight cases of cholera had occurred among her crew. These were all convalescent on arrival, and the vessel was therefore only detained for a sufficient time to enable disinfection and the necessary precautionary measures to be carried out. On the 7th August, the s.s. " Balmore," of Dundee, from St. Petersburg, arrived at Gravesend. She had five cases of cholera on board on entering the Thames, one of whom died just before reaching Gravesend. The vessel left St. Petersburg on 31st July. The first case was taken ill on 5th, and terminated fatally on 6th. The dead body was taken to the port hospital, and a post-mortem enabled the diagnosis of cholera to be confirmed by bacteriological examination. The four other patients were admitted into hospital and all recovered. The diagnosis was confirmed bacteriologically in the case of three of these men, in, the fourth case the result of investigation was negative. On the following day, the 8th, a case of suspicious diarrhoea, was removed from the same ship, but this was either an abortive attack or simply severe diarrhoea. The patient rapidly recovered. The ship was released as soon as the necessary cleansing and disinfection were completed. On the 15th August, the s.s. "Bedford," of North Shields, from St. Petersburg, arrived and landed one of the crew suffering from choleraic diarrhœa. The vessel left St. Petersburg on the 6th, and the patient was taken ill on the 12th with cramps, vomiting, and diarrhoea. The patient was convalescent on arrival, and the vessel was only detained for thorough disinfection. On the 17th August, the s.s. "Fountain Abbey," of Cardiff, from Cronstadt, on arrival reported that she had had cholera on board during the voyage. The vessel was lying at Cronstadt from the 23rd July to the 9th August, the patient being taken to the hospital on the 29th. The vessel was only detained for disinfection, &c. On the 21st August, the s.s. "Dwina," of London, from St. Petersburg, reported having had cholera on board while lying at St. Petersburg. The patient was taken ill on the 16th July, removed to hospital on the 18th, recovered and returned to his ship on the 22nd, the vessel leaving for London on the 8th August. The patient was in apparently perfect health on arrival. She was detained for the usual disinfection, cleansing, &c. On the 25th August, the s.s. "Calabria," of Dundee, from St. Petersburg, reported a case of diarrhoea. On inquiry it was found that the vessel had sailed from Shields (25th July) for St. Petersburg, arriving on the 4th August, and leaving again for London on the 17th. Two men were attacked on the 7th and 9th August respectively, with severe symptoms of a distinctly suspicious character. They both recovered, and were convalescent on arrival. The vessel was disinfected before passing up the river. On the 30th July the s.s. "China" arrived at Gravesend from St. Petersburg. The master reported all well, and that there had been no cases of diarrhoea on board during the voyage or stay in foreign port. As official information had been received from the Local Government Board that three cases of 40 choleraic diarrhoea had occurred on board during the stay of the vessel at St. Petersburg, the facts were reported to the Secretary of Her Majesty's Customs, who replied to the effect that on the vessel's return the master would be called upon to show cause why he should not be prosecuted for making a false statement under the Quarantine Act. On the 29th August the s.s. "Cyrus" arrived from Calcutta, having had two cases of cholera on the voyage, both terminating fatally. The two patients had been in the habit of bathing daily in a sewage-polluted dock, though repeatedly warned of the danger. The ship came through the canal, having received pratique. No action was necessary on her arrival. On the 23rd the s.s. "Risca" arrived, having had a suspicious case of diarrhoea on voyage. Convalescent at time of inspection. Our experience thus for the sis months has been an exceedingly fortunate one. Only six cases of undoubted Asiatic cholera have actually arrived at Gravesend and been removed to the port hospital, while five vessels on entry have been "infected" within the meaning of the Cholera Regulations. Obviously, so far as the necessary precautions of disinfecting the vessel, bedding and clothing, cleaning bilges, emptying drinking water, and careful medical inspection of every person on board, it is not practical nor safe to attempt any distinction between cholera and choleraic diarrhoea. With a view of preventing, if possible, mild cases of cholera or choleraic diarrhoea passing unnoticed as simple diarrhoea, the Local Government Board issued an order applying the provisions of section 56 of Public Health (London) Act, 1891, to diarrhoea in addition to those diseases therein specifically mentioned, such order to have effect from the 4th August until the 30th September. Erysipelas. The deaths attributed to erysipelas in the registration county of London in 1894 numbered 221, the corrected annual average of the preceding ten years being 307.5. The number of cases notified and the number of deaths registered during the last four years have been as follows— Cases. Case rate per 1,000 living. Deaths. Death rate. 1891 4,767 1.1 214 .05* 1892 6,943 1.6 292 .07* 1893 9,712 2.2 424 .10* 1894 6,104 1.4 221 .05* Whereas, therefore, there has been in 1892 and 1893 increase in the case and death rate from this disease, in the year 1894 there was decrease. The number of cases and the case rate of each sanitary district in London is shown in the following table— Sanitary district. Cases, 1894. Case rate per 1,000 living, 1894. Sanitary district. Cases, 1894. Case rate per 1,000 living, 1894. Paddington 123 1.0 Whitechapel 99 1.3 Kensington 186 1.1 St. George's-in-the-East 72 1.6 Hammersmith ... 95 .9 Limehouse 83 1.5 Fulham... ... 115 1.0 Mile-end Old Town 163 1.5 Chelsea... 142 1.4 Poplar 361 2.1 St. George, Hanover-sq. 52 .7 St. Saviour, Southwark 34 1.3 Westminster ... 33 .6 St. George, Southwark 75 1.3 St. James 23 1.0 Newington 174 1.5 Marylebone 261 1.9 St. Olave 17 1.3 Hampstead 66 .9 Bermondsey 94 1.1 Pancras... 468 2.0 Rotherhithe 116 2.9 Islington 410 1.2 Lambeth 307 1.1 Stoke Newington 23 .7 Battersea 299 1.9 Hackney 265 1.3 Wandsworth 247 1.4 St. Giles 63 1.7 Camberwell 328 1.3 St. Martin-in-the-Fields 15 1.1 Greenwich 257 1.5 Strand 11 .5 Lewisham 130 1.3 Holborn 77 2.4 Woolwich 32 .8 Clerkenwell 101 1.6 Lee 25 .7 St. Luke 95 2.3 Plumstead 63 1.1 London, City of 42 1.2 Port of London 2 Shoreditch 198 1.6 London 6.104 1.4 Bethnal-green 262 2.0 Puerperal Fever. The deaths attributed to puerperal fever in the registration county of London in 1894 numbered 210. The corrected annual average of the preceding ten vears being 302'6. The number of cases notified and the number of deaths registered from puerperal fever in each of the last four years were as follows— Cases. Deaths. 1891 221 222 1892 338 313 1893 400 352 1894 254 210 . See footnote (*), page 8. 41 If these cases and deaths are considered in relation to the total population and total births the following rates are obtained:— Year. Case rate per 1,000 living. Case rate per 1,000 births. Death rate per 1,000 living. Death rate per 1,000 births. 1891 .05 1.64 .05+ 1.65 1892 .08 2.56 .07+ 2.37 1893 .09 3.00 .08+ 2.64 1894 .06 1.94 .05+ 1.60 It will thus be seen that the rates for 1894 from this disease are lower than the corresponding rate3 for 1892 and 1893 whether the rates per 1,000 living or per 1,000 births are considered. The rise of the case and death rates in 1891-3 and the fall in 1894 corresponds with the behaviour of the case and death rates from erysipelas. Influenza, Bronchitis and Pneumonia. The number of deaths attributed to influenza in 1894 was slightly in excess of the corrected annual average of the preceding ten years. The deaths attributed to bronchitis and pneumonia were below the average. The deaths from these diseases in Registration London since 1889 were as follows:— Year. Influenza. Bronchitis. Pneumonia. Deaths. Corrected annual average for preceding ten yearn. Deaths. Corrected annual average for preceding ten years. Deaths. Corrected annual average for preceding ten years. 1890 652 70 12,448 11,342-8 6,224 4,9250 1891 2,336 74-0 13,136 10,887-3 6,915 4,883-0 1892 2,264 318-7 11,183 11,2300 6,164 5,171-9 1893 1,526 556-2 10,413 11,2500 7,198 5,341-6 1894 750+ 715-5 7,816+ 11,292-3 5,321+ 5,632-5 The number of deaths from influenza has therefore notably decreased in 1894. In that year there has also been decrease in the number of deaths from bronchitis and pneumonia. The deaths from influenza registered in 1894 and the death rate per 1,000 living in the several sanitary districts of London are shown in the following table— Influenza. Sanitary district. Deaths, 1894. Death rate per 1,000 living, 1894. Sanitary district. Deaths, 1894. Death rate per 1,000 living, 1894. Paddington 30 .25 Bethnal-green 13 .10 Kensington 33 .20 Whitechapel 13 .17 Hammersmith 11 .10 St. George-in-the-East 11 .24 Fulham 14 .13 Limehouse 3 .05 Chelsea 29 .29 Mile-end Old-town 17 .16 St. George, Hanover-square 18 .24 Poplar 16 .09 Westminster 11 .20 St. Saviour, Southwark — — St. James 1 .04 St. George, Southwark 7 .12 Marylcbone 31 .22 Newington 12 .10 Hampstead 21 .28 St. Olave 3 .23 Pancras 42 .18 Bermondsey 9 .11 Islington 51 .15 Rotherhithe 6 .15 Stoke Newington 7 .20 Lambeth 47 .17 Hackney 37 .17 Battersea 32 .20 St. Giles 23 .60 Wandsworth 37 .21 St. Martin-in-the-Fields 3 .22 Camber well 40 .16 Strand 1 .04 Greenwich 27 .16 Holborn 6 .18 Lewisham (excluding Penge) 22 .22 Clerkenwell 15 .23 Woolwich 5 .12 St. Luke 3 .07 Lee 9 .24 London, City of 4 .11 Plumstead 8 .14 Shoreditch 14 .11 London 742 .17* * See footnote (†), page 7. † See footnote (*), page 8. [6] 42 Phthisis. The deaths from phthisis in 1894 belonging to London numbered 7,354. The death rates of this disease per 1,000 living in successive periods have been as follows— 1851-60 2.86 1891 2.00 1861-70 2.84 1892 1.88 1871-80 2.51 1893 1.90 1881-90 2.09 1894 1.69+ It will thus be seen that there has been a progressive decrease in the death rate from this disease in recent years. It is, however, probable that part of this decrease is apparent only and due to more accurate diagnosis. The Registrar-General, in the annual summary relating to London for 1894, has distributed the deaths from phthisis occurring in public institutions belonging to London, to the sanitary areas to which they belong, and it is now therefore possible to compare the phthisis death rates of the various sanitary districts of London. The following table snows the number of deaths from pathisis, ana me death rate per 1,000 living in the various sanitary districts of London in 1894, and the accompanying chart exhibits graphically the distribution of the disease in that year— Sanitary district. Deaths, 1894. Death rate per 1,000 living, 1894. Sanitary district. Deaths, 1894. Death rate per 1,000 living, 1894. Paddington 154 1.3 Bethnal-green 238 1.8 Kensington 249 1.5 Whitechapel 193 2.6 Hammersmith 161 1.5 St. George-in-the-East 102 2.3 Fulham 160 1.4 Limehouse 136 2.4 Chelsea 159 1.6 Mile-end Old-town 197 1.8 St. George, Hanover-sq. 97 1.3 Poplar 282 1.7 Westminster 137 2.5 St. Saviour, Southwark 77 2.9 St. James 46 2.0 St. George, Southwark 165 2.8 Marylebone 274 2.0 Newington 231 2.0 Hampstead 71 0.9 St. Olave 32 2.5 Pancras 454 1.9 Bermondsey 188 2.2 Islington 502 1.5 Rotherhithe 66 1.6 Stoke Newington 42 1.2 Lambeth 447 1.6 Hackney 295 1.4 Battersea 219 1.4 St. Giles 119 3.1 Wandsworth 188 1.1 St. Martin-in-the-Fields 35 2.5 Camberwell 347 1.4 Strand 74 3.2 Greenwich 240 1.4 Holborn 77 2.4 Lewisham 110 1.1 Clerkenwell 151 2.3 Woolwich 82 1.9 St. Luke 116 2.8 Lee 42 1.1 London, City of 68 2.0 Plumstead 66 1.1 Shoreditch 265 2.2 London 7,354 1.7+ From the above table it appears that the phthisis death rate exhibits considerable variations in different districts, the death rate ranging from 0.9 in Hampstead to 3.2 in the Strand. In considering these differences it should be recollected that the proportion of London residents who, when suffering from phthisis, leave London to die elsewhere is not in all probability the same in each district, and that this circumstance may affect the relative incidence of mortality in the several districts of the country The death rates in the various groups of London districts in 1894 were as follows— West Group 1.55 North ,, 1.60 Central ,, 2.58 East „ 2.00 South „ 1.54 London 1.69+ It will thus be seen that the death-rates in the west, north and south groups were below the death rate of London taken as a whole, while those of the central and east groups were above the London death rate. It is interesting to observe the relation existing between phthisis and "overcrowding." The census of 1891 shows the number of persons occupying less than five rooms in the several sanitary districts, and from the figures given it is possible to show the proportion of the population of each district occupying tenements of one, two. three and four rooms, and in which there were more than two persons to a room.* Employing the term "overcrowding" to represent such usage and grouping the various districts in accordance with the proportion of " overcrowding " shown by the census figures of 1891, it is found that the phthisis death rates in these groups increase with the increase of such "overcrowding." It will be seen, moreover, from the following table that the death rates from "all causes" and "all causes other than phthisis" behave in similar manner. It is not of course possible to say to * These percentages are given in extensn in the annual report of the medical officer of health for 1892. † See footnote (†), page 7. 43 what extent this increase in the death rate may be due to overcrowding per se, or to other adverse social conditions with which overcrowding is usually associated. Proportion of total population living more than two in a room (in tenements of less than five rooms). Death rates per 1,000 living. Phthisis. "All causes." " All causes other than Phthisis." Districts with under 10 per cent. 1.07 12.71 11.64 „ 10 to 15 „ 1.38 15.68 14.30 „ 15 to 20 „ 1.57 17.07 15.50 „ 20 to 25 „ 1.81 18.09 16.28 „ 25 to 30 „ 2.11 19.45 17.34 ,, 30 to 35 „ 2.26 20.83 18.57 „ over 35 „ 2.46 21.85 19.39 Cancer. The deaths from cancer registered in the registration county of London in 1894 numbered 3,441, the average for the preceding ten years being 3.128.9. The death rates of this disease per 1,000 living in successive periods have been as follows— 1851-60 .42 1891 .77* 1861-70 .48 1892 .74* 1871-80 .55 1893 .79* 1881-90 .68 1894 .79* Anthrax. The occurrence of a death in London from anthrax, to which the attention of the Council was directed by the deputy coroner for Southwark, led the Public Health Committee to instruct me to report on the causes of the disease and the means by which it could be prevented. The subject had in 1883 been reported on by Mr. John Spear on behalf of the Local Government Board and it obviously became necessary that effort should be made to learn whether experience of the disease in London since that year supplied further information than was available at the time Mr. Spear made his inquiry. Dr. Hamer was therefore instructed to undertake this duty and in his investigation he received from Dr. Perry, the Superintendent of Guy's Hospital, all the information which the records of Guy's Hospital could supply. My thanks are due to Dr. Perry for valuable assistance thus rendered. Dr. Hamer felt difficulty in determining whether apparent increase in the number of cases of anthrax which became known was due to greater prevalence or to more general knowledge of the appearances of the local lesion, but he noted the fact that but one case of internal anthrax had been known to occur in London since 1883. Among the cases investigated by Mr. Spear were a number of cases in which the infection was traceable to a particular consignment of China hides. The cases which have occurred since Mr. Spear's inquiry do not generally appear to be traceable to hides from that country. Dr. Hamer found reason for thinking that dry hides were much more productive of disease than wet hides, and inasmuch as there was evidence of a tendency of the trade to discourage the use of dry hides he was led to hope that the frequency of the occurrence of cases of anthrax would be lessened. I presented to the Public Health Committee Dr. Hamer's report on this subject, and the committee adopted the recommendation that persons engaged in the skin trade should be invited to exhibit on their premises a notice giving advice to their workpeople as to the precautions which should be taken for the avoidance of infection, as to the early appearances of the disease, and as to the necessity of seeking medical advice in the event of any suspicion that the disease has been contracted. The committee also directed that a copy of Dr. Hamer's report should be sent to medical officers of health in London. Dr. Hamer's report is appended (see Appendix III.). The following notes of cases of anthrax which occurred in London in 1894 have been supplied me by Dr. Hamer — On January 19th a man who resided at Rawlings'-buildings, Melior-street, Bermondsey, and who was a waterside labourer, noticed a pimple on his cheek. He had for some days preceding his attack been engaged in "trucking" buffalo-hides from Penang and Australian sheep-skins from Gun and Shot-wharf to a warehouse adjoining the same. On the 22nd the patient felt very ill and went to Guy's Hospital; he was admitted and the pustule was excised. The man died. Anthrax bacilli were found to be present. During February two cases of anthrax affecting workers in horsehair were admitted to St. Bartholomew's Hospital. In both instances the pustule was excised and the patient was discharged cured. One of the patients resided in Lessada-street, and worked at Messrs. List and Son's factory, 51, Bunhill-row, where he was employed in washing horsehair. The other patient, G. N., of Nantstreet, Cambridge-road, had been working in Hackney-road, where he was employed as a "hackler," i.e., in pulling the horsehair through a comb to prepare it for the brushmaker. It transpired that this man's sister had developed a swelling "like vaccination" on the right side of the neck a day or two before G. N. became ill, and shortly after the latter date the father of these two patients had a * See footnote (*), page 8. 44 swelling on his left cheek. Mrs. N., the mother of G. N., stated that all three swellings "were the same thing, "G. N." was the worst, but his sister was very bad." No confirmatory evidence as to the nature of the swellings in question was forthcoming in the cases of sister and father. They had both of them been working with horsehair. On March 5th, V. D., æt. 33, who had been carrying goat skins at Topping's-wharf, noticed a pimple on the right side of his neck. On the 6th it "was like a boil." On the 7th it was excised at Guy's Hospital; the patient, however, died. D. had been engaged during the week preceding his illness in sorting and handling a consignment of 79 bales of goat skins from China. These skins arrived in the Thames on February 21st, some of them were scabby and had lost the hair in places. Two cwt. of the worst of the skins were kept back at the wharf, the remainder had been sent to New York. The medical officer of health of St. Olave, Soutliwark, Dr. Wightwick, made arrangements to. destroy the 2 cwt. of worthless skins. On September 17th, F. E. B„ æt. 18, was admitted to Guy's Hospital, having a malignant pustule on the right side of the neck. The patient lived in Snows'-fields, Bermondsey, and had been engaged in handling hides (some of them from China) at Messrs. Topping's wharf in Tooley* street. The pustule was excised and the patient made a good recovery. On December 10th, R. G. E., cet. 50, who was employed at a brushmaker's in Tabard-street, S.E., developed a swelling behind his left ear. When seen by his medical attendant he was found to be in a typhoid condition, and his temperature was 1043°. On the 11th, vomiting supervened. The swelling on this day was about the size of half-a-crown, and presented a central slough with a red border and considerable surrounding oedema. The patient became collapsed, and died on the 14th. The death was registered as being due to malignant pustule, and there seems to have been no doubt as to the nature of the malady; no bacteriological examination, however, was made. Meteorology. The tables published in the annual summary of the Registrar-General, and prepared by Mr. James Glaisher, F.R.S., from observations at Greenwich, show that the mean temperature of the air in the year 1894 was 49.9 degrees Fahrenheit, or 1.3 degrees Fahrenheit above the average of 123 years. The rainfall in the year amounted to 26'88 inches, and was 1.84 inches in excess of the mean of 79 years. The temperature and rainfall in each month of 1894 are shown in the following table:— Month. Temperature of the Air. Departure from average of 123 years. Rain. Highest by Day. Lowest by Night. Mean for Month. Number of days it fell. / Amount collected. deg. F. deg. F. deg. F. deg. F. inches. January 52.2 12.8 38.2 + P.5 21 3.09 February 55.9 24.4 41.5 + 2.7 13 1.59 March 68.0 29.3 44.4 + 3.3 12 0.72 April 75.8 34.3 51.0 + 4.9 13 1.44 May 70.4 32.3 50.3 — 2.3 17 1.52 June 82.1 43.3 58.6 + 0.3 14 2.04 July 86.0 49.0 62.0 + 0.3 22 3.26 August 80.5 44.2 59.6 — 1.3 17 3.03 September 70.3 33.3 54.1 — 2.5 13 1.25 October 62.0 30.5 50.2 + 0.7 18 3.99 November 64.9 31.1 46.9 + 4.4 17 3.00 December 52.9 28.2 42.2 + 3.2 15 1.95 45 ADMINISTRATION. Dairies, Cowsheds, and Milkshops. During 1894 the Council's inspectors made 9,329 inspections of dairies and milkshops. In 8 instances legal proceedings under the Dairies, Cowsheds and Milkshops Order were instituted, and in these, penalties amounting in the aggregate to £10 10s. were imposed. 172 cases of infectious diseases occurring in milkshop premises were dealt with during the year; these included 91 cases of scarlet fever, 50 cases of diphtheria and membranous croup, 21 cases of enteric fever, 2 cases of small-pox, 4 cases of erysipelas, 1 case of puerperal fever, 2 cases of continued fever, and 1 case of measles. In all cases measures were adopted to prevent contamination of the milk. In the endeavour to ensure that the conditions under which milk was sold in London were such as would prevent its exposure to risk of contamination, difficulty was experienced in dealing with itinerant milk vendors. These persons purchase milk from dealers having premises which are registered. They sell the milk in the streets which they perambulate, and at the conclusion of their day's work return to their homes, often consisting of single rooms, in which they live under conditions which do not conduce to the maintenance of cleanliness. In these rooms there is no proper opportunity for cleansing the milk cans, and any milk which remains at the end of a day's round and which is distributed the following day is exposed in the meantime to the atmosphere of a room occupied by day and by night. These persons avoid registration, they are migratory in their habits, and their dwelling places are only found with difficulty. Other difficulty was experienced in dealing with the numerous " general shops " in which the sale of milk constitutes but a small item in the business, and in which no proper provision is made for the ensurance of cleanliness necessary in the conduct of the business of a milk vendor. Such premises abundantly exist in London, and especially in the eastern districts where the sale of milk is not infrequently undertaken by foreigners whose standard of cleanliness falls far short of that which is necessary. With a view to securing a better control over these circumstances the Council during the year 1894 authorised the appointment of an additional inspector. The number of applications for renewal of existing licenses to cowsheds, dealt with during the year, was 459, of these 441 were granted. Offensive Trades. During 1894 the Council's inspectors made 4,083 inspections of premises upon which offensive trades (including that of a "slaughterer of cattle") were carried on. In 5 instances legal proceedings were instituted, and in 4 of these, penalties amounting in the aggregate to £25 15s. were inflicted. The number of applications during the year for renewal of existing licenses to slaughterhouse premises was 522, of which 502 were granted. In the case of knackers' yards, seven existing licenses were renewed. The Council sanctioned during the year the establishment anew of the business of a "slaughterer of cattle" in four instances, and that of a soap-boiler as defined in section 19 (2) of the Public Health (London) Act, 1891, viz., a business in which tallow or any animal fat or oil other than olein is not used by admixture with alkali for the production of soap. During the year four offensive businesses which had been discontinued for a period of nine months or upwards were struck off the Council's register. These businesses included a soap-boiler, tallow-melter, bone-boiler, and gut-scraper. Trade Nuisances. Nuisances due to trade operations are referred to in the annual reports of medical officers of health of the following districts— Kensington.—The conduct of the business of a fat extractor at Tobin-street in the Potteries, Notting-dale, "gives rise at all times to more or less local effluvium nuisance, despite improved arrangements, care on the part of the proprietor, and supervision by your vestry's inspector, as well as by the inspector of the London County Council." The business of a marine store dealer often gives rise to offensive smells. Dr. Dudfield urges that as it has been held by the Court of Appeal to be ejusdem generis with the businesses scheduled in the Public Health (London) Act, it is to be desired that the County Council should add it to the list "as many years ago your vestry, at my instance, requested the late Metropolitan Board of Works to do, but without success." The subject of brick-burning at Wood-lane, Hammersmith, is also discussed by the medical officer of health of Kensington. In 1889 the Kensington Vestry requested the London County Council to add the business of a brick-maker to the scheduled list of offensive trades. The Council drafted by-laws under section 23 of the Municipal Corporations Act, 1888, but these by-laws were not confirmed by the Local Government Board, the Board being of opinion that the nuisance could be dealt with under section 21 of the Public Health (London) Act. Dr. Dudfield states that the nuisance was a serious one, causing great annoyance over a very large area. Proceedings under section 21 of the Public Health (London) Act were instituted by the Kensington Vestry against three brick-makers in Woodlane, and a conviction obtained in all cases and penalties inflicted. Two of the defendants having formally agreed not to burn bricks at Wood-lane in future, the fine was reduced. The third defendent appealed to a superior court with a view to quashing the proceedings on a technical point, but the appeal was dismissed with costs, and the full penalty inflicted. Nuisance was experienced by residents at North Kensington on account of objectionable smells 46 proceeding from the Gaslight and Coke Company's works at Kensal-green. Dr. Dudfield describes very fully the processes adopted on these premises, and shows that the effluvium complained of mainly proceeds from the purifying chamber during the breaking up and removal of the spent lime to the discharging openings, comparatively little smell arising from the operation of removal to the boats. "It is contended," Dr. Dudfield says, " that it is impossible to empty the purifying chamber of spent lime without causing smell arising from the disturbance of the lime and the escape of gas containing sulphuretted hydrogren. It was this smell, escaping through the open spaces (window openings without windows) at the side of No. 2 purifier house, for No. 1 house was not in use at the time, which was the cause of complaint. It is not denied that, in addition to the evil smell evolved in connection with the emptying of the lime chambers, there is more or less effluvium at the works generally, such as is common to all such works, and arising from small escapes of gas here and there. Such escapes are stated to be unavoidable." With a view to the prevention of nuisance, Dr. Dudfield, on October 8th, advised the engineer to close with sacking, or other suitable material, the window openings on the south side of the No. 2 purifier house looking towards Kensington, and he states, "I was glad to find on the occasion of my second visit, on October 29th, that not only had this been done, but that, with a view to diffusing the effluvia from the lime chambers on the first floor, 16 shafts had been constructed to convey the said effluvia from the first floor to the top floor, a room, 412 by 97 feet, wherein the lime is slacked, and the peroxide of iron is both stored and revivified after use. This vast chamber has glazed windows at the sides, and is fitted with louvred ventilators throughout the entire length of either side of the pitch of the roof, so that any gases drawn into the space would escape gradually and at a considerable height— conditions which must tend to minimise the risk of nuisance." Dr. Dudfield adds that since this matter was before the Sanitary Committee in October he has received few complaints. Hammersmith.—The medical officer of health discusses the action of the Kensington vestry in proceeding against the brickmakers in Wood-lane, and states that nuisance to the inhabitants of Hammersmith had not resulted from this cause. Among the complaints as to nuisances which he investigated during the year were offensive odours from malting works and from the works of an electric accumulator company. Shoreditch.—The report of the medical officer of health states that effluvium nuisance was experienced from premises in which the business of a fat melter was carried on. This business cannot be established anew in London without the sanction of the London County Council; and in this case such sanction had not been obtained. Application was subsequently made to the Council by the proprietor for leave to establish this business. The vestry of Hackney opposed the application on the ground that the locality was not a fit and proper one for this business to be carried on, and the sanction of the Council was refused. Poplar.—The reports of the medical officers of health of Poplar and Bow parishes contain a tabular statement giving a summary of improvements effected in trade premises as the result of inspection by Mr. C. W. Raymond, inspector of nuisances in manufactories and workshops. In Poplar the following nuisances were thus dealt with:—nuisance caused by scraping and drying fish skins; nuisance discontinued. Nuisance caused by boiling indiarubber clippings; the operation is now carried on in a closed vessel. Artificial manure works; escape of noxious vapours from mixer; apparatus has been repaired. Fat melters, nuisance caused by boiling refuse fat in open vessels; the process has been discontinued. Lead works; escape of lead fumes from main shaft; the work is stopped for the present. Oil burning; furnace defective; the furnace has been repaired. Chemical works; escape of acid vapours; the condensing apparatus has been repaired. Dust destructor; offensive vapours and dust discharged in the atmosphere; extra precautions taken to prevent dust, &c., escaping. Fish curing; defective wooden smoke hole; smoke hole pulled down. Bone glue; vapour allowed to escape; extra condensing power has been provided. Oil and tar refuse discharged into sewer; the refuse is now sent away in casks. In Bow the following nuisances were dealt with:—Condensers of tar works defective; condensers have been repaired. Nuisance caused by boiling whalebone; process has been discontinued. Nuisance caused by blacks escaping from defective flues of lamp black works; the flues have been repaired. Nuisance caused by cork burning; roof of building has been repaired and a new chimney fitted. Nuisance caused by evaporating glycerine in open pans in glycerine works; the building in which this operation is carried on has been repaired. Nuisance caused by burning cocoanut fibre refuse in fibre works; the burning of the refuse has been discontinued. Nuisance from defective fat-boiling coppers in fat-melting works; the coppers have been repaired. Chemical refuse ; bone oil refuse discharged into sewer; discharge discontinued. Printing ink works ; vapours from boiled oil pots allowed to escape unburnt; the furnace for consuming the vapours has been repaired. Sulphuretted hydrogen from sulphate of ammonia works allowed to escape into atmosphere; defective pipes and condensers repaired. The following statement relating to nuisance in glycerine works is made by the medical officer of health of Bow, who thus refers to Mr. Raymond's report on this subject— "Among the many processes carried on by the firm (Messrs. Cook, East London Soap Works) is that of extracting glycerine from the soap liquors. The plan adopted is by means of evaporation in open pans. The first part is carried on in a set of pans heated by fire, where the liquors are concentrated up to a certain point, the salt which is deposited being fished out. This plant is merely covered by an iron roof, the sides and ends being open, so that all the vapours escape into tbe atmosphere. The steam evaporation is carried on in an enclosed shed, which at the time of inspection was very much out of repair. In this shed the liquors are neutralized with hydrochloric acid for the purpose of taking up any excess of alkali that may be present in the liquor. At times the vapours given off are of a pungent nature. This, in his (Mr. Raymond's) opinion, arises when the above process is in operation. After this treatment the liquor is further evaporated in steam pans, the vapours being allowed to escape as before, and more salt extracted therefrom, the final product being a concentrated solution containing 80 per cent. glycerine, 10 per cent. water, and 10 percent. salt. Mr. Cook, in the course of conversation, stated the plant used by them was generally adopted throughout the soap trade. The main question to be 47 sidered is whether the best practicable means are adopted for preventing the escape of vapours into the atmosphere. Granting that open evaporation is necessary, he was of opinion the same could be carried on in a properly constructed building, allowing for fresh air inlets, and having an apparatus fixed for drawing off all vapour given off during the process, and passing same through a series of condensers, where they would be effectually got rid of." Rotherhithe.—The medical officer of health refers to nuisance caused (a) by the dressing of roker skins in Fulford-street, (b) from premises in which manure had been manufactured in Rotherhithe New-road, and (c) from premises in Rotherhithe-street in which grain was dried. Battersea.—Complaints were made of nuisance from Beaufoy's Works, where the manufacture is chiefly acetic acid and Glauber's salts, the processes being by distillation of the acetic acid from oil of vitriol and acetate of soda, and also from muriatic acid and acetate of lime. Most of the stills were found to be steam jacketted, from these very little effluvium is given off. One still was not steam jacketted, this had been seldom used, but would appear to have been the cause of complaint. The use of this still has now been discontinued and the tanks of acetic acid covered, since which no nuisance has been detected. Nuisances. During the year the Council received 741 applications for assistance in securing the removal of conditions which it was alleged were dangerous to health. Inquiries were made into the merits of each complaint, and, where necessary, communications were addressed to the sanitary authorities concerned. In all cases the subject of complaint was kept under observation until a remedy had been provided. The Council's inspector made 1,275 inspections in connection with nuisances alleged to exist. Smoke Nuisances. References to cases of smoke nuisance are found in annual reports relating to the following districts— Hammersmith.—Letters of caution were addressed to offending persons in several instances; in one case the nuisance was continuous and proceedings were instituted, a penalty of £5 being obtained. Kensington.—1 summons was taken out, an order to abate the nuisance was made, but no penalty inflicted. Fvlham.—] 3 notices were served, and a temporary inspector appointed to watch and report on nuisance from a particular factory. Chelsea.—5 cases of smoke nuisance were dealt with. St. George, Hanover-square.—4 cases of smoke nuisance were dealt with. Westminster.—In all but 1 instance the service of notice sufficed. In the instance referred to the defendants were fined £5 and £3 3s. costs. St. James, Westminster.—4 smoke nuisances were abated. Marylebone.—Notices to abate were served in 4 instances. St. Pancras.—1 smoke nuisance was abated. Hackney.—The smoke inspector made 1,879 "observations." Intimation notices were served in 29 instances, and statutory notices in 9, and legal proceedings in 1 case only. The prosecution failed owing to a fault in the notice. Holbom.—There are 54 furnaces and boilers on the register, 28 without smoke consumers. A list of the smoke consumers in use in the district is given. In respect of 4 cases of nuisance notices were served. Clerkenwell.—11 smoke nuisances were abated. Shoreditch.—86 complaints were received from the London County Council relating to 30 persons. A practical engineer was from time to time engaged, and in a number of instances, by his advice, works have been carried out in connection with boilers, furnaces, shafts, &c., which have resulted in there being no further complaints received as to nuisance from black smoke issuing from these premises. The medical officer of health recommends the appointment of a practical engineer to deal with cases of smoke nuisance instead of the sanitary inspector. Whitechapel.—19 nuisances from smoke abated. St. George-in-the-East.—20 smoke nuisances abated. Limehouse.—13 smoke nuisances abated. Mile-end Old-town.—6 smoke nuisances abated. Poplar.—45 cases of smoke nuisance due to inferior and defective apparatus. A better class of fuel is now used. Newington.—Smoke nuisances, which occurred in seven streets, abated. St. Olave.—1 smoke nuisance dealt with. Bermondsey.—9 summonses were taken out, and penalties to the amount of £9 8s. inflicted. Rotherhithe.—Notice was served in 2 instances. Lambeth.—50 notices were served. Battersea.—21 smoke nuisances dealt with. Wandsworth (Clapham).—5 cases under observation and 3 notices served. Camberwell,—In 112 instances notices were served to abate smoke nuisances and raise chimneys. Greenwich.—In 6 cases notices were served. Lee (Charlton).—1 smoke nuisance was dealt with. Removal of offensive matter. The annual reports show that proceedings for enforcement of the Council's by-laws relating to the removal of offensive matter were instituted in the districts of Fulham, Greenwich and Wandsworth. In Battersea several persons were cautioned for neglect to comply with the by-laws. In Woolwich the local board made arrangements for the collection and removal of trade refuse, such as fish offal, and provided air-tight receptacles for this purpose, the refuse being subsequently destroyed in the destructor. The medical officer of health of Limehouse reports that with the advent of warmer weather in July, the usual complaints of nuisance from barges laden with fish offal in the Limehouse-cut were received. The 48 complaint stated that such barges were frequently in the cut for from three to eight hours at a time. The complainant was informed that if he gave notice to the sanitary inspector at the time of the existence of the nuisance legal proceedings could be taken. Question having arisen as to the application of the Council's by-laws to fat and bones when not offensive, a deputation of persons engaged in trades in which these materials were used, waited on the Public Health Committee. The Public Health Committee, on the 20th March, thus reported to the Council on this subject. By-laws under the Public Health (London) Act—Removal of offensive matter. We have had under consideration a memorial of scapmakers, tallow-melters, and bone-boilers in or near the county of London and a memorial of the butchers of London, asking the Council to modify its by-laws under the Public Health (London) Act, 1891, so that they shall not apply to the collection of fat and bones from the shops of butchers and marine-store dealers. Deputations from the memorialists in support of their petitions have attended before the Public Health Sub-Committee. The soapmakers, tallow-melters, and bone-boilers state that in the conduct of their businesses they have always collected at all times of the day fat and bones from the shops of butchers and marinestore dealers, that the articles are collected two or three times a week, and, when necessary, daily ; that it is of great importance to the petitioners in their businesses that the articles should be fresh, and that they use every endeavour to obtain them in that condition. They state that such collection in small quantities from numerous shops necessarily occupies longer time than the six hours allowed by by-law No. 1 made by the Council under section 16 (2) of the Act. When the by-laws were advertised the petitioners did not consider them as applying to their businesses, but recently several of the sanitary authorities have sought to enforce the by-laws so as to prohibit the collection of bones and fat from the shops in question, except between the hours mentioned in the by-laws. The Vestry of Fulham issued summonses against Messrs. Wickens, Pease and Co., bone-boilers, but they were ultimately withdrawn in order that the Council might be approached with a view to some modification of the by-laws if they should be held to apply to the collection before described. Similar summonses against Messrs. Edward Cook and Co., soapmakers, by the Clerkenwell Vestry were subsequently adjourned sine die for a similar purpose. The vestry obtained a rule nisi for a mandamus directing the magistrate to hear and determine the summonses, but the rule was dismissed on appeal. The memorials above referred to, praying for a modification of the by-laws, have accordingly been drawn up and submitted to the Council. We have given very careful consideration to the subject. The by-law objected to of course only applies to the removal of offensive matter, and in case of proceedings it is fcr the magistrate to determine whether or not a particular load of bones and fat is offensive. The petitioners express their decided opinion that these articles are not offensive, except in very hot weather, though if they are not removed at frequent intervals they would be liable to become offensive. Since the articles when inoffensive can be removed at any hour of the day, it is evident from the statement of the memorialists that the by-law would only apply under exceptional circumstances. When the articles are in an offensive state we think their removal should be subject to restriction in the same way as other offensive matter. The by-law was drafted after very careful investigation, and both the Council and the Local Government Board were strongly of opinion that offensive material should not be removed during the night time, when proper supervision cannot be exercised over its transport, but during the early hours of the day when the streets are not crowded, and transport can be expeditiously effected. We do not therefore see our way to recommend that any proviso should be added to the by-law exempting from its operation the collection of fat and bones from the shops of butchers and marine-store dealers. It is to the interest of both the butchers and the firms who collect these articles that they should be collected when fresh, but should it be found in practice, that however expeditious the method of collection, some offensive matter must accumulate, then we feel sure that some arrangement could be made whereby the offensive matter could be separated from the fresh and inoffensive articles and its collection and removal effected during the hours prescribed by the by-laws. With a view, however, to meeting as far as practicable the wishes of the memorialists, we are prepared to consider, in the event of a future revision of the by-laws, whether it is desirable to somewhat extend the hours during which offensive bones and fat can be conveyed through the streets, so that there may be no difficulty in collecting such articles and conveying them to premises outside the county within the prescribed hours. We do not think a strong enough case has been made out for at once altering the by-laws, which it will be remembered have only recently come into operation. We recommend— That the memorialists be informed that the by-law to which they take exception does not apply to the collection of fat and bones from the shops of butchers and marine-store dealers, except when these articles are in an offensive state, that the Council is not prepared to make any alteration in the by-laws at present, but that a note will be kept of the memorials, and that in the event of a future revision of the by-laws, the Council will consider whether it is desirable to somewhat extend the hours during which offensive bones and fat can be conveyed through the streets. With a view to securing the more complete enforcement of the Council's by-law relating to the removal of offensive matter the Public Health Committee addressed a communication to the Commissioner of Police, asking if the police might be instructed to take note of any infringement of the by-law and inform the sanitary authority. The Commissioner was good enough to comply with this request. Removal of House Refuse. With a view to obtaining fuller knowledge as to the systems adopted by the several sanitary authorities in connection with the collection and disposal of house refuse, Dr. Young was instructed to make inquiry into the subject. I subsequently presented to the Public Health Committee a report which had been prepared by Dr. Young, and which embodied the information which he had obtained (see Appendix IV.). This report showed that in a large number of districts the removal of refuse from houses depended upon the occupier hearing the cry of the dustman during his perambulation of the streets or upon the exhibition in the window of a card indicating the need for the dust collectors' assistance. Inquiry as to the manner in which house refuse is dealt with after collection showed that in 25 districts in which the authorities make the collection, in 6 only is the refuse subsequently manipulated in dust yards in London, in all other cases it is either destroyed by fire or removed outside the county. In the case of 14 districts where the removal is wholly effected by a contractor, the refuse of 10 is manipulated in dust yards in the county, in the remaining 4 it is tipped within or without the county. In order to learn the results obtained in the several districts by the systems adopted in connection with the collection of refuse, an inspector (Mr. Williamson) was instructed to make inquiry at a large number of houses in several districts. 49 In Betlmal-green it was found to be the practice of the dust collector to call bi-weekly for the removal of refuse, and in some parts to remove daily the refuse which was placed in pails on the pavement by the house occupier for that purpose. The result of Mr. Williamson's inquiry at nearly 800 houses showed that excellent results were obtained. In Newington the result of inquiry showed that the method of exhibiting a card in the window adopted in the district was unsatisfactory and did not secure the necessary result. Inquiry in Marylebone, Islington, and Plumstead showed that the first two districts, in which no systematic house to house call was made, were less efficiently scavenged than Plumstead, where it was the practice of the inhabitants to place outside their houses, once a week, a pail containing their house refuse. Communications were addressed by the Public Health Committee to the several sanitary authorities on this subject. Special reference to the subject of collection of house refuse is made in the reports of the medical officers of health of the following districts— Kensington.—The medical officer of health discusses this subject in detail, and refers to the law which supports the dust collector in his endeavour to secure the removal of refuse from a house. Difficulty has been experienced in finding accessible "shoots" for house refuse, to the deposit of which within their boundaries the sanitary authorities of other districts naturally object. The medical officer of health makes reference to his previous reports and to a report issued by the Council on the subject of destruction of such refuse by fire, and reminds the vestry of the opinion he had before expressed to them "that the erection and utilization of dust destructors in this parish would be a distinct advantage from the public health point of view." Fulham.— "A weekly visit is made to all premises for the collection of house refuse, and the service has been fairly satisfactory. 620 complaints of non-removal of dust were received, but a very fair proportion of these were due to the refusal of the servants to allow the refuse to be removed when the usual weekly call was made." St. James, Westminster.—"The London County Council having called the vestry's attention to the desirability of making arrangements for all houses in their district to be called at, not less frequently than once in every week, for the removal of house refuse, the vestry assented to the suggestion, and referred it to the sanitary committee to make the necessary arrangements for carrying the proposal into effect." St. Pancras.—The medical officer of health gives account of the number of complaints as to non-removal of house refuse in several years, and shows how this number, which in 1891 equalled 18,645, and in 1892, 10,335, was in 1893, 122, and in 1894, 224. He discusses the duty of the authority and the householder, and states that the destructor erected by the vestry will shortly come into use. Hackney.—During the year the sanitary committee of the vestry resolved to enforce the Council's by-laws relating to the carriage of house, trade or street refuse across or along any footway, pavement or carriageway, and as to the removal of house refuse not less frequently than once in each week. Strand.—Fixed bins are gradually being disused and abolished. City.— "Great benefit has accrued from the extensions of the 'skip system,' which has enabled us to take away most of the public dust-bins from courts and alleys where they were found to be a constant source of nuisance and complaint." The reports relating to other districts show the gradual substitution of moveable for fixed receptacles. The medical officers of health of Plumstead and Lee refer to deposits of house refuse within the distance prohibited in the Council's by-laws. On February 27th the Public Health Committee reported to the Council on the application of the Wandsworth District Board for a loan for the purchase of a site for a dust depot. The Southwark and Vauxhall Water Company objected to this use of the site on the ground of its proximity to their pumping station. The Committee, after inquiry, decided not to offer any objection to the granting of the loan, provided the Council's by-laws, as to the deposit of offensive matter, were not infringed. Regent's and Grand Junction Canals. In my last annual report I gave account of the proceedings of the Council in reference to the Regent's and Grand Junction Canals. It will be recollected that on February 13th, 1894, the Council resolved that the opinion of counsel should be taken whether it would not be competent for the Attorney-General, if called upon by the Council, to proceed against the Regent's and Grand Junction Canal Companies for creating a public nuisance by their neglect of the proper management of their canals and basins within the metropolis. On July 3rd, the Council declined to receive the report of the Public Health Committee, which stated— (a) That Mr. Poland, Q.C., was of opinion that this was not a case in which the Government would be likely to instruct the Attorney-General to take up the prosecution until after every effort had been made to put a stop to the nuisance under the Public Health (London) Act of 1891. (b) That the Council cannot pay expenses of a prosecution by indictment out of the County fund, but he suggested that the Council should obtain the necessary powers from Parliament. (c) That there was no case against the Grand Junction Canal Company. (d) That the Public Health Committee had addressed a communication to the sanitary authorities concerned asking information as to the scavenging of the canal, and as to the steps taken for diverting the drainage of the Zoological-gardens from the Regent's-canal. On Oct. 9th, the Public Health Committee presented the following report:— Regent's and Grand Junction Canals. In the report which we made to the Council on the 3rd of July last we stated that we had addressed a communication to the sanitary authorities through whose districts the Regent's and Grand Junction canals passed, inquiring what action had been taken since the conference at the County Hall in December last, whether any mud deposits had been removed from the canals, and whether the surface of the water was periodically or regularly scavenged. Replies have now been 7 50 received from all the authorities with the exception of the Vestry of Paddington, and wo observe with satisfaction the increased activity on the part of the several authorities which has resulted in a considerable improvement in the state of the canals. We submit the replies for the information of the Council in the following summarised form— Name of authority. Summary of reply. Hammersmith There are no mud deposits in the portion of the canal in that parish, and there is no necessity for the periodical scavenging of the water. Kensington No action is necessary. The canal is systematically cleansed, and the water is in a cleanly condition throughout. Chelsea No mud deposits have been removed by the canal company. The surface is not scavenged with sufficient regularity, but floating nuisances have been removed on request of the sanitary inspector. The surface of water is littered with papers blown off barges removing house refuse" There are no lay-byes in the parish. The three wharves are only used for loading bricks and gravel. St. Marylebone The canal is not dredged, but the company have removed floating offensive matter at least once a week. A sewer will be constructed to divert the drainage from the Zoological-gardens to the St. Pancras sewer system. St. Pancrat The canal company have been engaged in dredging operations, and 3,400 tons of deposit have been removed. Statutory notices have been served on owners of lay-byes, docks, and other places abutting on the canal, requiring the abatement of nuisances. Details of the proposed new sewer from the Zoological Society's Gardens are now settled with the Vestry of St. Marylebone. Islington The surface of the water is periodically cleansed. St. Luke's Notices have been served upon the company to scavenge the canal. The vestry is prepared to co-operate in any joint action that may be taken in the future. Shoreditch The vestry is in communication with the canal company as to the scavenging of the surface and banks and the removal of mud; and is also taking steps to deal with the condition of the wharves abutting on the canal. Hackney The house drains connected with the canal have been removed and the drainage carried into the local sewers. The dust wharves at Hertford-road Kingsland, have been repaired and drained. Initiatory steps have been taken for paving and draining two other wharves near Kingsland-basin. The Board do not know if any mud deposits have been removed or if the water is scavenged periodically or regularly. Bethnal-green The vestry has not found it requisite to take any action since the conference. Mile-end, Old-town Ballast has been laid on the towing paths remedying the nuisance from pools of stagnant water. The lock-keepers' houses have been drained with separate drains instead of into the canal as formerly. The vestry does not know if any mud deposits have been removed. Limehouse The surface of the water has been scavenged. No mud deposits have been removed since December, except that from Brunton's wharf. The Council will be glad to notice that the details of the proposed new sewer, which will divert the drainage of the Zoological-gardens from the Regent's canal, are now settled, and that one large source of nuisance will thus shortly be removed. We have thought it well to address further communications to the canal companies urging them to . have the surface of the water scavenged and mud deposits removed from the canals at regular periods, and are also still in correspondence with several sanitary authorities on the subject. Private Mews. Complaint having been made to the Council of the condition of various private mews in the parishes of Kensington, Paddington and Marylebone, I was instructed to report on the subject, and 109 private mews were therefore inspected for this purpose. In all but seven the paving, lighting, and general condition of maintenance and repair were found to be satisfactory. Inquiry was also made, for the purposes of comparison, into the condition of certain public mews, with the result that private mews were found to compare favourably with public mews. During the inquiry 70 dung receptacles were found which did not comply with the Council's by-laws, and communications were addressed to the sanitary authorities concerned. Combined Drainage. During the year the attention of the Council was directed to difficulties experienced by London sanitary authorities in dealing with old combined systems of house drainage, courts of law having decided that such combined drains were sewers for the maintenance of which the authorities were responsible, unless they were constructed under an order of the sewer authority pursuant to section 74 of the Metropolis Local Management Act. On November 20th, 1894, the Main Drainage Committee presented to the Council the following report, which was, however, by leave, withdrawn by the Chairman of the Committee— We have received several communications from local authorities in London on the subject of the law as regards combined drainage, and on the 28th of June last we received a deputation from a conference of vestries and district boards convened by the Holborn District Board to discuss the matter. The deputation referred to the difficulties experienced by local sanitary authorities in dealing with the question of combined drainage, and asked the Council to promote legislation with a view to an alteration in the definition of the words drain and sewer in the Metropolis Management Acts. The present definition of the word drain (sec. 150 of the Act of 1855) is— "any drain of and used for the drainage of "one building only, or premises within the same curtilage, and made merely for the purpose of "communicating with a cesspool or other like receptable for drainage, or with a sewer into which the "drainage of two or more buildings or premises occupied by different persons is conveyed;" and also (sec. 112 of the Act of 1862) "any drain for draining any group or block of houses by a combined "operation under the order of any vestry or district board, or pursuant to the order or direction or with "the sanction or approval of the Metropolitan Commissioners of Sewers." Old combined drains into which the drainage of more than one house is conducted are sewers within the terms of the Metropolis Management Act. These drains were no doubt originally constructed for tho accommodation of the particular houses, and in some cases through private land, It is now found that they are defective and wearing out, and their repair and renewal involves considerable expense and difficulty to the ratepayers. 51 It is therefore suggested that the meaning of the word drain should be extended so as to include any drain the plan of which has not been approved as a sewer under section 69 of the Act of 1855 and sections 45 and 48 of the Act of 1862. The result would be to transfer from the local authorities the liability under which they now are to maintain and repair these sewers, and to cast it back upon the owner of the property. It is admitted as regards drains hereafter made that no protection is needed, and the suggested legislation is therefore entirely retrospective. Under the Public Health Act, 1875 (which applies to the whole of the country except London), the distinction between drains and sewers is carefully drawn. Every pipe or channel conveying the drainage of more than one house is a "sewer." Every pipe or channel by which the drainage of one house only is conveyed to a point of junction with another drain or sewer is a "drain." The owner of the premises is responsible for the drain, the local authority for the sewer, and both private and public legislation have proceeded upon this basis. Assuming that the suggested legislation were obtained, difficulty would result even in a case where the drainage of only two houses erected by one builder passes at some given point into one channel. The houses will probably be sold to separate owners, and will certainly have different occupiers, and there is no legislative machinery under which, in the event of a sewer draining more than one house being defective, either owner or either occupier could have a remedy against the other, or indeed be entitled to deal with the matter, and it is further obvious that the difficulty would become increased in proportion to the number of houses drained into a common channel, unless the common channel were under the supervision and management of the local authority responsible for the drainage and health of the district. In many cases, doubtless, both from laxity of supervision and from the premeditated acts of builders and others, combined drains have been made without the requisite orders, and consequently must now come under the definition of sewers, and in other cases, probably from the laxity of the local authorities themselves and their predecessors, no proper record has been made of the combined drains sanctioned by them. It appears that some parishes of London are in greater difficulty than others in consequence . of the number of cases where sewers of this kind exist and have been constructed without the knowledge of the local authorities or their respective officers, and allowed to be constructed without proper control or record. It cannot be alleged with any show of truth that the vestries and district boards have been in ignorance of the meanings of the words sewer and drain, as there was a reported case on the point so long ago as 1865. Being of opinion that the question of whether the suggested legislation should be promoted by the Council or not, was one of policy, we have consulted the Parliamentary Committee, and they, after conference with the parliamentary agent, are of opinion that Parliament would not give effect to the wishes of the local authorities, and that application, especially by the Council, for any Act framed on such lines would be undesirable. After careful consideration of the whole case we are unable to advise the Council to promote the suggested legislation, and we recommend- That the secretary of the conference of vestries and district boards convened to consider the question of combined drainage be informed that the Council does not see its way clear to promote legislation with a view to an amendment of the definition of the words sewer and drain in the Metropolis Local Management Act. * Housing of the Working Classes. During 1894 the following steps were taken under the Housing of the Working Classes Act in respect of unhealthy areas. (а) Scheme undertaken by the Council under Part I. of the Housing of the Working Classes Act. Boundary-street—The Public Health and Housing Committee was actively engaged during the- year in dealing with questions of re-construction and re-arrangement of this area. The greater part of the property had come into the Council's possession by the middle of the year 1894, the number of houses which had not been acquired having been reduced from 160 in the in the middle of 1893 to 31 in the middle of 1894. At Midsummer, 1894, 118 houses acquired by the Council were still in occupation, affording accommodation to 215 tenants. Inquiry made by the valuer as to the distance to which 934 tenants formerly living in the area had removed, showed that 523 had removed to premises within £ mile of the area, 286 had removed to premises beyond £ mile, but within ½ mile of the area, 79 had removed to premises beyond but within one mile of the area, and 46 had removed to premises beyond one mile. (b) Schemes undertaken by the Council with contributions by the district authority under Part II. of the Housing of the Working Classes Act. Progress was made during 1894 in dealing with the Brooke's-market, Holborn, scheme, which was sanctioned in October, 1892 ; with the Ann-street, Poplar, scheme, which was sanctioned in February, 1894; and with the Mill-lane, Deptford, scheme, which was also sanctioned in February, 1894. (c) Schemes undertaken by district authorities with contributions by the Council under Part II. of the Housing of the Working Classes Act. Green-street and Gun-street.—The vestry of St. George-the-Martyr, having acquired the whole of the property under this scheme, requested the Council to purchase the land, and to erect dwellings thereon. The Council accordingly decided in November, 1894, to acquire the lands under Part III. of the Housing of the Working Classes Act, and to ask the Local Government Board to make the necessary modifications in the order issued with respect to this scheme. Moira-place and Plumber's-place, Shoreditch.—The order sanctioning this scheme was issued by the Local Government Board in April, and the confirming order was issued in October, 1894. The scheme is being carried out by the Shoreditch vestry. Norfolk-square, Islington.—This scheme was sanctioned by the Local Government Board in September, 1893, and the confirming order was issued in February, 1894. The scheme is being carried out by the Islington vestry. London-terrace, St. George-in-the-East.—This scheme was sanctioned by the Local Government Board in May, 1894. The scheme is being carried out by the Vestry of St. George-in-the-East. The following areas may be specially referred to, among others, which were under the consideration of the Public Health and Housing Committee during 1894, as having been the subject of decisions of the Council during the year 1894. St. Pancras areas.—Reference was made in my annual report of last year to the history of the proceedings with respect to these areas, and to the recommendation of the Public Health and Housing Committee with respect to the Somers'-town area, which the Home Secretary had decided should be * On the 12th February, 1895, the Committee, after further consideration of the subject recommended the Council to apply to Parliament for an amendment of the definition of the words sewer and drain in the Metropolis Local Management Act in the way desired by the local authorities. 52 improved by the Council. This recommendation was considered by the Council on October 31st, 1893, and an amendment was then carried instructing the committee to communicate with the freeholders, and to urge upon them the need of taking the necessary steps to put an end to the existing evils. In November, 1894, the Committee reported that Lady Henry Somerset, the freeholder of a portion of the represented area, had indicated her willingness to co-operate with the Council, and the Committee added that they hoped before very long to be in a position to submit a scheme which would meet with the Council's approval. Bell-lane area, Whitechapel.—In February, 1894, a memorial from the Whitechapel Board was presented to the Council, asking that this area might be proceeded with at the earliest practicable opportunity. The Board was informed by the Public Health and Housing Committee that they were unable to recommend the adoption of "so large a scheme as would be involved in the widening of Belllane and Sandy's-row combined with clearance of the central area." A deputation of the Board was received by the Committee on March 19th, and was informed that the Committee was unable to depart from the position it had taken up in regard to the matter. The widening of Sandy's-row was proceeded with by the Improvements Committee during the year. James'-street, Kensington.—The Public Health and Housing Committee reported to the Council in February, 1894, upon a scheme for dealing with a number of houses on the east side of James'street, Kensington, and with some adjacent property. The Vestry of Kensington asked the Council to contribute a moiety of the cost of this scheme. The Council resolved that having regard to the information in its possession, it was unable to make the contribution in question. Millbank Prison Site.—On October 24th, 1893, the Council had resolved to acquire about ten acres of the rear portion of the Millbank prison site at the sum of £2,500 per acre for the purpose of Part III. of the Housing of the Working Classes Act, 1890, subject to certain conditions as to approaches. The Committee were subsequently in negotiation with H.M. Office of Works as to the conditions under which the Government would be prepared to transfer the land to the Council. The Committee, on May 8th, 1894, presented to the Council a report showing the conditions under which this land could be obtained, and the Council adopted the recommendation of the Committee that the land should be purchased in accordance with these conditions. Proceedings in respect of houses represented as unfit for human habitation. The following tabular statement shows the procedure of district authorities as to houses represented as unfit for human habitation, and concerning which the Council has received copies of representations from the 1st January, 1894, to the 31st December, 1894— Local Authority. Total number of house.concerning which the Council has received information that representations have been made from the 1/1/94 to the 31/12/94. Number of houses closed, demolished or improved by owners without Magisterial intervention. Number of houses for which closing orders were granted. Number of houses for which closing orders were refused. Number of houses outstanding or concerning which proceedings are in progress. Closed. Demolished. Improved. Total. Subsequently demolished. Subsequently improved. No further action. Total. Battersea - - - - - - - - - - - Bermondsey 12 - - - - 9 - 3 12 - - Bethnal-green 35 - - 9 9 10 13 3 26 - - Camberwell - - - - - - - - - - - Chelsea - - - - - - - - - - - Clerkenwell - - - - - - - - - - - Fulham 103 7 4 26 37 3 14 41 58 - 8 Greenwich - - - - - - - - - - - Hackney 24 - - - - 24 - - 24 - - Hammersmith - - - - - - - - - - - Hampstead - - - - - - - - - - - Holborn - - - - - - - - - - - Islington 10 6 - 4 10 - - - - - - Kensington 1 - - - - - - 1 1 - - Lambeth - - - - - - - - - - - Lewisham - - - - - - - - - - - Limehouse 10 - - 10 10 - - - - - - Mile-end Old-town 38 8 5 16 29 2 - 6 8 - 1 Newington - - - - - - - - - - - Paddington - - - - - - - - - - - Plumstead - - - - - - - - - - - Poplar - - - - - - - - - - - Eotherhithe 5 - - 5 5 - - - - - - St. George, Hanover-square - - - - - - - - - - - St. George-in-the-East 25 1 7 8 16 - 8 1 9 - - St. George-the-Martyr - - - - - - - - - - - St. Giles 10 - 1 4 5 3 2 - 5 - - St. James, Westminster - - - - - - - - - - - St. Luke - - - - - - - - - - - St. Martin-in-the-Fields - - - - - - - - - - - St. Marylebone 10 1 - 7 8 - - 1 1 - 1 St. Olave, Southwark 9 - 5 - 5 4 - - 4 - - St. Pancras 1 - - - - - - - - - 1 St. Saviour, Southwark - - - - - - - - - - - Shoreditch - - - - - - - - - - - Strand 2 1 - - 1 - - - - - 1 Wandsworth 19 - 12 7 19 - - - - - - Westminster 46 - 18 - 18 26 2 - 28 - - Whitechapel 10 - - 10 10 - - - - - - Woolwich 6 - 6 - 6 - - - - - - Total 376 24 58 106 188 81 39 56 176 - 12 53 Customs and Inland Revenue Acts, 1890 and 1891. The Customs and Inland Revenue Acts, 1890 and 1891, provide that the assessment to inhabited house duty of any house originally built or adapted by additions or alterations and used for the sole purpose of providing separate dwellings for persons, where the annual value of each dwelling does not amount to £20, and occupied only by persons paying such rents, shall be discharged by the Commissioners of Inland Revenue, provided that a certificate of the medical officer of health of the district in which the house is situate shall be produced to them to the effect that the house is so constructed as to afford suitable accommodation for each of the families or persons inhabiting it, and that due provision is made for their sanitary requirements. The reports of the medical officers of health of the following districts show that certificates were given by them for the purpose of such exemption. Fulham.—Certificates were granted in respect of 95 houses, and refused in respect of 25. St. Pancras.—Certificates were granted in cases where houses were found to be constructed in conformity with the Metropolitan Building Acts, the Metropolis Local Management Acts, the Public Health (London) Act, and when they complied with the following requirements— 1. That each of the persons inhabiting the house is provided with at least 400 cubic feet of air space. 2. That each of the living or sleeping rooms is at least eight feet in height and at least 96 square feet in area. 3. That there is at least one draw tap and sink, with a sufficient supply of water thereto, for every twelve occupants or less on each floor. 4. That the drainage of the premises is in accordance with the regulations recognised by the sanitary authority. 5. That accommodation for clothes-washing is provided sufficient for the number of persons inhabiting the house. In future the requirements of the London Building Act, 1894, will also be made part of the requirements for the purpose of this certificate. Hackney.—Applications for a certificate under this Act were made in respect of 90 tenements, and the certificate was granted in respect of 80. City.—Application for certificate was made in one instance and refused. Shoreditch.—Application for certificate was made in respect of 135 tenements, and granted in respect of 111. Poplar.—An application for certificate was made in respect of 16 tenements and refused. St. George-the-Martyr.—Applications were made and certificates granted in respect of 86 tenements. Battersea.— "Some hundreds of tenements have been inspected and certified since the Act came into force in January, 1891, and many flats are now being built and converted in the parish in order to obtain exemption or abatement of the house duty." Wandsworth {Putney).—One application was made in respect of a block of houses, and the certificate granted. Workmen's Trains. The Public Health Committee had in 1893 directed its attention to the subject of workmen's train service in the metropolis, and the Council in April of that year approved certain recommendations which it was hoped the railway companies might be induced to adopt. Among these recommendations were "those which dealt with the question of a zone system, and the securing of an extension in the time of arrival at the termini of the morning workmen's trains; but among the minor recommendations may be mentioned one on which much stress was laid, viz., that for the removal of the restrictions which at present exist on most of the lines against the use of return workmen's tickets except by special trains and after certain hours." At the request of the Council, the Board of Trade on the 28th June, 1893, convened a conference of representatives of railway companies, particularly in relation to zone limits and tariffs, at which the thirteen metropolitan railway companies were represented. The Committee state that "whilst a readiness was then expressed to make one or two concessions, no agreement was come to on the two main points alluded to above, it being left for the companies to consider them further, with a view, if practicable, to a further conference being held." On the 4th May, 1894, the committee reported to the Council on a letter, dated January 18th, 1894, addressed by Sir Henry Oakley to the Board of Trade, which the committee thought " must be taken as a definite declaration of the extent to which the companies are prepared voluntarily to go, and that further argument is not likely to advance matters." The companies were of opinion that the present system of grouping, where possible, answers all practical purposes better than any universal zone system, but they were prepared to adopt arrangements, providing (a) that workmen's daily tickets shall be issued with the option to the company of issuing weekly tickets if preferred (b) that all workmen shall be allowed to return by any train conveying third class passengers after 12 noon, with the reservation of the right to the company to provide special trains for the accommodation of the workmen, and to except such train or trains as may be found necessary for the general convenience of the traffic, (c) that the fares and conditions for the issue of workmen's tickets shall be more particularly advertised at the stations by means of placards and posters. These concessions the Committee regarded as "very small." The Committee after reviewing the action taken by the railway companies and by Parliament in connection with the subject of provision of workmen's trains stated— "We feel satisfied that a further parliamentary inquiry is necessary either through a Select Committee or a Royal Commission, in order to ascertain (1) the amendment necessary to the Cheap 54 Trains Act, (2) whether the statements repeatedly put forward by promoters of new undertakings of the financial impossibility of running cheap workmen's trains are really well founded, (3) the cheapest method of constructing railways leading out into the suburbs, (4) as to the necessity of periodical inspection of the metropolitan railways by a duly authorised body with a view to the enforcement of obligations in the matter of workmen's trains, and (5) whether the Council is not the right body to be charged with that duty." The committee therefore recommended— That a petition be presented to the House of Commons, praying for an inquiry into the subject of workmen's trains, and the operation of the Cheap Trains Act, 1883, and that it be referred to the Parliamentary Committee to frame a petition giving effect to this resolution, and that the seal of the Council be affixed thereto. The recommendation of the committee was adopted. Houses let in Lodgings. Many of the sanitary authorities having made regulations under the Sanitary Act, 1866, and the Sanitary Law Amendment Act, 1874, for houses let in lodgings, the Local Government Board addressed to such authorities a letter pointing out that certain subjects to which these regulations applied would, under the Public Health Act of 1891, be otherwise dealt with, in some cases by by-laws made by the sanitary authorities and applicable generally to all houses in the district whether let in lodgings or not, and in others by by-laws made by the London County Council. Model by-laws under the Act of 1891 had therefore been prepared by the Local Government Board, and it was suggested that the existing regulations should be modified on the basis of the model by-laws. Most of the sanitary authorities accordingly took into consideration the revision of their regulations. Reference to the subject of houses let in lodgings is made in the annual reports relating to the following districts— Kensington.—The vestry had under consideration the modification of the existing regulations on the basis of the model by-laws of the Local Government Board. Hammersmith.—The preparation of by-laws was under consideration. St. George, Hanover-square.—Houses let in lodgings (73 in number) have been inspected, and the regulations as to cleansing complied with. Westminster.—An inspector was specially employed in this work, and 402 houses were registered. As many as 4,071 defects were found and dealt with, proceedings being instituted when necessary. St. James.—No additional houses were registered in the year. The number of houses on the register at Lady-day, 1895, was 35. By-laws were confirmed by the Local Government Board. Marylebone.—There were 21,166 inspections of houses let in lodgings. Hampstead.—843 houses let in lodgings were regularly inspected. By-laws were confirmed by the Local Government Board. St. Pancras.—The number of houses registered was 174. Stoke Newington.—By-laws were framed. St. Giles.—The report of the vestry clerk states that the vestry decided not to make by-laws under the Act of 1891 in supersession of the regulations already in force in the district. St. Martin-in-the-Fields.—Houses let in lodgings have been regularly inspected. Strand.—By-laws were confirmed by the Local Government Board, and 62 houses registered; in 21 cases overcrowding was found. Clerkenwell.—By-laws were awaiting the confirmation of tho Local Government Board. St. Luke.—By-laws were awaiting the confirmation of the Local Government Board. City.—By-laws were submitted to the Local Government Board, and remitted by that Board to the Commissioners of Sewers " with certain emendations marked thereon to which the Local Government Board invite consideration." Shoreditcli.—By-laws were confirmed by the Local Government Board. Houses are exempted from the operation of these by-laws until the landlord of the lodging-house " shall have been required, in pursuance of by-law 5, to furnish the statement of particulars therein mentioned." St. George-in-the-East.—29 houses were on the register. The vestry was in correspondence with the Local Government Board as to the exemption clause in the by-laws which the vestry had submitted for confirmation. Limehouse.—By-laws were ordered to be put in force, and 61 houses were registered. Mile-end Old-town.—"A large number of houses" are on the register. St. George-tlic-Martyr.—By-laws were confirmed by the Local Government Board. Unfurnished tenements having a rent above 7s. 6d. per week, and furnished tenements having a rent above 10s. 6d. per week, are exempted from the application of the by-laws. Bermondsey.—By-laws were confirmed in December, 1893. The number of houses on the register was 308. Rotherlnthe.—By-laws were awaiting the confirmation of the Local Government Board. Battersea.—By-laws were made and were "in active operation." Camberwell.—By-laws were made and confirmed. Unfurnished tenements, of which the rent is 5s. and upwards, and furnished tenements, of which the rent is 7s. 6d. and upwards, are exempted from the application of the by-laws. Lewisham.—The number of houses on the register was 15. Woolwich.—By-laws were awaiting the confirmation of the Local Government Board. Plum stead.—The medical officer of health reports that the vestry had adopted the model by-laws of the Local Government Board, but there had been great unwillingness on the part of the health committee to put them in force. Only 3 houses had been registered in Plumstead. 55 Common Lodging-houses. On the 5th of June, 1894, the Council adopted a report of the Public Health Committee stating that the Local Government Board had issued an order for transferring to the Council the duties of the Commissioners of Police under the Common Lodging Houses Acts, 1851 and 1853, the order to take effect on the 1st of November. The Committee recommended that the supervision of common lodging-houses should be undertaken by the Public Health Department, and that a chief inspector and eleven other inspectors should be appointed for this purpose. These appointments were made, the former on the 31st of July, the latter on the 23rd of October. On the 6th of November the Council adopted a report of the Committee recommending that their medical officer and Dr. Hamer and Dr. Young be appointed under seal of the Council inspecting and approving officers of common lodging-houses, in pursuance of section 8 of the Common Lodging Houses Act, 1851, and section 3 of the Common Lodging Houses Act, 1853. On the 18th of December the Council adopted a report of the Public Health Committee stating that for the purpose of removal to hospital of cases of infectious disease occurring in common lodginghouses in London, a medical certificate as to the nature of the illness was required; that in the ordinary course this would be obtained from the medical officer of the union in which the lodging house is situated, but that it might occasionally happen that the services of this officer would not be immediately available. The Committee therefore recommended that in view of such event the services of medical officers who are employed by the Council to attend the men of the fire brigade and the main drainage workmen should be utilised, the Council paying a fee in each case. The following table shows the number of common lodging-houses in each district, and the authorised number of lodgers at the time the duty of supervision of common lodging-houses was transferred to the Council— Common Lodging-houses. Number of registered common lodging. houses. Authorised number of lodgers. Number of registered common lodginghouses. Authorised number of lodgers. Paddington 4 66 Whitechapel 72 5,628 Kensington 33 960 St. George-in-the-East 22 552 Hammersmith 8 526 Limehouse 22 743 Fulham 3 86 Mile-end Old-town 7 253 Chelsea 21 827 Poplar 19 965 St. George, Hanover-square — — St. Saviour, Southwark 19 835 Westminster 25 1,683 St. George, Southwark 30 1,502 St. James 2 142 Newington 12 1,438 Marylebone 22 881 St. Olave 1 533 Hampstead 1 35 Bermondsey 4 226 Pancras 26 861 Rotherhithe 3 116 Islington 45 1,209 Lambeth 23 1,405 Stoke Newington 1 41 Battersea 5 207 Hackney 9 301 Wandsworth 13 281 St. Giles 43 2,178 Camberwell 10 534 St. Martin-in-the-Fields 6 225 Greenwich 23 1,020 Strand 10 569 Lewisham 11 136 Holborn 18 725 Woolwich 38 861 Clerkenwell 6 312 Lee 1 10 St. Luke 4 231 Plumstead — — Shoreditch 16 651 654 30,115 Bethnal-green 16 361 Underground Rooms. Reference to proceedings in connection with the occupation of underground rooms which did not comply with the requirements of the Public Health (London) Act are made in the reports of medical officers of health of many of the London districts. The illegal occupation of underground rooms was discontinued in the following number of cases—Paddington, 1; Fulham, "a number"; Chelsea, 3; St. George, Hanover-square, 18; Westminster, 1; St. James, Westminster, 11; St. Pancras, 21; Islington, 20; St. Giles, 22; Strand, 6; Holborn, 90; Clerkenwell, 36; St. Luke, 30; Bethnal-green, 5; Whitechapel, 40; St. George-in-the-East, 19; Limehouse, 3; Mile-end Old-town, 4; St. George-the-Martyr, Southwark, 2; St. Olave, 6; Bermondsey, 3; Lambeth, 30; Greenwich, 1. The medical officer of health of Fulham gives account of an appeal to the Local Government Board in respect of one underground room. The appeal was disallowed, but the vestry took no further action. Workshops. In the early part of the year I was informed by the Chief Inspector of Workshops of the Home Department that his officers were inspecting workshops throughout London, and that notice was given to the medical officers of health in all cases where sanitary defects were found that required remedy. He had, however, no information as to whether these defects were remedied. It was therefore arranged 56 that he should communicate to me the particulars of cases brought by him to the knowledge of the sanitary authorities in order that the Council should subsequently have these premises inspected to ascertain whether the defects were remedied. For this purpose the Council sanctioned a temporary addition to the staff of inspectors in the Public Health department. On June 5th the Public Health Committee reported to the Council that, in the month of March, 34 such workshops had been brought to the notice of the Council; in 13 of these workshops, situated in Battersea, Mile-end, Paddington, Poplar, St. George-in-the-East, Shoreditch, and Whitechapel, there was no evidence that any steps had been taken to comply with the notice, and the Committee had therefore communicated with the sanitary authority concerned with regard to these cases. On June 19th the Committee reported to the Council that 39 workshops had during the month of April been brought to the notice of the sanitary authorities by the Chief Inspector of the Home Department. In 19 of these workshops, situated in Bethnal-green, Camberwell, Hackney, Islington, Lambeth, Mile-end, Newington, St. George-in-the-East, St. George-the-Martyr, Southwark, and Whitechapel, there was no evidence that any steps had been taken to comply with the notice, and the Committee had therefore placed itself in communication with the sanitary authorities. Oil October 9th the Committee reported that they had had the workshops, first visited in April, May and June, re-inspected; it was found that with the exception of two workshops in Bethnal-green and one in Islington, either the defects complained of had been remedied or steps had been taken with that object. The committee had therefore addressed further letters to the authorities mentioned urging them to take immediate action. Inquiry had also been made concerning 10 workshops of which notice had been given to the sanitary authorities in June by the Chief Inspector of Workshops of the Home Department. With the exception of one workshop in Islington the defects had been remedied or steps had been taken for the purpose. The Islington vestry had been communicated with. References to workshop inspection are found in the reports of the medical officers of health of the following districts— Paddington.—The complaints received from the chief inspector of workshops have related almost exclusively to overcrowding, mostly during the "season." The medical officer of health is of opinion that some other standard than cubic space should be adopted as a gauge of overcrowding. He thinks there would be no difficulty in estimating the chemical impurity of the air at the time of inspection, and using the result of such examination as the basis for future action. Kensington.—The report of the medical officer of health contains inter alia a report by two women inspectors employed in the inspection of workshops, showing that a register of workshops is kept in this district, and that premises occupied as follows had been entered on the register, viz., 307 dressmakers and ladies' tailors, 225 laundries, 35 miscellaneous, making a total of 5G7 workshops. All these establishments had been systematically visited during the year. The report contains observations made under the following headings—"warming of work rooms,", "gas iron heaters," "ventilation," "rooms lighted by skylights," "cleansing of work-room floors," " overcrowding," "separate sanitary conveniences," "laundries," and "overhead drying." Dr. Dudfield. .reports upon the work thus done as eminently satisfactory, and states that one of the women. inspectors had been vested with the status of a sanitary inspector. Fulham.—Frequent inspections were made, and notices were served where-necessary. St. George, Hanover-square.—-A complete inspection was made of all premises in certain streets, and a number of inspections in other parts of the district as the result of special complaints. The number of workshops arid work places inspected was 108, containing 137 workrooms, 37 of which were overcrowded, and 9 in a dirty and unwholesome condition; the sanitary' arrangements of 94 were found defective, the drains of 47 having to be reconstructed. Westminster.—A large number of workshops has been inspected, but it has been found impossible to carry out a systematic inspection, owing to the pressure of other and more important work. The names and addresses of a large number of outworkers resident in the parish have been obtained, but no case of any infectious disease has been known to arise at any of their homes during the year. Marylebone.—The duty of supervising workshops and of carrying out the statutory provisions with regard to smoke was allotted to a special inspector. The report states that there were 3,550 workshops and workplaces in the district, and 329 outworkers residing in the parish but employed in other districts. St. Pancras.—Whenever complaints have been received from ratepayers and others, or notices have been received from inspectors of factories with regard to workshops, such workshops have been inspected and the necessary measures taken. Islington.—Endeavour was made to ascertain the names and addresses of outworkers employed in Islington, and an inspector was taken from his other duties for this purpose. The medical officer of health comments on the inconvenience thus caused, and states that his recommendation that an inspector should be specially appointed was engaging the attention of the vestry's public health committee at the close of the year. The inspector employed in connection with workshops first visited the establishments which employed outworkers, but owing to their number he was able to do little more than ascertain from the employers the addresses of the people employed by them. On calling on the person designated as an outworker by the original employer it was often found that this person employed others who worked at their own homes, and that the latter were constantly changing their employment. Stoke Newington.—A complete list of outworkers in the parish was prepared, and their names and addresses sent to the medical officers of health of the districts where they dwelt. Hachiey.—The number of workshops inspected was 72, of these only 13 were found to be in a satisfactory condition, 7 were overcrowded, 5 without sufficient sanitary conveniences, and 185 other nuisances were found, all of which were abated. The staff having been increased, the medical officer of health anticipates that a more complete inspection will be able to be made. St. Giles.—Workshops, 111 in number, were inspected and the necessary orders made. 57 Strand.—An inspector was specially appointed for this work. During the year 509 workplaces were inspected and orders requiring cleansing served in reference to 149 ; in 12 the ventilation was improved; in 4 overcrowding was abated ; and in a number, sufficient water-closet and urinal accommodation was provided at the instance of the Board. A list of 244 persons employed as outworkers in this district was made: most of these persons were engaged in making wearing apparel, their homes and workplaces were frequently visited, and when necessary the rooms ordered to be cleansed. The names of many persons employed in the district, but living elsewhere, were sent to the authorities in whose districts they resided. Similar returns were received from a few other authorities. During the year, in accordance with the provisions of section 27 of the Public Health (London) Act, notice was sent to the factory inspector of the district of the employment of 1,105 individuals, of whom 39 were children and young persons and the remainder women. Clerkenviell.—In this district 22 dirty workshops were limewhited and cleansed. City.—Communications were received from the factory inspectors relating to 30 cases of notice given by firms about to occupy premises for manufacturing purposes, to 42 cases of change of premises, and to 43 cases in which attention was directed to insanitary conditions, the latter including 7 instances in which female workers were unprovided with separate and adequate water-closet accommodation. Every defect was at once remedied. Shoreditch.—Notices were received from the inspector of factories relating to 119 workshops and factories; in 117 instances works were effected. In many of the cases, in addition to the abatement of the nuisance complained of by the factory inspector, extensive works were found to be necessary to put the premises in a satisfactory condition. Bethnal-green.—A special inspector was appointed for the inspection of workshops during the year. The number of workshops thus inspected was 1,332, and in 857, insanitary conditions were found. In 763 cases it was necessary to serve a notice, and in 38 to take out a summons. Whitechapel.—A tabular statement in the report of the medical officer of health shows that 181 workshops were cleansed, in 203 ventilation was improved, in 99 overcrowding was abated, in 90 additional water-closet accommodation was provided, and in 47 instances the workshop was closed. Limehouse.—A tabular statement shows that 157 workshops were inspected, and in 17 nuisances were abated. Mile-end Old-town.—The medical officer of health states that all the workshops are now in a very fair sanitary condition, and the occupiers show their desire to conform to the law both as regards general cleanliness of the premises, and also in not allowing overcrowding to take place. It was necessary to take proceedings in one instance only, when the occupier was ordered to abate overcrowding and was fined. The number of workshops inspected was 419; improvements were effected in respect of ventilation in 2, of cleanliness in 19, of overcrowding in 7, and in respect of water-closet and urinal accommodation in 26. Poplar and Bow.—Difficulty was experienced in keeping a register of outworkers, owing to employers constantly changing their hands. A letter was addressed to the Secretary of State expressing the opinion that the difficulty would be met if the occupiers of factories and workshops were compelled to give notice to local authorities of alterations in their lists of outworkers. In 18 instances increased latrine accommodation was provided, and two workrooms were cleansed. St. George-the-Martyr, Southwark.—The medical officer of health reports that there are 164 workshops on the register, and that registration has led to the abatement or the removal of nuisances such as filth, bad ventilation, or overcrowding. Referring to the outworkers' order, he states that all information supplied by the superintending inspector of workshops was acted upon, but that beyond this, the order was only partially enforced in the district. He urges upon his authority the appointment of a special inspector for this purpose. Thirty-two notices were served in connection with workshops, and in six instances summonses were obtained. Bermondsey.—" Factories and workshops were inspected, and many improvements in their sanitary condition carried out." Account is given of the result of inspection of 136 workshops. Lambeth.—Notices were served in 35 instances for cleansing workshops, and for the remedy of structural and sanitary defects. Battersea.—The medical officer of health states that " a very general inspection of the factories and workshops in the parish has been made during the year." Some 15 premises are referred to in which works of improvement were effected. Wandsworth—(Glapham).—Inspection of 49 workshops showed that their "condition generally was satisfactory, that three required cleansing, and three required additional water-closet accommodation. (Putney).—All workshops have been duly inspected, three required cleansing and lime washing, and one was overcrowded. Lists of outworkers have been obtained from all workshops employing the same, and notices forwarded to the authorities of the districts where the work people resided. No notice, however, was received from any other authority of work people employed in Putney. Greenwich.—The number of visits to factories and workshops was 89. Deptford.—Workshops and factories have received careful attention. Bakehouses. During the year the condition of bakehouses in London received the attention of the Public Health Committee, and I was instructed to report on this subject. Inquiry for this purpose was made by Dr. Hamer and Dr. Young, and the results of their inspection were embodied in a report which I presented on 1st February to the Committee. (See Appendix V.) This report was considered by the Committee, a copy was communicated to the Local Government Board, and the following report was presented to the Council on June 19th— Bakehouses in London. The medical officer under our instructions has submitted to us a report on the sanitary condition of bakehouses in London. As the report contains valuable information on this important question, we have had it printed and a copy sent to each member of the Council. 8 58 It will be seen that the existing law with reference to the sanitary condition of retail bakehouses in London may be considered under two headings, viz.— (а) Enactments peculiar to bakehouses.—The Factory and Workshop Act, 1878, section 34, provides that the inside walls of every bakehouse shall either be painted or varnished or be limewashed. If paint or varnish be used, it must be renewed every seven years, and be cleansed every six months ; limewashing must be renewed every six months. Section 35 prohibits the use as a sleeping place of any place on the same level as the bakehouse, and forming part of the same building, unless it be effectually separated from the bakehouse, and has adequate external ventilation. The Factory and Workshop Act, 1883. The provisions contained in section 15 of this Act apply only to bakehouses newly occupied after June 1st, 1883. Section 15 provides that—(i.) No water-closet shall be within or communicate directly with the bakehouse—(ii.) The cistern supplying water to the bakehouse shall be distinct from the cistern supplying a water-closet—(iii.) No drain or pipe carrying off faecal or sewage matter shall have an opening within the bakehouse. Section 16 authorises a court of summary jurisdiction to impose a fine not exceeding forty shillings if satisfied that any room or place used as a bakehouse (whether the same was or was not so used before the passing of this Act) is in such a state as to be on sanitary grounds unfit for use. The Public Health (London) Act, 1891, section 26, enacts that the above sections in the Factory and Workshop Acts shall be enforced by the sanitary authority of the district in which the bakehouse is situate. (б) Enactments applicable to bakehouses in common with other workshops.—A bakehouse being a workshop is subject to the provisions of the Public Health (London) Act, 1891, relating to such premises. Section 2 (i.) (q) provides that any workshop—(i.) not kept in a cleanly state and free from effluvia arising from any drain, privy, earth-closet, water-closet, urinal or other nuisance—(ii.) not properly ventilated—-(iii.) so overcrowded during worktime as to be injurious or dangerous to the workers—shall be a nuisance liable to be dealt with summarily under the Act. Section 38 requires that every workshop shall be provided with sufficient and suitable accommodation in the way of sanitary conveniences. The Council has power to take action if a sanitary authority make default in carrying out the provisions of the Public Health (London) Act, 1891, or of sections 15 and 16 of the Factory and Workshop Act, 1883, with regard to bakehouses. The report gives the result of the inspection made by Dr. Hamer and Dr. Young, the Council's assistant medical officers of health, of about 200 bakehouses in London, 118 of which were situated wholly or partially below the ground level. As regards ventilation, it was found during the inspection that in 28 bakehouses the provision for this purpose was quite insufficient, and with four exceptions these were all underground bakehouses. In several cases the lighting of underground bakehouses was also quite inadequate. Many bakehouses were found to be in a dirty condition, this being due in some cases to a disregard of cleanliness in the conduct of the business, and was most marked in bakehouses where confectionery was also made; in others this was due to insufficient limewashing and cleansing of the walls and ceilings. The paving in some cases was also uneven or defective, or entirely absent underneath the flour trough. Waterclosets were found within or communicating directly with the bakehouse in four cases, and 37 bakeries were found to have an inlet not aerially disconnected from the drains. There was no evidence of overcrowding. The vital statistics contained in the report raise some suspicion that the occupation of a baker is attended with certain dangers to health, but the statistics collected do not deal with a very large number of deaths. We are satisfied from the evidence obtained that it is very desirable that the provisions of the law with reference to bakehouses should be amended. We think that the central metropolitan authority, rather than the local sanitary authority, should have charge of the bakehouses of London, and that the Council should be empowered to make regulations which might deal with the following points, viz.— (1) The position and structure of workshops and workplaces used as bakehouses and of rooms or places used in connection therewith. (2) The lighting, ventilation (including air space), cleansing, drainage and water supply of such premises. (3) The provision and situation of water-closets and urinals in connection with bakehouses. (4) The prohibition of the use of the bakehouses for other purposes than the preparation of food. (5) The use of any room adjoining or opening into any bakehouse. (6) The conduct of the business and the prevention of the contamination upon the premises of any articles of food prepared in any bakehouse or of any materials to be used in the preparation of food. (7) The mode of making application for license to use any premises as a bakehouse. We also consider that— (а) No premises should be used as bakehouses which are not licensed by the Council, and that a license should be operative for a period of five years, power being, however, given to the Council to suspend any license for contravention of the regulations. (b) That all bakehouses which are occupied for the first time after these regulations come into force should before such bakehouses are occupied, be made to comply with all the regulations. (c) That bakehouses which are occupied before the by-laws come into force should be exempt for a period of five years from the regulations as far as these will require structural alterations other than those now required under existing law, but that after this period they should be required to comply with all the regulations. We may point out that the Government has introduced a bill for amending the Factory and Workshop Acts, ana this seems to afford an opportunity for amending the law relating to bakehouses. We recommend— That the Council do endorse the views expressed in this report, and give instructions for a copy of this report and of the medical officer's report to be sent to the President of the Local Government Board, with a request that he will take steps to obtain an amendment of the law relating to bakehouses in the manner here proposed. The Council on June 26th adopted the following amendment to the recommendations of the Committee. That the Council, while concurring in the view that regulations governing the position, structure, and internal arrangements of bakehouses should be made by the Council for the whole of London, is of opinion that the licensing and supervision of bakehouses and the duty of enforcing the Council's regulations should rest upon the local sanitary authorities (the Council having power to act in their default as under sec. 100 of the Public Health (London) Act, 1891), and accordingly refers the matter back to the Committee with instructions to communicate with the President of the Local Government Board and to ask him to propose an amendment of the law for the purpose. The Committee subsequently took into further consideration the distribution between the 59 Council and the sanitary authorities of the several duties in connection with bakehouses upon which the Council had adopted a resolution on June 26th. The following report was presented by the Committee to the Council on July 17th, and the recommendations embodied in it were adopted by the Council. On the 26th of June last the Council, after consideration of our report upon the subject of London bakehouses, passed the following resolution— That the Council, while concurring in the view that regulations governing the position, structure, and internal arrangement of bakehouses should be made by the Council for the whole of London, is of opinion that the licensing and supervision of bakehouses and the duty of enforcing the Council's regulations should rest upon the local sanitary authorities (the Council having power to act in their default as under sec. 100 of the Public Health (London) Act, 1891), and accordingly refers the matter back to the Committee with instructions to communicate with the President of the Local Government Board and to ask him to propose an amendment of the law for the purpose. We have again carefully considered the question, and we think with the Council that it would be well for the supervision of bakehouses and the enforcement of the regulations to rest upon the local sanitary authorities; but we are still strongly of opinion that the Council should be the licensing authority, as well as the authority to make regulations. We cannot consider that it would be at all satisfactory for the licensing of bakehouses in London to be in the hands of forty or more different authorities, as under such an arrangement it would be well nigh impossible to secure uniformity of administration. Before therefore communicating with the Local Government Board we have decided to bring the matter again before the Council, and to ask it to vary its resolution so as to provide for the licensing or registration of bakehouses to be in the hands of the Council and not the local sanitary authorities. We recommend— That the Council's resolution of the 26th of June last, so far as relates to the licensing of bakehouses, be rescinded, and that the Council do express the opinion that the licensing or registration of bakehouses should rest upon the Council and not the local sanitary authorities. On 22nd May the Local Government Board issued to London sanitary authorities a circular letter drawing attention to the powers and duties of these authorities in relation to bakehouses, and expressing the hope that they would give such instruction to their officers as would ensure the systematic inspection of bakehouses, and that the sanitary authorities would cause to be instituted such proceedings a3 might be necessary for a due enforcement of the law. A conference of vestries and district boards was convened by the Vestry of St. George-theMartyr, Southwark, and held on October loth, 1894, to consider certain proposed amendments of the law regulating bakehouses. The following resolutions were adopted— That the present state of the law relating to bakehouses requires amendment by the addition of the following clauses to the Public Health (London) Act, 1891— (а) That uniform metropolitan by-laws regulating bakehouses be made by the London County Council, and be confirmed by the Local Government Board, and that the duty of enforcing these by-laws shall devolve upon the various local sanitary authorities. (b) That the portions of the by-laws regulating the structure of bakehouses do not apply to existing bakeries. (c) That the London County Council be empowered to frame by-laws for the construction of underground bakehouses, and that all bakehouses erected after the passing of such by-laws shall conform thereto. The work done in connection with bakehouse inspection is referred to in the annual reports of the medical officers of health of the following districts— Paddington.—The bakehouses (73 in number) were inspected twice during the year. Kensington.—Bakehouses (136 in number) were regularly inspected, and action taken when necessary. Hammersmith.—The whole of the bakehouses (63 in number) were under a regular quarterly inspection; in six instances notices were served. Fulham.—The bakehouses (76 in number) were regularly inspected and found in satisfactory condition. St. George, Hanover-square.—There are 56 bakehouses on the register, of which 51 are in use; the condition of some of them has been improved as the result of notices which have been served. Westminster.—Bakehouses form the subject of a special report, giving details of the condition, ascertained as the result of a complete inspection. St. James, Westminster.—The bakehouses (27 in number) were under regular inspection; proceedings were instituted in one instance. Marylebone.—There were 108 bakehouses in the district, to which 388 visits were made. Hampstead.—The bakehouses (41 in number) were regularly inspected. St. Pancras.—The number of bakehouses in the district was 211, of which 193 were occupied; these were inspected half-yearly. A list is given of all the bakehouses, showing whether the floor is above or below the ground level, and to what extent it is above or below. Islington.—The number of visits paid to bakehouses was 441. Their state may be described as fairly good, considering the difficulties encountered in ventilating those underground. All were put into a cleanly condition during the year. Stoke Newington.—There are 14 bakehouses, all of which were inspected; in 13 instances notices were served to cleanse, limewhite, and repair sanitary defects. Hackney.—The number of bakehouses was 125, all of which were personally inspected by the medical officer of health; 42 are described as structurally bad, being partly or wholly underground. In 44 drain inlets were found, soil pipes were found passing through 8, more ventilation was required in 15, and 36 required cleaning. St. Giles.—There were 29 bakehouses in the district, of which 24 were underground and 5 on the ground level; all were periodically inspected, and where necessary, orders made for their improvement. 60 St. Martin.—The bakehouses were duly inspected, and found in a clean and satisfactory condition. Strand.—There are 29 bakehouses; all were frequently and systematically inspected, each was cleansed and limewashed twice during the year, and 6 more frequently. Holborn.—The bakehouses (23 in number) have all been inspected and defects remedied. Clerkenwell.—The bakehouses (58 in number) were inspected twice in the year; they were found to be clean and in good order. St. Luke.—There were 36 bakehouses inspected, and notices for the improvement of 18 were served. Shoreditch.—Ninety-three bakehouses were found to be in occupation, of which 50 were satisfactory, 24 fairly satisfactory, and 19 unsatisfactory ; the majority of the last have been dealt with, the remainder are receiving attention. In 4 instances the bakehouse was closed, and 2 of these bakehouses were subsequently re-opened after improvement. Bethnal-green.—The total number of bakehouses under inspection was 106 ; they were found in a fairly clean condition, about half of them were underground, and the ventilation of most of these left much to be desired. Whitechapel.—In this district 12 bakehouses were cleansed, in 5 the ventilation was improved, 2 were closed, and in one instance the use of the bakehouse as a sleeping apartment was discontinued. St. George-in-the-East.—Fifty-four bakehouses were inspected, and for the most part found to be in a satisfactory condition. Upon the receipt of the letter from the Local Government Board the inspectors were directed to inspect the Jewish bakehouses quarterly and the others half-yearly. A copy of the vestry's regulations was ordered to be sent to the occupier of each bakehouse. Limehouse.—The bakehouses (48 in number) have been inspected and reported on, 2 were not occupied. Mile-end Old-town.—During the year 146 inspections and re-inspections were made, 32 bakehouses were cleansed, in 2 the ventilation was improved. A tabular statement is appended showing the situation of every bakehouse, the date of inspection and the condition in which it was found when inspected. The medical officer of health reports that a marked improvement of bakehouses has taken place since 1891. Poplar.—There are 44 bakehouses in Poplar and 56 in Bromley, all were inspected and the drains tested; many were in a defective condition, and 4 bakehouses were found to be insanitary. Structural alterations were carried out in some and in others the drainage was reconstructed. In Bow the bakehouses were inspected twice during the year, and found to be in good sanitary condition. St. George-the-Martyr, Southwark.—At the end of 1894 there were 54 retail bakehouses in the district, or 9 less than in 1893. Proceedings were instituted against the occupiers of 8, out of a total of 23 underground bakehouses. The medical officer of health writes that " efficient ventilation and natural lighting of these underground workshops seemed to be out of the question, owing to defects of structure. Of the 8 cases proceeded against only 3 remained closed at the time of making this report. In the absence of any official standard of requirements by which the local authority may be guided, I may state that, in my opinion, none of the 8 bakehouses alluded to are in a fit condition to be used for the making of bread." Niwington.—The bakehouses in use number 79 ; they were found on inspection to be in a clean and satisfactory condition, with the exception of a few cases in which notices had to be served. St. Olave.—The bakehouses (9 in number) were inspected during the year; the worst of them has been closed, and notices served on the occupiers of those in which sanitary defects were found. Bermondsey.—The bakehouses, numbering 81, were all inspected; 3 were pulled down during the year, the rest were found to be in a clean and fairly satisfactory condition. Rotherhithe.—The bakehouses were inspected twice during the year. The attention of the vestry was drawn by the inspector of workshops to the dirty condition of 2 bakehouses, and the occupiers were ordered to cleanse them. Lambeth.—During the year 230 bakehouses were inspected, and 101 notices were served to cleanse, whitewash, and repair sanitary defects. Battersea.—Bakehouses were regularly inspected, 313 visits being made; 19 nuisances were abated, and improvements made with regard to ventilation and cleanliness. Wandsworth.—(Clapham.)—The bakehouses (50 in number) were inspected twice during the year; limewashing was required in 27 instances. Wandsworth.—(Putney.)—All the bakehouses were inspected twice during the year ; they were in a satisfactory condition, and 5 notices for cleansing were served. Wandsivorth.—(Streatham.)—The whole of the bakehouses were inspected, and the necessary cleansing and limewhiting carried out. Wandsworth.—(Wandsworth.)—There are 36 bakehouses, and they have been visited twice during the year. There are 21 above ground and 15 under ground ; the lighting and ventilation of the latter require improvement. Notices were served in several instances. Camberwell.—There were 461 inspections of bakehouses during the year. Greenwich.—All the bakehouses were inspected, and, when necessary, notices were served. Lewisham.—The bakehouses (92 in number) were regularly inspected. Woolwich.—There are 42 bakehouses in the district, many of them structurally defective. They were all systematically visited and the regulations enforced. Plumstead.—All the bakehouses were inspected twice during the year, and the medical officer of health reports that there was a general improvement in their condition. He considers they should not be occupied unless certified. Lee.—There are 8 bakehouses in Charlton. They were all inspected and found in a satisfactory condition. In Eltham there were 8 in fair state; in Lee and Kidbrooke they were in good condition, except one that was undergoing alteration. 61 Unsound Food. The majority of the reports of medical officers of health contain accounts of articles of food seized by them or by the sanitary inspectors on account of their unwholesome condition, and in numerous instances the persons selling the food were prosecuted and convicted. Thus, seizures were made in Paddington, Fulham, Chelsea, Westminster, St. James Westminster, Marylebone, Hampstead, St. Pancras, Islington, Hackney, St. Giles, Strand, Holborn, Clerkenwell, St. Luke, City, Shoreditch, Whitechapel, St. George-in-the-East, Limehouse, Mile-end Old-town, Poplar, St. Saviour, St. George, Southwark, Newington, St. Olave, Bermondsey, Lambeth, Battersea, Wandsworth (Clapham), Greenwich, Woolwich, Plumstead. The food seized usually consisted of meat, fish, vegetables, or fruit. Seizures of tinned milk and tinned lobsters were made in Poplar. A seizure of some tins of plums was made in St. Olave at the moment of delivery from a wharf in the district to a van standing in the public street with a view to removal to another district. At the hearing of the case by the magistrate, evidence was submitted to prove " that the goods were only being removed for examination and not for sale." Inasmuch as the medical officer of health states that " the magistrate's decision renders the Act to a great extent inoperative," it would appear that the summons was dismissed. The medical officer of health of the Strand thus refers to an important decision of the court for consideration of Crown Cases Reserved— "In the end of 1893, a summons was taken out by your Board against a Covent-garden firm, who had sold by auction to a costermonger two boxes of oranges, the contents of one box being entirely bad, and a fine of £10 and costs was ultimately imposed by the magistrate. An appeal was taken to the County of Londou Sessions and dismissed, as it was proved that ths boxes of oranges had been technically marked as being of good quality by the defendants' servants, who must, therefore, have first examined the contents of the box. Another case on somewhat similar lines in another district was brought before 11 judges sitting as a Court for Consideration of Crown Cases Reserved. The appeal was upheld, a decision in which 10 of the judges concurred. This case, however, differs from that taken up by your Board, in that it was not proved that the defendant had sold the walnuts as good and fit for food. The decision, however, relieves the wholesale seller of much responsibility (if he takes certain precautions), and it remains for the buyer to insist upon a proper opportunity for viewing the goods before he makes his purchase." The Manufacture and Sale of Ice-Creams. In 1892 I presented to the Public Health Committee a report by Dr. George Turner on an outbreak of enteric fever in south-east London during the preceding year. Dr. Turner found that the disease had been communicated to numerous people by means of ice-creams, which had been sold in the streets by Italian vendors. Inquiry into the conditions under which this article of food had been prepared in the homes of the vendors showed that abundant opportunities existed for the contamination of the cream. In 1894 the medical officer of health of Islington presented to his authority a report based on an investigation made by him as to the materials used in the manufacture of icecream sold in the streets, into the quality of the water used for washing the glasses in which the ice-cream is served to the consumer, and the conditions under which the ice-cream is made and stored. Specimens of the water and of the ice-cream thus sold were submitted to Dr. Klein, whose report shows that they were contaminated by numerous organisms, among which was the bacillus coli, " a normal inhabitant of the bowels of men and animals." The medical officer of health of Islington recommended his authority to memorialize the Local Government Board to introduce legislation which will empower local authorities to register the vendors of ice-cream, and to make by-laws for regulating the conditions under which it is made and sold. Disinfection and Destruction of Infected Articles, and Provision of Shelters. In April, 1893, I presented to the Public Health Committee a report showing the provision which existed in the several districts of London for the disinfection and destruction of infected articles, and for the temporary shelter of persons during the disinfection of their houses. Communications were then addressed by the Council to those authorities who had not made such provision, or in whose districts the arrangements appeared inadequate or unsatisfactory. In December, 1894, I presented a further report to the Committee, showing the provision which existed in that year (see Appendix VI.). This report showed that in 1894, 22 districts were provided with steam disinfecting apparatus, whereas in 1893, 16 were so provided. In the interval the districts of Chelsea, Hackney, Whitechapel, St. George-the-Martyr, Lewisham and Plumstead had substituted steam for dry heat apparatus. The districts of Islington and Westminster, which had previously relied on the services of a contractor, had been also provided with their own steam apparatus. In April, 1893, provision of a shelter, sometimes only of one or two rooms, had been made in 13 districts. The report of 1894 gives account of 20 districts which had made provision. The reports of medical officers of health of the following districts give further account of the steps taken in connection with the subject of disinfection and provision of shelters during the year. Fulham.—Land has been purchased for the purposes of provision of apparatus for disinfection. Marylebone.—Two vans, having different colours, have been provided for the removal of infected articles to, and disinfected articles from, the disinfecting station. Islington.—Two steam disinfecting chambers have been provided, and with these are associated a laundry. Stoke Newington.—The medical officer of health recommends the discontinuance of the present method of dry-heat disinfection, and the substitution for it of disinfection by steam apparatus. He thinks that in view of the character of the district this might be provided by contracting for the use of the apparatus in a neighbouring district. 62 Clerkenwell.—The report of the vestry clerk states that the vestry were not prepared to adopt the Council's recommendation that a steam apparatus should be provided. St. Luke.—The medical officer of health recommended the vestry to substitute a steam apparatus for the existing dry-heat apparatus. City.—"A steam disinfecting apparatus of the most modern and approved type, together with the necessary buildings, has been erected; at the same time the old fumigating chambers have been retained, so that a substantial increase of efficiency has been afforded in the methods and rapidity in which the processes are conducted, by which the goods sent to be disinfected are rendered completely safe from infection and returned to their owners within a few hours." St. George-in-the-East.—"The question of the provision of a proper disinfector and destructor again engaged the earnest attention of the Committee." Limehouse.—A site for various purposes having been obtained, the medical officer of health anticipates that disinfecting chambers will be erected on it. Poplar.—A Washington Lyon disinfecting apparatus has been supplied. Two closed vans have been procured. St. George-the-Martyr.—A new (steam) disinfector has been provided ; a properly constructed incinerator is still wanted. St. Olave.— The district board has provided a steam disinfector at Guy's Hospital. Wandsworth.—The question of providing a steam disinfector for the whole district was under the consideration of the district board. It was decided to leave each parish to make its own provision. The Clapham Vestry resolved to erect a steam disinfector in that parish as soon as a suitable site could be found. Plumstead.— A new boiler was purchased ; the question of providing an improved disinfecting chamber was under the consideration of the Public Health Committee; articles from Lee and Eltham are disinfected in the Plumstead apparatus. The reports of medical officers of health also show that in the district of the Strand disinfection is effected after death from phthisis, and in Plumstead after death from phthisis and after removal from a house of a person suffering from this disease. References to the provision of shelters are found in the reports of the medical officers of health of the following districts— Kensington.—The medical officer of health directs the attention of his authority to the statutory requirement of the provision of a shelter, and states that nothing has been done in this parish to give effect to the requirements of the section, which he points out " are of an obligatory character." He adds that some 64 cases of infectious disease in 1894 occurred in families occupying single rooms, and that 34 of the sufferers had scarlet fever, 19 had diphtheria, 7 had enteric fever and 4 had small-pox. Fulham.—The medical officer of health reports that the want of this accommodation was on several occasions severely felt, and he adds, the vestry had already decided that such shelter should be provided, and that land has been purchased for the purpose. St. George, Hanover-squcvre.—The shelter which the vestry have provided was not used during the year. The shelter "is the basement of the offices at No. 1, Pimlico-road." Westminster.—The number of families removed to this shelter in 1894 was 24. Marylebone.—A scheme has been adopted by the vestry to meet the want of a shelter. St. Pancras.—The shelter was completed in 1893, and came fully into use in 1894 ; 16 families availed themselves of it during the year. Islington.—The shelter is completed and will shortly be ready for use. Stoke Newington.—The medical officer of health states that he thinks the provision of two rooms would be sufficient. Hackney.—Accommodation was provided for the inmates of two houses while their rooms were being disinfected. Strand.—The board has now a house at all times available for the purpose of a shelter. Clerkenwell.—The Holborn Board has discontinued its joint tenancy of the shelter provided by the Clerkenwell Vestry. St. Luke.—The vestry determined their arrangement by which they made use of the shelter provided by the Clerkenwell Vestry in consequence of the accommodation not being available at night, and the difficulty in inducing people to go so far from those parts of the parish where the want of a shelter is most often felt. The vestry of St. Luke therefore proposed to provide the necessary accommodation in Wharf-road. City.—The sanitary committee selected a new commodious building at 6, Cotton-street, Aldersgate-street, at a rental of £275 and taxes, to be used as an office for the sanitary inspectors and as a shelter. The accommodation consists of several rooms in the basement and four upper stories, and includes water-closets, baths and lavatories. The shelter was used by 24 families, consisting of 77 persons, during the year. These persons were provided with plain wholesome food. The 24 families had been living 10 in one room, 11 in two rooms, and the rest in three rooms. The diseases which necessitated their removal were 10 cases of scarlet fever, 7 of diphtheria, 5 of enteric fever, 1 of small-pox and 1 of erysipelas. Shoreditch.—The shelter was used on 16 occasions for periods of time from 1 to 15 nights; 14 families were accommodated on account of small-pox having occurred, 1 on account of scarlet fever, and 1 on account of diphtheria. St. George-in-the-East.—The shelter was used once during the year. Limehouse.—The medical officer of health anticipates that a shelter will be erected on a site purchased for a mortuary and other purposes. Mile-end Old-tovm.—The medical officer of health mentions the useful purpose the shelter served during an outbreak of small-pox in the district; several families were removed there whilst their houses were properly disinfected. 63 St. George-the-Martyr.—The medical officer of health reports that the vestry have as yet come to no resolution on the subject of provision of a shelter. He states that in a number of cases efficient fumigation was impracticable owing to the absence of accommodation for people during the fumigation of their room. In 1894 there were 99 one-room tenements infected, 120 two-room, and 49 three-room ; the number of persons occupying the one-room tenements being 342, the number occupying two-room tenements being 699, and three-room tenements 290. St. Olave.—The shelter was used 17 times during the year by 72 persons, 65 of whom were provided with sleeping accommodation. Bermondsey.—The question of provision of a shelter is under consideration. Rotherhithe.—On the 12th March, 1895, the vestry resolved to purchase No. 15, Cathay-street, to be used as a shelter. Wandsworth.—(Clapham).—The shelter on the parish wharf was not used. Greenwich.—The shelter was occupied by 5 families. No one from Deptford made use of the shelter. Plumstead.—'The shelter was used on 9 occasions by families including 20 persons. It will be seen from the above statements that the use of shelters is increasing, and that when suitable provision has been made the poor are willing to avail themselves of these temporary homes during the disinfection of their own dwellings. Hospital Provision for Infectious Disease. The report of the Statistical Committee of the Metropolitan Asylums Board states that during 1894 17,759 fever, diphtheria and small-pox patients were removed .from their homes to the various hospitals of the managers; 5,159 convalescent patients were transferred to the Northern and Gore Farm hospitals; 5,465 recovered patients were brought back to London from the latter hospitals, and 269 patients were removed to other places than the managers' hospitals, exclusive of 143 who were taken from the out-patient departments of general hospitals to their homes, owing to there being no vacant beds in the managers' hospitals, and of 216 enteric fever patients who were' removed from their homes to general hospitals, where the managers had made arrangements for the reception of this class of patients. The accommodation provided for cases of scarlet fever was found sufficient during the year, but that provided for cases of diphtheria and enteric fever was inadequate, and consequently " much delay has occurred in the removal of enteric and diphtheria patients." The erection of a hospital at Shooter's-hill to contain 500 beds for fever and diphtheria patients was well advanced, and plans were prepared and adopted for the construction of hospitals in permanent materials at Hither-green and Lower Tooting for about 500 beds each. Works of reconstruction and enlargement were in course of being carried out at the existing hospitals of the Board, and the managers had under consideration the question of securing a site for the erection of a permanent convalescent fever hospital in the south of London. The report states that when the additional accommodation above referred to had been provided, the managers would possess about 5,900 beds for patients other than those suffering from smallpox. Additional land to the extent of about 350 acres near the hospital ships at Long-reach had been acquired as a site for an isolation hospital for small-pox patients. Spread of Disease by Vagrants. The spread of small-pox by vagrants was under the consideration of the Public Health Committee in 1893, in connection with a report which I had presented to the Committee, and which showed that in January and February, 49 per cent, and in March 52 per cent, of the whole number of cases of small-pox in London, concerning which I had obtained particulars, were furnished by the class which had no settled lodging or habitation. During the same year, Dr. Armstrong, the medical officer of health of Newcastle-upon-Tyne, presented a report to his authority, summarising replies to a letter addressed by him to the medical officers of health of 116 urban sanitary authorities. These replies, which related to 72 districts, showed that of 63 districts invaded by small-pox the disease was known to have been first introduced by vagrants in the case of 37 districts, Or 59 pet cent., and that in 46, or 73 per cent., the disease was sooner or later so introduced. In the large majority of cases the vagrants in question were housed, and the disease was manifested, in common lodging-houses. Dr. Armstrong having expressed the hope that the Council would afford facilities for a conference of urban sanitary authorities, I was instructed by the Public Health Committee to ascertain whether the authorities of the large towns in England and Wales were in favour of the holding of such a conference. The replies generally, being in favour of such a proceeding, a conference was held on July, 1894, at the County Hall, when the Chairman of the Council presided. The meeting was attended by delegates from six county councils, 26 urban sanitary authorities, and 33 London vestries and district boards; the Metropolitan Asylums Board was also represented. After discussion, the following resolutions were adopted— 1. That common shelters which are not subject to the law relating to common lodginghouses should be made subject to such law. 2. That there should be power for the local authority to require medical examinations of all persons entering common lodging-houses and casual wards, and that each inmate of a common lodging-house or casual ward should, on admission, have a bath of fresh water. 3. That the local authority should have power to order the keeper of a common lodginghouse, in which there has been infectious disease, to refuse fresh admissions for such time as may be required by the authority. 4. That the local authority should be empowered to require the temporary closing of any common lodging-house in which infectious disease has occurred. 64 5. That the local sanitary authorities should have power to require the detention of any inmate of a common lodging-house or casual ward who may reasonably be suspected of being liable to convey infectious disease. 6. That means should be provided for the detention and isolation of any vagrant found wandering in a public place, if reasonably suspected of being liable to convey infectious disease. 7. That the local authority shall have full power to require the disinfection of the person and clothes of any person in a common lodging-house or casual ward, whether infected or exposed to infection. 8. That arrangements should be made by which the occurrence of infectious disease in common lodging-houses or casual wards should be made known by the local authority of the district to the local authorities of other districts. 9. That local authorities should be empowered to require the vaccination or re-vaccination of persons in common lodging-houses or casual wards who are exposed to the infection of small-pox. The transcript of the shorthand notes taken at the conference was subsequently printed, and copies sent to the authorities represented. Mortuaries. In my last report I gave account of the districts which were provided with adequate mortuaries, and of the steps which were being taken in other districts to improve mortuaries which were incomplete in one or another respect. The reports of medical officers of health for the year 1894 show that in Limehouse a site was purchased in the Horseferry Branch-road for this purpose. In Mile-end Old-town the erection of a newly erected mortuary in the rear of the Vestry-hall was almost completed. The medical officer of health of St. George-the-Martyr directs attention to the need of separate accommodation for the bodies of persons who have died from infectious disease. The medical officer of health of St. Olave reports that the accommodation at the mortuary is inadequate. The report of the Rotherhithe Vestry contains an account of the steps taken with a view to the provision of a mortuary in the burial ground of St. Mary, Church-street. The Lambeth Vestry purchased a site in Wanless-road, Herne-hillroad, at a cost of £1,000, for the use of the northern parts of the district, and the sanitary committee was instructed to inquire as to the necessity of erecting a mortuary at Norwood for the use of the southern part of the district. The medical officer of health of Streatham states that the new mortuary had been of great service during the year. The medical officer of health of Plumstead reports that " no steps have yet been taken for providing a mortuary more adequate for the size of the parish." Water Supply. The report of the water examiner appointed under the Metropolis Water Act, 1871, supplies the following information as to the capacity of the subsidence reservoirs, and the monthly rate of filtration of the several water companies— No. of days' supply. Monthly rate of filtration per square foot per hour. Mean monthly average. Gallons. Maximum monthly average. Gallons. Chelsea 12.9 1.75 1.75 East London 14.9 1.33 1.33 Grand Junction 3.5 1.89 2.12 Lambeth 6.4 2.29 2.50 New River 4.7 2.19 2.45 Southwark and Vauxhall 1.5 1.50 1.50 West Middlesex 6.2 1.27 1.83 Dr. Frankland s report shows that the minimum and maximum numbers of microbes per cubic centimetre found in his monthly determinations of the waters of the several companies were as follows— No. of microbes per cubic centimetre. Minimum. Maximum. Chelsea 6 64 West Middlesex 4 112 Southwark and Vauxhall (several filters) ... 4 404 Grand Junction „ 6 464 Lambeth ,, 8 292 New River „ — 244 East London „ Kent 4 524 50 It should be stated that a monthly examination of the water delivered by any filter affords inadequate test of the continued efficiency of the filtration throughout the year. In November exceptional floods occurred in the Thames and Lea, and the records of bacterial examination show that in only two instances did the water of any company " as supplied" contain more than 40 microbes per cubic centimetre, the number of microbes in the case of the two exceptions being 68 and 124. The water appears to have been collected for this examination on the 5th, 6th, 7th and 8th of November, before the floods were conspicuous. It would, in view of the floods and of the exceptional behaviour of enteric fever in December, to which reference has been made, have been interesting to know the number of the microbes each day in the water supplied during the month of November. References to water supply occur in the reports of the medical officers of health of the following districts— Kensington.—The medical officer of health comments on the freezing of the mains during part of January and February, and to the regulation made under the Water Act of 1887, requiring the laying of the mains at least two feet six inches below the surface. 65 Fulham.—The medical officer of health refers to complaints of insufficient pressure in the West Middlesex Company's main supplying the Queen's Club Gardens Estate, where some 300 flats are occupied. In connection with the quality of the water he states that " samples of the water supplied by both companies (West Middlesex and Chelsea) taken in November last, were pronounced by Mr. Clayton, the public analyst, to be of unsatisfactory quality and not suited for dietetic purposes." Hackney.—The medical officer of health reports that " during the summer of 1894 complaints were received from the tenants of houses in Hackney, supplied with water by the East London Company, that the supply was cut off at night and only restored for a few hours during the day. This irregularity was continued for some months, much correspondence taking place between the Hackney sanitary authority and the company; but all to no purpose, as the action of the company was fully protected by their Water Acts." A report of the sanitary committee stated that the water company forwarded a copy of a report of their engineer " upon the causes necessitating the shutting off at night in portions of the company's district, to the effect that it is due to the drought of last year, and also that there is a great waste of water, as, even with the intermittent service, the company is giving 249 gallons per tenement daily, an amount fully equal to the average of all the metropolitan companies." Shoreditch.—The medical officer of health comments on the cutting-off of the water during the night in the portion of the parish which is supplied by the East London Company. Similar references are made in the reports of the medical officers of health of St. George-in-the-East and Bow. The reports of the medical officers of health of the Wandsworth district show that several local wells were closed during the year, and water laid on to the houses from the mains of the water company. Constant Water Supply. The annual report of the chief officer of the Council's Public Control Department shows that constant water supply was extended during the year ending 25th March, 1895, so that at that date 83 per cent, of the houses in London were thus receiving their water. Amendment of Regulations as to Water-fittings. In my last report I gave account of the proceedings of the Public Health Committee in connection with the subject of the regulations relating to water-fittings. On the 3rd January, 1894, the Committee reported to the Council as follows— On the 12th of December last we reported to the Council upon certain suggested alterations in the water companies' regulations with regard to water-closet flushing cisterns and other matters, and we made the following recommendation— That the Local Government Board be informed that, for the reasons given in the report, the Council is strongly of opinion— (a) That regulation No. 21, under the Metropolis Water Act, 1871, should be amended so as to read as follows— " Every water-closet, cistern or water-closet service box hereafter fitted or fixed in " which water supplied by the company is to be used, shall have an efficient waste" preventing apparatus, so constructed as not to be capable of discharging more than " three gallons of water at each flush." (b) That the requirements as to the supply of water to water-closets should apply equally to the supply of water to sinks used for receiving any solid or liquid filth. (c) That a regulation should be made which shall prevent cisterns being brought into use for supplying water for domestic purposes, or for food for beasts, so long as they directly supply any water-closet or sink used for receiving any solid or liquid filth. (d) That in all cases where any premises have a constant water service, one or more taps should be provided in connection with the rising main for the supply of water for drinking purposes. The Council adopted the recommendation with the omission of the words " not" and " more than " in line 3 of regulation 21, the effect of this alteration being to make it obligatory that cisterns shall be capable of discharging three gallons of water at each flush. The Council's views were communicated to the Local Government Board, and the Board now points out that the scope of the regulations referred to is limited to the prevention of waste, misuse, undue consumption and contamination of water, and calls attention to the fact that recommendation (a), as amended by the Council, cannot be considered as having for its object the prevention of either waste, misuse, or contamination. We agree with the Board in these remarks, and under the circumstances, have no alternative but to repeat our former recommendation, which was to the effect that the cisterns should be capable of discharging not more than three gallons. The Council could, if it thought fit, make a by-law, under section 39 of the Public Health (London) Act, 1891, prescribing a minimum, capacity of flushing cisterns, but, as the by-laws under this Act have so recently come into operation, we do not advise the Council to take this course at present. We propose, however, to consider this point when the by-laws are revised. The Local Government Board suggests that the most convenient method of bringing the question to an issue will be for the Council to make formal application to the water companies under section 19 of the Act of 1871 to make such alterations as the Council may judge to be reasonable and as are warranted by the Act; and that in the event of the companies' refusal it will be competent for the Board to proceed in the manner directed in the section. We accordingly recommend— That the Committee be authorised to make formal application to the London water companies for the amendment of their regulations in the particulars specified in the recommendations made by the Committee to the Council in December last, and quoted above. The report of the Committee was adopted. On the 9th October the Council adopted the following report of the Public Health Committee— In accordance with the resolution of the Council of the 30th January last, we addressed communications to the London water companies in February, asking them to make the following alterations in the regulations made under the Metropolis Water Act, 1871, viz.— (a) To amend regulation No. 21 so as to read as follows— "Every water-closet, cistern or water-closet service box hereafter fitted or fixed in which "water supplied by the company is to be used shall have an efficient waste-preventing apparatus, "so constructed as not to be capable of discharging more than three gallons of water at each "flush." (b) To amend tho regulations so that the requirements as to the supply of water to waterclosets shall apply equally to the supply of water to sinks used for receiving any solid or liquid filth. [9] 66 (c) To make a regulation which will prevent cisterns being brought into use for supplying water for domestic purposes, or for food for beasts, so long as they directly supply any water-closet or sink used for receiving any solid or liquid filth. (d) To make a regulation requiring that in all cases where any premises have a constant water service, one or more taps shall be provided in connection with the rising main for the supply of water for drinking purposes. On the 16th of April a reply was received from Messrs. Hollams, Sons, Coward and Hawksley on behalf of the seven associated metropolitan water companies, stating that the suggested regulation (a) as quoted in the Council's letter, which would increase the authorised flush of water from two to three gallons, raised a question of general public importance, for it would cause an enormous addition to the consumption of water and entail increased expense to the public as regards the requirements of future supply. The companies desired to point out that the regulations made under the Act of 1871 were framed after full inquiry, and were based on the evidence of very competent witnesses, who considered two gallons amply sufficient. In the opinion of the companies the adequacy of the flush for sanitary purposes depended on the construction of the apparatus, the head or pressure under which the water is discharged, the size of the down pipe " between the flushing apparatus and the basin of the closet, and the construction and shape of the closet basin, rather than on the actual quantity of water discharged." In conclusion, it was stated that the companies confidently anticipated being able to demonstrate that a two-gallon flush was abundantly sufficient, and that no advantage whatever would result from a greater consumption of water. As regards the other matters referred to, Messrs. Hollams expressed the desire of the companies to concur in any regulations which might be reasonably required for sanitary purposes without involving consumption of water for useless objects. With a view to obtaining a definite expression of the companies' intentions, we thought it desirable to inquire whether the Council was to understand from their letter that the companies, while declining to make the alteration in regulation No. 21 asked for by the Council, would comply with the Council's request as regards the other matters, viz.—those referred to in paragraphs marked (6), (c) and (d), and quoted above. The companies thereupon asked for a draft of the suggested amendment marked (6), in order that the practicability of the proposed change might be considered by their engineers. The suggested amendment (c) was not in their opinion one which concerned the companies, and if made they would have no means of enforcing compliance with it. They had no objection to suggestion (d). In response to the request of the companies to be furnished with a draft to an amendment to meet suggestion (6), we submitted to them that a means of giving effect to the suggestion would bo to add the following definition of " water-closet " to the regulations, viz.— The word "water-closet" in these regulations shall include "any sink used for receiving any solid or liquid excremental filth." and from regulation No. 20, line 2, to omit the words " other than water-closets in which hand flushing is employed." In answer to the companies' observations that if the regulation suggested in paragraph (c) were made they would have no means of enforcing compliance with it, we pointed out that the object of the suggestion was to prevent the use for domestic purposes of water supplied by a service cistern of a water-closet. We have now received a letter from the Kent Waterworks Company stating that they are unable to assent to the alterations proposed by the Council, deeming them in some respects unnecessary, and in others undesirable. They suggest that the better remedy would be found in arranging for proper testing and stamping of all water fittings before use, thus ensuring the rejection of insufficient, defective, or flimsy appliances and materials. In our report presented to the Council on the 5th of December last we expressed our reasons, arrived at after very careful inquiry, for considering that water-closet cisterns should be capable of discharging a three-gallon flush, and our subsequent correspondence with the water companies has not in any way affected our opinion on this point. We may add that since we last reported to the Council on this subject, several further letters have been received from London sanitary authorities urging the desirableness of a flush of at least three gallons. More than six months have now elapsed since formal application was made to the London water companies for the alteration of their regulations in the points specified, and in view of their refusal to make the most important alteration suggested, viz., that relating to the capacity of flushing cisterns, and of the fact that they have not intimated their intention to alter the regulations in the other points suggested, or taken any steps to do so, we think that the Council should now ask the Local Government Board to proceed in the manner directed in section 19 of the Metropolis Water Act, 1871. Under the powers given by that section, if any company on being requested in writing by the Council to repeal or alter any of the regulations for the time being in force, or to make new regulations instead of any of the same, refuses to do so, the Local Government Board may, if they think fit, appoint a competent and impartial person of engineering knowledge and experience to report to them on the subject, and on the report of such person the Board may make such regulation, repeal or alteration, as they think proper. We therefore recommend— That a letter be addressed to the Local Government Board, communicating the purport of tho correspondence between the Council and the London water companies as regards the suggested alteration of the regulations made under the Metropolis Water Act, 1871, and asking the Board now to appoint a person of engineering knowledge and experience to report to them on the subject as provided for in section 19 of the Act.* The London Equalisation of Rates Act, 1894. The Equalisation of Rates Act provides that the London County Council shall in each year form a fund equal to a rate of sixpence in the pound on the rateable value of London. The contribution from each parish to the fund is to be in proportion to its rateable value. The fund thus formed is to be distributed among the sanitary districts in proportion to their population. Where a sanitary district comprises two or more parishes, and the aggregate of the contributions from such parishes is less than the grant apportioned to the district, the difference shall be paid out of the fund to the sanitary authority of the district, and no payment towards any equalisation charge shall be required from any parish in the district. Subject to the above, when the contribution from a parish is less than the grant due, the difference shall be paid out of the fund to the sanitary authority of the district forming or comprising the parish; and if it exceeds the grant due to the parish, the Council shall, for the special purpose of meeting the excess, levy on the parish a county contribution as a separate item of the county rate. * The Local Government Board ordered an inquiry as requested, and while these pages are passing through the press the Council has received the decision of the officer thus appointed, which is to the effect that the only amendment which is recommended is (b) relating to the water supply of slop sinks. 67 Every sum paid to a sanitary authority must be applied in defraying the expenses of the sanitary authority incurred under the Public Health (London) Act, 1891, and so far as not required for that purpose those incurred in respect of lighting, and so far as not required for that purpose those incurred in respect of streets, and where the sanitary district comprises two or more parishes, the sum paid must be apportioned among such parishes in proportion to their population, and the amount apportioned to each parish credited to the parish in the reduction of the rate required from such parish towards the above-mentioned expenses. The sanitary authority is required to render annually to the Local Government Board a return showing the amount of the sum so paid, and the total expenses incurred in respect of the three subjects mentioned. If the Local Government Board, under section 101 of the Public Health (London) Act, are satisfied that the sanitary authority have been guilty of such default as in such section mentioned, and have made an order limiting a time for the performance of the duty of the authority, the London County Council shall, if directed by the Local Government Board, withhold the whole or any part of the payment of the sum due to such authority. The Act provides that for the purposes of the distribution of the fund a census shall be taken on the 29th March, 1896. In other years an estimate of population on the 6th of April will be made by the Registrar-general upon returns which the Local Government Board will receive from the authority making the poor rate in each parish, showing the total number of houses entered in the rate book of the parish. The following table shows the estimate of population on the 6th of April, 1894, and the amount of excess of contribution over grant or of grant over contribution in respect of each district for the half-year ended 31st March, 1895— Sanitary District. Estimated population, 6th April, 1894. Equalisation charge, being excess of contribution over grant. Net grant, being excess of grant over contribution. £ s. d. £ s. d. Paddington 121,029 4,750 8 1 - - - Kensington 169,004 9,008 9 - - - — Hammersmith 98,956 — — — 2,878 14 11 Fulham 106,540 — _ — 4,419 18 — Chelsea 97,845 — — — 438 8 4 St. George, Hanover-square 75,489 16,057 8 2 — _ — Westminster 53,738 4,487 11 10 — - — St. James 24,432 7,026 11 4 _ — — Marylebone 141,252 5,198 5 4 — — Hampstead 73,972 1,799 15 9 -— — — Pancras 241,959 — — — 3,807 8 1 Islington 323,853 — — — 10,549 16 10 Stoke Newington 31,300 — — — 650 12 9 Hackney 202,151 — — — 7,579 4 10 St. Giles 39,302 1,394 18 4 - — — St. Martin-in-the-Fields 13,631 5,298 12 4 — — — Strand 23,963 4,675 19 4 - — _ Holborn 32,854 (a) 1,598 15 10 - _ - Clerkenwell 64,321 — - - 1,653 14 9 St. Luke 40,096 95 13 11 _ — — London, City of 36,707 48,263 12 10 — — — Shoreditch 120,913 — — — (a)3,375 6 9 Bethnal-green 127,605 — — — 7,193 17 — Whitechapel 74,336 — — — (a) 2,142 12 -— St. George-in-the-East 44,568 — — — 1,988 17 — Limehouse 56,139 — — — 1,781 8 2 Mile-end Old-town 108,309 — — — 5,951 19 11 Poplar 169,947 — — — 7,879 5 — St. Saviour, Southwark 24,609 1,888 — 7 — — — St. George, Southwark 56,452 — — — 2,051 16 6 Newington 115,745 — — —- 5,440 11 6 St. Olave 11,420 1,443 18 8 _ — —- Bermondsey 83,202 — — — 2,917 5 2 Rotherhithe 37,920 — — — 1,090 2 6 Lambeth 278,227 — — — 7,759 10 10 Battersea 158,925 — — — 5,714 16 5 Wandsworth 173,617 — — — 3,076 19 3 Camberwell 247,204 — _ — 11,214 15 9 Greenwich 170,455 — — — 6,137 10 6 Lewisham 99,338 — — —- 1,534 10 — Woolwich 41,417 — — — 1,354 10 4 Lee 38,058 — — — 279 13 6 Plumstead 56,810 — — _ 3,271 3 7 The Charterhouse 136 140 — 2 _ — — Gray's-inn 253 176 18 9 - — — The Close of the Collegiate Church 235 24 15 11 — — _ of St. Peter Inner Temple 88 276 8 1 — — — Middle Temple 96 175 6 8 — — — Lincoln's-inn 27 255 11 6 — — — Staple-inn 19 32 11 1 — — — Furnival's-inn 121 (a) 64 16 8 — — — (a) The grant in respect of a portion of this district is paid to the sanitary authority of the City of London 68 Sanitary Condition and Administration of Districts. During the year the sanitary circumstances of Deptford, Whitechapel, Mile-end Old-town and Bethnal-green were investigated on behalf of the Council, the inquiry into Deptford being made by Dr. Young, into Whitechapel and Mile-end Old-town by Dr. Hamer, and into Bethnal-green by Dr. Young. Copies of the reports of these officers will be found in the appendix (see Appendices VII., VIII., IX. and X.) Dr. Young found that for the purposes of Deptford an increase of the staff of sanitary inspectors was necessary. Dr. Hamer arrived at a similar conclusion as a result of his enquiry into the sanitary circumstances of Whitechapel. In the case of Mile-end Old-town, Dr. Hamer expressed the opinion that when the vestry enforced by-laws for houses-let-in-lodgings, the existing staff of sanitary inspectors would be found inadequate. In respect to Bethnal-green Dr. Young also found the staff of sanitary inspectors insufficient for the wants of the district. In Deptford the mortuary accommodation was found to be unsatisfactory. In Whitechapel no shelter had been provided for the use of persons during the disinfection of their houses as required by section 60 of the Public Health (London) Act, but the subject was under the consideration of the district board. In Bethnal-green a shelter had not been provided, and Dr. Young points to the necessity of such provision. These several reports were forwarded to the sanitary authorities concerned, and led to increase of the staff of sanitary inspectors in Deptford, Whitechapel, and Bethnal-green. In 1893 I presented to the Public Health Committee a report upon the sanitary condition and administration of the district of St. Saviour, Southwark. A copy of this report was communicated to the district board of St. Saviour, and the recommendation as to the staff of sanitary inspectors embodied in the report was in 1894 adopted by that authority. The provision of a proper mortuary and of better apparatus for the disinfection of infected articles has not yet been made and is much needed. Medical Officers of Health and Sanitary Inspectors. The Public Health (London) Act, 1891, requires that the Council shall pay a moiety of the salary of every medical officer of health and sanitary inspector appointed or re-appointed after the passing of the Act. Up to the end of the year 1894, 35 medical officers of health and 142 sanitary inspectors had been thus appointed or re-appointed. The following table indicates those London districts in which the medical officer of health has been elected in accordance with the above requirement of the Public Health (London) Act, up to the end of 1894— District. District. District. District. *Battersea *Holborn *Poplar (Bow) St. Pancras Bermondsey *Islington * „ (Bromley and Poplar) *St. Saviour, Southwark *Bethnal-green *Kensington Rotherhithe *Shoreditch Camberwell Lambeth St. George, Hanover- *Stoke Newington *Chelsea Lee (Charlton) square * Strand *City * „ (Eltham) *St. George-in-the-East Wandsworth (Clapham) Clerkenwell „ (Lee) *St. George-the-Martyr „ (Putney) *Fulham Lewisham *St. Giles „ (Streatham) Greenwich (Deptford) *Limehouse St. James, Westminster „ (Tooting) „ (Greenwich) *Mile-end Old-town *St. Luke * „ (Wandsworth) *Hackney Newington *St. Martin-in-the-Fields *Westminster Hammersmith *Paddmgton St. Marylebone Whitechapel Hampstead *Plumstead *St. Olave *Woolwich Sanitary districts mentioned in Schedule C of the Metropolis Local Management Act, 1855. *St. Peter, Westminster (close of the Collegiate Church) *Gray's-inn sanitary authority *Inner Temple *Furnival's-inn, Stapleinn, and Liberty-of-theCharterhouse *Middle Temple *Lincoln's-inn In 1894 I presented to the Public Health Committee a report based upon information supplied by London Medical Officers of Health as to the number of Sanitary Inspectors in each district of the County (see Appendix XI.) The London Building Act, 1894. During the year 1894 the London Building Law was consolidated and amended. The Act of 1894 is especially deserving of comment in the report of the medical officer of health, inasmuch as it recognises for the first time in London the principle that (in addition to the height of the building being proportionate to the width of the street on which it abuts, which point is touched on lower down), the amount of open space about the rear of a building should also be proportionate to its height, and hence the future crowding of buildings on area is put under limitation. The Act requires in the case of domestic buildings erected after the commencement of the Act which shall have a habitable basement, that there shall, for the purpose of giving light and air to such basement, be provided in the rear of the building and exclusively belonging to it, an open space of not less than 100 square feet, free from any erection above the level of the pavement. If the domestic building be erected abutting upon a street formed or laid out after the commencement of the Act it shall have at its rear an open space, exclusively belonging to it, of not less * Appointment or re-appointment sanctioned by Local Government Board. A moiety of the salary appertaining to these appointments is payable by the London County Council. 69 than 150 square feet, extending throughout the entire width of the building, and to a depth in every part of at least 10 feet from such building; except that where there is a basement storey directly and sufficiently lighted and ventilated by the 100 square feet of open space before mentioned, or where there is no basement storey and the ground storey is not constructed or adapted to be inhabited, the required open space of 150 square feet may be provided above the level of the ceiling of the ground storey or a level of 16 feet above the adjoining pavement. The height of such domestic building is, moreover, to be limited by the extent of the open space at the rear, so that the height shall not exceed twice the distance from the rear of the building to the boundary of the open space. A modification of this last requirement is made in the case of domestic buildings abutting upon a street formed or laid out before the commencement of the Act. Under such circumstances the height of such part of the building as is 16 feet above the level of the adjoining pavement, is not to exceed twice the distance from the rear of the building to the boundary of the open space; and further, the requirements as to the extent of 150 square feet of open space, and that such open space shall extend throughout the entire width of the building and to a depth in every part of at least 10 feet from such building, may be met by providing such open space above the level of the ceiling of the ground storey or above a level of 16 feet above the level of the adjoining pavement. Dwelling-houses to be inhabited or adapted to be inhabited by persons of the working class do not, however, share in this modification, as far as it deals with the height at which the open space may be provided in the rear of the building. Special provisions allow domestic buildings to be erected on the site of domestic buildings existing at the time of the passing of the Act, which had less than the newly prescribed rear air space,, provided that no more ground is occupied by the newly erected buildings than was occupied by the previously existing buildings. For the purpose of ensuring the provision of open space about dwelling-houses to be inhabited or adapted to be inhabited by persons of the working class when such houses will not abut upon a street, plans exhibiting the extent and height of the dwelling-house and its position in relation to other buildings must be submitted to the Council, and the Council, if satisfied that the open space about the dwelling-house for the admission of light and air is insufficient, may refuse its sanction to such plans or may approve them subject to conditions. The Council, however, may not require more open space or open spaces than would have to be provided if the dwelling-house were erected abutting on a street or way formed or laid out before the commencement of the Act. Following previous legislation no building (other than a church or chapel) may be erected in a street of less width than fifty feet formed or laid out after the 7th August, 1862, to a height exceeding the distance from the nearest external wall of such building to the opposite side of such street. This provision has been incorporated in the Act of 1894, and the law has been extended so that no dwelling house inhabited or adapted to be inhabited by the working class may be erected without the consent of the Council within "the prescribed distance" (20 feet from the centre of a roadway used for the purpose of carriage traffic, and 10 feet from the centre of a roadway used for the purpose of foot traffic), to a height exceeding the distance of the front or nearest external wall of such building from the opposite side of such street, and no building or structure may be converted into such dwelling house within the prescribed distance so as to exceed such height. The effect of this extension of the law will benefit less the dwellings which are thus limited in height than those which are in their immediate vicinity. In my report for the year 1892 I commented on the system frequently adopted in buildings constructed in "flats," in which the only light and air received in some rooms is derived from small internal courts which are inadequate in size, and through which air does not circulate, with the result that such rooms are dark and unwholesome. The Building Act of 1894 imposes conditions on the construction of such courts. Where the court is wholly or in part open at the top, but enclosed on every side and constructed or used for admitting light or air to a domestic building, and where the depth of such court from the eaves or top of the parapet to the ceiling of the ground storey exceeds the length or breadth of such court, adequate provision for the ventilation of the court must be made and maintained by the owner of the building by means of a communication between the lower end of the court and the outer air. Further, no habitable room, not having a window directly opening into the external air otherwise than into a court enclosed on every side, shall be constructed in any building unless the width of the court measured from such window to the opposite wall shall be equal to half the height measured from the sill of such window to the eaves or top of the parapet of the opposite wall. A court, however, of which the greater dimension does not exceed twice the less dimension is held to comply with these requirements if a court of the same area but square in shape would comply with it. It is a frequent custom in London to construct extensions from the main building of a house or back additions which have the light of the rooms in these extensions or back additions obstructed by similar extensions or back additions of other houses. In large blocks of dwellings, numerous extensions are frequently made from the same building with similar result. The Act, therefore, endeavours to ensure light from above for those rooms having their windows facing such back extensions or additions. For this purpose the Act provides that no habitable room above the level of the ground storey, not having a window directly opening into the external air otherwise than into a court open on one side, the depth whereof measured from the open side exceeds twice the width, shall be constructed in any building unless every window of such room be placed not nearer to the opposite wall of such court, or to any other building, than one-half the height of the top of such wall or building above the level of the sill of such window. With a view to ensuring the proper lighting of staircases in houses the Act requires that in every building constructed or adapted to be occupied in separate tenements by more than two families the principal staircase used by the several families in common shall be ventilated upon every storey above 70 the ground storey by means of windows or skylights opening directly into the external air or shall be otherwise adequately ventilated, and the principal staircase in every dwelling-house not subject to the above provision shall be ventilated by means of a window or skylight opening directly into the external air. The following are the requirements as to habitable rooms under the Act of 1894— The height of such rooms must be eight feet six inches, an increase of one foot six inches beyond the height previously required. Habitable rooms, however, wholly or partly in the roof must, under the new Act, be not less than eight feet high throughout not less than onehalf the area of the room, an increase of one foot above the height previously required. Every habitable room must have one or more windows opening directly into the external air or into a conservatory, with a total superficies clear of the sash frames, free from any obstruction to the light, equal to at least one-tenth of the floor area of the room, and so constructed that a portion equal to at least one-twentieth of such floor area can be opened, and extending to at least seven feet above the floor level. Special requirements are made for the lighting and ventilation of rooms having no external wall or situated wholly or partially in the roof. Provision is made to secure the ventilation of the space beneath the wooden floor of a basement room when the floor is not constructed of solid wood bedded in concrete. Provision is also made to protect habitable rooms over stables from nuisance from such stables. With a view to giving facilities to land owners to clear areas and re-arrange streets, power is given to the Council to relax or modify the conditions of the Act as to open space and width of streets if they think it desirable to do so. A consideration of the provisions relating to air space about houses and intended to ensure the adequate lighting of habitable rooms shows that the requirements of the Building Act of 1894 are in some particulars insufficient. The provisions of the Act differ materially from those of the Bill introduced by the London County Council. It may be hoped, however, that as certain important principles have, although inadequately, received recognition by Parliament, the Act will have an educational value which will lead to results still better than can be actually enforced under its provisions. How far the Building Law of 1894 will attain the object in view remains to be seen, but it may be anticipated that if its provisions are later found to be inadequate, an extension of the powers it confers will not be refused by the legislature. Metropolis Management (Plumstead and Hackney) Act, 1893. On the 25th March, 1894, in pursuance of the Metropolis Management (Plumstead and Hackney) Act, 1893, the parish of Plumstead ceased to be united with the parishes of Charlton-next-Woolwich, Eltham, Lee, and Kidbrooke, these four parishes continuing to be a district under the name of the Lee district. At the same time the parish of St. Mary, Stoke Newington, ceased to be united with the parish of Hackney. The Act of 1893 also provided that all by-laws and regulations made by the Plumstead district board, and subsisting on the 25th March, 1894, shall continue in force in the parish of Plumstead, and be enforceable by the Plumstead vestry instead of by the Plumstead district board, until repealed or altered by the Plumstead vestry in accordance with the law applicable thereto; and all the by-laws and regulations made by the Hackney district board, and subsisting on the 25th March, 1894, shall continue in force in the parishes of St. Mary, Stoke Newington, and Hackney, and be enforceable by the St. Mary, Stoke Newington vestry, and the Hackney vestry in their respective parishes instead of by the Hackney district board, until repealed or altered in accordance with the law relating thereto. In my last report I stated that the date on which an annual report relating to London could be presented to the Council depended on the dates on which the annual reports of the medical officers of health were received. The following table shows the month in which the reports for the year 1894 were received, relating to districts other than those mentioned in Schedule C of the Metropolis Local Management Act— No. of Reports. No. of Reports. February, 1895 1 August, 1895 4 March, ,, 3 September, „ 2 April, „ 6 October, „ 7 May, „ 7 November, „ 3 June, „ 3 "December „ 2 July, „ 6 January, 1896 1 February, 1896. Shirley F. Murphy, Medical Officer of Health. appendix i . London County Council. Public Health Department, Spring Gardens, S.W. 31st May, 1894. Report of the Medical Officer of Health on a recent outbreak of Scarlet Fever at Blackheath. (Ordered by the Public Health, &c., Committee to be printed, 11th June, 1894.) On Saturday, March 24th, I learnt from Mr. C. H. Hartt, Medical Officer of Health of Greenwich, that a number of cases of scarlet fever had been notified in his district and in the adjoining district of Kidbrooke among persons who were obtaining their milk from a particular farm in the latter district. I at once proceeded to Kidbrooke and saw the medical officer of health, Mr. H. C. Burton. I learnt that 15 or 20 cases had been notified within the past few days in Kidbrooke, among persons who were consuming milk from the farm in question. It was then stated that about half the milk obtained from the cows at this farm was distributed by the farmer himself (Mr. A.), partly in Kidbrooke and partly in Greenwich, the remaining half was sold by Mr. A. to a retail vendor, Mr. B., whose dairy premises were situated in the Greenwich district, but within half a mile of Mr. A.'s farm. Mr. Burton had, at an early period, ascertained that Mr. A.'s milk carrier was himself suffering from sore throat, and inasmuch as at that time it was not known to him that Mr. B.'s customers were involved in the outbreak, the circumstances gave rise to the impression that infectious property might have been communicated to the milk after it left the farm, in such a way that Mr. A.'s customers were attacked while Mr. B.'s escaped. I now visited Mr. A.'s farm, and then called upon Mr. B., and elicited facts which altered the aspect of affairs. Mr. B.'s customers were it appeared distinctly involved in the outbreak, and although cases of scarlet fever had occurred in Mr. A.'s own house and among his employes and their families, the dates of attack of these cases did not, so far as I could ascertain, accord with the hypothesis that any one of them was responsible for the contamination of the milk. On visiting Mr. A.'s cowshed, moreover, my attention was directed to a roan cow which bad lost patches of hair and which presented on the teats a number of excoriations and scabs. This cow, I was informed, was one of a pair of newly calved cows which had recently been purchased from a cattle dealer at Eltham. On making further investigations, I found a white cow standing in the shed was also affected with abrasions and scabs on the teats. This cow was milked by the man who milked the two Eltham cows. The farmer who had from the outset accepted the evidence incriminating his milk, and who showed every desire to prevent the spread of the mischief, whatever the loss inflicted upon himself might be, had already discontinued the supply of milk on March 22nd. He was now informed by Mr. Burton that this discontinuance of the supply should be maintained, and to this he consented. Messrs Burton and Hartt now instituted a detailed investigation into the phenomena of the outbreak, and the result of the inquiries made by them and of further inquiry made by myself I now propose to give. I.—The distribution of the disease in locality and time and its relation to milk supply. The special incidence of scarlet fever upon the districts affected commenced about March 20th; the area attacked lay, for the most part, on the eastern side of Blackheath. The Shooters-hill road after passing along the northern boundary of the open space approaches Kidbrooke parish at the northeastern corner of the heath, and then for a distance of about half a mile pursues an easterly direction to join the Old Dover road, having Kidbrooke on its south side and Greenwich to the north. The roads running north and south out of this portion of Shooters-hill road were those specially attacked. As part of the heath lies in Lewisham, a few outlying cases occurred in houses situated in that district. The milk of Messrs A. and B. was thus distributed mainly in the following districts— Kidbrooke parish situated within the jurisdiction of the Lee Board of Works. Greenwich sub-district situated within the jurisdiction of the Greenwich Board of Works, but it may have been in small part distributed in The north-eastern portion of Lewisham. And in parts of the Lee and Charlton sub-districts within the jurisdiction of the Lee Board of Works. The milk was distributed therefore in three sanitary districts, and the notifications of scarlet fever received from those districts during successive weeks were as follows— Lee. Greenwich. Lewisham. Week ending March 4th 2 23 8 March 5th-llth 4 14 6 „ 12th-17th 0 16 3 ,, 18th-24th 19 37 4 ,, 25th-31st 29 35 7 April lst-7th 1 32 10 These figures sufficiently indicate the existence of an increased incidence of scarlet fever commencing in the week ending March 24th so far as Lee and Greenwich are concerned. Sold by Edward Stanford, 26 and 27, cockspur-street, Chariying-cross, S. W. No. 189—Price 1d. [1320—m. 94a 2 It is desirable to study more particularly the dates of occurrence of cases in the sub-districts of Greenwich and Lee which were specially attacked, and for those sub-districts, viz., Kidbrooke sub-district and Greenwich sub-district, the dates of commencement of illness have been ascertained, as being more important for the purpose of defining the limits of the outbreak than the dates of notification. I give particulars which have been derived from information furnished by Mr. Hartt, Mr. Burton and other gentlemen, whom I have to tbank for the trouble they have taken in the matter. The cases given in the table have been classified according to their milk supply, so as to snow whether they received their milk from Mr. A, Mr. B, or from other milk vendors, and in the case of Mr. B's customers whether their milk was distributed on one or other of three different rounds.t Greenwich. ' \ Kidbrooke. Date of commencement of illness. Mr. A.'s customers. Mr. B.'s customers. Other vendors. Mr. A.'s customers. Mr. B.'s customers. Other vendors. Son's round. Man's round. Walking round. Son's round. Man's round. Walking round. March 19 — — — — — 3 „ 20 — — — — 1 4 — — — — „ 21 6 — — — — 8 3 — — — „ 22 4 1 2 — — 10 1* — — — „ 23 8 — 1 1 — 3 4* — — — „ 24 3 — 2 3 2 — — — — „ 25 — — — 1 2 1 — — — — „ 26 — — — — 1 — — — „ 27 — — — — 1 1 — — — — „ 28 — — — 1 2 — 1* — — — April 1 — — — 3 5 — — — — — * These cases are properly speaking on B.'s son's round, but they may have been served with milk by B.'s man. The incidence of the disease on the drinkers of Mr. A.'s milk was so marked that from the outset there was no doubt that a milk supply was involved. Mr. Hartt has however supplied me with the results of enquiry in an area selected for the purpose of showing the relative incidence of disease on the suspected and other supplies. This area is bounded by Shooter's-hill road on the south side, on the east by a line drawn from the east end of Shooter's-hill road through the Rectory field cricket-ground to Charlton-road, on the north by a line drawn along the Charlton-road taking in the north side, and the south side of Westcombepark road as far as Vanbrugh-park road. On the west side it is bounded by Vanbrugh-park road and Vanbrugh-terrace. Inquiry in this area gave the following results— Total number of houses in area 368 Number of houses supplied by Mr. A 27 Number of houses supplied by Mr. B. 97 Number of houses supplied by other vendors 244 The cases of scarlet fever were limited to houses supplied by Mr. A. and Mr. B. and were equally distributed between them. II.—As to the possibility that contamination of the milk was caused by the conveyance of infection from some person suffering from scarlet fever who was employed at the farm. This question has been the subject of careful inquiry, and it may be well to enumerate the facts which have been ascertained in reference to the matter. Three men were employed in milking the cows at the farm. These men said they had not recently suffered from any illness, and when examined by me on March 31st they presented no evidence of having suffered from scarlet fever, and, save that one of the men had recently cut his finger, their hands showed no sores and they stated that they " had never had cowpox." The milk was taken round by a carrier who was assisted by a boy. This carrier, J. D., was the man who was in the first instance suspected of having communicated to the milk the power of conveying infection. He gave the following account of his illness. He did not feel well on the 18th, and recollected that he overslept himself on that morning. This indisposition passed off, however, until on the 20th he again felt unwell, and on the evening of the 21st his throat became sore. On the 22nd his case was pronounced to be one of scarlet fever. J. D. took out the milk until the morning of the 22nd, when the supply was stopped. His illness appears, however, to have corresponded in time of development with the early cases forming part of the general outbreak, and there can be little doubt that he was infected by the milk just as the rest of the early sufferers were. The boy who assisted J. D., Mr. A.'s wife and daughter, a milk clerk, and a woman living in a cottage on the farm, were also attacked by scarlet fever, but in none of them did the first symptoms date back so far as in the case of J. D., and the possibility of their having originally infected the milk is therefore out of the question. These attacks of illness then did not precede in time of development the early cases occurring among consumers of milk. There were, however, certain cases of illness in children of farm employes, occurring prior to the general milk outbreak, which demand attention. 1. The cases in N.'s family. N. is a foreman who works on the farm, and is never brought in contact with the milk. His cottage is situated within a few hundred yards of the cowshed. His son T. N. worked at a linendraper's in Lee. In February some of the apprentices in the shop were † It will be seen later that Mr. B. personally distributed the milk of another farmer in a fourth round. No cases of scarlet fever occurred in this round. 3 attacked with scarlet fever and on 11th February T. N. sickened. He was removed to hospital. On February 16th, T. N.'s sister began to be ill, and on the 23rd his younger brother was attacked. Both children were removed to hospital. The father, mother and three children remaining at home continued to enjoy good health, and when examined by me on March 31st, they showed no evidence of having suffered from scarlet fever. The facts that N. was not brought at all into relation with the milk business, and that those of his children who were attacked had been removed to hospital a month before the occurrence of the milk outbreak, negative the supposition that infection was communicated to the milk by any member of the N. family. 2. In a cottage not far from that occupied by N. lived the D.'s. A man who was one of the three milkers above alluded to lodged in this cottage. Two children suffered from illness in this house. One of them, J. D., was attacked by scarlet fever on March 21st, and her illness was therefore not prior to the general outbreak. F. J. D., an infant, had, however, undergone an operation at St. Thomas's Hospital, and had returned home only to be again removed to hospital just about the time of commencement of the outbreak. Enquiry was therefore made with reference to this child, and it was ascertained that he was a patient at St. Thomas's Hospital from February 9th to March 5th. On admission he was suffering from difficulty of breathing, and tracheotomy was performed. The wound healed and he was discharged, but he was readmitted on March 20th, suffering from diphtheria. Tracheotomy was again performed, but he died on March 21st. There was no evidence of scarlet fever in this case. The result of enquiry as to the possible source of infection among farm employes and their families is thus negative. Cases of scarlet fever had, it is true, occurred in the neighbourhood of the cowshed, but there was no evidence to show that the milk had been contaminated by them. ni.—As to the manner of distribution of the milk of Air. A. and Mr. B., and the condition of the cows in Mr. A.'s cowshed. Mr. A. distributed daily some 27 barn gallons of the milk of his cows in his own retail trade, and sold some 17 barn gallons daily to Mr. B. Mr. A.'s retail customers were all served on one round, about 16 barn gallons being distributed in the morning and about 11 in the afternoon. There was no possibility of distinguishing between the milk supplied to different customers numbering 86 in all, save in the following particulars— (a) A few customers had, with other milk, the milk from three special cows, which was sold as "nursery milk," and one family had nursery milk only (this family was not attacked). (b) Two houses were supplied with milk in the morning only; no one was served with milk in the afternoon only. No case occurred in the two families having only morning milk. (c) Mr. A.'s own family received in the morning the milk of a particular cow, an Alderney; so much of the milk of this cow as remained over went to augment the general supply. In the afternoon Mr. A.'s family received "nursery milk." Mr. B. supplied about 260 customers, and his milk was distributed on four different rounds. (Three " cart rounds," and one " walking round "). The milk distributed daily consisted of 17 barn gallons received from Mr. A.'s farm, and 20 barn gallons derived from another source (Mr. X.) On the first round (some 76 houses), only the milk last referred to, that of Mr. X., was distributed by Mr. B. himself, and no cases occurred on this round. Mr. B.'s son took charge of the second round (some 63 houses), and served customers with Mr. X.'s milk exclusively in the morning; in the afternoon he distributed either Mr. X.'s milk or Mr. A.'s milk. Mr. B.'s man M. took charge of the third round (some 53 houses), and served customers with Mr. A.'s milk exclusively in the morning, but in the afternoon distributed either Mr. A.'s milk or Mr. X.'s milk. The last round, the walking round (some 68 houses), was supplied with what was left over after customers on the cart rounds had been supplied, the milk remaining in the several churns being mixed, and then despatched on this fourth round. Mr. A's milk was fetched either by Mr. B.'s son or by his man; the man always fetched it in the morning and distributed it to customers in a road leading from the farm, and on his own special round. In the afternoon either the son or the man fetched it; if the former, he distributed it along the road referred to, and then on his special round; if the latter, he supplied the customers living in this road, and then took it on his own round. The recollection of Mr. B.'s son was that he fetched Mr. A.'s milk on the afternoons of the 17th, 19th and 20th March, and that the man fetched it on the afternoons of the 18th, 21st and 22nd March. The man's recollection was that he fetched the milk each afternoon from tho 18th to the 21st inclusive. There was agreement, however, between them as to the man's having always fetched Mr. A.'s milk in the morning. Mr. A. supplied Mr. B. with " nursery milk " from certain special cows (not the same cows which yielded Mr. A.'s own " nursery milk "). A few families supplied by Mr. B. had nursery milk only. None of these were attacked. As to the order of milking at the farm and the manner of distribution of the milk from particular cows, the following facts were elicited. The cows were milked in definite order by the three milkers. The two cows from Eltham were on their arrival on the 17th placed apart, and they were milked last in order of those milked by the head milkman C. This arrangement obtained until the 19th. On the 20th the two cows were placed in the general shed, and on this day and on the 21st C was away from work. It is uncertain whether the Eltham cows were milked last on the 20th, but on the 21st Mr. A.'s groom stated that he milked them, and milked them last. In the morning the first milk was given to the carrier who arrived first, and the carrier arriving late usually waited for the last cows to be milked, and their milk was included in the consignment 4 handed over to him. In this way, so the head milkman C. stated, it came about that Mr. A. would have the milk of the two Eltham cows in the morning, and that Mr. B. would have it in the afternoon. On questioning the carriers they agreed generally with this statement, but seemed to think it was rather too absolute as far as the morning was concerned. They could not positively assert, however, that with respect to any particular morning from the 18th to the 22nd C.'s statement did not hold good. With regard now to the cowshed and to the cows therein, the following observations were made— There was one large shed constructed in the form of the letter L, and at the end of one arm of the L a portion was partitioned off to be used for the purpose of isolating cows newly arrived at the farm. On the occasion of my first visit, March 24th, I found, as already mentioned, that two cows presented an ulcerated condition of the teats (a roan cow newly arrived from Eltham, and a white cow). Mr. A., on my pointing this out to him, at once gave directions for the isolation of these two cows, and of a third (the other cow which arrived from Eltham at the same time as the roan cow affected). These three cows were placed in the portion of the shed separated off. The roan cow from Eltham had lost patches of hair, but its companion cow did not present any abnormal appearance. On the occasion of a subsequent visit on March 30th, the sores on the roan cow were almost healed, and those on the white cow were in process of scabbing over. Two fresh cows were found to be affected with ulcerated teats, the Alderney cow and another. This last cow, the two Eltham cows, and the white cow, were all milked by the milker C. The Alderney cow was, however, milked by another milker. An attempt was made to follow up the previous history of the two cows bought from the Eltham dealer. It was understood from this dealer's foreman that the cows came to Eltham on March 15th, and were taken to Mr. A.'s farm at Kidbrooke on the 17th. It was maintained that it was impossible to state where they had come from. As regards their milk during their stay at Eltham, it was said it might have gone to a neighbouring village, but on inquiring there the farmer who would have received it denied having done so, and no scarlatina had recently occurred in the locality. The chief facts ascertained with reference to the outbreak may be summarised as follows— Three cases of illness among milk consumers commenced on the 19th March and four on the 20th, the number attacked then increased considerably, on the 21st 17 persons fell ill, on the 22nd 19, on the 23rd 19. The cases then rapidly diminished in numbers, and the special incidence of the disease upon persons consuming the particular vendor's milk may be said to have ceased after the 24th. This date of the cessation of fresh attacks accords with the stoppage of the milk supply on the 22nd, allowing for period of incubation. Throughout the outbreak Mr. A.'s customers suffered to a greater extent than Mr. B.'s ; again Mr. A.'s customers were attacked earlier than Mr. B.'s. The arrival of the Eltham cows on the 17th, some two days before the outbreak commenced, caused suspicion to fall upon them; this suspicion was in some degree strengthened by the statement made that the larger morning yield from these cows had gone to Mr. A.'s customers, while the smaller afternoon yield had gone to Mr. B.'s; a statement in correspondence with the larger proportion of Mr. A.'s customers attacked. On following up the matter, however, and examining the proportionate incidence and time of incidence of disease on Mr. B.'s separate rounds in relation to the distribution of the milk of the Eltham cows, it was found that the evidence was conflicting, and it proved impossible to arrive at any certain conclusion. The chief feature of the outbreak which remains insufficiently explained on the assumption that the milk of the two Eltham cows was infective, is the prior incidence of the disease on Mr. A.'s customers and the early implication of Mr. A.'s own family. Assuming C. not to have been mistaken, Mr. A.'s own family would not have been supplied with milk from the Eltham cows on their first arrival, and Mr. B.'s customers would have been the first to receive milk from those cows. Assuming C. to have been mistaken as to the distribution of the milk on the afternoon of the 17th (the day when the cows arrived), there would still be difficulty in reconciling a hypothesis that the milk of the Eltham cows was infective, with the recollections of Mr. B. and his carriers as to the particular customers supplied by them with Mr. A.'s milk. Shirley F. Murphy, Medical Officer of Health. Appendix II. London County Council. Memorandum by the Medical Officer of Health on the Distribution of Enteric Fever in London in 1894, considered in relation to water supply. Public Health Department, 8th July, 1895. I have for some time been engaged in the study of the distribution of cases of enteric fever in London, and, inasmuch as I have observed an appearance of exceptional behaviour of this disease in 1894, I now beg to present to the Committee a memorandum on the subject. The notification of cases of enteric fever has been obligatory in London since 1889. The results therefore of notification during five whole years, 1890-4 inclusive, are now available for examination. For the purpose of studying the behaviour of enteric fever as regards seasonal prevalence in 1894, it is necessary to ascertain as far as possible the normal behaviour of the disease in this respect. For this purpose Diagram I. has been prepared, based on the number of cases concerning which the Metropolitan Asylums Board received copies of certificates in the four years 1890-3, and showing the number of cases concerning which certificates were received in each week in relation to the mean weekly number of the four years. For the purpose of comparison, the number of cases in each week in the year 1894 is also shown in relation to the mean weekly number notified in that year. Comparison may therefore be made between the curves thus prepared, and the point to which I desire to direct attention is that whereas in the period 1890-3 there was decrease of the cases in the 49th, 50th and 51st weeks, in 1894 there was increase. If the distribution of the cases of each of the five years be considered (see Table I.), it will be seen that only in the year 1894 did this increase occur in these weeks. It is necessary that I should here state that I am not now discussing any large prevalence of enteric fever, but a slight increase, a mere sprinkling of cases among the vast population of London, which might readily occur at times when the disease is apt to be prevalent without exciting observation. It is desirable to ascertain whether this apparently exceptional behaviour of enteric fever in London in 1894 has been shared by other communities. A curve has accordingly been prepared based upon the number of cases notified in each week in 1894 occurring in a group of districts from which the Local Government Board receives returns, and it will be seen that this curve, which in Diagram 1. is described as the curve of " large towns," resembles that of London for the period 1890-3 ; that is to say, there is decrease in the number of cases notified in the 49th, 50th and 51st weeks (see Table II.). It should be stated that in one respect the large town curve is not strictly comparable with the others, for while the London curves are based upon the number of cases, of which the Metropolitan Asylums Board each week receives copies of certificates from the London medical officers of health, the large town curve is based upon the number of cases of which the provincial medical officers of health each week receive certificates. There is, in fact, a little delay in the receipt by the Metropolitan Asylums Board of a few certificates in each week.* If correction be made for this, however, the effect in the diagram is so small that it in no way affects the fact that London in 1894 suffered from increased prevalence of enteric fever in the 49th, 50th and 51st weeks; whereas, in London, in 1890-3, and in the large towns 1894, the number of cases in these weeks was decreasing. It is, of course, necessary here to bear in mind that the normal behaviour of enteric fever in London can now only be studied by the statistics of a few years, and the experiences of a longer period is desirable for the purpose of construction of a mean seasonal curve as well as for the purpose of ascertaining how far the curve of any one year may differ from this mean without suggestion of some special factor of disease coming into operation in that year. It must also be remembered that the mean seasonal curve of every community may not be the same, and that in considering how far the curve of any one community in a particular year indicates exceptional behaviour of enteric fever, the mean curve of that community affords a more reliable basis for comparison than that of other communities. At the present time it is impossible to do more than state that the behaviour of enteric fever in London in the weeks in question of 1894 was exceptional as compared with its behaviour in the same weeks of four other years in which there has been notification of infectious disease. In considering the circumstances which may have caused this apparently exceptional behaviour of the disease in London in 1894, it is necessary to ascertain whether the increase in the 49th, 50th and 51st weeks has been due to a purely local increase, its cause operating only on one or two districts, or whether this cause has been operative over a large area of the county. A map has been prepared showing by a spot each house newly invaded in these weeks. It is, of course, impossible to distinguish in this manner between cases due to causes constantly operative and those due to any new factor of disease which has come into operation; all that it can show is that the spots are distributed over a wide area, and that there is no suggestion of local grouping. An increased prevalence of enteric fever over a very wide area, at a time when enteric fever, might be expected to decrease, raises question whether the disease has been disseminated * In Diagram II., as the figures upon which the curves are based are very small, this correction has been made in that part relating to the last 16 weeks. [4749 2 by water. Endeavour has been made to learn the water supply of the house in each case of enteric fever, to which the notification certificates relate. In this work difficulty has in a limited number of cases been experienced, especially where the house invaded is situated in a street supplied by two water companies. I am satisfied however that any error due to this cause is so small that it does not disturb the general indication of the figures. Inasmuch as curves have been prepared to show the behaviour of enteric fever in London and other communities, I have thought it well that similar diagrams should be prepared to show the behaviour of the disease in the populations supplied by the several water companies, and Diagram II. has been prepared with this object. It must be stated that when the number of cases is small the method of exhibiting increase and decrease, as percentage above and below a mean, is open to objection, but the general correspondence between the curves in Diagram II. leads me to the conclusion that their indications are sufficiently trustworthy for the purpose I have in view. They suffice to show a correspondence in the behaviour of the disease, i.e., increase of prevalence in the three weeks under consideration in the populations supplied by all the water companies except the East London and the Kent Companies. In view of this exceptional behaviour of enteric fever in the later weeks of 1894, it is necessary to consider whether any special circumstance may have led to failure of filtration of the water supplied to London at some time which corresponds with that at which such failure might be expected to manifest itself by increased prevalence of enteric fever. Diagrams III. and IV. show the condition of the Thames and Lee as to flood at Teddington Weir and Fielde's Weir respectively during three years 1892-4, the number of gallons of water passing over these weirs in each week being stated as a percentage above and below the mean, and it will be seen by reference to these diagrams that notable floods occurred at a time, antecedent to the weeks of prevalence of enteric fever, at which some new factor in the dissemination of the disease might be expected to have come into operation in London. In order to ascertain the effects of these floods on the waters supplied to the consumers, Diagram V. has been prepared. This diagram is based upon the reports of the chemists who analyse the water for the London water companies, and shows the close correspondence between the condition of the rivers and the quality of the water which is supplied after filtration as regards organic impurity.* It is important to ascertain whether the same behaviour of the disease is observable in the populations supplied from the Thames and Lee outside London. To follow such increase to the population supplied by the London water companies outside the County of London is more difficult, because, although I am favoured by the Local Government Board with a return showing the number of cases of enteric fever notified each week in many communities, this return does not cover the whole of the area which has to be taken into consideration. I have, therefore, to supplement the return of the Local Government Board, sought the aid of the medical officers of health of other districts in which there is notification of infectious diseases, and I am able, through the courtesy of those who have responded to my request, to state that when these districts are grouped, the same exceptional behaviour of disease in the 49th, 50th and 51st weeks is observable in the group of districts in the neighbourhood of London supplied by the London companies drawing water from the Thames and Lee, whereas it is wanting in the group of districts otherwise supplied, concerning which I have received information. (See Table III.) I might mention, however, with regard to the latter districts, that there is considerable difficulty in obtaining a population in the vicinity of London sufficiently large to give reliable figures for comparative purposes, as, generally, the more thickly populated districts in]the vicinity of London are more or less supplied by the London water companies drawing from the Thames and Lee. It is necessary to consider what other circumstances may have given rise to this increase of enteric fever in London and the surrounding neighbourhood. In this connection the distribution of an infected milk supply deserves reference, for the milk of a single farm may in a few days be distributed in many districts. A hypothesis of milk infection would not suffice to explain a practically simultaneous increase of disease over so wide an area as that involved, although the effects of distribution of a polluted milk supply, as in the case of a polluted water supply, are otten manifested beyond the area of distribution of the supply. More recently the possibility of dissemination of enteric fever by oysters has excited attention. Our knowledge of this subject is as yet very small, but it does not appear that this hypothesis would afford adequate explanation of the circumstances observed. Subject to what has already been said as to the fewness of the number of years of notification upon which these observations are based, the hypothesis of water-borne contagion appears better able to afford explanation of the increase of disease in the weeks in question. The absence of the evidence of this increase in the London population of the East London Company no doubt needs explanation, and it is to be regretted that in the absence of information as to the operations of the water companies I am unable now to discuss this further ; but apart from this exception there appears to be a difference in the behaviour of the disease in the area supplied with Thames and Lee water by the London companies and in the area otherwise supplied ; and there is further the fact that very exceptional floods occurred in these rivers at a time which corresponds with that at which some new factor in the causation of enteric fever might be expected to have come into operation. These circumstances, I submit, indicate the need for watchfulness over the distribution of enteric fever in London in its relation to water supply. SHIRLEY F. MURPHY, Medical Officer of Health. * The diagram does not show a curve relating to the Chelsea Company's water for the reason that the report of the metropolitan water examiner of the 9th of August, 1894, contains a statement to the effect that the water previously taken for the purpose of analysis of that company's Water had been drawn, through error, from a standpipe supplied from the New River Company's main. 3 TABLE I. Cases of Enteric Fever notified in London in each Week of the Years 1890-94. No. of Week. 1890. 1891. 1892. 1893. 1894. 1 53 44 39 47 42 2 33 32 32 57 40 3 28 40 29 49 50 4 35 45 31 44 60 5 27 46 36 39 52 6 22 33 21 46 58 7 19 40 31 57 60 8 20 39 27 33 55 9 27 42 24 38 46 10 34 62 28 40 59 11 30 62 22 30 44 12 46 51 26 38 45 13 36 37 22 23 33 14 19 38 33 50 53 15 21 30 21 32 44 16 35 56 32 38 41 17 31 63 19 43 41 18 17 60 30 37 36 19 18 42 33 48 43 20 29 24 43 51 41 21 34 18 49 41 46 22 33 38 36 34 35 23 43 50 34 42 46 24 35 48 32 73 54 25 30 44 35 148 35 26 38 46 45 98 35 27 40 41 47 62 33 28 39 50 62 78 33 29 37 44 41 63 41 30 44 72 46 79 47 31 58 30 44 78 53 32 62 46 47 83 48 33 53 56 63 73 45 34 76 73 46 73 40 35 78 75 64 75 63 36 114 57 70 113 61 37 107 51 81 103 67 38 113 74 108 87 84 39 106 98 82 70 93 40 109 171 70 96 98 41 102 289 66 94 79 42 97 145 53 97 85 43 123 106 80 T3 103 44 109 108 88 101 105 45 106 111 64 111 109 46 91 107 72 138 131 47 75 111 64 153 105 48 89 101 71 135 130 49 67 83 62 113 135 50 73 65 56 91 139 51 63 25 61 69 145 52 44 53 47 79 101 53 51 — — — -- 4 TABLE II. Cases of Enteric Fever notified in large towns of England and Wales, 1894 (excluding London).‡ No. of week. Cases, 1894. No. of week. Cases, 1894. No. of week. Cases, 1894. 1 183 19 155 37 269 2 205 20 132 38 281 3 223 21 127 39 330 4 194 22 119 40 270 5 196 23 139 41 286 6 225 24 155 42 268 7 172 25 172 43 277 8 183 26 143 44 277 9 179 27 165 45 263 10 174 28 147 46 289 11 169 29 172 47 275 12 158 30 186 48 297 13 174 31 172 49 206 14 173 32 195 50 249 15 168 33 229 51 228 16 170 34 307 52 180 17 166 35 339 18 195 36 292 TABLE III. Cases of Enteric Fever notified in three groups of districts in the vicinity of London. A, supplied, by the London Water Companies drawing water from the Thames and Lee ; B, not so supplied ; C, partially so supplied. No. of week Week ended. A Cases of enteric fever notified in areas in the vicinity of London supplied by London "Water Companies' drawing water from Thames and Lea. B Cases of enteric fever notified in areas* in the vicinity of London not so supplied. C Cases of enteric fever notified in areas in the vicinity of London partly supplied by London Water Companies drawing water from Thames and Lea. 1894. 40 Oct. 6 20 7 4 41 „ 13 16 9 6 42 „ 20 26 1 3 43 „ 27 37 4 9 44 Nov. 3 21 2 2 45 „ 10 29 4 4 46 „ 17 31 5 4 47 „ 24 16 8 4 48 Dec. 1 22 15 7 43 „ 8 39 7 9 50 „ 15 33 9 11 51 „ 22 35 7 3 52 „ 29 24 10 5 ‡ Guildford, Croydon, Wimbledon, Chatham, Gillingham, Dover, Eastbourne, Hove, Gosport and Alverstoke, Bournemouth, Southampton, Heading, Heston and Isleworth, Willesden, Edmonton, Enfield, Homsey, Tottenham, Wood Green, Oxford, Northampton, Peterborough, Bedford, Cambridge, Leyton, Walthamstow, West Ham, Colchester, Norwich, Swindon New Town, Exeter, Plymouth, Devonpoit, Bath, Bristol, St. George, "Gloucester, Stafford, Burslem, Hanley, Longton, Burton-upon-Trent, Wolverhamptcn, Waleall, Handsworth (Staffs.), West Bromwich, Rowley Regis, Worcester, Smethwick, Birmingham, Aston Manor, Coventry, Leicester, Grimsby. Nottingham, Derby, Stockport, Hyde, Macclesfield, Birkenhead, Wallasey, Liverpool, Bootle, West Derby, Widnes, St. Helen's (Lanes.), Southport, Wigan, Warrington, Bolton, Bury (Lanes.), Heywood, Eccles, Salford, Manchester, Ashton-under-Lyne, Stalybridge, Chaddert<.n, Oldham, Accrington, Raw tent tall, Burnley, Nelson. Blackburn, Darwen, Preston, Blackpool, Lancaster, Barrow-in-Furness, Ripon. Keighley, Hmldersfield, Halifax, Bradford, Batley, Dewsburv, Wakefield, Barnsley, Sheffield, Rotherham, Doncaster, York, Hull, Scarborough, Middlesbrough, Darlington, Hartlepool, West Hartlepool, Sunderland, Jarrow, South Shields, Gateshead, Newcastle-on-Tyne, Tynemoutb, Carlisle, Newport (Mon.), Cardiff, Ystradyfodwg, Merthyr Tydfil, Swansea, Llanelly. + Comprising Wimbledon U., Willesden TJ.. Edmonton U., Homsey U., Tottenham U., West Ham U., Leyton U., Walthamstow D., Acton U., Southgate U., Brentford U., Hanwell U., Ealing U. Teddington U., Wanstead U., Surbiton U., Chiswick U., Kingston U., East Ham U., and Woodford U. Total population censuB 1891, over 740,000. * Comprising Harrow U., Sevenoaks U., Barking U., Staines U., Dartford U., Staines R., Barnet R„ Barnet U., Uxbridge R., Eritli U., Chert^ey R., Norwood. U„ Romford U. Romford R., Finchlev U., Friern Barnet U., Sutton U., Carshalton U., Epsom R., Bromley U., (iuildford R , Hendon R., Berkhamstead R, Tring U, South Mimms R., Hemel Hempstead R.. Watford R., Welwyn R., Reigate R , iieigate U. (part of). Dorking U., Dorking R. (part of), Dorking parish (pait of), Epsom U., Cheshunt U., Bexley U., EastWickham, Hartford R., Ougar R., and Wembley. Total population census 1891, over 490,000. § Croydon U., Heston and Isleworth U., Enfield U., Hendon U., llford U., Richmond U., Waltham U., Croydon R., and Epping R Total population ceiiMis 1891, over 270,000. Abbrevations—U., Urban Sanitary District. R., Rural Sanitary Di strict. DIAGRAM I ENTERIC FEVER. DIAGRAM II DIAGRAM SHEWING WEEKLY NUMBER OF CASES OF ENTERIC FEVER IN THE VARIOUS WATER COMPANIES' AREAS IN LONDON IN RELATION TO THE MEAN OF THE YEAR 1894. DIAGRAM III DIAGRAM SHEWING WEEKLY DISCHARGES OF THE THAMES AT TEDDINGTON IN RELATION TO THE MEAN WEEKLY DISCHARGE, 1892-93-94, DIAGRAM IV DIAGRAM SHEWING WEEKLY DISCHARGES OF THE LEE AT FIELDE'S WEIR IN RELATION TO THE MEAN WEEKLY DISCHARGE, 1892-93-94. DIAGRAM V DIAGRAM SHEWING QUANTITY OF OXYGEN REQUIRED TO OXIDISE THE ORGANIC MATTER IN SAMPLES OF WATER FROM THE MAINS OF THE COMPANIES. Appendix III. London County Council. Public Health Department, Spring Gardens, S.W. 5th April, 1894. REPORT OF THE MEDICAL OFFICER ON ANTHRAX IN LONDON. {Printed by order of the Public Health Committee, 16th April, 1894.) On September 9th, 1893, a letter was received from the deputy-coroner for Southwark, stating that at an inquest held on the body of F. W. Morgan, who died from anthrax communicated from imported dried skins, the jury had requested him to draw the attention of the Council to the case in the hope that it would use its influence for preventing the recurrence of any similar calamities. I was therefore instructed to report on the matter. The question of the occurrence of anthrax in persons engaged in the London hide and skin trade was carefully and exhaustively enquired into some ten years ago by the late Mr. John Spear, whose report is contained in the 12th annual report of the medical officer of the Local Government Board published in 1883. This report gives an account of the. hide and skin trade as carried on in London, and contains the results of Mr. Spear's inquiries into the extent of prevalence of anthrax among those engaged in the trade. A concluding section of the report discusses suggested remedial measures. During the ten years which had elapsed since the publication of Mr. Spear's report, an increasing amount of attention had been devoted to the subject. Alterations had, moreover, occurred in the leather trade, and the bearing of these changes, if any, upon suggested remedial measures required to be considered. With a view to collecting the information available since Mr. Spear's report was written, Dr. Hamer has been instructed to ascertain as far as possible the extent to which this disease has prevailed in London, and to make inquiry into the circumstances of the cases, and of the hide and skin trade generally. I now present Dr. Hamer's report on this subject. On the question whether there has been any increase of this disease in man during recent as compared with earlier years, Dr. Hamer has felt some difficulty in arriving at any positive conclusion. There has been an undoubted increase in the recorded cases, but with this has to be considered an increase of knowledge of the appearances of the local lesion, enabling cases of this malady to be better recognised. It deserves, however, to be stated that notwithstanding that Dr. Russell in Glasgow, and Mr. Spear in an inquiry at Bradford, directed attention, in 1878 and 1881 respectively, to the occurrence of internal anthrax in this country, but one case of this form of the disease could be heard of as having occurred in London since the date of Mr. Spear's report. A large number of the cases of external anthrax inquired into by Mr. Spear were associated with the manipulation of a particular consignment of China hides. The more recent cases Dr. Hamer did not find especially associated with hides from that country, but he did find much reason for thinking that dry hides as distinguished from wet hides were especially productive of the disease, and as there appears a tendency in the trade to discourage, for other reasons, the use of dry hides, he finds ground for hoping that the substitution of wet hides for dry hides will be attended by a lessened risk to those manipulating foreign hides in London. During recent years, London tanners have practically ceased to use dry foreign hides, and their men have during this period been much more free from anthrax, while cases of this disease have been recorded with undiminished frequency among the sorters and labourers engaged in the brokers' warehouses where dry foreign hides are manipulated. The practicability of ensuring the exclusion of diseased hides from this country is not now greater than at the time of Mr. Spear's inquiry, and no advance has been made in the application of methods of disinfection to foreign hides before their shipment. So far, therefore, the safety of those who manipulate hides is dependent upon precautions taken in London. Mr. Spear placed "in the very first rank of defensive measures the dissemination of a knowledge of the danger among workmen," in order that remedial measures should be adopted at the earliest moment, and he gives a form of notice to workmen employed by one firm. Dr. Hamer, who shares this view, finds ten years later this firm still exhibiting the same notice, and failed to find a similar course being adopted by other firms with whom his enquiry brought him into relation. The dissemination of knowledge in this manner is especially necessary in view of the fact that a considerable number of persons employed in the trade are casual labourers who have no experience of the risks to which they are exposed. Inasmuch as many of the places where hides are stored cannot be made subject to special requirements under section 8 of the Factory and Workshops Act, the Committee might, I think, Sold by Edward Stanford, 26 and 27, Cockspurstreet, Charing-cross, S. W. No. 175—Price 7d. [10980—1985 (s.v. 93). 2 endeavour to obtain the adoption of the practice of exhibiting notices by all persons engaged in trades in which there is risk of anthrax infection. I desire to express my thanks to Dr. Perry, of Guy's Hospital, for searching the records of that institution, and supplying notes for Dr. Hamer's use of the cases of anthrax occurring there. Shirley F. Murphy, Medical Officer of Health. The first question which demands consideration in connection with this subject is the extent of prevalence of anthrax in London. This is a matter upon which considerable diversity of opinion exists among those who are brought into relation with the disease, and attention requires to be directed to such facts bearing upon this point as are available. For due appreciation of the extent to which the recorded cases approximate to an exact account of the manifestations of the disease in man, it is moreover necessary to have regard to the comparatively recent development of knowledge respecting anthrax, and to recognise that the lines upon which that development has occurred have materially influenced the probability of the disease being recognised in one and another quarter. The attempt to estimate with as much precision as possible the entent of anthrax prevalence in London was made rather more than ten years ago by Mr. Spear. A table had been already prepared by Mr. Davies-Colley, giving the record of cases observed during a number of years at Guy's Hospital. This table was brought up to date and added to by Mr. Spear, who succeeded in obtaining information concerning 39 cases of the disease occurring between 1873 and 1883. The help generously afforded by gentlemen connected with the various London hospitals* has made it possible to obtain particulars concerning a number of cases of anthrax occurring in the last ten years. Upwards of 60 medical men practising in south-east London, in the neighbourhood of the seat of the hide and skin industry, have been communicated with and have kindly rendered assistance, and in a few instances, cases have been heard of from other sources and have been followed up. It has thus been possible to collect information concerning 119 cases of anthrax (27 fatal) which have occurred in London during the last 21 years. These cases are tabulated in Appendix I. It will be seen that they date back to 1873, and though the record is certainly incomplete (other cases having been heard of concerning which full particulars could not be obtained) it probably fairly represents the extent to which anthrax has been recognised in London in the human subject. The important question then arises as to how far recognition of the disease corresponds with its occurrence, and to form any judgment on this matter it is necessary to realise the way in which knowledge concerning the clinical manifestations of anthrax has grown up. It is therefore proposed to give, in the first instance, an outline of the history of anthrax with a view to illustrating more particularly the degree of reliability to be placed upon the record in the appendix; that record may then be more particularly discussed, attention being especially devoted to the subject of the suspected source of infection in the different cases ; it will then be necessary to note the changes that have occurred in the London hide and skin industry since the time of Mr. Spear's inquiry; and then, finally, it will be possible to discuss in the light of more recent events the remedial measures suggested by him, and to come to a conclusion as to the value and practicability of those or of other methods. A.—Outline of the history of the disease known as anthrax. There is no doubt that the anthrax bacillus produced disease in animals and in man long before it was discovered by the eye of the investigator. The recognition of the role played by the bacillus, however, greatly stimulated the collection of exact knowledge on the subject, and it is probable that prior to the demonstration of the cause of the disease, the effects produced by it were not always grouped together and classed in the same category. In animals the malady appears to have frequently manifested itself on the continent, and even in the last century it was well recognised that malignant carbuncle (French "charbon") was apt to effect human beings who manipulated certain animal products. The term anthrax signifies literally carbuncle, and seems to have been applied in this country to any severe form of carbuncle. When the peculiar features of the local lesion, which is now known to be caused by the anthrax bacillus, became recognised, the term malignant pustule was used to designate the condition, and it is under this head that the first records of human anthrax in this country appear. Cases of malignant pustule were described by Mr. Lawrence in 1847; a series of cases was collected and published in 1852 by Mr. Harvey Ludlow, and in 1862 a paper on the subject was read before the British Medical Association in London by Dr. William Budd. Dr. Budd in this paper (Observations on the occurrence of malignant pustule in England, illustrated by numerous fatal cases) noted that malignant pustule had long been known in France, Germany, Russia, Lapland, Sweden, Italy, and other parts of Europe. He wrote " Malignant pustule in man is identical with and derived from the eminently contagious disease which under the name of charbon (germanice, milz-brand, spleen-gangrene), or in sheep 'sang,' has prevailed from time immemorial in various countries in oxen, sheep, horses and other animals." Dr. Budd gave the histories of some thirty cases, but relying as he did upon the naked eye appearances of the pustule to establish the diagnosis, it is possible that some of the cases investigated by him were not truly examples of anthrax. It is noteworthy, however, that in one instance the patient was a tanner, and that another patient had been employed in unloading hides. In 1863, the year after that in which Dr. Budd read his paper, Davaine's researches on the * To Dr. Perry, of Guy's Hospital, thanks are especially due for the kind interest he has taken in the matter. 3 subject of the anthrax bacillus were published. The bacillus had, it is true, been described by Pollender in 1849, but Davaine, who discovered the bacillus quite independently, first showed that there was reason for looking upon it as the cause of the disease affecting animals and man. In the same year, 1863, malignant pustule appears for the first time as a cause of death in England in the Registrar General's reports (vide Appendix II.) In 1876, Koch completed the proof that the bacillus was the cause of the disease, and he instituted a series of researches which led to the anthrax organism being studied in many laboratories, and to knowledge concerning it becoming much more widely diffused than had hitherto been the case. It was at about this period that the subject began to attract special attention at Guy's Hospital, and the occurrence of malignant pustule in workers in the hide and skin trade in Bermondsey from this time forward was carefully inquired into. In 1878, the attention of Dr. Russell, of Glasgow, was called to certain cases of sickness and death among horsehair workers. In February and March of that year Dr. Russell was able to trace nine cases of illness among women employed at a particular horsehair factory ; four of these cases were fatal, and in one case, anthrax bacilli were proved to be present. Dr. Russell attributed the outbreak to the manipulation of a particular kind of hair known as " raw Russian manes," and he drew attention to three deaths of workers in the same factory which took place in 1876-7, and to three deaths which occurred in another factory in Glasgow in which raw Russian manes were being dealt with.* Dr. Russell's cases in a few instances suffered from malignant pustule, but the majority were affected with constitutional symptoms unaccompanied by any skin lesion ("internal anthrax"). Dr. Russell refers in his paper, which is published in the annual report of the medical officer of the Local Government Board for the year 1878, to several similar outbreaks among workers in horsehair recorded by other observers. Rayer's experience in Paris, and that of Ibrelisle at Metz, are quoted, Trousseau's cases are referred to, details are given concerning outbreaks in Massachusetts and in Leipzig. Dr. Russell also refers to the cases described by Lawrence (already mentioned) as the only cases of malignant pustule arising in an English hair factory recorded at the time of occurrence of the Glasgow outbreak. In Bradford certain anomalous forms of illness had been noted as occurring from time to time among wool-sorters. These cases are said to have become more numerous after 1863 when Van mohair (the fleece of the goat inhabiting the Van district in Asia Minor) was introduced into Bradford, and the sorters came to regard the manipulation of these fleeces as particularly dangerous. Dr. J. H. Bell was led to the conclusion that the "wool-sorters' disease" was really anthrax, and in 1880, the Local Government Board directed Mr. Spear to make inquiry into the matter. Mr. Spear's report on the so-called "Woolsorters' Disease" appeared in the 10th report of the medical officer of the Local Government Board. Mr. Spear made careful inquiry into the history of upwards of forty recent cases of the disease, and studied such material as was available relating to the mortality statistics of wool-sorters. His researches established the theory put forward by Dr. Bell that the wool-sorters' disease was internal anthrax. Mr. Spear was shortly after the completion of his Bradford inquiry engaged in his investigations into the occurrence of anthrax in persons engaged in the hide and skin trades in London. Mr. Spear's attention was especially directed in this connection to an outbreak of the disease which occurred in 1882-3 in association with the manipulation of certain particular bales of China hides. He appended to his report a table of 39 cases of anthrax occurring in London between 1873 and 1883. Of these, no fewer than 37 cases occurred among persons engaged in the hide and skin trade, and of these 37 cases, more than one-third, appeared to be attributable to the manipulation of the particular consignment of China hides in question. In recent years, considerable attention has been directed by the veterinary profession to the occurrence of anthrax in animals. An important new departure was made in the autumn of 1886, when anthrax was added to the list of contagious diseases legislated for under the Contagious Diseases (Animals) Acts. The order empowered local authorities to regulate the movement of animals from premises on which anthrax had broken out, to cleanse and disinfect premises where diseased animals had been kept, and to dispose of carcases of animals dead of anthrax by burial or other means. No power to slaughterf was given. As a result of this order, anthrax returns are now available from 1887 onwards, and are given in the annexed table— Anthrax Statistics—Great Britain. Animals (cattle, sheep, swine, horses). Year. Infected counties. Fresh outbreaks. Animals attacked. 1887 51 237 649 1888 49 185 407 1889 44 168 315 1890 48 157 543 1891 51 234 484 1892 60 294 664 These returns show some extent of variation of prevalence during the six years, but judging by the figures given, the disease would appear to be but little more prevalent now than it was n 1887. * Some suspicious cases of illness were shortly afterwards observed by Dr. Russell in the case of girls employed in picking and sorting Russian manes in another hair factory, but from that time to the present, no further suspected case of anthrax has been noted by him in Glasgow. † A new order was passed at the end of 1892, giving power to local authorities to slaughter, the owner having, however, a right of appeal to the Board of Agriculture. 4 It must be remembered, however, that the order of 1886 only makes it optional on the part of the owner to give notice of the existence of the disease. It is stated, moreover, in the Annual Report of the Veterinary Department for 1889, that "the returns for 1887 are probably much too high, because for some time after the Anthrax Order of 1886 was passed, inspectors of local authorities often included black leg or symptomatic anthrax in their returns, but this source of error has probably now been entirely eliminated." While it is quite likely that a number of cases were included in the 1887 returns as the result of errors of diagnosis, it is also probable that some anthrax cases escaped recognition or were not notified. The novelty of the procedure under the order of 1886 would tend, in the absence of any compensating source of error, to an under-statement of anthrax prevalence during the first few years after the passing of the order. In an editorial article in the Journal of Comparative Pathology and Therapeutics for September, 1893, the reliability of the returns furnished by the Board of Agriculture is discussed, and it is stated that "the custom of granting compensation which has been adopted by several local authorities has tended to swell the number of returns in 1892," that "during the recent summer months a very considerable proportion of the cases returned as anthrax were not of that nature," and that "the increase in the number of outbreaks during the past summer has been more apparent than real." While, therefore, the data furnished in these returns will be as time goes on of increasing value, they must not be accepted as giving an absolutely accurate picture of anthrax prevalence among cattle in Great Britain at the present time. It seems, however, to be unquestioned that the system of reporting outbreaks has shown that anthrax is much more rife among farm stock in Great Britain than was supposed to be the case prior to 1886. It is remarkable that certain counties are particularly prone to anthrax outbreaks, this proclivity being marked throughout a series of years. Thus, in the appendix to the Report of the Veterinary Department for the year 1892, p. 51, a table is given of outbreaks in Great Britain for the five years 1888-92. In this table it is seen that Northamptonshire, Somersetshire and the West Riding of Yorkshire are particularly favourite seats for anthrax outbreaks. B.—Cases of anthrax recorded in London since 1873. From what has been noted as to the history of anthrax it will be clear that but little value can be attached to any statement as to anthrax prevalence in London prior to 1880. The table in the appendix dates back to 1873, the earlier cases are, however, almost without exception from Guy's Hospital, and it cannot be assumed that they represent all the cases of anthrax which occurred. The record for the years subsequent to the outbreak of 1882-3 may be regarded as more and more nearly approximating to the actual facts, though even in recent years it is probable that cases of anthrax have been overlooked. The cases dealt with in the appendix are 119 in number; in a few instances the diagnosis must be regarded as doubtful, but such cases have been included as being more likely to be anthrax than not. The list does not include three cases seen by a gentleman practising in the South of London of which no notes are available, nor does it include one or two other suspicious cases which could not be further investigated. As regards the apparent source of infection— 90 cases occurred in persons engaged in the hide and skin trade. 5 cases occurred in persons engaged in slaughtering animals. 7 cases occurred in persons engaged in the manipulation of horsehair or the manufacture of brushes. 1 case occurred in a person employed in a bacteriological laboratory. 16 cases occurred in persons in whom the source of infection was not traceable. The 16 cases last mentioned include among them the doubtful cases which have already been alluded to. Probably, therefore, the number given under the head " source of infection not traceable " is somewhat too high. It will be seen that during recent years there has been a growing tendency for cases of anthrax to be detected in persons who have nothing to do with the Bermondsey hide and skin trade. Nearly 95 per cent. of the total number of cases recorded by Mr. Spear occurred in persons engaged in that trade, while the cases collected since the construction of his table show a reduction in this respect from 95 per cent. to less than 70 per cent. of the total number of cases among persons so employed. Mr. Spear made careful inquiry into the precise nature of the employment in each of the 37 persons engaged in the hide and skin trade of whom he obtained knowledge. He classified them as follows— One stevedore, one foreman, nine wharf labourers, eleven warehouse labourers, one merchant, one carter, twelve tanners, and one unhairer of rabbit skins. These cases naturally fall, however, into two main groups, viz., cases occurring in persons who manipulate the hides in course of their removal to the broker's warehouse, or who are engaged in sorting them in the warehouse, and secondly, cases occurring in persons who manipulate the hides after they have passed out of the hands of the broker. Classifying the cases under these two heads, a comparison may be made between Mr. Spear's figures and the later results— Mr. Spear's figures Later figures 1873-1883. 1883-1893. Persons manipulating hides while in the possession of 23 40 the hide broker. Persons manipulating hides after their removal from 14 9 the broker's warehouse. (12 tanners) (3 tanners) Doubtful — 4 5 The immunity of the second class of persons in the later period as compared with the earlier is striking, and is no doubt connected with the greatly diminished extent of manipulation of dry hides in Bermondsey tanneries in recent years, which will be noted later. As regards the particular kind of raw material supposed to be concerned in conveying infection, the following statement may be given— No. of cases. Hides— China hides 26 East India hides 12 Other specified kinds 9 Kind unspecified 34 Skins 9 In this connection the chief point of interest is the special prominence assumed by China hides in the above list. The general impression in the trade is that hides from China are particularly dangerous, and it is possible that in several of the 34 instances in which the kind of hide is not specified China hides may really have been at fault. On the other hand, all the cases in which infection has been definitely attributed to China hides occurred during the years 1881-2-3 and 4, and the large majority of these cases occurred in connection with the particular consignment of hides which was the special subject of Mr. Spear's inquiry. In almost all cases the hides incriminated have been dry hides; in two instances, however, mention is made of wet hides, the apparent source of infection being stated as "hides chiefly wet Russian" in one case, and as "handling wet hides from the East Indies "in the other. Of course, it is quite possible that in both these instances the actual infection was conveyed by dry hides, as men working with wet hides are likely to have been in contact with dry hides also. It might be urged on the other hand that it was possible the infection had been conveyed by wet hides in instances where dry hides are mentioned. It is none the less remarkable that the mention of wet hides should be so uncommon, and that there should be no conclusive evidence incriminating wet hides such as exists in the case of dry hides. These facts accord with what is known of the life history of the anthrax organism. In the dry hide, the resistant spores would be preserved for long periods of time, in the presence of moisture the spores would germinate and assume the bacillar form in which they would be much more likely to succumb to hostile influences. As regards the seven cases which have been noted among persons engaged in the manipulation of horsehair* or the manufacture of brushes, it will be seen that two occurred in 1888, one in 1891 and four in 1893. There is therefore no record of an outbreak in London as extensive as that observed by Dr. Russell in Glasgow. It has not been found possible to trace the four cases of last year to a common origin, though it is quite likely that a particular consignment of hair was responsible for all of them. In three of the seven instances the workers themselves had suspected China bristles or hair, and not Russian horsehair, as being the source of the disease. I was informed by a large manufacturer, who had been in the trade 25 years and who employs some 400 hands, that only three cases of anthrax had come to his knowledge among his workpeople. He explained that he never dealt in " raw Russian manes," and regarded this particular commodity as specially fraught with danger. Although only seven attacks of anthrax have been recorded among horsehair workers, five other cases of illness have been heard of to which considerable suspicion attaches but of which full details are not available. The rarity of cases of "internal anthrax" in London is remarkable. Mr. Davies-Colley, in his paper written in 1882, anticipated that as a result of the inquiries relating to internal anthrax at Bradford the attention of the profession in London would be directed to the subject, and that they would find that some of their "cases of severe inflammation of the lungs or intestines with septicaemic symptoms" were due to internal infection. Mr. Spear devoted considerable attention to this matter, and believed that he came across records of two or three such cases (one of these is included in his table). In 1881, an undoubted example of the internal form of the disease was met with at Guy's Hospital. Since that time, however, no record of a similar case has come to hand. C.—Alterations in the Bermondsey hide and skin trade as affecting liability to anthrax infection. Mr. Spear, in his report gives a full account of the hide and skin trade as carried on in London, and discusses the varieties of raw material, the sources of supply, the curing process, and the methods of dealing with raw material in this country. For the most part, Mr. Spear's account is as true now as when it was written, but two points merit attention; first, changes in the character of the raw material dealt with in London tanyards, and secondly, a few words must be devoted to the curing process. Mr. Spear, in an appendix to his report, gives tables showing the imports of hides and skins into the United Kingdom, and into its principal ports during 1882. A comparison of these figures with the figures for 1892 is instructive. The most marked change is a general falling off in the amount of hides imported, this falling of being more marked in the case of dry than in the case of wet hides (see Table.) Dry. Wet. Cwts. £ Cwts. £ 1882 576,196 2,098,895 614,471 1,645,786 1892 368,191 946,354 541,286 1,138,903 * An account of the processes incidental to the manipulation of horsehair is given by Dr. Ballard in the eighth report of the medical officer of the Local Government Board. 6 London, some 15 years ago, seems to have enjoyed to a large extent a monopoly in the hide trade. Raw hides were brought over to this country, tanned in Bermondsey, and re-distributed sometimes to the very localities from which the raw product came. In several places, however, which at one time exported nothing but raw hides, local enterprise has led to the development of tanyards, so that, instead of the raw product, a more or less finished article is sent to Europe; moreover, the alteration of trade routes brought about by the construction of the Suez Canal is said to have affected the leather industry (a good deal of material which would in former days have found its way to Bermondsey being intercepted and dealt with in Italy and elsewhere). Further it may be noted that increasing amounts of dry hides have been exported of late years to America, where they are tanned. Whatever the causes of the change may be, there can be no doubt that during recent years there has been— (a) A considerable diminution in the number of tanyards in Bermondsey. (b) A tendency for London tanners to deal more and more exclusively with English hides. In several yards the pits are pointed out which were formerly employed for the treatment of dry foreign hides, and it is apparently quite an exceptional occurrence for them to be put to their original use. At the same time it may be noted that in one or two instances inquiry elicited the statement that China hides had been manipulated in recent years in Bermondsey. While the London tanner is now only exceptionally brought in contact with dry hides, the hide broker's warehouseman still continues to sort and handle large quantities of them, the hides being brought into Tooley-street warehouses, and then sent, for the most part, abroad. The table shows the number of cwts. of raw hides brought into the two chief English ports in 1882 and 1892. Total imported. London. Liverpool. cwts. cwts. cwts. 1882 1.190,667 666,763 203,208 1892 909,477 441,638 173,247 During 1892, 256,460 cwts. of raw hides were exported from London. This leaves a balance of 185,178 cwts. of hides, and this may be taken to represent the yearly quantity of foreign hides at present dealt with in London or distributed by vessels " going coastwise "to Hull, Goole, and other English ports. It may be assumed that a considerable part of this balance is disposed of in the lastnamed manner. As regards China hides, the Custom House return already quoted shows that the number brought to Great Britain has never formed any considerable proportion of the total import of dry hides. In 1882 China hides constituted rather more, and in 1892 rather less than 2 per cent. of the total import of dry hides in the respective years. (The total import of dry hides in 1892 is between 30 and 40 per cent. less than in 1882.) There can be no question that the outbreak of 1882 and 1883, investigated by Mr. Spear, impressed those interested in the hide trade with the idea that particular danger attaches to the manipulation of China hides, and this may, in some measure, account for the diminution; on the other hand, the falling off in the import of China hides is not much in excess of the falling off in the import of dry hides generally. With regard to the "curing process" there seems to be some indication of a tendency in the trade to encourage the adoption of the "wet" as opposed to the "dry" cure. In the "dry" cure, the hide is usually treated with one or other material which is supposed to prevent its becoming worm-eaten, but the essential part of the "cure" consists in drying by exposure to the sun. The dry cure is largely adopted in places where difficulty of transport makes weight an important consideration; the hard dry hide weighing much less than the wet hide. In the "wet" cure, salt is rubbed into the hide, or the hides are steeped in brine and subsequently stacked. The inferiority of the hide cured by the dry process is insisted upon in a recent article on the "Proper Curing of Hides,"* and it is stated that improved systems of working hides are now beginning to be adopted in several places, such as parts of India, the Cape, and Mauritius, and it is implied that to some extent the dry hide is going out of fashion. The article continues "we have said sufficient to show to merchants engaged in the China trade how much it would be to their advantage in all their chief centres to establish saladeros as they have in South America, where all green hides shall, after slaughtering, go through a proper system of brining or arsenic curing or salting by which the pelt will be preserved." D.—Remedial Measures. Mr. Spear discussed this subject under four heads. (1.) "The establishment of an organisation by which this country may be warned of the existence of the disease among cattle" with a view to prohibiting the import of suspected hides. Mr. Spear did not look upon this suggestion as a promising one, and nothing has occurred since his report was written to make it more likely to be regarded as a practicable and efficient safeguard. (2.) "The general adoption of some process of cure which would serve not only to protect the skin from the ravages of the 'worm,' but would lead to the destruction also of morbific germs." Mr. Spear commented upon the extraordinary power of resisting chemical agents possessed by the spores of the anthrax bacillus, and added: "It might, however, be possible so to treat the skins by a preliminary process as to cause any attached spores to germinate into the easily destructible rods." There seems some reason for hoping that the problem will, at no distant period, be to some extent worked out on these lines. The facts which have been ascertained as to anthrax prevalence, point to the conclusion * Leather Trades Circular and Review, February, 1894. 7 that the infectious property is, in the great majority of cases, conveyed by dry hides, and there are distinct indications of the existence of a tendency to look upon the dry cure with more and more disfavour. In this matter, fortunately, the interests of those desirous of obtaining good leather, and of those concerned with preventing the spread of anthrax seem to point in the same direction. (3.) A classification at the port of export by which hides removed from the dead animal could be kept apart to be afterwards dealt with under strict precautions. This, as Mr. Spear observed, would "result in the limitation of dangerous material mainly to one class of goods instead of its distribution throughout the entire bulk." Such a system would, in effect, transfer the danger incident to "sorting" from the London warehouse to the port from which the hides are originally sent out. If some satisfactory and practicable means of disinfecting inferior qualities of hides could moreover be discovered, and such method could be carried out before the hides were despatched from the warehouse, the risk to those engaged in the London trade would be well nigh done away with. During the last ten years there has been a considerable growth of knowledge concerning the practice of disinfection. There seems to be no doubt, however, among those engaged in the leather trade, that exposure to steam or to reliable chemical disinfectants would materially damage hides. The question might well be made the subject of experiment. In the existing state of knowledge, the employment of disinfection on a large scale appears no more feasible than it did when Mr. Spear wrote his report. (4.) Prophylactic or palliative measures applicable to individual workshops and individual workers. As the majority of the cases recorded have been developed in connection with work in places which do not come within the scope of the Factory and Workshops Act, but little advantage could be expected to accrue from the adoption of special rules and requirements under section 8 of that Act. The question of protective inoculation of cattle against anthrax has received considerable attention in recent years, the idea of applying this method to men engaged in the hide and skin trade may certainly at the present time be dismissed. Mr. Spear insisted on the importance of adequate ventilation and cleanliness of sorting rooms, the avoidance of unnecessarily rough handling of the hides so as to produce dust, and the desirability of the dissemination of a knowledge of the danger amongst workmen. He gives a form of notice which was issued by Messrs. Dyster, Nalder and Co. to their employes, and which they caused to be hung up in their warehouses. An amended form of this notice is given in Appendix III. The example set by this firm does not appear to have been followed by others. Mr. Spear wrote "Experience continues to show that the disease is amenable to early and proper treatment," and the history in later cases bears out the importance of excision of the pustule as soon as its nature is recognised.* In view of this fact, it is most important that no one should handle hides who is ignorant that the employment is a source of possible danger, and it is desirable that the employer should recognise that he has neglected to take reasonable precautions against risk of injury if he has failed to acquaint the workman with the possibility of danger, and with the nature of the steps to be taken in the event of any suspicion of mischief. W. H. Hamer, Assistant Medical Officer of Health. * The use of ipecacuanha in the treatment of anthrax has attracted some attention within recent years. Dr. E. B. Muskett, practising in South Africa treated "about fifty cases of this disease in this manner, extending over a period of 15 years, and hitherto it has never failed." Lancet, 1888, volume 1, page 269. Mr. Davies-Colley has published a paper on this subject in the Guy's Hospital Reports 1890, volume xlvii. APPENDIX L 8 9 A Table showing particulars as to 119 cases of Anthrax which have occurred in London in recent years. The particulars concerning the first 39 cases have been obtained from the similar Table prepared by Mr. Spear, and printed as an Appendix to his Report in the Supplement to the Twelfth Annual Report of the Local Government Board. No. Place of treatment. Patient. Sex. Age. Date of attack. No. of days before applying for treatment. Seat of Charbon. Condition of adjacent parts. Constitutional symptoms. Where employed. Occupation. Apparent source of infection. Treatment. Result. ks. 1 ... Mr. G. M. – Mar. 29, 1873 1 Under chin March 30, slight swelling. March 31, much oedema March 30, feverishness; later, difficulty of breathing and swallowing, delirium, prostra- ... Hide merchant (?) The handling of raw hides, or the sting of an insect on the river banks where the patient had driven Incisions and stimulants Died April 4 . When first seen, the swelling presented what appeared to be a minute central puncture. 2 Guy's Hospital M. A. C. F. 11 Oct. 13, 1873 6 Under chin (Edema of face and neck, glands swollen Dyspæa ... ... Not ascertained. Patient lived in Horselydown Incisions Died Oct. 19 . P. M. (Edema glottidis, diphtheritic patches in the small intestines and vagina. 3 Guy's Hospital E. M. M. 43 Nov. 15, 1873 7 Neck Hard oedema of neck Dyspnoea, vomiting. Temp. 100.5° Wharf Labourer Foreign hides Laryngotomy Died Nov. 24 . P. M. (Edema of larynx. No pus in veins. 4 Guy's Hospital J. F. M. 33 Dec. 14, 1873 6 Chin No surrounding œdema None Messrs. Anning& Cobb's warehouse Sorter's labourer East India hides Excision, chloride of zinc paste Cured 5 Guy's Hospital G. J. M. 27 Mar. 31, 1875 7 Cheek Some swelling of glands under jaw None Wharf Labourer Foreign hides Excision, chloride of zinc Cured 6 Guy's Hospital J. O. M. 47 Aug. 20, 1877 15 after appearance of papule, 5 after swelling Cheek Great swelling, glands enlarged Vomiting. Temp. 103°. Slight dyspnoea, great restlessness Sun & Topping wharf Labourer East India dry hides (Calcutta and Bombay) Excision (Sept. 4), chloride of zinc Died Sept. 8 . P. M. Certain morbid appearances were found in the stomach and small intestines. The term "charbon of intestine" applied to the indurated areas in the ileum. 7 Guy's Hospital D. D. M. 20 Oct. 14, 1877 3 Neck Whole side of neck much swollen and brawny Temp. 103°. Day after operation, vomited, drowsy, restless, jerking movements of face and hands South - Eastern wharf Labourer Five weeks before illness unloaded dry hides; since then employed at same wharf, but chiefly in unloading potatoes and currants Excision, nitricacid Cured No bacilli found in blood. 8 Guy's Hospital A. P. M. 17 Jan. 12, 1878 6 Anterior surface of forearm Glands enlarged Sick, faint, no rest. Temp. 101.2° Tannery Labourer (puts hides to soak) Foreign hides • Excision Cured 9 Guy's Hospital F. H. M. 18 Nov. 1, 1878 3 Chin Much brawny infiltration ... Hide wharf Labourer Foreign hides Excision and caustic applied Cured Nothing abnormal found in blood. 10 Guy's Hospital J. E. M 23 Nov. 9, 1878 4 Cheek Swollen, glands enlarged Headache, shivering Tannery Labourer At "soaks" (first handling of hides) Excision, carbolic and tannic acid Cured 11 Guy's Hospital J. R. M. 28 Nov. 24, 1879 5 Forearm Blush up to axilla None ... Labourer Sheep and goat skins from Cape Excision, chloride of zinc Cured No bacilli found in blood or serum. 12 Guy's Hospital D. W. M. 23 Oct. 5, 1880 5 Cheek Much swelling, eye closed, lip an inch thick, glands enlarged None on admission to hospital. Two days before had fainted twice, and had had a sleepless night. Sun & Topping wharf Labourer Sorting East India hides Excision, cautery Cured The day he came to the hospital the swelling was subsiding. [2] 10 11 Anthrax cases in recent years—(continued). No. Place of treatment. Patient. Sex. Age. Date of attack. No. of days before applying for treatment. Seat of Charbon. Condition of adjacent parts. Constitutional symptoms. Where employed. Occupation. Apparent source of infection. Treatment. Result. ks. 13 . Mr. Francis Bonney J. W. M. 67 Mar. 10, 1881 1 Neck March 12, dense swelling over throat, and entire surface of cheek On 10th sick and giddy. 12th Temp. 104°, coma A Thames wharf Labourer Hides, chiefly wet Russian Said he had been stung by a fly on March 10. Constitutional Died second night of illness 14 Guy's Hospital F. R. M. 31 April 9, 1881 7 Lower eyelid Upper eyelid and cheek swollen, also glands Sleeplessness, trembling Sun & Topping wharf Labourer Australian fleeces. There were also hides in the warehouse where he worked Excision, chloride of zinc Cured Bacilli found in blood taken from wound. 15 Guy's Hospital F. F. M. 47 June 29, 1881 4 Back of forearm ... None A Thames wharf Stevedore Loading Australian fleeces on June 22 and again on June 29 Excision Cured 16 Guy's Hospital T. W. M. 39 July 5, 1881 6 Cheek CEdema to third rib Headache, loss of appetite, Temp. 101° Messrs. Barrow Tanyard labourer (?) Chinese hides Excision, chloride of zinc Cured Bacilli found in the layers of the corium beneath eschar. 17 Guy's Hospital C. T. M. 30 Aug. 25 1881 2 Cheek ... Loss of appetite and sleeplessness Sun & Topping wharf Sorter's labourer Bombay and Zanzibar hides Excision, chloride of zinc Cured 18 Mr. Marshall R. N. M. 18 Sept. 4 (about) 1881 8 Under chin Much swollen Headache, vomiting, restlessness, slight delirium Messrs. Barrow Tany ard labourer (?) Chinese hides Poulticing Cured In bed three days, and only went to doctor on getting up. Off work eleven days; very weak for some time. 19 Gay's Hospital J. R. M. 27 Sept. 16 1881 3 Cheek Swollen No appetite, sick, limbs feel stiff Sun & Topping wharf Sorter's labourer Bombay and Calcutta hides, horns, and hoofs Excision, galvanic cautery Cured 20 Guy's Hospital S. C. F. 47 Dec. 25, 1881 11 Cheek Eye closed, glands under jaw enlarged Very little Own home C u b i tt Town Household work Husband unloads ships, but had not handled hides Excision, cautery Cured Strict enquiry failed to show source of infection. 21 London Hospital out-patient F. D. M. 18 Feb. 1882 — Under chin Swollen down to chest None Messrs. Woods Carter (?) Chinese hides Cauterisation Cured Off work a week. 22 Mr. Dry J. D. M. 23 Feb. 10, 1882 5 Upper lip Much swollen Headache Messrs. Barrow Tanyard labourer (?) Chinese hides Poulticing Cured Confined to house two days, off work seventeen. 23 Mr. James G. N. M. 24 Feb. 11, 1882 10 Chin Neck much swollen Headache and vomiting Messrs. Barrow Tanyard labourer (?) Chinese hides Poulticing Cured In bed one week, then got up and walked to doctor's surgery ; off work a month. 24 — W. — M. 18 Feb. 20, (about) 1882 — Forehead Swollen None Messrs. Barrow Tanyard labourer (?) Chinese hides Poulticing Cured Patient went into the country. Manager of works describes typical pustule. 25 Mr. Adcock R. C. M. 21 March 3, 1882 4 Neck Great swelling, extending down to breast Extreme restlessness, cold sweats, difficulty of breathing, cyanosis Messrs. Barrow Tanyard labourer and flesher (?) Chinese hides Poulticing Died March 7 No post-mortem. 12 13 Anthrax cases in recent years—(continued). No. Place of treatment. Patient. i Sex. Age. Date of attack. No. of days before applying for treatment. Seat of Charbon. Condition of adjacent parts. Constitutional symptoms. Where employed. Occupation. Apparent source of infection. Treatment. Result. ks. 26 Mr. Marshall s. — M. 52 March 4 (about), 1882 9 (about) Neck Swollen and dark Vomiting, restlessness, slight delirium Messrs. Barrow Tanyard labourer (?) Chinese hides Poulticing Died March 17 Constitutional symptoms first appeared on 12th. No post-mortem. 27 ... C. B. M. 50 April 6, 1882 2 Under chin Glands on each side swollen Headache only Messrs. Barrow Tanyard labourer (?) Chinese hides Poulticing Cured In bed two days, off work five weeks. 28 Guy's Hospital M. S. M. 22 April 17, 1882 3 Neck Extensive oedema Dyspnoea. Temp. 101.6° Messrs. Barrow Tanner (?) Chinese hides Excision without cauterisation Died. Swelling increased after operation Died from dyspnoea. No bacilli in blood or serum. No post-mortem. 29 Guy's Hospital J. J. M. 29 July 25, 1882 1 Neck Diffused redness and oedema. Faint, profuse sweats. Temp. 102-4° Butler's wharf Labourer (?) Chinese hides Excision and cauterisation Cured During convalescence pain in legs with bluish red patches ; slight diarrhoea. 30 Guy's Hospital T. E. M. 28 Aug. 8, 1882 8 Cheek Face, neck and cervical glands swollen (Before admission) headache, shivering Butler's wharf Labourer (?) Chinese hides Excision Cured The pustule developed at seat of old wound that had healed about six weeks before. 31 Guy's Hospital D. C. M. 18 Oct. 27, 1882 3 Neck Much swelling On admission Temp. 102.2°. Oct. 31, Temp. 104.6° Gun and Shot wharf Labourer (?) Chinese hides Excision and cauterisation Cured 32 Guy's Hospital G. B. M. 31 Dec. 10, 1882 3 Neck A few small glands Shivering, headache. Temp. 101.8° A Thames wharf Labourer Carrying dry hides Excision, caustic potash Cured 33 Dr. Douglas J. W. M. 30 Dec. 10 (about), 1882 6 Neck Swollen Headache, shivering Butler's wharf Foreman (?) Chinese hides Poultices Cured Came to work every day, but felt very ill. 34 Dr. Gittins D. T. M. 44 Jan. 9, 1883 3 ? Internal Anthrax ... Profuse and foetid perspirations, great restlessness, vomiting, dyspnoea, cyanosis, tetanic spasms Messrs. Anning and Cobb Sorter's labourer (?) Chinese hides Died Jan. 13 Jan. 9. Shivering, nausea, pain in back. Jan. 10. Went to work. Jan. 11. Felt very unwell, neck seemed a little puffy. Jan. 12. Perspirations, &c.,setin. Jan. 13. Died, apparently asphyxiated. Mr. Spear regarded the case as probably one of internal anthrax. 35 Guy's Hospital G. P. M. 50 Feb. 1, 1883 1 Left lower eyelid Œdema Temp. 99° to 102° Messrs. Barrow Carries the skins, after undoing the bales, to the pits (?) Chinese hides Excision Cured Considerable inflammation and sloughing, which resulted in ectropion, followed operation. ft 36 Guy's Hospital A. B. M. 43 Feb. 15, 1883 5 Cheek Puffy swelling, enlarged glands Rigor, delirious at night, cough Messrs. Flack and Chandler Sorter's labourer (?) Chinese hides Excision and cauterisation Cured Bacilli found in all the excretions. 37 Guy's Hospital W. S. M. 33 Feb. 22, 1883 4 Cheek Enlarged glands beneath jaw; oedema down to clavicle Shivering, lividity of extremities. Temp. 100.2° Messrs. Flack and Chandler Sorter's labourer (?) Chinese hides Excision and cauterisation Died Feb. 26 . Secondary affection of intestine, stomach, and lungs. 38 Guy's Hospital B. M. F. 14 May —, 1883 6 Upper lip Swollen and brawny glands enlarged None ... Unhairer English and Australian rabbit skins Excision and cauterisation Cured The centre of the pustule was black, but there was no secondary ring of vesicles. No organisms discovered in blood or serum. 39 Guy's Hospital E. W. M. 37 July 23, 1883 4 Cheek Swollen red and tense. A few enlarged submaxillary glands None Messrs. Flack and Chandler Sorter's labourer (?) Chinese hides Excision and cauterisation Cured Bacilli found. 14 15 Anthrax cases recent years—(continued). No. Place of treatment. Patient. Sex. Age. Date of attack. No. of day before applying for treatment Seat of Charbon. Condition of adjacent parts. Constitutional symptoms. Where employed. Occupation. Apparent source of infection. Treatment. Result. Remarks. 40 Guy's Hospital W. E. N M. 28 Dec. 22 1883 2 Right cheek Œdema None Fenning's wharf Waterside labourer Australian sheep's wool Excision Cured 41 Guy's Hospital H. B. M. 59 Dec. 27 1883 1 Right cheek Stiff and swollen. Enlarged glands None Messrs. Flack and Chandler Hide sorter Hides Excision, Paquelin's cautery Cured 42 Guy's Hospital J. R. M. 48 Feb. 13, 1884 3 Neck Œdema Vomiting Messrs. Barrow Tanner Bombay kips Excision, zinc chloride Died Feb. 17 P. M. Œdema of mediastinum, ulceration of stomach 43 Guy's Hospital G. R. M. 33 Mar. 11, 1884 6 Left cheek (Edema, slough, vesicles and enlarged glands in neck Temperature was 100° Messrs. Anning & Cobb Hide broker's labourer; is engaged in baling hides Had been working with Bombay kips, opossum skins, and Cape hides Excision, zinc chloride Cured 44 Guy's Hospital M. W. M. 26 Mar. 15, 1884 3 Right side of neck Oedema and central black slough with circle of vesicles Nil Messrs. Flack and Chandler Hide broker's labourer Chinese kips Excision, zinc chloride Cured 45 Guy's Hospital W. B. M. 39 Mar. 27, 1884 4 Right side of neck Œdema Pyrexia and coma Messrs. Flack and Chandler Warehouseman Chinese kips Excision and ipecacuanha Died P. M. Œdema of mediastinum, anthrax of small intestine 46 St. Bartholomew's Hospital J. L. M. 42 Mar. 27, 1884 11 Behind right ear Œdema and brawny swelling Vomiting, temperature, 101'4° ... Waterside labourer Apparently the same kips as in the two cases above. Excision Cured No bacilli found. 47 Guy's Hospital A. W. M. 46 Mar. 31, 1884 3 Neck Œdema ... Butler's wharf Leather carrier Patient attributed it to rabbit skins, but he had been carrying Chinese kips, buffalo, and other hides. Excision, zinc chloride. Tracheotomy Died P. M. Œdema of larynx, hæmorrhage in stomach. 48 Guy's Hospital D. C. M. 54 April 4, 1884 2 Back of left hand Œdema Nil Gun and Shot wharf Hide warehouseman Arsenicated skins from China and Cape Excision, zinc chloride Cured 49 Guy's Hospital W. S. M. 37 April 7, 1884 2 Back of right hand. Œdema Enlarged supracondyloid glands Messrs. Beresford and Co., St. O1ave's wharf Tanner Hides from China Excision. Incisions in fore-arm and potassa fusa to wound Cured 50 Guy's Hospital J. P. M. 44 April 13, 1884 5 Back of neck Slight oedema Slight vomiting; " out of sorts" Warehouse in Tooleystreet Hide sorter Hides Excision and strong carbolic acid Cured 51 Guy's Hospital P. G. M. 23 April 17, 1884 3 No externa] wound ... Temperature 10.'6°, coma, convulsions Nash's wharf Dock labourer Chinese kips which he had been unloading Pot.Brom. Digitalis. Inhalation of chloroform Died P. M. Anthrax of lungs, stomach, small intestine, and meninges of brain. 52 1 London Hospital — M. 44 1884 — Angle of jaw Extensive oedema Temperature 100°, oedema glottidis .... Docker Engaged in loading a ship with hides a few days before admission to hospital. ... Died Bacilli found. 53 London Hospital — M. 38 1884 — Left side of neck ... ... ... Lighterman Engaged in carrying hides Excised Cured 16 17 Anthrax cases in recent years (continued). No. Place of treatment. Patient. Sex. Age. Date of attack. No. of days before applying for treatment. Seat of Charbon. Condition of adjacent parts. Constitutional symptoms. Where employed. Occupation. Apparent source of infection. Treatment. Result. Remarks. 54 Guy's Hospital J. S. M. 43 Dec. 10, 1884 3 Forehead Slight oedema, glands enlarged Temp. 102.7° Gun and Shot wharf Labourer on wharf Skins from Australia and Japan Excision, thermocautery, caustic potash Cured 55 Guy's Hospital J. McS. M. 34 Dec. 19, 1884 3 Right side of neck Inflammatory swelling Nil Messrs. Culverwell, Brooks and Co. Hide sorter Calcutta hides Excision Cured 56 Guy's Hospital W. B. M. 59 Jan. 1, 1885 4 Left side of neck Œdema Shivering, nausea, febrile pains ... Hide broker's labourer Hides Excision, chloride of zinc, injection of carbolic acid Cured 57 Guy's Hospital C. A. M. 29 Jan. 19, 1885 2 Left temple Œdema Shivering and depression, headache Messrs. Anning and Cobb Hide sorter Hides Excision and cautery Cured • 58 Guy's Hospital J.D. M. 19 Jan. 30, 1885 4 Chin Slight glandular enlargement Nil Messrs. Anning and Cobb Hide packer Hides from Bombay or rabbit skins from Australia Excision, thermocautery Cured 59 Guy's Hospital G. B. M. 56 Jan. 30, 1885 5 Left cheek (Edema. Large glands in neck Nil ... Works in a hide warehouse Hides Excision, thermocautery Cured 60 Guy's Hospital M. M. M. 38 Mar. 26, 1885 3 Neck No oedema or glandular enlargement Weak and giddy ... Labourer, unloading foreign hides Hides Excision Cured 61 Guy's Hospital H. J. M. 53 Aug. 13, 1885 5 Right forearm (Edema, supracondyloid and axillary glands enlarged Nil ... Leather dresser ... Excision, chloride of zinc Cured 62 Guy's Hospital W. H. M. 53 Aug. 19, 1885 2 Neck Hypersemic Nil ... Foreign hide sorter Hides ... Excision, chloride of zinc Cured 63 Guy's Hospital J. N. F. 30 Sept. 6, 1885 3 Left cheek Slight oedema and enlarged sub-maxillary glands Nil ... Married. Housework Not known Excision Cured There is some doubt whether this was really a case of anthrax. No bacilli found. 64 Guy's Hospital J. M. M. 50 Oct. 27, 1885 4 Angle of jaw, left side Œdema Nil. Temp. 104° after operation ... Waterside labourer ... Excision, carbolic acid Cured 65 Guy's Hospital A. H. F. 25 Oct,. 31, 1885 5 Chin Œdema Nil ... Married. Husband dresses skins ... Excision Cured 66 Guy's Hospital W. H. M. 51 Jan. 16, 1886 5 Right cheek Œdema, enlarged glands Nil ... Hide broker's labourer Hides from China, Australia, Bombay or the Cape Excision, pure carbolic acid Cured 67 Guy's Hospital J. D. M. 32 April 8, 1886 6 Left side of neck Œdema Nil ... Dresser of foreign skins Hides Excision, pure carbolic acid Cured 68 Guy's Hospital W. H. H. M. 54 June 9, 1886 1 Right side of cheek Hypersemic, glands enlarged Nil ... Hide broker's labourer Hides Excision, cautery Cured [3] 18 19 Anthrax cases in recent years—(continued) . No. Place of treatment. Patient. Sex. Age. Date of attack. No. of days before applying for treatment Seat of Charbon. Condition of adjacent parts. Constitutional symptoms. Where employed. Occupation. Apparent source of infection. Treatment. Result. Remarks. 69 London Hospital ... M. 44 July 7, 1886 4 Right side of neck Brawny œdema Temp. 103° ... Slaughterer of foreign cattle ... Excision Cured No bacilli found 70 St. Bartholomew's Hospital C. D. M. 30 July 27, 1886 6 Left side of neck Much œdema Collapsed, blue ... Butcher ... Not excised Died Bacilli in wound. None in viscera. 71 Guy's Hospital J. H. F. 42 Jan. 2, 1887 4 Forehead Œdema Headache and giddiness ... Married ... Excision and injection of phenol Cured 72 Guy's Hospital J. B. M. 29 Jan. 28, 1887 4 Cheek, just under left eyelid Œdema of neck and enlarged glands Temp. 103° ... Works in leather warehouse Hides Excision, injection of carbolic acid Cured 73 Guy's Hospital G. T. M. 18 Jan. 29, 1887 1 Right foot and leg Œdema Nil ... Dyer Has to do with skins from the Cape and Australia Excision and injection of phenol Cured 74 Guy's Hospital G. R. M. 45 Mar. 6, 1887 4 Left side of neck Great œdema Temp. 101° Works in warehouse adjoining Topping's wharf Potato warehouseman Works next door to a warehouse where hides are stored. Says some potatoes had been pitched among the hides Excision, zinc chloride, laryngotomy Died P. M.—Anthrax of meninges and meningeal hærrhages, anthrax of small intestine. 75 Reported by Mr. Reilly H. I. S. M. April 12, 1887 2 Nape of neck Œdema and brawny thickening Prostration, vomiting, convulsions ... Master tanner Had been sorting hides on the 9th Excision Died On the morning before patient died his head was fixed rigidly backwards and tonic and clonic spasms of muscles of trunk and limbs supervened. 76 Guy's Hospital H. S. M. 23 Aug. 7, 1887 5 Forehead Œdema Nil ... Sailor ... Excision Cured 77 London Hospital ... M. 50 1887 7 Left hand Much œdema of arm Œdema glottidis ... ... Seven days before admission wounded left hand with a hook Incisions Died 78 St. Bartholomew's Hospital E. D. M. 22 May 7 1888 10 Left side of neck Not much swelling Nil Messrs. List and Son Horsehair dresser ... Excised Cured Bacilli found. 79 Guy's Hospital C. P. M. 22 June 21, 1888 6 Right external canthus of eye Hyperæmic Nil 4. Messrs. Culverwell, Brooks & Co. Hide sorter Bombay hides Excised and dressed with powdered ipecacuanha Cured 80 Guy's Hospital H. W. M. 43 July 7, 1888 3 Right side of neck near angle of jaw Œdema and enlarged lymphatic glands Temperature 102o ... Carman .... Excision Died P. M. Intestinal anthrax. 81 Guy's Hospital W. H. M. 21 Oct. 30, 1888 1 Left side of neck Hyperæmic and œdematous; enlarged glands Rigors, headache, nausea ... Works in hides Hides Excision. Injection of carbolic and tannic acid and creolin Cured Erysipelas supervened. 20 21 Anthrax cases in recent years—(continued). No. Place of treatment. Patient. Sex. Age. Date of attack. No. of days before applying for treatment. Seat of Charbon. Condition of adjacent parts. Constitutional symptoms. Where employed. Occupation. Apparent source of infection. Treatment. Result. Remarks. 82 St. Bartholomew's Hospital J. H. M. 15 Nov. 4, 1888 5 Below and to left of angle of mouth Not much surrounding oedema Headache... ... Polishes backs of brushes in a brush manufactory ... Excision Cured Bacilli found. 83 Guy's Hospital C. M. M. 27 Feb. 17, 1889 6 Right cheek Œdema, enlarged glands Nil ... Waterside labourer Bombay hides Excision, potassa fusa and cautery Cured 84 Guy's Hospital W. J. M. 21 Mar. 10, 1889 1 Neck Œdema Temperature 102° Messrs. Anning & Cobb Hide broker's labourer Kangaroo or Bombay hides Excised, and dressed with powdered ipecacuanha Cured 85 Guy's Hospital H. S. M. 25 April 7, 1889 4 Cheek Brawny œdema and enlarged glands Temp. 100.2°. Felt "very ill and shivery " ... Employed in hide and skin trade Hides Excision Cured 86 Guy's Hospital J. P. M. 51 Aug. 15. 1889 3 Left cheek Œdema and redness. Nopustule; taken in as erysipelas Fever ... Tanner Bite of an insect Free incisions Died Bacilli found in serum. P.M. Anthrax of stomach and intestines. 87 Guy's Hospital A. E. C. M. 19 Oct. 27, 1889 2 Right elbow Hypersemic Nil ... Hide warehouseman Bombay and Madras hides Excision, creolin externally and internally Cured 88 Guy's Hospital W. B. M. 43 Nov. 3, 1889 2 Forehead Hard and red and œdematous Temp.99.2°. "Feels perfectly well" ... Same wharf as above Bombay and Madras hides Excision, cautery Cured 89 Guy's Hospital J. B. M. 26 Dec. 10, 1889 2 Under the chin Œdema Nil Fresh wharf Dock labourer Does not handle hides Excision, dressed with powdered ipecacuanha Cured 90 Guy's Hospital C. P. M. 17 Dec. 13, 1889 2 Left cheek Œdema, enlarged glands Nil South Eastern wharf Dock labourer Buffalo hides Excision, dressed with powdered ipecacuanha Cured 91 Guy's Hospital G. R. H. M. 28 Dec. 17, 1889 1 Left forearm Hypersemic Nil St. Olave's wharf Waterside labourer Handling wet hides from the East Indies Excision, cautery, creolin externally Cured 92 London Hospital – M. 27 1889 4 Right side of neck Extensive œdema of chest and neck Rigor. Temp. 103° ... Foreman superintending carrying of hides Hides Excision Cured Bacilli found. 93 Guy's Hospital W.J. P. M. 23 Jan. 28, 1890 5 Chin Œdema and enlarged glands Slight dysphagia ... Fish salesman Never worked in hides Excision, dressed with powdered ipecacuanha Cured Bacilli found. 94 Guy's Hospital D. W. M. 32 Feb. 20, 1890 2 Right side of chin Slight oedema and enlarged glands " Queer in the head," sweating ... Labourer in hide and skin warehouse Hides Excision, injection of carbolic acid Cured 95 Guy's Hospital W. T. M. 33 Mar. 17, 1890 1 Neck Œdema Temp. 101.2°, feels "shivery " ... Leather warehouseman Cape hides Excision, cautery, and ipecacuanha externally Cured 22 23 Anthrax cases in recent years (continued). No. Place of treatment. Patient. Sex. Age. Date of attack. No. of days before applying for treatment. Seat of Charbon. Condition of adjacent parts. Constitutional symptoms. Where employed. Occupation. Apparent source of infection. Treatment. Result. Remarks. 96 Guy's Hospital J. M. M. 26 . April 4, 1890 2 Under chin No œdema Nil Messrs. Dyster, Nalder and Co. Skin factor Hides Excision Cured • 97 St. Thomas's Hospital W. H. C. M. 20 May 16, 1890 5 Left cheek Much oedema Nil Lived at Chertsey Painter Lived in same house as a butcher, and he did odd jobs in a slaughterhouse, not however during fortnight preceding illness Excision Cured Bacilli found. 98 Guy's Hospital H. T. M. 18 May 10, 1890 3 Right forearm Brawny œdema, axillary glands enlarged Temp. 100.4° ... Hide sorter Hides Excision, cautery Cured 99 Guy's Hospital W. B. M. 30 March 8, 1891 6 Left cheek Œdema Headache, Temp. 101° ... Butcher Does not work in the slaughterhouse Excision, cautery, ipecacuanha externally Died P. M. Anthrax of stomach. 100 St. Barholomew's Hospital J. D. M. 41 May 6, 1891 7 Front of left elbow Considerable œdema Shivering, headache, insomnia ... Dock labourer Working lately among hides from Calcutta Excision Cured Bacilli abundant in blood from wound, in vesicles, and blood of right arm. 101 Guy's Hospital R. N. M. 31 May 28, 1891 2 Left temple Œdema and enlarged glands Temp. 100° ... Horse slaughterer Diseased horse Excision, dressed with ipecacuanha Cured 102 St. Bartholomew's Hospital D. S. M. 51 Nov., 1891 3 weeks Middle of right forearm Not much swelling Nil Messrs. List and Son A sorter of horsehair " China hair " A. Excision Cured Bacilli found. 103 Guy's Hospital G. H. M. 28 Nov. 30, 1891 12 Left forearm and hand, 3 pustules in all. Slight œdema Nil ... Cowman Cow supposed to have died of apoplexy Excision Cured A very doubtful case. No bacilli found. 104 South Eastern Hospital C. H. M. 32 Mar. 25, 1892 7 Back of neck Surrounding parts inflamed and indurated Temp. 104°-104.6° Lived in Rotherhithe Dock labourer ... Fomentations applied to neck Died Case was notified as one of typhus. Patient was only in South Eastern Hospital 15 hours. 105 Guy's Hospital J. L. M. 33 Oct. 23, 1892 6 Left side of neck Redness and oedema Vomiting, Temp. 101.6° ... Broker's officeman Cape hides which he sorted Excision, dusted with powdered ipecacuanha Cured 106 Guy's Hospital J. G. M. 48 Dec. 14, 1892 2 Right side of neck Hypeæmic Headache, Temp. 99.8° ... Waterside labourer Hides Excision, cautery, ipecacuanha internally Died P. M. Meningeal and cerebral haemorrhage, bacilli found in blood from meninges. 107 London Hospital ... M. 17 1892 3 Over left eye Marked œdema of left eye and side of face Temp. 100° on admission ... Van boy Has nothing to do with hair or wool Excision Cured Bacilli found. 108 London Hospital ... M. 42 1892 5 Right malar bone Much surrounding inflammation Temp. 103° on admission ... Wool porter ... Excision Cured Bacilli found. 109 London Hospital H. J. M. 27 1893 3 Left malar bone Marked œdema Temp. 99.8° on admission Co-operative Stores, Leman-st. Brushmaker Engaged in passing hair through a comb to get rid of waste. Arsenicated China bristles. Excision Cured 24 25 Anthrax cases in recent years—(continued,). No. Place of treatment. Patient. Sex. Age. Date of attack. No. of days before applying for treatment. Seat of Charbon. Condition of adjacent parts. Constitutional symptoms. Where employed. Occupation. Apparent source of infection. Treatment. Result. Remarks. 110 London Hospital G. A. M. 34 1893 12 Right side of neck Marked oedema, which spread even after the pustule was excised Temp. sub-normal on admission Co-operative Stores, Leman-st. Brushmaker Employed in "pitching on" the bundles of hair to the backs of brushes. Arsenicated China bristles. Excision Cured Bacilli found. 111 London Hospital G. N. M. 19 1893 5 Angle of lower jaw ... Temp 99.2° on admission Messrs. Tomkins & Son Horsehair dresser Sorted horsehair to send to brushmakers Excision Cured Bacilli found. 112 Royal Free Hospital W. B. M. 24 Mar. 14, 1893 4 Left cheek Swollen and hard Slight rigors Royal Veterinary College Assistant in bacteriological laboratory A pimple appeared on cheek and he opened it with a scalpel, which had been employed for cutting diseased tissues, but had been subsequently put in carbolic acid solution Excision Cured No bacilli found. 113 St. Bartholomew's Hospital J. L. M. 15 April 16 1893 3 Chin Front of neck, from jaw to sternum, œdematous swelling Temp. 104° on admission Messrs. List and Son Upholsterer Engaged in stuffing chairs with Russian horsehair Excision Cured Secretion from wound injected into guinea pig which died same evening. Blood swarming with bacilli. 114 Guy's Hospital G. T. B. M. 31 April 20 1893 2 Below right ear Much œdema Nil ... Riverside hand Was carrying dry hides on 18th Excision, injection of carbolic acid Cured 115 Gay's Hospital E. W. M. 17 Aug. 15 1893 3 Left cheek; also scattered vesicles elsewhere Not much oedema Nil ... Leather dresser ... Excision, ipecacuanha Cured Bacillus found. 116 Guy's Hospital F. W. M. M. 32 Sept. 1, 1893 3 Right side of neck Much œdema Restless, then collapsed Sun wharf Hydraulic crane worker Had been sorting goat skins from Aden Excision, ipecacuanha Died In small intestine, a raised patch with haemorrhage in mucous tissue. 117 Guy's Hospital W. P. M. 23 Oct. 26, 1893 3 Right side of neck Much œdema ... Messrs.Lucas and Spencer's wharf Waterside labourer No connection with hides traced Excision, injection of carbolic acid Died on 30th Bacilli found. 118 Poplar W orkhouse J. W. M. 64 Dec. 4, 1893. ... Right forearm Much oedema Comatose when seen by medical man Aberdeen wharf Carter No hide infection traceable Nil Died Bacilli said to have been found. 119 Guy's Hospital J. M. M. 28 Dec. 16, 1893 5 Left angle of mouth Not much oedema Nil ... Wharfinger Carrying hides Excision, dusted with powdered ipecacuanha Cured 26 APPENDIX II. Table showing the mortality from the disease under consideration in England as recorded by the Registrar-General. (a) First period (1868-76)—Deaths recorded under the head Malignant Pustule. Male. Female. 1863 1 1864 1 1 1865 2 1 1866 2 4 1867 4 2 1868 2 1 1869 2 2 1870 2 1 1871 4 1 1872 — 1 1873 3 1 1874 — — 1875 3 2 1876 — 4 (b) Second period (1877-80)—The heading Malignant Pustule retained, and the headings Charbon and Woolsorters' Disease introduced in 1877 and 1879 respectively. Malignant Pustule. Charbon. Woolsorters' Disease. Male. Female. Male. Female. Male. Female. 1877 4 4 1 1 — — 1878 7 7 — — — — 1879 2 6 1 — 3 — 1880 3 3 — — 12 — (c) Third period—The heading Splenic Fever adopted. Male. Female. 1881 8 1 1882 10 5 1883 5 3 1884 13 5 1885 7 4 1886 8 3 1887 10 1 1888 11 I 1889 6 1 1890 3 1 1891 1 2 1892 5 I 27 APPENDIX III. Notice to workmen engaged in handling rate hides and skins or in sorting horsehair or wool, and to slaughtermen and others. The disease known as anthrax occasionally affects animals (especially cattle), and it is in rare instances communicated to those who handle hides, &c., which have been removed from the carcasses of such animals. The disease in man is usually inoculated through some scratch or abrasion on the skin surface, but the poison may be breathed in the form of dust into the lungs, and may possibly gain entrance to the system by being swallowed with the food. Malignant Pustule.—The first method (by inoculation beneath the skin) is the usual way in which the poison is admitted into the system, and when this occurs a tiny boil or pimple appears; inflammation of the surrounding tissues is soon set up, and in the course of a few days the apparently insignificant pimple has developed into a swelling of considerable size. The parts of the body attacked by the disease are those which are uncovered (neck, face, arms, &c.), and which may therefore come into contact with infected materials. In several instances men who have suffered from the disease have remembered noticing that before their illness a spot or pimple which they had scratched with their fingers, or a slight wound or scratch, had existed on the face or neck; into such place the poison must have entered, as it was there that the swelling afterwards developed. Internal Anthrax.—When absorbed internally, constitutional symptoms afford the first indication. These at the commencement are not unlike the symptoms of a feverish cold, except that there is more marked weakness and depression; generally, too, the breathing becomes from time to time oppressed; sometimes there is vomiting. Experience shows that the danger of these conditions is greatly aggravated by neglect in the early stages. This is particularly the case when the disease is inoculated beneath the skin, and very serious risk is incurred if no attention is paid to the pimple or boil when it first appears, and if the swelling is allowed to develope and the general health to become affected before a medical man is consulted. It is therefore extremely important that those who have been working with hides, &c., should seek medical advice if there is the slightest suspicion that the anthrax poison has become lodged beneath the skin. The following rules are suggested for the guidance of employers and workmen. 1. The condition of the skin of the uncovered parts of the body should always be carefully watched, and any crack or sore place should be protected from coming into contact with the materials handled. In sorting "dead hides" or other material with regard to which there may be the slightest suspicion, only workers whose skin is absolutely sound should be employed. 2. Needlessly rough handling of the hides, &c., so as to cause an unnecessary amount of dust, should be avoided. 3. Coats, &c., should not be hung in the warehouse rooms, and dust should be brushed from other clothes before leaving work. 4. Food should not be taken in the warehouse rooms; the hands should always be cleansed before meals. Lavatory accommodation should be provided for workers that they may have opportunity of thoroughly washing all uncovered parts of the skin when work is finished. When "dead hides" or other materials with regard to which there may be suspicion have been handled the men would do well to thoroughly rinse the hands in a disinfectant* solution before washing. * The disinfecting fluid may be thus prepared—Dissolve half an ounce of corrosive sublimate and five grains of commercial aniline blue in three gallons of water and add thereto one fluid ounce of hydrochloric acid. Preserve in earthenware jars or wooden tubs. This solution being highly poisonous must be kept under lock and key. ' Appendix IV. London County Council Public Health Department, Spring Gardens, 22nd October, 1894. Report by the Medical Officer submitting Summary of Reports by Dr. Young on the collection and disposal of house refuse by London Sanitary Authorities. (Ordered by the Public Health, &c., Committee to be printed.) During the month of December, 1893, and succeeding months of the present year, Dr. Young made enquiries concerning the collection and disposal of house refuse in the several districts of the county of London. As the enquiry in respect of each district was completed, Dr. Young's report thereon was presented to the Public Health Sub-Committee, and in particular instances communications were addressed to the sanitary authorities concerned. The Committee have now instructed me to present to them in a condensed form the results of Dr. Young's investigations, and the summary appended has therefore been prepared by him for this purpose. Considering first the collection of house refuse, Dr. Young found that of the 42 sanitary districts in London, excluding the City, the collection was effected in 25 by the sanitary authority without the intervention of a contractor, in 14 instances contractors were employed, and in 3 the collection was made in some parts by a contractor, in other parts by the authorities themselves. Dr. Young's report shows that the system adopted in connection with the removal of house refuse differs in the several districts. The claim is usually made that this refuse is removed at least once a week from all premises, but it is very doubtful whether this is really effected unless, in all cases where a pail containing the refuse is not deposited on the pavement, an actual call at each house is made for the purpose of such removal. In many districts, however, this is not the practice. More frequently the dust collector perambulates every street once a week or more, and the occupiers of houses indicate in some manner that they desire their dust to be removed. It is obvious that in many cases this desire will not be expressed until inconvenience is caused by the amount of accumulation. Frequent removal of house refuse is necessary, not only to obviate the inconvenience caused by excessive accumulation, but also because the refuse, as a rule, contains vegetable and animal matter liable to decomposition, and hence even when the quantity which has accumulated is small, it is an objectionable practice to postpone its removal beyond a certain period. The requirement specified in the Council's by-law that all house refuse shall be removed from all premises at least once a week, should be strictly observed throughout London. There is no probability that this condition will be fulfilled unless there is a definite house to house collection, i.e., unless all houses in the district are called at for the purpose. The results of each system can only be ascertained by direct inquiry at houses in the district. Such inquiry has up to the present time been made in a few districts only, namely, Bethnal-green, Newington, Marylebone, Islington, and Plumstead, by an inspector acting under the Committee's instructions. It has thus been ascertained that excellent results are obtained in Bethnal-green, where there is a bi-weekly call at all houses, except those where the occupier places the pail on the pavement. Inquiry at nearly 800 houses showed that almost without exception the refuse was removed once or twice weekly from every house in the district. In Newington it is not professed to be the practice for a call to be made at every house, but every street is visited on a given day in the week, the occupier making his wants known by the exhibition of a card bearing the letter D, supplied by the vestry. The Council's inspector visited nearly 800 houses, and the results of his inquiries in this district contrasted unfavourably with those obtained in Bethnal-green. In many instances it was stated by the inhabitants that the card in the window was apparently unobserved by the dust collector, and undue accumulations of dust were found in 64 instances, the dust having been allowed to accumulate for periods of from four to ten weeks. In Marylebone Dr. Young was informed that the contract provides for the house refuse to be removed once a week or more frequently from all houses in the district. Inquiry by the Council's inspector at nearly 650 houses led him to the conclusion that an actual weekly call was only made in respect of about one-third of the houses he visited. The remainder were dependent for the removal of their refuse upon applications to the dust collector when in the street, or failing this at the offices of the vestry. Accumulations of refuse were not infrequently found, and in 51 cases the accumulation was stated to be due to neglect of removal for periods of from four to ten weeks. Inquiry at 1,525 houses in Islington showed that in more than half the total number visited it is the practice to place a card in the window, and as a rule this is attended to. In the remainder Sold by Edward Stanford, 26 and 27, Cockspur Street, Charing-cross, S. TV. No. 207. Price 2id. [869—3020 2 it is customary to hail the dust cart, either once in each week, or as often as the householder requires the dust removed. In 54 instances accumulations of refuse were observed, which the occupiers of the houses stated were due to non-removal for periods of from four to eight weeks. In Plumstead the pail system is very generally in vogue, and the pails are emptied once in each week. The inspector visited 391 houses, and in nearly all these houses it was found to be the custom to place out the dust pail for collection once a week. In a few instances the inspector was informed that at the request of the householder the dust was removed fortnightly. No accumulations of refuse were observed. With respect to the other districts inquiry was made of the officers of the several sanitary authorities. The following tabular statement has been based upon the information which has been obtained— A Authorities who make a house-to-house call at least once a week. B Authorities who only collect at houses with card bearing letter " D " in window. C Districts where collection depends upon householders hearing dustmen in street. D Authorities who collect by pail system. E Authorities who arrange for call to be made on specified day. Kensington. Hammersmith. Fulham. Chelsea. W estminster (St. Margaret and St. John). St. Pancras. St. Giles. St. Martin. Shoreditch. Limehouse. St. Saviour, Southwark. St. Olave. Rotherhithe. Woolwich. Lee and Kidbrooke (sub-districts of the district under the Lee District Board). St. George - the Martyr. Iu the following a house-to-house call is partly made— St. George, Hanoversquare. Marylebone. Mile-end Old Town. Greenwich. St. Luke. The district of the Wandsworth Board of Works. Islington. Stoke Newington. Clerkenwell. Newington. Partly— Hackney. Paddington. St. George, Hanover- square. Holborn. St. George-in-the- East, Mile-end Old-town. Lambeth. Greenwich. Lewisham. Charlton (sub- district). St. Luke. Hampstead. Camberwell. The district of the Wandsworth Board of Works. St. James (partly). Marylebone (partly). Paddington (partly). Hackney (partly). Holborn (partly). St. George-in-theEast (partly). Lambeth (partly). Lewisham (partly). Charlton(sub-district, partly). St. Luke (partly). Hampstead (partly). Camberwell (partly). The district of the Wandsworth Board of Works (partly). Strand. Bethnal-green. Whitechapel. Poplar. Bermondsey. Plumstead. Lambeth (partly). Greenwich (partly). Holborn (partly). St. James (partly). Marylebone (partly). Paddington (partly). C'harlton(sub-district, partly). Eltham. ' With regard to the methods of disposal of house refuse—Of the 25 districts in which the authorities themselves collect the refuse, in only six cases is it subsequently manipulated in dust-yards in London, in all other cases it is either destroyed by fire or removed by barge or rail beyond the limits of the county. Of the 14 districts in which the removal is wholly effected by contractors, the refuse is, in the case of ten, subsequently manipulated in whole or in part at dust yards within the county ; in the case of the remaining four it is tipped within or without the county on vacant land. Dr. Young's inspections of the several dust yards, wharves, and railway sidings, to which house refuse was removed, showed that the wharves in which refuse was not sorted were in a satisfactory condition. Of the 12 others in which this process was carried on, he regarded five as being in a satisfactory condition, three were being or were about to be improved, one was inadequately paved, and three were in a dirty condition. The water-closet accommodation generally was sufficient. In one wharf, however, where some 24 to 82 men, women and boys were employed, a water-closet had been provided for the women, but there was no special accommodation in the yard for the men. Lavatory accommodation and rooms for meals had only exceptionally been provided. Shirley F. Murphy, Medical Officer of Health. Summary of Dr. Young's Reports. Enquiry has recently been made throughout the county into the methods in force in each sanitary district for the collection and disposal of house refuse. The information contained in this report has been obtained with the aid of the local medical officers of health and surveyors, and by inspection of the various wharves and dust depots. Further information was subsequently supplied by the Vestry of Hampstead and the Lewisham District Board to the effect that a house-to-house collection of house refuse was made throughout the district every week. M. 94b] 3 As to methods of collection and disposal of house REFUSE generally. (a) Collection of refuge. The collection of the refuse from houses is carried out either by the sanitary authority itself— that is to say, the authority employ men, and have provided the necessary plant for the purpose, or else by contract. At the time of enquiry it was ascertained that— In 25 districts the collection was performed by the sanitary authority; In 8 districts partly by the sanitary authority and partly by contract; and In 14 districts by contractors. The following system has been adopted for facilitating the collection at regular intervals throughout most of the districts. Each district has been sub-divided into areas, each of which is visited by the dustmen and carts on a specified day once a week, and in some cases twice a week, for the purpose of collecting the house refuse. In some districts it is a part of the system to make a house to house call in order to ascertain whether the dustbin requires to be emptied, but in others no call is made unless some indication to this effect is given by the occupiers, either by placing a card bearing the letter D in the window, by hailing the dustman as he drives down the street, or by arrangement with the sanitary authority that a call shall be made at the house on a specified day, either once or more often during the week. In some of the districts, chiefly those situated in the central parts of the county, it is stated that owing to the varying class of property and the existence of business premises, it has been found necessary to have a daily removal in some streets, and a removal once, twice, or thrice a week in others, rendering the same frequency of collection for the whole district, or a division of the district an impracticability. As the result of the enquiry it does, however, appear to be necessary in order to ensure a regular weekly collection of the house refuse from all premises, that in those parts of a district in which a daily collection is not in force a call should be made at every house once a week, either by an inspector of the authority or by the dustman while on his round. The collection of the refuse is generally made in carts or vans provided with some form of cover. Tarpaulins are most generally in use for the purpose, but in some districts carts with flaps or patent covers are used. (b) Disposal of refuse. In Appendix I. attached to the report to the Council by the engineer and medical officer of health on dust destructors, particulars are briefly given of the different methods of disposal of the house refuse collected in each of the London sanitary districts. The methods in force at the date of that report, and also at the time of this enquiry, were— (1.) Immediate removal from the district by barge or rail, or by both barge and rail without previous manipulation. (2.) Sorting and sifting of the refuse by machinery, or by hand-labour, prior to removal by barge and rail. (3.) Removal to shoots. (4.) Burning in a destructor. (1.) The first method has been adopted in the following districts— Fulham. Chelsea. Kensington. Hammersmith. Bermondsey. St. Pancras. The Strand. Greenwich. Shoreditch. St. Martin-in-the-Fields. Wandsworth (partly). St. Saviour. Shoreditch. Islington. St. George-the Martyr. Westminster. Camberwell. Lambeth. St. George, Hanover-square (part of the refuse). St. James, Westminster (part of the refuse) In all these cases the house refuse is conveyed by the dust cart, as soon as this is loaded, to a wharf or railway siding, and there the refuse is either shot or loaded direct into barges and railway trucks for removal to various parts of the country without undergoing any manipulation. The refuse which is loaded into the railway trucks during the day is invariably removed at the end of that day. At wharves situated on the river, the movements of barges depend on the tides, but the result of enquiries made at these wharves, and also at those on canals, show that in practice the house refuse is brought into the wharf, loaded into barges, and removed within twenty-four hours. Removal by barge is, however, subject to interruption at times, owing to the occurrence of fog, ice, or neap tides, and it may then be necessary to deposit the house refuse on the wharf temporarily for a longer period than twenty-four hours. (2.) The second method, namely, sorting and sifting of the refuse into its constituent parts, at depots situated in London, is adopted in connection with the house refuse collected in the following districts— (a) By machinery— Paddington. St. George, Hanover-square (part of the refuse). St. James (part of the refuse). Marylebone. (b) By hand labour— Hackney (Dart of the refuse). St. Giles Holborn It was stated by the contractor that part of the refuse from these districts is at times sent away by barge at once. Clerkenwell. 4 (b) By hand labour—continued— St. Luke. Bethnal-green (partly). St. George-in-the-East. Limehouse. Mile-end Old-town. Poplar (partly). St. Olave. Newington (at certain periods of the year when there is much demand for ashes and breeze by brickmakers). Sorting by machinery is carried on at the dust depots belonging to the Vestry of Paddington, and to Messrs. Hobbs and Messrs. Mead. They are all situated on the north side of Paddington-basin on the Grand Junction Canal, and it was stated at each that usually the refuse brought in during the day is sorted and sifted and removed from the wharf within twenty-four hours of its arrival. The ashes and breeze are conveyed along shoots direct from the sorting machine, and loaded into barges alongside the wharf. The soft core is collected and either burnt in a furnace or loaded into barges and removed. The condition of these depots on the days when they were visited confirm the statements that this process of sorting by machinery can, generally speaking, be carried on without infringement of the by-law which limits the time during which deposited house refuse in course of removal may remain in proximity to occupied buildings, streets, &c. But at the wharf belonging to the Vestry of Paddington and at that of Messrs. Mead and Co. collections of fine ash were observed, and in both cases it was stated that these accumulations had lain there for a longer period than twenty-four hours; it is also stated that during hot weather this fine ash is liable to become offensive owing to the presence of small quantities of vegetable refuse which are not separated by the machine. The details of the business of hand sorting and sifting have already been described in the report of the engineer and medical officer on dust destructors. This process doubtless can also be so carried on that the house refuse is manipulated and loaded into barges within twenty-four hours of arrival at the dustyard. But it may be said that the business of hand or machine sorting, in itself, may at times be a cause of delay in the prompt removal of the refuse or of some of its constituent parts. The following is a list of dust depots in the county at which sorting and sifting is still carried on, all these have been inspected during the course of the enquiry into the collection and disposal of house refuse. Dust depot of the Paddington Vestry, Paddington-basin.—This yard was found to be well paved and drained and kept in a cleanly condition. Sorting is done by machinery, twenty-seven hands are employed on the work, this number including 14 women. Sufficient water-closet and lavatory accommodation, as well as a sitting room and kitchen, is provided for the workers. On the day of inspection a heap of fine ash was observed on the wharf, which it was stated had been there for a period of three or four days. The work is carried on under cover. Messrs. Meads' wharf, Paddington-basin.—Yard paved and drained and clean. Sorting is effected by machinery, a varying number of men, women and boys being employed ; these work under cover. Adequate water-closet accommodation for the two sexes is provided, namely, two water-closets for women and two water-closets and a urinal for the men. There is no lavatory nor room for meals; during meal hours all hands go home. A heap of fine ash, said to be the accumulation of two or three days, was also observed on this wharf; it was stated that this occurrence was unusual. There is a furnace here in which the paper and lighter portions of the house refuse are burnt. Messrs. Hobbs' wharf, Paddington-basin.—On the day of inspection this yard was found to be only partially paved, and consequently not in a cleanly condition. It was stated that the yard is about to be properly paved. The sorting is now done by machinery only, all hand sorting having been given up, and as a result the yard was found to be cleaner and kept in a better condition than at the date of a visit some twelve months previously. Adequate water-closet accommodation for the two sexes is provided. There is no room for meals and no lavatory, all workers going home at meal times. Men, women and boys are employed for the work which is carried on under cover. Crane's wharf, Kingsland Basin, Regent's Canal—Hackney parish.—At the date of inspection one of these wharves was being paved and drained, and sanitary conveniences were being provided. Sorting and sifting is here carried on by hand labour, men and women being employed, but no work was going on when the wharf was visited. The refuse, after manipulation, is removed by barges. A large heap of soft and hard core was observed on the wharf, but it is possible that at the time this was unavoidable owing to temporary disuse of one wharf which was undergoing repairs, decreasing the berth accommodation for barges and interfering with the ordinary routine removal of the refuse. The wharf was in an untidy and dirty condition. Cookson's dust depot, Tinworth-street—Lambeth parish.—This yard is paved and drained. About 20 women and 10 men and several boys were engaged in hand sorting and sifting the house refuse brought here. The work is carried on in an uncovered yard immediately adjoining the London and South-Western Railway, one of the arches under the line being used for storing breeze separated from the refuse; a large heap of this in a steaming condition was observed on the day of inspection. There is a 2-celled furnace here in which the paper and soft core is burnt. The ashes and breeze are removed by barge to Kent and Essex from a wharf in close proximity to the yard on the Albert-embankment. It is stated that as a rule the refuse, which is brought into the yard during one day, is manipulated and the offensive portions removed within 24 hours. The yard is situated in a narrow street and within 100 yards of inhabited houses. Separate water-closet accommodation for the sexes is provided. No lavatory nor room for meals has been provided ; it is stated all the workers live near the yard and go home during meal hours, and that there is no necessity for providing this accommodation. 5 The dust depot of the Vestry of Clerkenwell, Commercial-road—Lambeth parish.—This is a wharf situated on the south bank of the river Thames. The yard is well paved and drained. The refuse is sorted by hand labour ; twelve women, six men and two boys were employed in this process at the time the wharf was visited, the work being carried on under a roofed-in shed. It is stated by the superintendent that the refuse brought to the wharf is sorted, loaded into barges, and removed within twenty-four hours of its arrival except when neap tides occur or when the departure of the barges is interrupted by fog or frost. There is a small furnace at this wharf in which the paper and lighter portions of the refuse are burnt. Adequate water-closet accommodation for the sexes is provided for the workers at the wharf, but there is no lavatory and no meal room. The dust wharf of the Vestry of St. Luke, Macclesfield-street, City-road—St. Luke's parish.— This is a wharf on the City basin of the Regent's Canal. The yard is paved and drained. It is stated that house refuse is brought here and kept for a period of two to three days, and at times for longer periods, in order that it may be sorted and sifted before removal by barge to Ware and Ponder's End. Men and women are engaged in the work of sorting, which is carried on in the open yard. Separate water-closet accommodation for the sexes is provided, but no lavatory nor room for meals, as all the workers are said to live near and go home during meal hours. On the day of inspection a large heap of breeze and hard core was noticed on the wharf; it was stated that this had been there several days. No sorting was going on. Copenhagen wharf, Limehouse-cut, Limehouse.—A badly-paved and drained wharf, which on the day of inspection was found to be in a dirty condition owing to accumulation of various kinds of refuse. The house refuse brought to this yard is hand sorted and sifted by women, men and boys. It is stated that four gangs are generally engaged on the work (a gang includes two women, one man and a boy), and that the refuse is removed within twenty-four hours of its arrival at the wharf. No large accumulation was observed except a heap of " hard core," which was said to have been there for a " considerable period." The paper and lighter material derived from the house refuse is burnt in a heap on the open wharf, and there was much smoke from this when the wharf was visited. Separate sanitary conveniences for the two sexes are provided. There is no lavatory, but there is a small building which can be used by the workers as a meal room, though on the day of inspection several men and women were sitting around a fire in the yard eating their mid-day meal. Abbott's-yard, Limehouse-cut, Limehouse.—This yard was in a dirty condition when visited, owing to the accumulation of various kinds of refuse. It appears to be unpaved. Hand-sorting of household refuse is carried on by some eight women, four or five men and a few boys. It is said that the refuse carted to this wharf is sorted and removed within twenty-four hours, and this was confirmed by the small amount of house refuse noticed in the yard. There was, however, a heap of " hard core," which Mr. Abbott, junior, stated was the product of several days' work. There is a small furnace here, in which is burnt the paper and lighter material separated from the house refuse. Water-closet accommodation for the two sexes is provided, but there is no lavatory nor room for meals. It is stated that all the hands live in houses in close proximity to the yard and go home during meal-time, and that it has not therefore been found necessary to provide such accommodation. Dust depot and siding of the Mile-end Old-town Vestry—Mile-end Old-town.—This is situated on the eastern bank of Regent's Canal, and has also a siding in connection with the Great Eastern Railway. For the purpose of sorting the refuse the Vestry employ six to eight gangs of women, men and boys. The work is done by hand, and is carried on under a roofed shed. It is said that the house dust brought here is sorted and loaded into trucks within twenty-four hours of its arrival, and that it is never allowed to accumulate on the wharf. During that period of the year when the amount of house refuse is very large some is loaded direct into barges on the canal without previous sorting. On the day of inspection no accumulation was observed. The yard has recently been drained, but is unpaved. There is a four-cell furnace here in which soft core is burnt. The women employed at, this yard are provided with a room containing a cooking stove, and with lavatory and water-closet accommodation. There is no water-closet for the men. Prior's wharf, Orchard-street, Poplar.—This wharf is situated on Bow-creek. The yard on the day when wharf was visited was found to be unpaved and was in a dirty condition. Sorting and sifting of house refuse by hand labour is carried on. Mr. Prior, jun., states that usually three or four gangs of women, men, and boys are employed, and that a room with lavatory and water-closet accommodation is provided for the workers in a disused house on the wharf, but that all hands go home during msal hours. Large heaps of hard core and breeze, which appeared to be the accumulation of several days' work, were noticed on the wharf. The dust wharf of the St. Olove's District Board, Shad Thames—St. Olave's.—The yard, which belongs to the District Board, is well paved and drained. The house refuse collected by the sanitary authority is tipped on the wharf. Here the refuse is dealt with by a contractor prior to its removal by barge. The contractor who carries on this business had in his employ, at the date of inspection, some five women and six men for the purpose; these work under a roofed shed. There is a furnace in which the soft core is burnt. It is stated that no refuse is retained on the wharf for a longer period than twenty-four hours, except hard core, which is not of an offensive nature. Adequate water-closet accommodation for the workers was to be provided. There was no room for meals and no lavatory. (3.) The following is a list of the districts, the house refuse of which is taken wholly or in part to " shoots " on vacant pieces of ground situated within the county— Lewisham Plumstead Rotherhithe Charlton Lee and Kidbrooke Lee District Board of Works. The refuse of the parishes of Streatham and Tooting in the Wandsworth district, and of Eltham in the Lee district, as well as some of the refuse of Hackney and Bethnal-green is said to be taken to shoots outside the county. 6 (4.) Destructors for the purpose of burning house refuse have been erected by the sanitary authorities of— Woolwich Hampstead Battersea Whitechapel In all these the refuse is burnt in the rough state, that is to say, without undergoing any previous manipulation, except in the case of Hampstead. The destructor of the Hampstead Vestry at certain periods of the year is not large enough to deal with the whole amount of refuse which is brought into the depot during the 24 hours, and the surplus is sorted by hand labour (this is only carried out on a small scale). The fine ash is barged away, the breeze is utilised for stoking the cremator furnace of the destructor, and the residue is then burnt with the ordinary refuse. The Battersea destructor is also, it is stated, too small lor the needs of the district during a few months in the year, when the output of house refuse is at its maximum, and it is necessary at this time to remove the surplus by barge or rail. The Whitechapel and Woolwich destructors have been found large enough to destroy the house refuse of the districts at all periods of the year. It is stated that the Vestry of St. Luke and of St. Pancras have decided to erect destructors, and in at least one other district the matter is engaging the attention of the sanitary authority. Details as to the methods of Collection and Disposal of Refuse in each District, Kensington.—Tbe collection is made by the sanitary authority. Every house in the parish is visited at least once a week, many houses twice or thrice a week, and a limited number of buildings every day except Sundays. The collection is made in vans and carts provided with tarpaulin covers. The refuse is taken to the wharves belonging to the Vestry, where it is tipped direct into barges and thence removed to brickfields outside the county. One of the wharves is situated on the north bank of the Thames, at Lots-road, Chelsea, the other on the Grand Junction Canal, in the Kensal-green portion of Chelsea parish. Hammersmith.—The sanitary authority collect the house refuse, and all houses in the district are visited once in each week. This weekly collection has been in force since July, 1893. The refuse is taken to the Vestry's wharf and discharged direct from the carts into barges for removal to Sittingbourne, Rainham, and Hadley Castle for the purpose of brick making. Fulham.—A weekly visit is made to all premises for the collection of the house refuse. This system has been in force in this parish since June, 1892, and the work is done by the sanitary authority. The dust carts are covered with tarpaulins, and convey the refuse to the Vestry's wharf on the river near Putney-bridge, where it is tipped direct to barges for removal to brickfields in Kent and Essex. Paddington.—The collection is carried out by the Vestry ; all parts of the parish being visited once in each week, and the house refuse removed as required. It is not the custom to make a houseto-house call. It is stated that this practice was tried a few years back but was discontinued owing to objections on the part of, householders. Covered vans are used in the collection. The refuse is taken to the Vestry's wharf on Paddington-basin, and there sorted and sifted by machinery. The ashes, breeze, soft core, &c., are then loaded into barges alongside and conveyed to brickfields and market gardens in the neighbourhood of Cowley. It is stated that the manipulation and the removal of the refuse is as a rule effected within 24 hours. Chelsea.—The sanitary authority carry out the collection. All houses are called at once a week for the purpose of dust collection, but a daily visit is made to large buildings, such as flats and barracks. The carts are provided with tarpaulin covers, and convey the refuse to the Vestry's wharf on the river Thames, Lots-road, Chelsea, where it is tipped direct into barges. St. George, Hanover-square.—Two contractors are employed by the sanitary authority for the collection and disposal of the house refuse of this parish. The collection is made— (1.) Daily from houses in a considerable part of the parish, (2.) Twice and three times a week from some premises, and (3.) All other premises are called at not less frequently than once a week on specified days. The Vestry require each cart to be provided with a suitable cover. The refuse is taken to— (1.) Covington's wharf on the river Thames, where it is tipped direct into barges and removed to brickfields in Kent. (2.) Hobbs' wharves, Paddington-basin ; here it is sorted and sifted by machinery (hand sorting having now been given up), and the breeze, ash and soft core are loaded into barges for removal to Cowley, Drayton and neighbourhood. It is stated that a small amount of refuse is sent by Messrs. Hobbs to Gabriel's wharf on the Thames and there tipped direct into barges. Westminster (St. Margaret and St. John).—The removal of house refuse has for the last three years been carried out by the sanitary authority. The collection is made— (1.) Daily in a considerable part of the parish, (2.) Bi-weekly in some streets, and (3.) All other premises are called at once in each week. Both covered and uncovered vans are used. The refuse is taken to the Vestry's wharf on the Thames, near Vauxhall-pier, where it is tipped direct into barges, which convey it to brickfields near Erith in Kent. St. James.—The collection is made by a contractor. Every street in the parish is perambulated daily by the dust carts, and the dust is removed from premises as follows— (1.) Where a request has been made to the Vestry office for the removal of house refuse. (2.) Where a request is made of the carman while on his round. (3.) Certain houses are called at twice or thrice a week on days fixed by the householder a list of these premises being kept at the Vestry office. It is stated that in no case is the dust removed less frequently than once in each week. 7 Covered vans are used for the collection, and the refuse is taken to Mead's wharf on Paddington-basin where it is separated by machinery into its constituent parts; the cinders, ash, soft core, being loaded into barges alongside, and the paper and lighter matters burnt in a special furnace on the wharf. The manipulation and the loading of the refuse is said to be completed during one day, and no refuse is as a rule kept on the premises. Marylebone.—The Vestry employ two contractors, viz., Messrs. Hobbs and Mead, for the collection and disposal of the house refuse of the parish. The contract stipulates for a collection to be made from premises as follows— (1.) Daily in some of the main thoroughfares, e.g., Oxford-street, Regent-street, Edgware road. (2.) Twice or three times a week from certain institutions, as the Middlesex hospital, the workhouse, &c. (8.) Once a week in the rest of the district. Covered vans are used for the collection, and the dust is conveyed to the wharves of Messrs. Hobbs and Messrs. Mead on Paddington-basin, where it is sorted and sifted by machinery. Hampstead.—A weekly collection of house refuse is made by the sanitary authority, but it is not customary to make a house-to-house call in every part of the district. The carts are provided with tarpaulin covers. A dust destructor has been erected at the Vestry's wharf on the Grand Junction Canal. This contains eight cells, but is only large enough to consume about two-thirds of the whole amount of the parish house refuse. Sorting and sifting by hand of some of the refuse is therefore carried on to a small extent at the wharf by a contractor who employs some two or three women and a few men for the work. The fine ash obtained in the process is barged away, the breeze is used for stoking the cremator, and the soft core is burnt in the destructor. Pancras.—Contractors are employed by the Vestry for the collection and disposal of the house refuse. A weekly call is made at every house in the district; lists are thus obtained of the premises from which it is necessary to remove the refuse, and these lists are handed to the contractor each day before starting on his round. At the date of enquiry the dust collected in the east, west, and south wards was being taken to railway sidings at Kentish-town, Tufnell-park, and King's-cross, where it was loaded direct into trucks for removal to the country. The refuse collected in the north ward is taken to Williamson's brickfields, near Green-lanes. The Vestry have obtained a site adjacent to the Regent's Canal, where a destructor is about to be erected. Islington.—The collection is made by the sanitary authority. Every street in the district is perambulated three times a week, and a call made at those premises where the removal of the house dust is required. Cards bearing the letter D have been supplied to householders, stating the days upon which the dust vans pass through each street, and notifying that a call will be made at those houses at which the card is exhibited. The collection is made in vans provided with tarpaulins, and the dust is conveyed to— (1.) The Vestry's wharf on the City basin of the Regent's Canal, where it is tipped direct into barges and removed to the country. (2.) Ashburton-grove railway siding, Tufnell-park railway siding, and York-road railway siding, where it is loaded direct into trucks. The screening of ashes from the refuse at Ashburton-grove depot has now been discontinued. Hackney.—Since enquiry was first made this district has been divided into the Hackney and Stoke Newington parishes, and the arrangements for dust collection have undergone alteration. In Hackney parish two contractors are employed to collect the house refuse, and it is customary to call only at those premises in the parish at which an indication is given that the householder requires the removal of the house refuse, but all streets in the district are visited by the dust carts once a week on regular days. It is proposed however to make a call at all houses once in each week in future. Covered carts are used for the collection, and the refuse is taken to— (1.) A wharf on Kingsland-basin, Regent's Canal, and there sorted and sifted prior to removal by barge (see Bethnal-green.) (2.) To shoots situated outside the county. Stoke Newington.—The Vestry employ a contractor to collect the house dust of the parish once a week. Each street is visited on a specified day, but only those houses are called at from which the removal of house refuse is required. Uncovered carts are in use. The dust is taken to Tottenham, where it is utilised for the purpose of brick-making. St. Giles.—A contractor is employed by the Board of Works for the collection and disposal of the house refuse of the district. A weekly call is made at all houses by an inspector of the sanitary authority, and lists thus obtained of those premises from which it is necessary to remove the refuse. These lists are supplied daily to the contractor's foreman. The dust carts pass through each street in the district twice a week on regular days, but the main thoroughfares are visited, and the dust collected, daily. A second visit is made by an inspector of the authority to see that the refuse has been removed from each house, t Covered vans are used to convey the refuse to the contractor's yard in Tinworth-street, Lambeth, where it is sorted and sifted before removal. St. Martin-in-the-Fields.—The sanitary authority collect the house refuse in this district. The collection is made— (1.) Daily from premises in the main thoroughfares. (2.) Twice or thrice weekly from some premises. (3.) A weekly call is made at all other houses. The dust-carts are provided with tarpaulin covers, and convey the refuse to Gabriel's wharf, Commercial-road, Lambeth, where it is tipped direct to barges and removed to brickfields in Kent and Essex. 8 Strand.—The sanitary authority make a daily collection of the house refuse in this district. At most of the houses in the district the refuse is placed by the occupiers in pails on the kerbstone, and in the main thoroughfares is collected before 10.30 a.m. Covered vans and carts are used, and the refuse is taken to a wharf belonging to the District Board, situated in Commercial-road, S.E., on the south bank of the river east of Waterloo-bridge, and there tipped direct into barges for conveyance to brickmakers in Kent and Essex. Holborn.—The collection is made by a contractor. In a large part of the district the collection takes place daily from all premises. The rest of the district is visited by the dust carts twice weekly on regular days, and the collection made from any premises as often as required, but it is not customary to make a house-to-house call once in each week. Covered carts are used for the collection. The refuse is taken— (1.) To Gabriel's-wharf, on the south bank of the river immediately to the west of Waterloo-bridge, where it is tipped direct into barges, and (2.) To the contractor's depot, Tinworth-street, Albert-embankment. Here sorting and sifting by hand labour is carried on. It is stated that the dust brought into the yard is sorted and the various component parts are removed during the same day, as a rule. Clerkenwell.—The collection is made by the sanitary authority. The whole district is perambulated twice a week, each street being visited on regular days, and those premises are called at which exhibit a sign that the householder desires to have the dust removed. Cards bearing the letter D have been supplied by the Vestry for this purpose to all houses. It is said that this system works well, and that there are very few complaints as to non-removal of dust. The collection is made in vans provided with tarpaulins, and the refuse is taken to the Vestry's wharf at Commercial-road, Lambeth, where it is sorted and sifted by hand, and then barged away to Faversham and neighbourhood for use in the brickfields. There is a small furnace in the yard for burning paper and the lighter portions of the refuse. It is stated that usually the refuse is sorted and removed from the wharf within twenty-four hours. St. Luke.—The sanitary authority collect the house refuse, daily from houses in the main thoroughfares of the district, and once a week from all other premises in side streets, each street being visited on a regular day. Uncovered carts provided with tarpaulins are used for the collection. The refuse is taken to a wharf on the City-basin of the Regent's Canal, where it is temporarily deposited in order that it may be sorted and sifted before removal by barge to Ware and Ponder's End. When the wharf was visited the sorting process was not going on, but it was stated that the refuse generally remains on the wharf three to four days before removal. The Vestry have obtained a site for the purpose of erecting a destructor for dealing with the house refuse of the parish. Shoreditch.—The sanitary authority make a weekly collection of refuse from all premises in the district, all streets being visited on regular days, and all premises called at. Covered vans are in use at present, but are being replaced by uncovered carts provided with tarpaulins. The refuse is tipped direct into barges at the Vestry's wharf on Kingsland-basin, Regent's Canal, which, it is stated, carry it to Rainham. Bethnal-green.—Two contractors are employed for the collection of the house refuse. The collection is made twice weekly from all premises; in many parts of the district it is customary for householders to place their dust pails on the pavement in front of the house ready for collection, if this be not done the house is called at. The dust-carts are provided with tarpaulins for covering the refuse while being conveyed through the streets. At the time of enquiry the refuse was being taken to— (1.) Shoots at Hackney-wick near Temple-mills, and at Bow outside the county. (2.) Crane's-wharf, on Kingsland-basin, Regent's Canal, where it is sorted and sifted by hand labour. This wharf was being repaved and redrained when visited, and it was stated that suitable accommodation would be provided for those engaged at work on the wharf. Whitechapel.—The collection is made by the sanitary authority and every street in the parish is visited daily. It is customary at most premises for the householders to place the house dust in pails on the pavement ready for removal. Houses and block dwellings where this is not done are called at twice or thrice weekly. Uncovered carts are in use, but it is stated that covers will be provided. The Board of Works have erected a destructor (16 cells) in which all the house refuse of the district is burnt. St. George-in-the-East.—Collection by contract. Every street is visited twice a week, but it is stated that each house is not actually called at unless necessary. Uncovered carts are used for conveying the refuse to Copenhagen-wharf on Limehouse-cut, where it is sorted and sifted by hand before being barged away. It is stated that as a rule the refuse does not remain on the wharf for a longer period than twenty-four hours. Limehouse.—Two contractors are employed by the District Board of Works to collect the house refuse. All parts of the district are visited twice weekly, and it is stated that all premises are called at. The dust carts are covered with tarpaulins while conveying the refuse to— (1.) Abbott's-yard on Limehouse-cut, where it is hand sorted prior to removal by barge or rail. It is stated that as a rule the refuse is not kept in the yard longer than 24 hours. (2.) Copenhagen-wharf, Limehouse-cut. Mile-end Old-town.—The collection is made by the sanitary authority. At the time the enquiry was made it was the custom to make the collection daily in some streets, every house being called at, but, in a large part of the district the removal of house dust did not take place more frequently than once a fortnight, and only from those houses exhibiting the letter D. The dust is carried in uncovered carts to the Vestry's depot, a railway siding adjoining the Regent's Canal, and is there sorted by hand before being loaded into trucks. For the purpose of sorting, the Vestry employ six or eight gangs of women, men and boys ; each gang includes two women, one man and a boy. 9 It is stated that house refuse does not remain here longer than 24 hours. During the time of year when the amount of refuse is greatest some is loaded direct into barges on the canal and sent to low-lying land belonging to the Vestry in the neighbourhood of Edmonton. There is a four-celled furnace here, in which all the paper and soft core separated from the refuse is burnt. Poplar.—The collection and removal of house refuse is carried out by contractors. A bi-weekly collection is made, each part of the district being visited on regular days. Dust-pails have been supplied by the sanitary authority to all houses, and it is customary to place these on the pavement in front of house ready for removal on the day of collection ; if this be not done in any case, the house is called at. Carts provided with tarpaulins are used. The refuse is taken to— (1.) Abbott's-yard, Limehouse-cut. The method of dealing with house refuse at this yard has been described above. (2.) A shoot on land adjoining the Great Eastern railway near White-post-lane. (3.) Prior's dust yard, Orchard-street, Bromley, on Bow-creek. It is here sorted and sifted by hand by men and women before removal by barge to brickfields in the country. St. Saviour.—The house refuse is collected by the sanitary authority, and the collection is made daily in parts of the district, thrice weekly in other parts, and weekly in the remaining parts. All houses are called at in order to ascertain if the removal of the dust is required. The carts are provided with tarpaulin covers and convey the refuse to Honduras-wharf, Bankside, where it is tipped direct into barges, unless for any reason this is interfered with (this, however, only occurs exceptionally); the refuse is then temporarily deposited on the wharf, but is not kept there for any length of time. St. George, Southwark.—The clerk of the Vestry has forwarded the following information—A collection of house refuse is made twice weekly by the sanitary authority; vans provided with tarpaulins are in use. The refuse is taken to the wharf belonging to the board of works for the Strand district. The method of disposal of house refuse at this wharf has already been referred to. Newington.—The collection is made by the sanitary authority. Every street in the parish is visited once a week, but only those houses are called at where the removal of house refuse is required. This is indicated by exhibiting a card bearing the letter D, supplied to householders by the authority, in one of the front windows of the house. The refuse is taken to the Vestry's dust depot at Manor-lane, Walworth. Here it is either loaded into trucks direct and removed at once, or it is hand sorted and sifted by women and men. It is stated, however, that the house refuse never remains here longer than 24 hours. At the time of enquiry the refuse was being removed at once without previous sorting. St. Olave.—Collection is made from all premises at least once a week, in the main thoroughfares the collection is made every other day. The collecting vans are provided with tarpaulins. The refuse is taken to the wharf belonging to the District Board of Works in Shad Thames, where it is sorted by hand labour, and then removed by barges to brickfields in Kent and Essex. It is stated that no refuse of an offensive character is retained on the Board's wharf for a longer period than 24 hours before removal by barge. Bermondsey.—The sanitary authority collect the house refuse twice weekly throughout the district. Pails are in general use as dust-bins, and it is left to the householder to place them on the pavement in front of the house ready for collection by the dustmen. Uncovered four-wheel vans are in use, each van being provided with a tarpaulin cover. The refuse is taken to the Vestry's wharf, situated in East-lane, on the river Thames, and there tipped direct into barges for removal to brickfields at Sittingbourne and neighbourhood. Rotherhithe.—The collection is made by a contractor employed by the Vestry, all premises being called at twice weekly. The carts are provided with tarpaulin covers. At the time of enquiry the refuse was being taken to a shoot at East Greenwich, in Charlton parish. Lambeth.—The collection of house refuse in this district is made partly by the sanitary authority and partly by a contractor. The sanitary authority collect twice weekly in the inner wards, or northern part of the parish. The pail system is in force. In the outer wards, or southern part of the parish the collection is made once in each week by the contractor, but it is not the custom to make a house-to-house call unless necessary. The Vestry collect approximately half the total amount of refuse produced in the whole district. The dust carts are provided with tarpaulin covers, and convey the dust— (1.) To the Vestry's wharf, Belvedere-road, Vauxhall, where it is tipped direct into barges for removal to Kent. (2.) To railwuy sidings (chiefly to Herne-hill and Gipsy-hill sidings), where it is loaded at once into trucks and removed the same day. (8.) To Burton's-wharf, Nine-elms-lane, where it is loaded direct into barges. Occasionally a small quantity is taken to Clarkson's-yard, Tinworth-street, and sorted. Battersea.--A weekly collection of house refuse is carried out by the sanitary authority. The carts in use at present are provided with tarpaulin covers, but covered vans are to be provided. The refuse is taken to the destructor at Culvert-road, Battersea ; this contains 12 cells and is large enough to destroy all the refuse of the district except during a short time in the winter months. It is stated that when this occurs the surplus is taken to the Vestry's wharf, Lombard-street, Battersea, and there tipped direct into barges and sent to brickfields in Kent or Essex. Wandsworth—Clapham parish.—The sanitary authority collect the house refuse from all premises once a week. The dust carts, which are provided with tarpaulin covers, take the refuse to Stewart's-lane railway siding, and it is here loaded from the carts into trucks and removed to the country on the day of loading. Wandsworth—Wandsworth parish.—The District Board of Works contract for a weekly collection of house refuse from all premises in this parish. At the time of the enquiry the greater amount of the refuse was removed from the district by barge from the parish wharf, Bell-lane, Wandsworth. It was stated that some refuse was also sent away from New Wandsworth goods station, and a small amount to a shoot in the district of Mitcham. 10 The parish has since the date of enquiry obtained a site on the river for a new wharf with a view to facilitating the removal of house refuse from the parish. Wandsworth—Putney.—A weekly collection of the house refuse from all houses in the parish has been carried out by the sanitary authority since March, 1893. A new wharf has recently been constructed from which the refuse is barged away. Streatham and Tooting.—The collection is made by contractors. At the date of enquiry houses were only visited once a fortnight, but a weekly collection is now in force. The refuse is taken to shoots in Mitcham parish. Camberwell.—The sanitary authority make a weekly collection of the house refuse from all premises in the district; carts provided with tarpaulin covers are in use. At the time of enquiry the refuse was disposed of as follows— (1.) A large quantity was being taken to the Vestry's wharf, on the Surrey Canal, and there loaded direct into barges and removed to brickfields in the country. (2.) Removed by rail from railway sidings at Bricklayers'-arms, Gipsy-hill, Camberwell New-road and East Dulwich stations. At all these sidings the refuse is loaded direct to truck and removed from the siding within 24 hours. A small quantity was also being deposited on land adjoining Cold Blow-lane siding, near New Cross, and ultimately screened before final removal. Greenwich.—The house refuse in the three parishes of St. Alphege, Greenwich, St. Nicholas, and St. Paul, Deptford, is collected once a week by the sanitary authority. It does not appear to be the custom to make a house-to-house call throughout the whole district. In some parts of Greenwich parish the pail" system has been tried, and a bi-weekly collection attempted, but it is stated that the system has not been extended as it has been found that householders do not as a rule put out their house refuse for collection more frequently than once a week. In the parish of St. Paul the sanitary authority have supplied cards bearing the ietter D to householders, and this is displayed in a window when the collection of dust is required, but in the poorer parts of the parish a house-to-house call is made by the dustmen, and the premises are frequently visited by the dust superintendent to see that the work is efficiently carried out. Tarpaulins are used for covering the refuse in the carts during transit through the streets. (1.) The refuse from Greenwich parish is taken to the parish wharf, Chester-street, East Greenwich, and there loaded direct into barges and conveyed to Tilbury. (2.) All the house refuse of St. Nicholas' parish, and the greater amount from St. Paul's parish, is taken to the parish wharf, Knott-street, Deptford, and thence removed to Tilbury by barge. At the time of enquiry a small portion was being taken to Cold Blow railway siding. The Board has informed the Council that this has now been discontinued. Lewisham.—A weekly collection of the house refuse is made by the sanitary authority in the district of Lewisham, including Penge, but it does not appear to be customary to make a call at every house once in each week. The collecting carts are provided with tarpaulin covers. It is stated that formerly the work was carried out by contract, but the present system has been found more satisfactory, and to have been effective in diminishing the number of complaints. All the refuse is sent to " shoots " at Lady well and Hither-green in the county, and to Kent House brickfields and Bex-lane without the county of London. The " shoots " at Ladywell and Hither-green are situated on cultivated land, and are more than 300 yards from inhabited houses. Woolwich.—The sanitary authority collect the house refuse, three times a week in some streets, twice a week in others, and once a week in the rest of the district (including North Woolwich). All premises are called at at least once a week. Movable dust receptacles have been supplied by the sanitary authority to all houses in the district. The dust carts are provided with tarpaulin covers. The Vestry have erected a destructor in which all the refuse is burnt. Plumstead parish.—The collection of house refuse is carried out by a contractor on behalf of the Vestry. The parish is divided into sub-districts, and at the time of enquiry the collection took place once a fortnight in three sub-districts, daily in one sub-district, and once a week from all houses in the remaining districts. The fortnightly collection was to be altered. The refuse is taken to shoots, chiefly to one situated at Wickham-lane. Small quantities were also being taken to shoots within 800 yards of inhabited houses. This has now ceased. Lee district—Lee and Kidbrooke parish.—The collection of the household refuse in these parishes is carried out by the sanitary authority, every house being called at once in each week on fixed days. The collection is made by carts provided with tarpaulin covers, the refuse is taken to shoots at Horn-park Farm and to Southbrook-road. The former of these is far removed from any houses; the latter is situated at the side of the South Eastern Railway and between 200 to 300 yards from houses. It is stated that the question of the disposal of house refuse in the district is at present under the consideration of the authority with a view to the adoption of some other method. Charlton.—Collection by contract, once a week in some parts of the parish, in others once a fortnight. A list is kept of householders who have applied for a regular weekly removal, and these houses are called at once in each week, in other cases it is not customary to call unless some indication is given. The dust carts are provided with tarpaulin covers. The refuse is taken to a shoot at the disused brickfields on the north side of Shooter's-hill near Marlborough-lane. It is stated that this shoot has no inhabited houses within 300 yards. A small amount has also been taken to the marsh land adjoining Anchor and Hope-lane, East Greenwich, and used for agricultural purposes. Eltham.—The sanitary authority contract for a weekly removal of house refuse from all premises. Uncovered carts are used, and the refuse is taken to market gardens outside the County of London. C. W. F. Young. Assistant Medical Officer of Health. Appendix V. London County Council Public Health Department, Spring Gardens, S.W. 1st February, 1894. Report of the Medical Officer on the Sanitary Condition of Bakehouses. (Printed by order of the Public Health and Housing Committee.) In the development of legislation with regard to factories and workshops, the bakehouse has been usually regarded as a thing apart and dealt with on special lines. An enquiry into the condition of bakehouses and into the manner in which the bread-making industry was conducted, instituted by the Home Office in 1862, resulted in the passing in the following year of the Bakehouse Regulation Act of 1863. This Act dealt with two matters, the sanitary condition of the bakehouse and the regulation of the employment therein of persons under 18 years of age. The duty of enforcing both classes of provision was vested in the local sanitary authorities. The bakehouse was thus cut adrift from the legislation dealing with factories and workshops and on the passing of further acts in 1864, 1867 and 1871 amending this legislation it still remained excluded from the scope of the general law. The Royal Commission appointed in 1875 to enquire into the working of the Factory and Workshop Acts, reported that it was " only here and there that any active steps had been taken by the local authorities to carry out the provisions of the Bakehouse Act." The Commissioners go on to state " we by no means recommend that the local authorities should be relieved of their general duties in respect of the sanitary supervision of bakehouses, which, on the contrary, we trust, will in future be more effectually administered." On the passing of the Factory and Workshop Act of 1878, however, the Bakehouse Regulation Act was repealed, and the duty of regulating the sanitary condition of bakehouses was transferred from the local authority to the inspectors of factories. It soon became apparent that whatever the defects of the old system might have been, the new one was unworkable. It was a physical impossibility that the limited staff of Home Office inspectors should be able to deal in an adequate manner with the large number of retail bakehouses existing throughout the country. It was, of course, still more impossible for that staff" to institute any thorough inspection of workshops. In the case of the bakehouse a fresh departure was made by the passing of the Factory and Workshops Act of 1883. This Act extended the power of regulating the sanitary condition of bakehouses and provided that " the medical officer of health of the local authority shall have and exercise all such powers of entry, inspection, taking legal proceedings and otherwise, as a factory inspector under the Factory and Workshop Act, 1878. The medical officer of health of the local authority thus became directly responsible for the sanitary condition of bakehouses in 1883. Section 26 of the Public Health (London) Act, 1891, however, repeals this enactment and makes it the duty of the sanitary authority to enforce the provisions of the Factory and Workshop Acts of 1878 and 1883. The Factory and Workshop Act of 1891 makes the local authority responsible for the sanitary condition of workshops generally. It thus appears that bakehouses have for ten years derived the advantage of being under local supervision, which is now being extended in larger degree to ordinary workshops. It is only to be anticipated that as far as the provisions of the existing law are concerned the bakehouse should be at the present time in a more satisfactory condition than the ordinary workshop. A reference to the annual reports of London medical officers of health for the years 1890 and 1891 bears out this anticipation. In the case of 35 districts, special mention is made of bakehouses, the usual comments being that they have been systematically inspected and found to be in a fairly satisfactory condition. In one instance, that of Fulham, the medical officer of health expresses great dissatisfaction, and intimates that a number of instances of non-compliance with existing requirements were discovered. The necessary steps to enforce the provisions of the law were taken. The medical officer of health of St. George's, Hanover-square, states it to be his opinion that legislation is necessary to compel the closing of all bakehouses that are situated in underground rooms. In the case of five districts no mention is made of bakehouses in the annual reports for 1890 and 1891. The medical officer of health of St. George-the-Martyr, Southwark, presented to his authority in April of last year a special report on bakehouses in his district, in which he called attention to the undesirability of underground rooms being used as bakehouses. He said " efficient ventilation is impossible in these cellars," and he alluded to certain underground bakehouses in his district in which flooding had occurred during times of heavy rain. He concluded that a clause should be inserted in the Factory and Workshop Act, forbidding the use in the future after a certain fixed date of all underground No. 163.—Price 2d. Sold by Edward Stanford, 26 and 27, Cockspur-atreet, S.W. [10112-1716 % 2 bakehouses not previously in use as such. He moreover advocated the compulsory registration and annual licensing of all bakehouses. The medical officer of health of St. Marylebone also called attention to the subject of bakehouses in the course of last year, and caused a special inspection of the bakehouses in his district to be made. On referring to the annual reports of medical officers of health for 1892, specific mention of bakehouses will be found in most instances. In the majority of cases the statement is made that the bakehouses have been regularly inspected, and in many of the reports a list of the bakehouses in the district is given. The medical officer of health of St. George, Hanover-square, again states it to be his opinion that legislation is necessary to compel the closing of all bakehouses that are situated in underground rooms. The medical officer of health of St. Pancras alludes to the extreme difficulty of cleansing and ventilating underground bakehouses. The medical officer of health of Holborn discusses the question of watercloset accommodation for workers in bakehouses. The reports of the medical officers of health of Shoreditch and Bethnal-green are highly condemnatory. In the former it is stated that only 30 bakehouses out of a total of 104 are satisfactory, while in the latter only 7 were found satisfactory out of a total of 102. The medical officer of health of Bethnal-green writes, " I am afraid the bakehouses are not sufficiently well looked after. They require frequent inspection, and should be visited at least four or five times a year, but your present staff of inspectors are too fully occupied to devote sufficient time to them, and I think that the appointment of a workshop inspector as recommended by the Sanitary Committee should be at once proceeded with." Before detailing the results of an inspection of bakehouses in London, which has recently been made by Dr. Hamer and Dr. Young on behalf of the Council, it may be well to briefly indicate the nature of the requirements of the existing law with respect to the sanitary condition of bakehouses. The statutory enactment regulating the sanitary condition of retail bakehouses in London, that is to say, of places " in which are baked bread, biscuits or confectionery, from the baking or selling of " which a profit is derived," may be considered under two headings, viz.— (a) Enactments peculiar to bakehouses. (b) Enactments applicable to bakehouses in common with other workshops. These are to be found in the Factory and Workshop Acts of 1878 and 1883, and in the Public Health (London), Act, 1891. (a) Enactments peculiar to bakehouses. The Factory and Workshop Act, 1878. Section 34 provides that the inside walls of every bakehouse shall either be painted or varnished or be limewashed. If paint or varnish be used, it must be renewed every seven years, and be cleansed every six months; limewashing must be renewed every six months. Section 35 prohibits the use as a sleeping place, of any place on the same level as the bakehouse, and forming part of the same building, unless it be effectually separated from the bakehouse, and has adequate external ventilation. The Factory and Workshop Act, 1883. The provisions contained in section 15 of this Act apply only to bakehouses newly occupied after June 1st, 1883. Section 15 provides that—(i.) No water-closet shall be within, or communicate directly with the bakehouse—(ii.) The cistern supplying water to the bakehouse shall be distinct from the cistern supplying a water-closet—(iii.) No drain or pipe carrying off faecal or sewage matter shall have an opening within the bakehouse. Section 16 authorises a court of Summary Jurisdiction to impose a fine not exceeding forty shillings if satisfied that any room or place used as a bakehouse (whether the same was or was not so used before the passing of this Act) is in such a state as to be on sanitary grounds unfit for use. The Public Health (London), Act, 1891, section 26, enacts that the above sections in the Factory and Workshop Acts shall be enforced by the sanitary authority of the district in which the bakehouse is situate. (b) Enactments applicable to bakehouses in common with other workshops. A bakehouse being a workshop is subject to the provisions of the Public Health (London) Act, 1891, relating to such premises. Section 2 (9) provides that any workshop—(i.) Not kept in a cleanly state and free from effluvia arising from any drain, privy, earth-closet, water-closet, urinal or other nuisance—(ii.) Not properly ventilated—(iii.) So overcrowded during worktime as to be injurious or dangerous to the workers—shall be a nuisance liable to be dealt with summarily under the Act. Section 38 requires that every workshop shall be provided with sufficient and suitable accommodation in the way of sanitary conveniences. In order to ascertain the conditions existing in London bakehouses, inspection has been made by Dr. Hamer and Dr. Young of these premises in several sanitary districts. Altogether 200 bakehouses have been visited, some being situated in the central and more crowded, others in the outer districts ; the results obtained therefore may be taken as fairly representing the state of things to be found in London bakehouses generally. They found that in 118 instances the bakehouses were situated below the ground level, or partially so, many being practically the cellars underneath the baker's shop. In several cases the lighting and ventilation of these was quite inadequate, and this remark especially applies to the lighting of the bakehouses by natural means. It may be said in reference to this matter that since a great part of the work of bread making is carried on late at night and during the early hours of the morning, when artificial light is necessary under any circumstances, the question of natural lighting loses much of its significance, it must be borne in mind, however, that at many bakehouses, confectionery is also made, and work goes on during the daytime as well as at night, and that at bakeries where bread only is baked, the hours of work range from 11 p.m. to 12 noon or 1 p.m. The necessity of ample natural light for the purpose of maintenance of cleanliness is of course obvious. As regards ventilation, it was found during the inspection that in 28 bakehouses the provision for this purpose was quite insufficient, and with four exceptions these were all underground bakehouses. 3 In 63 instances the ventilation was good, this number including 22 bakehouses situated underground or partially so. In the remaining 109 premises the means of ventilation were considered fairly adequate. Everything, of course, depends upon the standard adopted, but the terms used serve for the purpose of comparing underground bakehouses with those situated on the ground level, so far as the question of ventilation is concerned. This comparison may be stated thus— Means of ventilation. Out of 118 bakehouses below the ground level. Out of 82 bakehouses on ground level. Good Fair Bad 18 per cent. 61 „ 20 „ 50 per cent. 45 „ 5 „ There is no doubt that it is more difficult to adequately ventilate a room situated partially or entirely under the level of the surrounding ground than one situated on the ground level, and especially so when the room used is really the cellar underneath the shop. Although the high temperature of a bakehouse during the time that baking is going on is conducive to great interchange of air, any advantage which might be derived in this way is lost, as owing to the very general opinion found to exist among bakers that all draughts must be guarded against during the time that fermentation is in progress lest the whole batch of bread be spoilt, windows and other openings into the external air are kept closed during work. Indeed, in the case of many of these basement rooms, owing to their small size and low ceilings, adequate ventilation is practically impossible without creating a draught. In a certain number of cases the temperatures of the bakehouses were observed. These ranged from 65° Fall, in a bakehouse where work had ceased some two or three hours previously, to 102° Fah. in one case where a batch of bread was being drawn at the time of visit. The latter temperature occurred in a small and badly ventilated underground bakehouse, and appears to be exceptional; in the majority of cases the range of temperature was between 72°—88° Fah. No evidence was obtained during the inspection that overcrowding takes place in bakeries. The condition in which the bakehouses were found, as regards the general state of repair and cleanliness, is evidence that the supervision of the sanitary authorities is, generally speaking, attended with good results. In twenty-nine cases out of the total number visited the premises were in a dirty condition, this being due in some cases to a disregard of cleanliness in the conduct of the business, and was most marked in bakehouses where confectionery was also made ; in others this condition was due to insufficient limewashing and cleansing of the walls and ceilings. At some of the bakeries which were kept in a cleanly condition, small accumulations of dry flour, &c., were noticed under the troughs; these, however, were evidently not the collections of any long period, and in most cases it was stated that this refuse was regularly removed twice or three times a week; this habit of permitting accumulations is very undesirable, as it encourages vermin. In some instances the paving of the bakehouse was uneven or defective, or entirely absent underneath the flour trough. Water-closets were found within or communicating directly with the bakehouse in four cases, and in six cases the position in relation to the bakehouse was objectionable. In two instances the water for the use of the bakehouse was obtained from the the cistern supplying the water-closet. Section 15 (iii) of the Factory and Workshop Act, 1883, enacts that "no drain or pipe for carrying off faecal or sewage matter shall have an opening within a bakehouse ; " this requirement applies only to bakehouses occupied newly since June 1st, 1883. During the inspection 37 bakeries were found to have an inlet which was not aerially disconnected from the drains, though with the exception of nine all were provided with proper traps. In the underground bakehouses, situated in the low lying districts which were visited, attention was specially directed to the question of flooding of the bakehouse from the drains during times of storm. Information was obtained of this occurrence at five premises. At one of these flooding occurred a year ago, at another flooding occurred three times in five years, a third was flooded three years ago during a storm, a fourth was flooded some years ago, and is still liable to suffer during storm, but the occurrence is prevented by fixing a plug in the drain; at another bakehouse the trap in the yard outside, and on the same level as the bakehouse, was forced during a storm 12 months ago, and this had occurred four times in 15 years. It may be well now to consider the nature of the indirect evidence pointing to the conclusion that there is need of improvement in the sanitary condition of bakehouses. Such evidence would naturally be expected to be considered under two heads— (a) The peculiarities of the occupation as affecting the health of the bakers. (c) The liability of the bread to contamination. The subject of the vital statistics of bakers is not one upon which it is possible with our present knowledge to express any very decided opinions. Dr. Arlidge in his work entitled The Diseases of Occupations enumerates the unhealthy influences to which the baker is exposed as follows— " Exposure to heat from ovens, dust, steam, variations of temperature, in too many instances unhealthy bakehouses, fatiguing movements necessitated where kneading is done by hand, disagreeable emanations from materials used, prolonged hours of work, more or less night-work and loss of rest." He concludes that there are " many incidents in the occupation of baking which reduce vital energy, predispose to lung affections and shorten life," but comments upon the discrepancies noticeable in the vital statistics of bakers compiled by different authors, and suggests that this may be in part due to the disturbing effect produced on the results by change of occupation. 4 Dr. Ogle's figures with respect to comparative mortality in various occupations are given in the supplement to the 45th annual report of the Registrar General. The calculations were made from deaths registered during 1880-1-2 (prior that is to say to the passing of the Bakehouse Regulation Act of 1883.) The comparative mortality figure is given for each occupation, the mortality among all males being taken as 1,000 and reference made to it as a standard. One hundred different headings are dealt with in all, and in 37 of these the comparative mortality figure exceeds, while in 62 it falls short of 1,000. The comparative mortality figure of the baker and confectioner stands at 958, and it may be noted that while he compares unfavourably with the grocer and with the shop keepers as a whole he compares favourably with the cheesemonger milk or butterman, the greengrocer and fruiterer, the fishmonger and poulterer, and the butcher. Dr. Ogle has moreover attempted to ascertain what is the comparative mortality in the several industries from each separate disease or group of diseases, and with this intention has abstracted from the registers a considerable sample of the causes of deaths in certain industries, and has divided out the total mortality in the industry ascribed to the several causes in the proportions existing in the sample. In basing conclusions upon the results so obtained, it must not be forgotten that the total number of deaths dealt with varies in the different occupations. The number of deaths of bakers and confectioners so divided out is 629, and while this number is sufficiently large to base general conclusions upon, it is sufficiently small to render it inadvisable to attach great importance to small variations in the figures. The following table is an abstract of Dr. Ogle's table. (Table L, Comparative Mortality of Males 25-65 years of age, in different industries; from all and several causes.) Diseases of Nervous System. Suicide. Diseases of Circulatory System. Phthisis Diseases of Respiratory System. Diseases of Urinary System. Liver Diseases. Other Diseases of the Digestive System. Alcholism. Gout. Plumbism. Accident. All other Causes. All Causes. (Comp. Mort. Figure.) All Males 119 14 120 220 182 41 39 38 10 3 1 67 146 1,000 Baker and Confectioner 136 26 131 212 186 40 46 26 15 2 — 21 117 958 Grocer 107 17 107 167 116 48 52 31 10 2 — 14 100 771 Butcher 139 23 132 261 208 55 96 33 23 5 35 160 1,170 Dr. Ogle remarks with reference to bakers and confectioners, that the death rates" have not altered materially since the previous record; they are still rather high though far short of those of butchers." Again he says " There is some indication in the table of Mortality by Causes, Table L, of abuse of alcoholic drinks by bakers ; for the mortality in this trade directly ascribed to alcohol is high, and that ascribed to suicide very high, while the mortality from liver disease is also somewhat above the average. In spite of the high temperature in which bakers work, and the inhalation of flour dust that their craft entails, their mortality from phthisis and from diseases of the respiratory organs hardly departs from the average for all males." Dr. Ogle again returns to the subject of phthisis among bakers in dealing with the " Influence of Dust " (page lix. of the report already quoted). He shows (Table O) that the bakers occupation, though constrasting favourably in respect of phthisis and diseases of the respiratory organs with the majority of dust-inhaling occupations, constrasts unfavourably with carpenters and coal miners. The excess of deaths of bakers from phthisis over those of carpenters is very small, but from diseases of the respiratory organs greater, and he observes that it may be doubted whether the higher mortality of bakers as compared with carpenters from diseases of the respiratory organs is due to the flour dust so much as to the heated atmosphere of the bakehouse. Dr. Arlidge in the work already referred to disputes the accuracy of the assumption that flour dust is innocuous, and says there is ample evidence of flour entering the pulmonary tissue and setting up chest affections ; he admits, however, that the exposure of bakers to flour dust " is neither considerable in extent nor long in duration." I am indebted to Mr. S. N. Fox for the privilege of being permitted to see the advance sheets of an interesting article on the statistics of operative bakers, which he has contributed to the Economic Journal, and which will shortly appear. Mr. Fox contends that two circumstances deserve to be taken into account in estimating the value of Dr. Ogle's statistics of the mortality of bakers, the one that confectioners are included with bakers, the other that master bakers are included with journeymen bakers; the former of these is important because the hours and conditions of work of confectioners are very different from those of bakers proper, the latter because the master bakers, except in East London, do not as a rule share in the labour of the journeymen, and are not therefore exposed to the same unhealthy conditions. Mr. Fox has been able to use the records belonging to the Amalgamated Union of Operative Bakers and Confectioners. Of this union only five per cent. are confectioners, and only working bakers are admitted as benefit members. Mr. Fox extracted from these records the deaths which occurred among the members of the society during the three years, July 1890, to July 1893, and found that of 131 deaths occurring between 25 and 65 years of age, phthisis caused 32, and bronchitis and pneumonia 48 deaths. The number of members at this age is not shown, and the death rates from these causes cannot therefore be given, but Mr. Fox points out that the deaths from phthisis constituted 24 per cent., and those from bronchitis and pneumonia 36'6 per cent. of the total deaths. 5 In the decade 1881-90 these diseases caused respectively 26 9 per cent. and 15.3 per cent. of the deaths of London males at these ages, showing, so far as this method of dealing with the subject can show, an excessive tendency of bakers to die of pneumonia and bronchitis. It seems then that such figures as are available raise some suspicion that the occupation of a baker is attended with certain dangers to health, but the statistics collected do not deal with a very large number of deaths. With regard to contamination of bread it may be at once said that there is at present no evidence pointing to the transmission of infectious disease by the consumption of this article of diets such as exists in the case of water and milk. It is none the less desirable that in a bakehouse there should be scrupulous attention to cleanliness and wholesomeness of surroundings, and there is occasionally evidence of a lack of such attention in London bakehouses. Even in the best conducted and most cleanly places, kneading by hand necessarily implies a certain amount of organic pollution, and there can be no doubt that this source of contamination far outweighs in degree all others. Hand kneading is, it is said, being fast replaced by machinery, and as Dr. Arlidge observes, " the whole details of bread and biscuit making are being rapidly metamorphosed by this agency to the sanitary gain of bakers, and to the advantage of cleanliness." It now remains to consider whether the present law relating to bakehouses is adequate for ensuring that the sanitary condition of these premises is satisfactory both as regards the health of the workers and the manufacture of bread. The number of bakehouses situated either underground or partially so indicates that this situation is found especially convenient by the trade, probably on account of the comparatively large amount of room required. The inspection has however shown that a proportion of these (20%) owing to inadequate ventilation cannot be considered to be in a proper sanitary condition. In view of the fact that even 18 per cent, of the underground bakehouses were found to be well ventilated it is obvious there can be no general prohibition on the score of ventilation of bakehouses thus situated. It may be urged however, that inasmuch as it is a frequent custom to convert underground rooms into bakehouses, that this custom is largely responsible for the existence of ill-ventilated bakehouses, and that section 16 of the Factory and Workshops Act of 1883 provides an insufficient power of control, more restriction should be placed on the use of premises which never can be made to meet the proper requirements of a bakehouse. Any provision which would lead to the creation in a London district of bakehouses of greater excellence from a hygienic point of view would undoubtedly have the eflect of raising the standard by which other bakehouse premises would be judged for the purposes of section 16 of the Act of 1883, and the requirement of a higher standard than at present for new bakehouses would thus indirectly lead to the improvement of existing premises. I think, therefore, the course which suggests itself at the present time is the provision of a power to require that all premises hereafter brought into use as bakehouses shall, before these premises are used, comply with regulations relating to the structure and position, the lighting and the ventilation, including air space, and the cleansing, drainage, and water supply of the premises. It would, no doubt, be a distinct advantage if the sections of the Act of 1883, as to the exclusion from a bakehouse of any privy or ashpit, or any inlet connected with a drain or sewer, and the provision of a water supply from a cistern separate and distinct from the cistern which supplies the watercloset were applicable, not only to bakehouses newly occupied since 1883, but to all bakehouses. The provision that there shall be no inlet connected with a drain or sewer, if enforced, would prevent the risk of flooding in underground bakehouses in low-lying districts which now exists to a small extent. This question of flooding, however, is not of importance in respect to bakehouses only, but raises question as to the sufficiency of sewerage and as to the need of control of the levels of basements which are drained into sewers. Apart from the alterations which might be affected in the condition of London bakehouses by the amendment of the present law on the lines indicated, other needed improvements in their condition are such as depend on their regular inspection, and the enforcement of existing provisions by the sanitary authorities. Shirley F. Murphy, Medical Officer of Health Appendix VI. London County Council. Public Health Department, Spring Gardens, S.W. 12th December, 1894. DISINFECTION AND DESTRUCTION OF INFECTED ARTICLES. Report by the Medical Officer of Health of the Administrative County of London on the provisions which have been made in the several districts of the county for disinfection and destruction of infected articles, and for the shelter of persons during the disinfection of their homes. The Public Health (London) Act, Section 59, requires " that every sanitary authority shall pro" vide either within or without their district, proper premises with all necessary apparatus and attendance " for the destruction and for the disinfection, and carriages or vessels for the removal of articles " (whether bedding, clothing, or other) which have become infected by any dangerous infectious disease, " and may provide the same for the destruction, disinfection, and removal of such articles when infected " by any other disease; and shall cause any such articles brought for destruction or disinfection, " whether alleged to be infectcd by any dangerous infectious disease or by any other disease, to be " destroyed or to be disinfected and returned, and may remove, and may destroy, or disinfect and return " such articles free of charge." " Any sanitary authorities may execute their duty under this section by combining for the pur" poses thereof, or by contracting for the use by one of the contracting authorities of any premises " provided for the purpose of this section by another of such contracting authorities, and may so combine " or contract upon such terms as may be agreed upon." I now present a return which is based upon information supplied by medical officers of health in London, and which shows the provisions which the London Sanitary Authorities have made in pursuance of this section or of the optional power which was conferred upon them by the Sanitary Act of 1866. Apparatus for disinfection. The return shows that twenty-two sanitary authorities have provided themselves with disinfecting apparatus, in which disinfection is effected by steam; eight authorities possess apparatus in which disinfection is effected by dry heat; nine authorities arrange with a contractor. The return also shows that in several instances authorities have ordered or have under consideration the replacement of existing disinfecting ovens by apparatus in which steam is used. The districts provided with steam apparatus are— 1. Chelsea. 18. Whitechapel. 2. St. George's, Hanover-square. 14. Mile End Old Town. 8. Westminster. 15. St. George-the-Martyr. 4. St. James, Westminster. 16. Bermondsey. 5. Hampstead. 17. Lambeth. 6. St. Pancras. 18. Camberwell. 7. Islington. 19. Greenwich— 8. Hackney. Greenwich. 9. St. Giles. Deptford. 10. Strand. 20. Lewisham. 11. Shoreditch. 21. Woolwich. 12. Bethnal-green. 22. Plumstead. The districts provided with dry-heat apparatus are— 1. Hammersmith. 6. Poplar— 2. St. Maryleboue. Poplar and Bromley. 8. Clerkenwell. Bow. 4. St. Luke. 7. St. Saviour. 5. Limehouse. 8. Newington. The districts which have not made any provision of their own, but which depend on the services of a contractor, are— 1. Paddington (steam). 5. St. Martin-in-the-Fields (steam). 2. Kensington (dry-heat principally used. 6. Holborn (steam). Super-heated steam when beds are 7. Rotherhithe (steam). in a foul condition). 8. Battersea (steam). 3. Fulham (steam). 9. Wandsworth (steam). 4. Stoke Newington (dry heat). The sanitary authority of St. Olave makes use of the steam disinfector at Guy's hospital; the sanitary authority of St. George-in-the-East is still, as noted in my previous report, unprovided with a disinfecting apparatus. Two of the parishes belonging to the Lee district (Lee and Eltham) make use of the steam disinfecting apparatus at Plumstead ; the third parish, Charlton, destroys instead of disinfecting articles. In my previous report, dated April, 1893, I pointed out that disinfection by dry-heat is a much less satisfactory procedure than disinfection by steam, and I expressed the opinion that " sanitary Sold by Edward Stanford, 26 and 27, Cockspur-street, Charing-cross, S.W No. 214.—Price 3d. [2530 2 authorities should not now be satisfied with dry-heat apparatus, and where this means of disinfection exists it should be replaced by proper and efficient steam apparatus." The number of districts provided with steam apparatus has increased from 16 in April last to 22 at the present time. It is worthy of observation that nine authorities still arrange with a contractor for the disinfection of infected articles. I have no reason for thinking that the work of disinfection is not now as carefully and thoroughly done under these arrangements as if the disinfection were performed by the authorities themselves, but I do not regard it as entirely satisfactory as a principle that this duty should be in other hands than those of the sanitary authority. It is obvious that the difficulty of finding suitable sites for the erection of disinfecting apparatus is considerable in central districts of London, and that there would be economy if districts were to combine in the manner provided by section 59 (2) of the Public Health (London) Act. There would, moreover, be advantage if in connection with the machinery for disinfection a laundry were provided where articles which can be boiled could be thus treated and returned in a clean condition to their owners. In the new disinfecting station erected by the Vestry of Islington a laundry is provided. Apparatus for destruction. The following statement shows the existing arrangements for the destruction as distinguished from the disinfection of infected articles— Kensington By contract. HammersmithBurnt in a heap on the ground at the vestry's wharf after being saturated with paraffin. Fulham By contractor, who has a cremator erected for the purpose. Paddington By contractor. Chelsea Burnt, after soaking the goods in paraffin, at one of the vestry's wharves. No special apparatus. St. George, Hanover-square Burnt in a destructor erected at a cost of £170. The fumes from the burning material before escaping pass through the furnace of the disinfector. Westminster (St. Margaret and Provision is made for destruction as distinguished from disinSt. John) fection of infected articles. St. James, Westminster When occasion requires, bedding is burnt in the large furnaces for the steam boilers at the baths and washhouses. Marylebone No special appliance. Hampstead Bedding, clothing, &c., burnt in the dust destructor when necessary. St. Pancras Destroyed in a furnace which adjoins the disinfecting apparatus. Islington A furnace has been erected at the new disinfecting station. Hackney Stoke Newington St. Giles Removed by contractor in covered vans and burnt in a destructor. St. Martin-in-the-Fields By contractor who has a cremator erected for the purpose. Strand A destructor has been in use since 1885. Holborn Sent to contractor. Clerkenwell Occasionally burnt in the wharf in Commercial-road. St. Luke An apparatus has been erected for the purpose of destroying any old, dirty and infected articles. Shoreditch Burnt in a destructor which is under the same roof as the disinfector. Bethnal-green Burnt at the stone-yard after being saturated with paraffin. No special apparatus. Whitechapel Burnt in the dust destructor. St. George-in-the-East No special apparatus. Limehouse No provision made for destruction at present. Mile End Old Town Burnt in a destructor. Poplar— Poplar and Bromley Burnt in the open air on land adjoining the disinfecting apparatus. No special apparatus. Bow St. Saviour, Southwark Burnt in an open stove in the yard after being subjected for some hours to temperature of 280° F. in the disinfecting oven. St. George, Southwark Burnt in the furnace of disinfector. Medical officer of health is not satisfied with this arrangement, and points out the need for a proper incinerator. Newington An incinerator is being constructed. St. Olave Burnt in a furnace at St. Olave's wharf, Shad Thames. Bermondsey Rotherhithe Mode of destruction left to sanitary inspector to determine. Lambeth Burnt in a furnace in the stone-yard. Battersea Burnt in the dust destructor. Wandsworth Clapham possesses a special furnace in the stone-yard. Putney and Wandsworth have made no provision, but contractor for disinfection could destroy articles. In Streatham infected articles when of little value are burnt. 3 Camberwell A stove is employed for the purpose. Greenwich— Greenwich The sanitary authority are provided with a destructor as well as a disinfector. Deptford Burnt when necessary at the Board's yard. No special apparatus. Lewisham Woolwich Burnt in the dust destructor. Plumstead Burnt on the open ground near the river. Lee Accommodation for temporary shelter. Section 60 of the Public Health (London) Act requires every sanitary authority to provide, free of charge, temporary shelter or house accommodation with any necessary attendants for the members of any family in which any dangerous infectious disease has appeared, who have been compelled to leave their dwellings, for the purpose of enabling such dwellings to be disinfected by the sanitary authority. It will be seen by reference to the return, that this provision has not yet been made in every district. In April, 1893, I gave account of the character of the provision which had already been made in thirteen districts. The shelter provided in St. Saviour Southwark, is no longer available, and the authority is seeking for accommodation elsewhere. The Vestry of St. Luke has discontinued an arrangement made to share the use of the Clerkenwell shelter. On the other hand nine authorities who had not provided shelters in 1893 have now done so. The following statement shows the nature of the accommodation which has been afforded in different districts— 1. St. George, Hanover-square The shelter consists of a basement with two rooms and a water-closet in the yard. It is provided with a fireplace, chairs, bedstead, and crockery. There is no special attendant. It has been in existence since February, 1893, and has been used ten times. It is said that difficulty is experienced in inducing people to use the accommodation. 2. Westminster (St. Margaret Five rooms, with one bed in each, have been provided in and St. John) connection with the new mortuary and coroner's court. There is moreover a bath-room with hot and cold water services laid on. 3. St. James, Westminster 6, Dufours-place. A house adjoining the vestry's stone-yard has been fitted up for use as a shelter. There are two rooms, sitting-room and bedroom, on the second floor, and there is similar accommodation on the third floor. There are two water-closets. No bath is provided. There is a resident caretaker, and crockery and cooking utensils are available for the use of persons coming into the shelter. A few families have already been accommodated there. 4. Marylebone At present a house in Orcus-street, Lisson-grove, is used temporarily until the erection of a shelter which has been sanctioned by the vestry, and which will provide accommodation for at least four families. 5. Hampstead A two-storey two-roomed house has been provided in the stone-yard, Lithos-road. The ground floor and upper floor are approached by separate entrances, and each has a water-closet in connection with it. Each room is furnished with a fireplace, a table, chairs and crockery. This shelter is in the care of the man in charge of the 6tone-yard. 6. St. Pancras Situated at Cambridge-street; four rooms on first floor of a ing the ground floor of which is used as a coach-bouse for the disinfecting vans. These four rooms are approached by a singlo staircase, adjoining each room is a bath-room with hot and cold water laid on. The rooms are furnished, but there are no beds. Crockery and cooking utensils are provided. There are two water-closets. The shelter has been used by sixty or seventy persons, but great reluctance to go there is manifested by the inhabitants. 7. Islington The shelter house (Seven-sisters-road) adjoins the new disinfecting station. It consists of four two-roomed tenements, each provided with a bath-room and watercloset. There is a separate approach to each set of tenements. The rooms are now being furnished, beds, bedding, crockery, &c., will be provided. The caretaker's rooms are situated between the shelter-house and the disinfecting-station. 4 8. Strand No. 3, Little Chapel-street, Wardour-street, has been taken on lease by the Board, and is occupied by one of the sanitary inspectors', rooms being set apart for use as a shelter. On the first floor is a sitting-room with an adjoining lavatory. On the second floor are two bedrooms, each containing two beds. The rooms have not as yet been used. 9. Clerkenwell A three-storey six-roomed house has been provided. It has one water-closet. The rooms are furnished with fireplaces, chairs and crockery, and in one ground floor room there are two beds for children to lie down on. The caretaker lives next door. This accommodation has been in existence three years, and has been used ten times. Difficulty is experienced in inducing people to avail themselves of it. This accommodation is shared by Holborn, the Charterhouse, Staple and Furnival's Inns. 10. Shoreditch No. 18, Branch-place, a house fronting the canal and with good yard space at the rear. On the second floor is a furnished room. The second floor back is not furnished. On the first floor are a sitting-room and a bedroom, both furnished. On the ground floor are the caretaker's-room and a furnished bedroom. Beds and bedding, washing utensils, crockery, knives, forks, &c., are provided. Every room is disinfected after it is used. Since it was opened forty-three persons have been accommodated in the shelter, in some instances people have remained there for two or three days. The place has mainly been made use of in cases of small-pox. 11. St. George-in-the-East A two-storey four-roomed house has been provided. The house has a back yard, in which is situated the watercloset. Each room is furnished with a fireplace, chairs and crockery. The gardener of an open space adjoining is the only available attendant. 12. Limehouse A three-storey house, No. 82, High-street, Shadwell, has been provided; there is a resident caretaker. The first and second floor front rooms are furnished with couch, chairs and washhand-stand ; crockery is provided. The caretaker lives in the ground floor front room. The shelter has hitherto only been used on two occasions, and there is considerable difficulty in inducing people to avail themselves of the accommodation. 13. Mile End Old Town A house, No. 47, Globe-road, has been furnished as a shelter. There are three rooms; beds, bedding, crockery, &c., are provided ; there is a resident caretaker. The shelter is said to be used on an average about once a week. 14. St. Olave Three cottages (Nos. 2, 3 and 4, New Cottage-row) have been acquired by the Board for use as a shelter. New Cottagerow is a narrow court adjoining, and entered from Parishstreet. It consists of four two-storey cottages; No. 1, is occupied by the caretaker of the shelter, No. 2, is furnished with beds, bedding, chairs and table ; cooking utensils, &c., are provided. Nos. 3 and 4 have not yet been furnished. Since the shelter was provided in December, 1893, it has been used by fifteen families, and it has proved specially useful in the case of persons occupying rooms in blocks of tenement dwellings. 15. Battersea A waiting room at the Municipal-buildings, Lavender-hill, is available for use as a shelter. It contains a fireplace, table and chairs. There is water-closet accommodation in connection with it. There is no bed, and no provision is made for cooking meals. It is not intended that the shelter shall be occupied at night time. No use has as yet been made of it. 16. Wandsworth— Putney One room has been provided at the vestry's new wharf on the Putney-embankment. The room is now furnished as a kitchen, and bed furniture has not yet been supplied. The house is now occupied by the clerk of the wharf. It has not yet been used as a shelter. Clapham One room furnished as a kitchen has been provided in a lean- to building at the vestry's stone-yard. No provision for sleeping has been made. 5 17. Greenwich A house, No. 86, East-street, has been provided for the whole district. It is partially fitted for use. A sitting-room and two bedrooms are available. There is no bath-room, and crockery, cooking utensils, &c., are not provided. There is a resident caretaker. 18. Woolwich A house has been provided containing five bedrooms (two furnished), a dining-room, a kitchen, and a bath-room. There are also in the house two rooms occupied by a caretaker. It is stated that people have no great aversion to going there. The house has been much used, the average stay in it being one night, but some persons have been there six nights. 19. Plumstead No. 38, The Slade, a two-storey detached house overlooking the common. One of the inspectors lives here, and two bedrooms and a sitting-room are furnished for use of persons requiring temporary shelter. Such persons have the use of the kitchen and of cooking appliances, and crockery, &c., is provided. In the bedrooms there is washing accommodation but there is no bath-room. There is one water-closet in the yard at rear. Eight families have used the house up to the present time. No one has stayed in the shelter more than one night. 20. Lee— Charlton One room has been provided in a lean-to building at the parish wharf. It is supplied with chairs and a table and a small gas-stove. No provision has been made for cooking or sleeping. It has only been used once since it was opened a year ago. It will be seen that somewhat different views have been taken by the several sanitary authorities who have provided a shelter as to the character of the accommodation which is required. In some instances this accommodation is provided for use by night, but in others only day accommodation has been considered necessary. The time occupied in the removal of infected articles to the disinfecting station, in their disinfection, and in their return, extends to several hours. The time occupied in the purification of the room, often the only room of the family, extends to many hours. It is obvious that the use of the shelter by night must be contemplated in any arrangements made ; provision, however, which would meet the necessities of the use of the dwelling-room at night has not in a number of instances been made. This is a consideration which undoubtedly deserves the attention of the sanitary authorities. The provision of baths is another consideration which should be borne in mind, for opportunities for personal cleanliness are especially necessary for those coming from infected houses. The opinion was frequently expressed during the enquiry that poor persons were unwilling to use the accommodation which has been provided. In connection with this difficulty it deserves to he pointed out that these people need the experience which time only can give; they will eventually find this accommodation meet their convenience, and I do not doubt that tbe use of shelters will grow from year to year. But it must be remembered that the expectation that the poor will avail themselves of these temporary homes must depend very largely upon the shelter being made reasonably attractive, as in the case of hospitals and mortuaries. Districts mentioned in Schedule C to the Metropolis Local Management Act, 1855. The tabular statement does not give account of the arrangements made in these districts in respect to disinfection, but it may be stated briefly that Lincoln's-inn makes use of the St. Giles disinfecting apparatus; the Inner Temple and the Middle Temple have arranged with the Commissioners of Sewers for the disinfection of infected articles; the Charterhouse, Staple-inn, and Furnival's-inn, included in the Holborn Union, use the dry-heat oven belonging to the guardians of that union; the Close of the Collegiate Church of St. Peter has arranged with a contractor; and Gray's-inn has left the arrangements to its medical officer of health. Shirley F. Murphy, Medical Officer of Health. 6 7 Return showing particulars of replies received from Medical Officers of Health as to the Method of Disinfection adopted in the several sanitary districts within the County of London. No. Parish or District. Whether Sanitary Authority has provided disinfecting oven. Where oven is situated. Whether disinfection effected by dry heat or steam. Manner in which dry heat is produced. Arrangements made where no oven has been provided. Whether any chemicals used in connection with the oven. Length of time feather bed of average size is retained in oven, and highest temperature in centre of bed. Arrangements made for removal of infected articles to and from oven. Method adopted for disinfecting houses. Disinfectant recommended for disinfection of excreta. Whether charge is made for disinfection. Whether shelter has been provided as required by Section 60 of the Public Health (London) Act, 1891. Diseases after which Authority carries out disinfection. Remarks. 1 Paddington No ... Bedding, carpets, and large woollen fabrics bysuperheated steam ... By contract with Messrs. Armfield of Battersea No ... WEST In waterproof bags and covered van, by Messrs. Armfield, who call daily at the Vestry at 11 a.m. The goods when purified and disinfected are returned to the owners in other vans DISTRICTS. Sulphurous acid gas Solution of 12¾ oz. zinc sulphate, 4½ oz. copper sulphate, 11/3 oz. manganese sulphate, to one gallon of water. Used without further addition of water for chamber purposes, and in proportion of 1 oz. to a pint of water Only occasionally No All notifiable diseases, except trifling cases of erysipelas Carbolic soap supplied gratuitously to poor for washing and cleansing purposes. Everything done by Messrs. Armfield is cleansed as well as disinfected, bedding being taken to pieces, purified, and re-made. 2 Kensington No ... 1. Dry heat principally used 2. Superheated steam when beds are in a foul condition Gas Disinfection carried out by a contractor No 4 to 5 hours. Feather bed 245° F., common mattress 232° F., hair mattress 237° F. Temperature in chamber ranges from 260 to 270° F. Necessary vehicles provided by contractor. Infected articles taken away in waterproof canvas bags. Disinfected articles taken back in separate and noninfected vehicles Sulphurous acid gas for drains Sulphate of iron, 1 lb. to 1 gallon of water recommended. But it is mainly left to discretion of medical man in attendance No No Smallpox, scarlet fever, diphtheria, continued fevers, cholera; and puerperal fever occasionally Articles disinfected are also cleansed. 3 Hammersmith Yes The Vestry's wharf, Chancellor's - road, Hammersmith Dry heat Furnace ... Sulphur 3 hours. Temperature of oven 250° F. Articles removed in an iron cart which is part of disinfecting apparatus; cart and contents being placed inside disinfector during process Sulphurous acid gas. Floors, &c., washed with carbolic acid solution Perchloride of mercury 1 in 5,000 No No. Clerk authorised to provide accommodation when occasion arises Smallpox, chicken - pox, scarlet fever, diphtheria, typhus, typhoid, erysipelas, continued fever, puerperal fever and cholera, also measles, when sanction can be obtained When requested clothes infected with pediculi corporis are disinfected. 4 Fulham No Steam ... By contract with Mr. Lacy of Fulham No 10-20 minutes; 250° F. ... ... ... Sulphurous acid gas. Floors, &c., washed with corrosive sublimate 1 in 960, whitewashing and repapering Condy's fluid 1 oz. to the pint No No Every disease enumerated in the Public Health (London) Act, 1891 Sec. 55, sub-sec. 8 The disinfection of houses is done by a separate officer, and if assistance is required a temporary officer is employed. 5 Chelsea Yes Lot's-road Steam (Washington Lyon) ... ... No 30-40 minutes 220°-250° F. Two vans supplied by Vestry, one for infected and one for disinfected articles Sulphurous acid gas by burning sulphur, or by use of liquified SO2 St. Bede disinfectant No No Rooms are disinfected, and bedding, clothing, &c., removed, for steam disinfection, after all notifiable diseases except erysipelas. 6 St. George, Hanover-square Yes Commercialroad, Pimlico Steam(Goddard, Massey and Warner) ... ... No 45 minutes; 248° F. Two vans, one for infected and one for disinfected articles Sulphurous acid gas. Scrubbing with carbolic soap and water. Removal and destruction of Alkalised gas creosote No Yes diseases except erysipelas. Smallpox, scarlet fever, diphtheria, membranous croup, enteric fever, erysipelas, puerperal fever, continued fever, typhus, relapsing fever, cholera 7 Westminster (St. Margaret and St. John) Yes Disinfecting station, Horseferry-road Steam ... ... ... 35 minutes; 240° F. Special vans ... wall papers. Sulphurous acid gas Left to discretion of medical man in attendance if case is treated at home No Yes Smallpox, cholera, diphtheria, membranous croup, scarlet fever, typhus, enteric, puerperal and continued fevers, and sometimes erysipelas. Fumigation has been carried out in many cases of measles 8 St. James, Westminster Yes Dufours - place, Broad - street, Golden-square Steam (Washington Lyon) No 2 hours Covered hand truck Sulphurous acid gas. Cylinders containing liquified S02 are employed Chloride of lime According to circumstances Yes All notifiable diseases, but not always in cases of erysipelas or diphtheria 8 9 Return of Replies from District Medical Officers of Health—continued. No. Parish or District. Whether Sanitary Authority has provided disinfecting oven. Where oven is situated. Whether disinfection effected by dry heat or steam. Manner in which dry heat is produced. Arrangements made where no oven has been provided. Whether any chemicals used in connection with the oven. Length of time feather bed of average size is retained in oven, and highest temperature in centre of bed. Arrangements made for removal of infected articles to and from oven. Method adopted for disinfecting houses. Disinfectant recommended for disinfection of excreta. Whether charge is made for disinfection. Whether shelter has been provided as required by Section 60 of the Public Health (London) Act, 1891. Diseases after which Authority carries out disinfection. Remarks. NORTH DISTRICTS. 9 St. Marylebone Yes The Stone-yard, Capland-street Dry heat Hotwater pressure pipes ... No 2-3 hours. Temperature of centre of beds not known Special men employed. Infected articles fumigated with liquified sulphurdioxide before removal in vestry's van to disinfecting apparatus Liquified sulphur dioxide Commercial carbolic acid 90-95 per cent. For drains 40-45 per cent. A charge is made only in cases of request for disinfeetion after nonnotifiable diseases Yes Notifiable diseases, except erysipelas. By request measles and influenza A new steam disinfector will be erected at the Stone-yard, Caplandstreet 10 Hampstead Yes Stone-yard, Lithos-road Steam (Washington Lyon) ... ... No About 1 hour Two carts, one for infected, one for disinfected articles Sulphurous acid gas, whitewashing and cleansing Carbolic acid, sulphate of iron for sewers No Yes, at Stoneyard. Accommodation for two families Smallpox, scarlet fever, diphtheria, typhoid, puerperal fever, by request measles, whooping cough, diarrhoea, rotheln 11 St. Paneras Yes Cambridge - st., N.W. Steam (Goddard, Massey and Warner) ... ... No Entire process ½ to 1 hour; 212° F. Two vans,one for infected and one for disinfected articles Sulphurous acid gas, stripping, cleansing. and whitewashing' Left to discretion of medical attendant, but alkalised gas creosote is left for cleansing No; except for special service at night Yes All notifiable diseases except erysipelas 12 Islington Two new ovens are nearly ready for use Seven - sisters'road Steam (Goddard. Massey and Warner) ... By contract with Messrs. Rood and Co., of Is1 i n g t o n, until the new disinfectors are read for use No Messrs. Rood provide covered carts. Vestry are providing covered vans Sulphurous acid gas, washing with carbolic acid, or solution of perchloride of mercury, stripping walls, repapering and white - washing walls and ceilings Carbolic acid or solution of perchloride of mercury No Yes Smallpox, cholera, diphtheria, scarlet fever, typhus, typhoid fever, continued fever, measles, membranous croup, and erysipelas The disinfecting station is also provided with a laundry and a crematory. 13 14 Hackney Stoke Newington Yes No Hackneymarshes ... Steam (Washington Lyon) Dry heat ... ... ... By contract witliMessrs. Rood and Co. No ... £ hour 3 hours; temperature of oven,220°F. Two hand-carts, one for infected, one for disinfected articles Two carts, one for infected and one for disinfected articles Sulphurous acid gas Sulphurous acid gas, stripping, cleansing, &c., when judged necessary Sanitas powder, carbolic acid solution 1 in 150 Perchloride of mercury No No No No Notifiable diseases. All notifiable diseases except erysipelas CENTRAL DISTRICTS. 15 St. Giles Yes Stone-yard, 197, High Holborn, YV.C. Steam (Washington Lyon) ... ... No 30 minutes; 265° F. Hand trucks Sulphurous acid gas Perchloride of mercury No No. In cases of emergency shelter will be provided in spare rooms at the public Notifiable diseases, except erysipelas and croup. When cases of erysipelas occur at the workhouse, the bedding there is disinfected 16 St. Martin-in the-Fields No ... Steam ... By contract with Mr. Lacy, of Fulham No 30 minutes; 250u F. A special zinc-lined van Sulphurous acid gas Calvert's carbolic powder 20 per cent. and Jeyes' fluid A small charge to those who can afford tuary An arrangement is in contemplation Smallpox, cholera, typhus, typhoid, scarlet fever, diphtheria, puerperal fever. 17 Strand Yes Denzell - street, Clare-market Both: Wasliington Lyon's steam and Fraser's dryair oven ... ... With the Fraser sulphur may be employed Lyon's, 1 hour; steam at 20 lbs. pressure being on for 20 mins; 250° F. Fraser's used for leather articles, books, &c. Air-tight iron cart for removing infected articles, separate truck to return them from oven Sulphurous acid gas and stripping walls Corrosive sublimate, Calvert's No. 5 carbolic acid and crude Sanitas. according to nature of case No Yes All notifiable diseases, and any others required. Cleansing is carried out after deaths from phthisis. 18 Holborn Yes, but useless for the purpose In Stone - yard at Town Hall, (used only for cases of itch) Steam used by Contractor By contract witliMessrs Armfield, of Battersea No About 1 hour; about 250° F. A preliminary fumigation with strong sulphurous acid gas before leaving house Sulphurous acid gas Carbolic acid and Jeyes' Fluid No At present share with Vestry of Clerkenwell the use of shelter in that trict Notifiable diseases and measles. 19 Clerkenwell Yes 49, Northampton-road Dry heat Gas .... No At least 4 hours; 250° F. or under 300° F. Sheet-iron truck Sulphurous acid gas 1 lb. of sulphur to every 300 cubic feet, all apertures being tightly closed Carbolic acid No Yes Notifiable diseases. 20 St. Luke" Yes Warwick-place, Whitecross street Dry heat Gas ... No 7 hours; temperature of oven,240° F. A covered van Sulphurous acid gas Carbolic acid solution and powder No No. Arrangement made for the use of Clerkenwell shelter was discontinued in September, 1893 Notifiable diseases Bedding, Ac., subjected to fumigation before removal. [2] 10 11 Return of Replies From District Medical Officers or Health—continued. No. Parish or District. Whether Sanitary Authority has provided disinfecting oven. Where oven is situated. Whether disinfection effected by dry heat or steam. Manner in which dry heat is produced. Arrangements made where no oven has been provided. Whether any chemicals used in connection with the oven. Length of time feather bed of average size is retained in oven, and highest temperature in centre of bed. Arrangements made for removal of infected articles to and from oven. Method adopted for disinfecting houses. Disinfectant recommended for disinfection of excreta. Whether charge is made for disinfection. Whether shelter has been provided as required by Section 60 of the Public Health (London) Act, 1891. Diseases after which Authority carries out disinfection. Remarks. EAST DISTRICTS. 21 Shoreditch Yes Town Hall, Oldstreet Steam (Goddard, Massey and Warner) ... ... No 40 minutes Two vans (one horse) one for infected and one for disinfected articles Sulphurous acid gas; whitewashing and washing with chloride of lime Left to discretion of medical attendant No Yes Notifiable diseases 22 Bethnal-green. Yes Vestry-yard, Digby-street Steam (Washington Lyon) ... ... No 1 hour Covered hand-carts Sulphurous acid gas Sanitas and perchloride of mercury No No Smallpox, scarlet fever, typhus, typhoid, diphtheria, cholera. 23 Whitechapel Yes Wentworthstreet and George - yard, Whitechapel Steam (Goddard, Massey and Warner) ... ... No 1 hour. Highest temperature probably 280° F. Two trucks are used; two men are employed to bring and return the articles Sulphurous acid gas and when deemed necessary solution of perchloride of mercury Calvert's carbolic powder,20 per cent, strength No Permanent provision is in process of arrangement, at present coroner's court room is available, if necessary Notifiable diseases. Measles in case of death and when other children are resident in the house. In deaths from choleraic diseases, Ac., and where articles are particularly dirty and offensive they are destroyed in the cremator. 24 St. George-inthe-East No ... ... ... A contemplated arrangement with District of Limehouse has fallen through ... ... ... Sulphur, walls stripped and washed with hot lime Carbolic acid, liq. sodae chlorinatse No Yes Smallpox, scarlet fever, diphtheria, typhoid, typhus, cholera, and membranous croup when supposed to be diphtheritic, and in other cases when recommended by the medical officer of health. 25 Limehouse Yes Little Johnstreet, Dorsetstreet, Commercial-road Dry heat Gas ... No 4 hours A hand box-truck is used to take infected articles to the oven, and another similar truck is used to take them home after disinfection Sulphur, stripping walls, and washing ceilings, paint and floors with disinfectants Carbolic acid No Yes Typhoid, typhus, d iphtheria, smallpox, scarlet fever, puerperal fever, simple continued fever and cholera. A Washington Lyon's steam disinfector has been ordered, and will shortly be erected in place of that now in use. 26 Mile End Old Town Yes Riga- wharf, Emmet-street Steam ... ... No 2 hours; 250° F. in centre of bed Two zinc-lined handcarts, one for infected, one for disinfected articles Sulphur Burnett's fluid No Yes Scarlet fever, typhoid, diphtheria, smallpox. 27 Poplar— Poplar and Bromley Yes Bickmore-street Dry heat Coke fire ... Sulphur 2-4 hours Iron truck Sulphur, chloronaphthalene, corrosive sublimate Chloro - naphthalene undiluted and carbolic acid iso No Smallpox, scarlet fever, diphtheria, membranous croup, puerperal fever, typhus, enteric, erysipelas, simple continued fever, cholera. A new steam apparatus (Washington Lyon) will shortly be in use. Bow Yes Old Ford - road Dry heat Coke fire ... ... 5 hours; 124° F. Closed van. Naphtholeum Naphtholeum and Condy's fluid SOUTH DISTRICTS. 28 , St. Saviour ... Yes Ewer-street ... Dry heat Gas ... ... Sulphur 6 hours 1 A closed van used for conveying articles to and from oven Sulphur Solution of perchloride of mercury, 1 in 1000 No Rooms were provided, but are no longer available. Accommodation is being sought elsewhere Notifiable diseases, except erysipelas. The authority has resolved to provide a steam apparatus. 29 St. George-theMartyr Yes Stone-yard, King Jamesstreet,Borough road Steam ... ... No 1 hour; temperature within apparatus 260° Infected articles carried in covered hand-truck to oven, taken back in another truck Sulphur Carbolic acid, 5 per cent, solution No Under consideration Notifiable diseases and such other infectious diseases as come to knowledge of medical officer of health. Medical officer of health observes that "many cases occur in parish where inefficient fumigation is practised, owing to want of a reception house or temporary- shelter." 30 Newington Yes Depot, Manorplace, Wal• worth-road Dry heat Gas ... No 3 hours ; temperature of stove 250°F. Special van and men; bedding wrapped in macintosh Sulphur, stripping walls, whitewashing Sulphate of iron, 1 in 40; perchloride of mercury, 1 in 1000; carbolic acid, 1 in 50 No No. Plans are being prepared Smallpox, diphtheria, membranous croup, scarlet fever, typhus, typhoid, puerperal fever. Vestry is constructing a new disinfecting chamber and an incinerator, both of which are just on the point of completion. The new apparatus to be the best (steam) that can be procured. Two vans are to be used. 31 St. Olave Yes Guy's Hospital Steam ... ... No ... In cases where betiding, Ac., is to be destroyed or disinfected a properly covered zinc-lined truck is used Sulphur, walls stripped; paint,Ac., washedwithacidor solution of carbolic acid or perchloride of mercury Perchloride of mercury, 1 in 1000 or 1 in 2000 No Yes Scarlet fever, smallpox, diphtheria, typhus, typhoid, puerperal fever; occasionally measles, tubercvJosis, erysipelas. 12 13 Return of Replies from District Medical Officers of Health—continued. No. PariBh or District. Whether Sanitary Authority has provided disinfecting oven. Where oven is situated. Whether disinfection effected by dry heat or steam. Manner in which dry heat is produced Arrangements made where no oven has been provided Whether any chemical used in connection with the oven. Length of time feather bed of 9 average size is retained in oven, and highest temperature in centre of bed. Arrangements made for removal of infected articles to and from oven. Method adopted for disinfecting houses. Disinfectant recommended for disinfection of excreta. Whether charge is made for disinfection. Whether shelter has been provided as required by Section 60 of the Public Health (London) Act, 1891. Diseases after which Authority carries out disinfection. remabke 32 Bermondsey Yes Town-hall, Sparoad Steam(Goddard Massey and Warner) ... ... No ¾ hour;230°F. SOUTH DISTR Two zinc-lined trucks, one for disinfected and one for infected articles ICTS—continued. Sulphur, subsequent cleansing with carbolic acid Carbolic acid, 98 per cent. and 30 per cent. In cholera, sulphate of iron and carbolic acid No No Smallpox, typhus, diphtheria, scarlet fever, erysipelas, typhoid, cholera Disinfector erected July, 1892; cost of apparatus, £241; cost of building, £200. 33 Rotherhithe ... No ... Steam (Washington Lyon) By contract with Messrs Lyon, of Old Kent-road Feather, hair, or flock beds, 2 hours average ; 260° F. A zinc-lined van belonging to Yestry conveys articles in canvas bags to the disinfecting ovens. The same van takes Sulphur would be used Sanitas, carbolic acid, Condy's fluid No No Smallpox, scarlet fever, typhus, typhoid, diphtheria. 34 Lambeth Yes Yestry Wharf, Belvedere-road Steam ... ... No 30 minutes; 200° F. them back. Covered vans, one for infected and one for disinfected articles. Cleansing and sulphur Carbolic acid for drains No No,but arrangement on occasion is made for the use of a suitable house in the district All notifiable diseases. 35 Battersea No ... Steam By contract with Mr. Lacy, of Pulham ... ... ... Sulphur. In certain cases corrosive sublimate is burnt Sanitas, carbolic acid, Condy's fluid No Yes All notifiable diseases If bedding is very foul it is destroyed in the dust destructor, and compensation given. 36 Wandsworth— Clapham Putney Streatham ... Tooting Wandsworth.. No ... Steam By contract with Mr. Lacy of Fulham No 20 minutes; 260° F. Special zinc - lined vans. Articles removed in canvas bags with sulphur. Sulphur. Subsequent stripping of walls and thorough cleansing of woodwork Carbolic powder, permanganate of iron, bichloride of mercury, sulphate of iron No Clapham and Putney have provided shelters. Wandsworth, Streatham and Tooting about to do so All infectious diseases It has been decided to erect a disinfecting station at Clapham. 37 Camberwell ... Yes Park-road, Peckham Superheated steam ... ... No About 1 hour Air-tight iron carts Washing, cleansing, and sulphuring, and, if necessary, Perchloride of mercury No Willbe provided shortly Notifiable diseases except erysipelas Occasionally rooms are washed with corrosive sublimate solution. 38 Greenwich— Greenwich Yes Chester - street, East Greenwich Dry heat; steam d i s infe ctor (Washington Lyon) in course of erection ... ... No ½ hour; temperature of oven 240° F. Two metal - lined carts, one for infected and one for disinfected articles repapering Sulphur Carbolic acid, Jeyes' disinfectant, perchloride of mercury with hydrochloric acid. No Yes Notifiable diseases. Deptford Yes The Board's Yard, Knottstreet, Steam (Washington Lyon) ... ... No 40 minutes; 251° F. Two separate vans, for infected and disinfected articles Sulphur Solution of perchloride of mercury No Yes. Share the use of the above Notifiable diseases. 39 Lewisham Yes (2 ovens) ford 1. The Depot, Molesworthstreet,Lewis- Steam ... ... No 30 minutes; 260°-268° F. Iron tank carts Sulphur, washing, and cleansing. Repapering if Jeyes' fluid, one pint to three gallons of water, carbolic, No No Notifiable diseases. ham 2. Stone - yard, Penge Dry heat Gas ... ... 15 minutes at temperature of 210°-220° sary sanitas, and permanganate of potash 40 Woolwich Yes Dockyard Wharf Steam (Washington Lyon) ... ... No F. 30 minutes; 230 F. Special vans Sulphur Perchloride of mercury eight oz., methylated spirit two pints, aniline green half oz., No Yes Notifiable diseases. 41 Plumstead Yes Parish Yard, Maxey-road Steam (Washington Lyon) ... ... No 4hours; 250°260° F. Two zinc - lined covered carts, one for infected, one for disinfected articles Sulphur, general cleaning ter to 50 gallons Solution of perchloride of mercury 1 in 1,000 No Yes Notifiable diseases, and phthisis when application is made. 42 Lee— Charlton No ... ... ... None ... ... ... Fumigation with chlorine gas Carbolic powder No Yes Scarlet fever, smallpox, diphtheria Infected bedding is destroyed and compensation given, if necessary. Lee and Kidbrooke Yes At Plumstead . Steam ... ... No About3 hours; 250° F. A properly constructed closed van Fumigation with chlorine gas, stripping walls, washing floors with car Pure carbolic acid . No No Scarlet fever, diphtheria, smallpox, typhoid and typhus fevers. Eltham Yes At Plumstead .. Steam ... ... No. About 3 hours Brought in carts lined with zinc bolic acid solution By burning sulphur Carbolate of lime . No No Scarlet fever, typhoid, diphtheria, smallpox. Appendix VII. London County Council. Public Health Department, Spring Gardens, 8th November, 1894. Report by the Medical Officer, presenting Report by Dr. Young on the Sanitary Condition and Administration of Deptford. Printed by order of the Public Health Committee, ls£ October, 1894. In the early part of 1893, Dr. Young inquired, on behalf of the Council, into a representation made by the Mansion House Council on the Dwellings of the Poor that there was neglect to maintain in proper sanitary condition a number of houses situated in the two parishes of Deptford. A copy of Dr. Young's report on the condition of these houses was communicated to the Greenwich District Board, with an expression of the opinion of the Public Health Committee, that the sanitary staff of Deptford was then insufficient, especially as no clerical assistance was provided. The Greenwich Board later stated in reply that an inspector had been appointed since the date of the Council's letter, and that the staff was now adequate. Dr. Young was then instructed to report upon the sanitary condition and administration of the district generally, with a view to enabling an opinion to be formed as to the sufficiency of the sanitary staff, and I now present his report. Dr. Young's report shows that a considerable part of Deptford is occupied by poor persons, for whose houses sanitary inspection is especially needed. While he bears witness to the fact that much had been done since the complaint of the Mansion House Council was first received and since he first inspected the district in the early part of 1893, he nevertheless points out that about half the houses he inspected in 1894 were faulty in one or another particular, the conditions being those which frequently occur in houses of the class which abound in Deptford. Beyond this Dr. Young found that no houses let in lodgings had been registered, in many instances there was overcrowding of tenements, and but little effort had been made to inspect workshops. Numerically the sanitary inspectors are below the average of London, and the disadvantages of any deficiency of staff are accentuated by the absence of clerical assistance to the sanitary inspectors. The conclusion to which Dr. Young's report points is that in view of the character of the district, the sanitary staff should be still further strengthened, and especially should arrangements be made for the more economical use of the time of the sanitary inspectors. Shirley F. Murphy, Medical Officer of Health. Dr. Young's Report. The district of Deptford is situated in the south-eastern part of London, on the southern bank of the Thames adjoining the parish of Rotherhithe, and consists of the two parishes of St. Nicholas and St. Paul (including Hatcham). Deptford is not a separate sanitary area, but forms part of the area under the jurisdiction of the Greenwich District Board of Works which includes the parish of St. Alphege, Greenwich, and the two parishes of St. Nicholas and St. Paul, Deptford. The boundary between Deptford and Greenwich is formed practically by the river Ravensbourne and Deptford-creek. The population of the entire sanitary area at the date of the last census report, was 165,413, of which 108,173 persons resided in Deptford. At the present time the rateable value of the parish of St. Nicholas is £58,327, and of the parish of St. Paul £495,732. The area of the combined parishes of Deptford is given in the census report as follows: 1,663 acres of land, 22 acres of water, and 67 acres of tidal water and foreshore. Nearly the whole area of the district has now been built upon, and with the exception of some land in the north-western part of St. Paul's parish, adjoining Rotherhithe, which is at present largely U3ed as market gardens, and some ground not built upon in the south-western part of the same parish, there are no open spaces in the district. The following figures, which have been extracted from the census reports, show the changes which have taken place in the district since the year 1851— Population. St. Nicholas. St. Paul. Houses inhabited. St. Nicholas. St. Paul. 1851 7,071 24,899 1,122 4,177 1861 8,139 37,834 1,172 5,905 1871 6,474 53,714 1,006 8,523 1881 7,901 76,752 1,096 11,438 1891 6,887 101,286 922 14,834 No. 201.—Price 2d. Sold by Edward Stanford, 20 and 27, Cockspur-street, Gharing-croas, S. W. [1799 2 Since the year 1851, therefore, there has been a considerable and continued increase in the number of houses and in the population of St. Paul's parish, whereas, with some slight fluctuations, the conditions in St. Nicholas have remained stationary. The census report of 1871, remarking upon this, states " the increase of population in the parish of St. Paul, Deptford, is attributed to building operations, the houses being chiefly occupied by persons in business in London who are attracted by the facilities of railway communication." The decrease in the population of the parish of St. Nicholas at the date of the last census is in part accounted for by the demolition, under Cross's Acts, of a large number of houses in the Hughesfields area, which took place a few years previous to 1891. For statistical purposes Deptford is included in the registration district of Greenwich, being divided into three registration sub-districts, namely, North, South and Central Deptford. Owing to the fact that it is not a separate sanitary area, and forms but part of a registration district, statistical information is not readily obtainable. Mr. Roberts, the medical officer of health of Deptford, gives in each of his annual reports the number of births and deaths occurring in the district during a period corresponding to that to which the figures in the annual summary of the Registrar General relate. These figures have been made use of in calculating the following rates. Only the last four years have been taken into account, as prior to 1890 the annual reports deal with the twelve months ending in March, and further the number of deaths of parishioners of Deptford who died in outlying institutions is not available. The parish of St. Paul, Deptford, contains the South Eastern Hospital of the Metropolitan Asylums Board. Those deaths occurring in the hospital, and which do not belong to Deptford, have been excluded. During this period the birth-rate for each year in Deptford has been— 1890. 1891. 1892. 1893. 83.7 82.8 82.7 31.9 The Registrar General in his annual summary for each of these years gives the following rates for registration London— 1890. 1891. 1892. 1893. 29.1 81.8 30.9 81.0 The deaths which have occurred in Deptford during each of the same four years give the following rates for deaths from all causes. The death rate for London generally for each year is also given— Deptford. London. 1890 20.1 20.0 1891 20.58 21.1 1892 19.60 20.3 1893 20.6 21.0 These rates are uncorrected for sex and age. The infantile death rates (or the deaths of children under one year of age to every 1,000 births) are as follows— Deptford. London. 1890 157 162 1891 146 154 1892 159 154 1893 174 164 The deaths from the principal zymotic diseases, given by the medical officer of health in his reports, give the following rates per 1,000 living— Deptford. London. 1891 2.02 2.28 1892 2.62 2.80 1893 3.51 3.05 For the year 1890 the number of deaths from zymotic diseases which occurred amongst parishioners of Deptford in outlying institutions is not separately given. During these four years therefore the general death rate has been somewhat less than in London generally. The zymotic death rate has, however, tended to increase to a greater extent than in London. Of the two parishes which together form the district known as Deptford, St. Nicholas is considerably the smaller, its area being 109 acres as compared with 1,554 acres of land in the parish of St. Paul. St. Nicholas parish is situated in the north-eastern portion of the district, and the houses generally are of an older date than in other parts of Deptford. It is in this parish that the Hughesfields area is situated. The parish of St. Paul may be said to consist of two parts, namely, that which contains the residential and better class property, and that containing the poorer class of dwellings. The former, situated for the most part to the south of a line formed across the district by the South Eastern Railway, contains many large houses in broad roads, and provided with large gardens. It is probably to this part of the district that reference is made in the quotation given above from the census report of 1871 as to the cause of the increase of population in the parish. The portion of the parish which contains the poorer class of dwellings lies chiefly to the north of the above line, but it is mainly in the neighbourhood around Deptford railway station, and in the parish of St. Nicholas that the poorest class of dwelling is to be found. Speaking generally, the houses in Deptford are two storeys high, built in fairly wide streets, and provided with fair-sized yards or gardens in the rear. Considerable improvement has been made, and is still in progress, in apart of the district, known as New-town, lying to the west of the Mill-lane area, by 3 the widening of the streets and the rebuilding of houses. Improvement will also result from the new road which it is proposed to make between the end of Evelyn-street and Creek-road, as this will doubtless involve the demolition of some old houses in the parish of St. Nicholas. During the course of my inquiry, I inspected 386 houses in various parts of the district. Of these 104 were premises which were visited during a previous inspection made in 1898 as the result of a complaint to the Council by the Mansion House Council on the Dwellings of the Poor, and which were then found to be in such a defective condition as to constitute nuisances within the meaning of the Public Health Act, and a list of which was forwarded to the Greenwich District Board by the Council. As regards these premises I found that the majority had undergone repair, generally of a substantial character, while a few were undergoing repair. Among the remaining 282 houses it was found that 91 were either in a fair condition, or else were at the time undergoing repair, owing to the action of the sanitary authority; but in 191 houses the following 424 defects were found to exist, viz.— Unpaved yards, or paving defective, in 91 houses. Defective gullies in 38 „ No water supply to water-closets in 20 „ Defective, or foul condition of water-closets in 75 ,, No dustbins in 81 „ Defective, or dilapidated dustbins in 49 „ Dilapidated roofs in 15 „ Defective stackpipes, floors, and other structural defects in. 58 ,, Insufficiently covered, or uncovered drinking-water cisterns 52 „ These defects were found in houses, some of which are situated in each of the four sub-divisions into which the district is divided for the purpose of sanitary inspection, and may be taken as showing the conditions which exist in many of the poorer class of houses throughout the district. The fact that 91 premises were found either in fair condition, undergoing repair, or under notice from the sanitary authority, as well as the fact that since the complaint of the Mansion House Council all the houses contained in the list supplied by that body as well as others adjoining them have been inspected, and have had works carried out for placing them in more habitable condition, is evidence that a large amount of work is being done in Deptford; but, on the other hand, the large number of defects quoted above as existing in 191 houses goes to show that much yet requires to be done. As regards the work which was being carried on, it was in all cases found that a thorough and careful supervision was exercised by the officers of the authority during the progress of the work. It may be well to quote a few examples, illustrating the conditions found in some of the above houses. Blackhorse-place Yard badly paved, water-closet pan foul, flushing apparatus defective. Dustbin wooden, and accumulation of dust; it is stated that the dust has not been removed for several weeks. House below level. The Orchard Yard unpaved, water-closet pan foul, no flush. Guttering defective, no stack pipe. Roof badly broken. Ground floor rooms damp. Deptford-green Tenemented house. No yard paving, water-closet pan foul, uo flush. Drinking-water cistern insufficiently covered. Dustbin dilapidated. Roof leaky. Passages dirty and dilapidated. The Orchard House in fair condition. Yard drain inlet untrapped. The Orchard Yard paving bad, drain inlet blocked, said to be frequently stopped. Roof, top front room, leaks badly. Front guttering defective. Watergate-street Water-closet flushing apparatus defective. No dustbin. Queen-street Wash-house ceiling defective, and flooring broken. Yard unpaved, trap of drain inlet defective. Water-closet, no water supply. No dustbin. Queen-street Yard unpaved, stack pipe defective, wash-house floor defective. No dustbin. House undergoing repairs. Blackhorse-road No dustbin, an accumulation of refuse in corner of yard. The drinking- water cistern in wash-house has no cover, and water in dirty condition. Wash-house, plaster of walls broken. Complaint made of smell from drains. Pomeroy-street No dustbin, otherwise in fair repair. Masons-court Drinking water cistern insufficiently covered. House in fair condition. Goodson-street Dustbin dilapidated, water-closet, inadequate flush and pan in foul condition. Flooring defective. Goodson-street Wash-house floor defective. Water-closet, inadequate flush, pan foul. Ground floor, front room, wall damp. Martha-place Water-closet door and seat defective. Flooring defective. House generally out of repair. Falkner-street Yard, trap setting defective. Water-closet pan dirty, flush inadequate. Faulkner-street Yard paving defective, untrapped drain inlet in yard. Drinking water cistern insufficiently covered, plaster of wash-house walls broken. Mill-lane (3 houses) Furnished lodgings. The yard common to these houses is badly paved. Two drain inlets, one choked and the setting of trap of the other is defective. Two water-closets, no water supply, but in cleanly condition. Dustbin dilapidated. No stack pipes to the back addition buildings. Knotts-terrace Wash-house out of repair, floor rotten and defective. Yard badly paved and setting of trap of drain inlet defective. Cistern not well covered. Interior of house clean. Knotts-terrace Yard badly paved and setting of trap of drain inlet defective. Drinking water cistern, no cover. No guttering to back addition building, washhouse roof defective. No dustbin. Knotts-terraco Water-closet pan foul, inadequate flush of water. No guttering to back addition. Yard insufficiently paved. Drinking water cistern insufficiently covered. Trap of drain inlet badly set. Fisher's-rents A common yard, fairly well paved, one common water-closet, no water supply, pan clean. Houses clean and in fair repair, but very old and situated much below level of adjoining street. There are few instances in Deptford of houses built back to back. This condition was found at Fisher's-rents, Wybourn's-cottages, Providence-place, Slow-cottages, and Nos. 3 and 4, Mary's- 4 cottages, which are back to back with houses in Barton's-buildings. A row of six houses, known as Kentfield-place, have no back yards, and are without through ventilation. Most of these houses are old and badly arranged, but some of them have been recently repaired, and the premises are at present in fair condition. There is also a block, consisting of two houses with wooden outhouses at the rear, which is badly situated at the southern end of Hughes-fields. In the parish of St. Nicholas many of the houses are very old and worn out. This remark also applies to some premises in the neighbouring part of St. Paul. Only a few wooden houses wore found to exist. Among the houses which I visited during the inspection, I found that in the majority of cases the premises were let out in lodgings ; often as single-roomed tenements, which are mostly let as furnished rooms, the rent for which is taken daily. In these houses defective conditions were frequently found to exist, and in many single-tenemented rooms it was found that the amount of cubic space per head for the number of inhabitants, ascertained to be residing in the tenement, was below the minimum laid down in the model by-laws of the Local Government Board, and in the regulations of the sanitary authority. The following may be given as examples of the above remarks— Addey-street House in clean condition and fair repair; let in furnished rooms. Ground floor, back room, occupied by husband arid wife, as living and sleeping room; cubic capacity, 398 feet. First floor, front room, occupied by father, mother, girl (over 10) and a baby, as living and sleeping room; cubic capacity, 781 feet (about). Addey-street House in fair condition; let in furnished rooms. First floor, front room, occupied by father, mother and two children, as living and sleeping room; 756 cubic feet (about). Addey-street House in fair condition; let in furnished rooms. Ground floor, front room, occupied by father, mother and one child, as living and sleeping room ; 578 cubic feet. Addey-street House in fair condition; let in furnished rooms. Ground floor, back room, occupied by husband and wife, as living and sleeping room; 400 cubic feet. Addey-street Yard badly paved. Drinking water cistern insufficiently covered and water dirty. Dustbin no lid. Water-closet no water supply. House clean;, let out in furnished lodgings. Ground floor, back room, occupied by husband and wife, as living and sleeping room; 630 cubic feet. First floor, front room, occupied by father, mother and two children, as living and sleeping room; 920 cubic feet. Regent-street A four-roomed house, occupied by four separate families. Ground floor, back room, by man and wife. Ground floor, front room, by man and wife. Top floor, front room, by father, mother, three children; 930 cubic feet. Top floor, back room, by father, mother, one child; 630 cubic feet. Giffen-street Yard badly paved, water-closet pan foul, dustbin no lid. House in bad repair. Let in furnished lodgings, each room occupied as a single tenement. Ground floor, back room, by man, wife, and baby; 720 cubic feet. Top floor, back room, by man and wife ; 680 cubic feet. Top floor, front room, by man, wife, one adult, and two children ; 1,092 cubic feet. Mill-lane (3 houses) In these houses the rooms are let out as furnished lodgings, which appear to be numbered consecutively. There is a common back yard in which are two water-closets for the three houses. Yard badly paved, two drain inlets, one choked, the setting of the trap of the other was defective. No water supply to the closets, but pans clean. Dustbin dilapidated. No stackpipe to the back addition buildings. The passages were clean, but the houses are old and worn out. Most of the rooms were locked at the time of inspection, but one room was found to be occupied by two women as a sleeping and living room. The size of this room was 722 cubic feet. There was no means of obtaining reliable information as to the total number of people living in one house, but inasmuch as most of the houses contained not more than four to six rooms it is probable that the one water-closet belonging to the house was generally adequate accommodation for the number of residents. As regards overcrowding in dwellings it is stated by the medical officer of health that up to the present time cases of overcrowding have been abated on complaint, or whenever they come to the knowledge of the inspectors in the course of their ordinary duties, but that it has not been considered necessary to make special enquiry as to whether overcrowding exists in the district. Bakehouses and workshops.—According to a list which was obtained from the medical officer of health, there are altogether 93 bakehouses in the two parishes of St. Nicholas and St. Paul; 66 were inspected. Of these I found that 22 were situated below the level of the adjoining street. In 12 cases it was noticed that the walls or the floors required cleansing, while in 4 bakehouses the building was in disrepair or unsuited for the purposes of a bakery, and in 17 the means of ventilation were inadequate. In one case a stable was found to communicate directly with the bakehouse, through which the horse had to pass on entering and leaving the stable. This bakehouse was at the time under notice from the sanitary authority. In one case the dustbin was badly situated underneath the window of the bakehouse. The remaining bakehouses were found to be well maintained, and in a cleanly condition both as regards the periodical limewashiug of the walls and the sweeping of the floors. With the exception of three instances, no drain inlet within a bakehouse was observed, and the water supply in the majority was obtained direct from the rising main. As regards workshops, Mr. Roberts, the medical officer of health, states that with the exception of a small number of wood-choppers' premises situated in railway arches and some others, no inspection of workshops has been made; indeed, up to the time of the commencement of this inquiry, no list of the workshops in the district bad been obtained. One of the inspectors whose time is taken up with duties connected with the occurrence of infectious disease and with the Food and Drugs Act had, however, been instructed to give such time as he could spare for finding out and making a list of the workshops in the district. 5 Cowsheds and slaughterhouses.—Eleven licensed cowsheds and ten slaughterhouses in the district were visited. All the cowsheds were found to be in good repair and well kept. The slaughterhouses were also found to be kept in a cleanly condition, and were in good repair. In three cases the use of the slaughterhouse is restricted to the killing of small animals; two of these are structurally not well adapted for slaughterhouses, but their condition of maintenance was satisfactory. Infectious disease and disinfection.—One of the inspectors of the district devotes his time to the duties arising in connection with the notification of infectious disease, and the collection of samples under the Food and Drugs Act. With reference to the former, he visits each house at which a case of infectious disease has occurred, makes inquiry and reports verbally to the medical officer of health. A book is kept showing the action taken in each case. The disinfection of the rooms is carried out by an assistant under the supervision of the inspector; a second assistant disinfects the articles of clothing and bedding, &c., at the depot of the sanitary authority in Knott-street, Deptford, and for this purpose a steam disinfector (Washington Lyon) has been furnished. The articles are fetched from and returned to the houses in separate vans. The board of works has also provided a shelter for the use of the whole district of Greenwich and Deptford, in which persons can be temporarily accommodated during the period necessary for the disinfection of their rooms. It consists of a house in Lower East-street, Greenwich, in charge of a resident caretaker, and in which a sitting-room and two bedrooms have been somewhat scantily furnished, such necessaries as cooking, or food utensils being wanting. There is no bath-room. It was stated by the caretaker that during the eight months previous to my visit the shelter had been made use of on four separate occasions, on each occasion for a period of one night. Mr. Roberts informs me that none of the persons who have used the shelter belong to either of the parishes of Deptford, and that up to the present time the necessity for its use by inhabitants of Deptford has not arisen. It is desirable that a bathroom and ordinary household articles required by persons during their stay should be provided. Mortuary.—There are two mortuary buildings in the district, one of these, situated in the churchyard adjoining St. Nicholas church, is an old but substantial building containing one room, a part of which is used as a store for gardeners' tools. Only a small number of bodies appear to be brought to this mortuary. The second is a suitable building situated in St. Paul's-churchyard. It contains one fair-sized room, used as a mortuary chamber for the bodies of persons who have died from infectious and noninfectious complaints, and also as a post-mortem room. This mortuary is under the control of the St. Paul's, Deptford, Burial Board, and Mr. Roberts has obtained the following information as to the use of the mortuary during the years 1892 and 1893. During 1892, 76 bodies were received in the mortuary, of which 63 were the subjects of inquests, and two the bodies of persons who had died from infectious disease. 1893, 78 bodies were received, on 73 of which inquests were held. It appears therefore that the use of the mortuary is almost entirely limited to bodies awaiting a coroner's inquest. The mortuary chamber is well maintained and fitted up, but it is desirable that separate accommodation for the bodies of persons dying from infectious and non-infectious diseases, and for postmortem examinations, should be provided. It must be added that there is another mortuary in the district of the Greenwich Board of Works, namely, the parish mortuary in the churchyard of St. Alphege, Greenwich, which has a mortuary chamber and a post-mortem room. The question of mortuary accommodation in the Greenwich district has been the subject of correspondence between the district board and the Council. The collection and disposal of refuse.—The collection and removal of the dustbin refuse from houses is carried out by the sanitary authority. In the parish of St. Paul this work is under the supervision of a special dust superintendent, who states that a weekly collection is in force throughout the parish, but that it is not the custom to call each week at each house except in the poorer streets where a house to house call is made by the dustmen. The superintendent, however, makes periodical visits in all parts of the parish to see that the work is efficiently performed. In St. Nicholas parish the work is supervised by the road surveyor, and a weekly collection from all houses is made. The experience gained during the course of the inspection tends to show that the work is well carried out, as in few premises was any accumulation of house refuse observed. The refuse is taken to the vestry's wharf on Deptford-creek, and there loaded direct into barges. The removal of road slop and sweepings is also carried out by the servants of the board under the supervision of the road surveyor. It is stated that trade refuse is removed by the sanitary authority on application, but not otherwise. Some few years back the authority undertook the collection and removal of offal from fish shops in the district, but this has since been discontinued. Grand Surrey Canal.—This canal passes through the northern part of the district, and an inspection was made of the condition of the water and the banks. There are few wharves on this portion of the canal, and there was no evidence that any drainage, except surface drainage from the banks, takes place into the water. At one wharf, where the distillation of tar oil is carried on, the surface washings from the edge of the wharf which at times drain into the canal are mixed with a small amount of tar oil which, floating on the water, produces a greasy, iridescent appearance on the surface, but there is no evidence that this produces any nuisance. It was stated at some premises that the passage of barges down the canal serves to stir up the mud in the bed of the canal, and at times creates nuisance, but it was also stated that the company periodically dredge the canal. On the day of inspection the surface of the water was in a cleanly condition, and there was no evidence of any nuisance arising from it. The sanitary authority for Deptford have supplemented the powers which they possess under the Public Health (London) Act, 1891, by making by-laws with respect to— (1.) Particular nuisances (under section 16, Public Health (London) Act, 1891). (2.) The cleansing of cisterns (under section 50, Public Health (London) Act, 1891). 6 (3.) The provision of an adequate water supply to water-closets (under section 39 (2) Public Health (London) Act, 1891). (4.) Houses let in lodgings, or occupied by members of more than one family (under section 35 of the Sanitary Act). The by-laws made under sections 16, 39 (2) and 50 of the Public Health (London) Act, 1891, are similar in all respects to those made by several other authorities in London, except that in the case of Greenwich, no by-law has been framed with regard to the removal of rubbish, filth, snow, &c., in streets which are not repairable by the inhabitants at large. These by-laws were confirmed by the Local Government Board in 1893. The regulations made with respect to houses let in lodgings wore confirmed by the Local Government Board in the year 1884. In these regulations the standard of the model by-laws as to the minimum amount of cubic space has been adopted, viz., 400 cubic feet for each person exceeding ten years of age in the case of a room not used exclusively as a bedroom, and 300 cubic feet in the case of a room used exclusively as a sleeping apartment. Half these amounts are required for children under 10 years of age. Provision is also made for periodical cleansing of the premises, paving and draining of yards, adequate water-closet accommodation, and for the registration of such houses. No houses have hitherto been registered under these regulations in the two parishes of Deptford. In dealing with the question of overcrowding and of houses occupied by members of more than one family in the first part of this report, it has been shown that defective conditions and overcrowding were frequently found. Instances of these conditions have been given. These facts show that there is need now for the enforcement by the sanitary authority of these by-laws, which would largely increase their opportunity for ensuring the maintenance in proper sanitary condition of the houses occupied by the poorer residents in the district, and for the abatement of overcrowding. The Public Health (London) Act also empowers sanitary authorities to make by-laws for the following purposes— (1.) For promoting cleanliness in, and the habitable condition of, tents, vans, &c., and for preventing the spread of infectious disease by the persons inhabiting the same. (Section 95.) (2.) With respect to the management of mortuaries. (Section 88.) (3.) For removing to hospital persons brought within the district by any vessel who are infected with a dangerous infectious disease. (Section 66.) The Greenwich District Board have not framed by-laws for the above purposes. During the inquiry I inspected four gipsy vans, which were temporarily located on a vacant piece of land adjoining the railway near Deptford station. According to the information which I obtained, it appears that this ground is used throughout the year as a halting place for gipsy vans, during the summer for short periods, but in the winter months for several weeks at a time. The four vans which were found there at the time of my visit contained a total population of nine adults and four children, and were clean and well kept. In view of the fact that there is a recognised halting ground of this character in the district, it may perhaps be desirable that the sanitary authority should exercise their powers for making by-laws under section 95.* Sanitary administration.—The sanitary authority for Deptford is the Board of Works for the Greenwich district, which comprises the two parishes of St. Paul and St. Nicholas and the parish of Greenwich. There are two committees, one for each of the parishes of St. Paul and St. Nicholas, each consisting of all the members of the board elected by the respective vestries; and for the parish of St. Paul there is a sanitary sub-committee. No powers are, however, delegated by the board to these committees. The district board meets once a fortnight; at these meetings, cases in which no steps have been taken by owners and others to comply with the intimation notices of the sanitary authority are brought before the board, and where necessary resolutions passed that statutory notices be served; a further resolution is also passed that if the works be not carried out within a specified time the clerk shall take proceedings for the abatement of the nuisances. The sanitary staff for the two parishes of Deptford consists of the following officers— The medical officer of health, who is engaged in private practice in the district. 5 inspectors. 2 assistants for disinfection. One of the inspectors is occupied entirely with the duties arising out of the Notification of Infectious Disease, and the Food and Drugs Acts. Each of the remaining four inspectors has a district assigned to him for ordinary inspectorial duties ; they also visit the houses in their respective districts in which cases of infectious disease have occurred, and enquire into the sanitary condition of the premises. Mr. Roberts states that the work of the inspectors chiefly consists of the inspection of premises upon complaint, and the re-inspection involved in seeing that the necessary works are carried out; it has also been customary to have house-to-house inspections made of such portions of the district as the Committee or the medical officer of health considers necessary. A systematic house-to-house inspection throughout the whole district has not been undertaken. No clerical assistance is provided, each inspector makes out his own intimation and statutory notices, and also keeps a complaint book, a journal and a report book. In the last of these, note is kept of the conditions found on the inspection of premises, and the action taken in each case. The clerical work is done by the inspectors at home. The inspectors report to the medical officer of health daily, at his home, and attend each week-day morning from 10 to 10.30 a.m., at the Board's offices, 141, *Mr. Roberts informs me that, owing to the sanitary authority having required certain works to be carried out on this land, in view of the use to which it was put, the owner has decided to discontinue letting it out as a halting place for gipsy vans. 7 wich-road, for the purpose of receiving complaints and giving information required. A complaint book is also kept at the Board's office, in which complaints may be registered ; complaints are also received at the vestry and the relieving offices. I may briefly summarise the results of my inquiry into Deptford as follows— (1.) The district contains a number of houses occupied by poor persons, and requiring constant supervision. (2.) The many defective conditions which were found to be present in this class of house, and the overcrowding, show that there is failure to maintain all premises in the district in a proper sanitary condition as required by section 1 of the Public Health (London) Act, 1891. (3.) At the present time no attempt is made to enforce the regulations as to houses let in lodgings, nor indeed has any sufficient attempt been made to inspect workshops in the district. (4.) The staff of sanitary inspectors is below the average of London, for whereas in London there is now one inspector to 20,000 persons, in Deptford the proportion is one to 21,600. (5.) The inspectors have not clerical assistance as in the majority of London districts. (6.) The existing mortuary accommodation cannot be regarded as satisfactory. C. W. F. Young, Assistant Medical Officer of Health. Appendix VIII. London County Council. Public Health Department, Spring Gardens, S.W., 15th October, 1894. Report by the Medical Officer on the Sanitary Condition and Administration of Whitechapel. (Ordered to be printed by the Public Health and Housing Committee.) The Public Health and Housing Committee instructed me in May last to report on the statements contained in the annual report for 1893 of the Sanitary Committee of the Jewish Board of Guardians respecting the sanitary condition and administration of Whitechapel and Mile End. I reported to the committee, and was instructed on May 31st to cause inquiry to be made as to the sufficiency of the number of sanitary inspectors in those districts. A communication was addressed by the clerk of the Council to the Whitechapel District Board, asking that Board to afford facilities to one of the Council's assistant medical officers, Dr. Hamer, who was instructed to make the inquiry in question. On June 14th a letter was received from the clerk of the Board stating that the matter had been referred to the Board's medical officer, that he might give Dr. Hamer such assistance as he desired. During June and July Dr. Hamer made inspection of the district, and he has now prepared the appended report, which I present to the Committee. Dr. Hamer's report discusses in some detail the character of the Whitechapel district, and he shows that in respect of certain conditions the sanitary authority have greater difficulties to contend with than the majority of London authorities. Whitechapel still has an exceptional number of ill-arranged courts and alleys, notwithstanding that three improvement schemes (the Royal Mint-street scheme, the Flower and Dean-street scheme and the Goulston-street scheme) have been carried out by the Metropolitan Board of Works under the Artizans' and Labourers' Dwellings Improvement Acts. The district, moreover, contains a poor population, the results of an inquiry by Mr. Charles Booth in 1887 placing Whitechapel seventh in order of poverty in his list of London registration districts. Further evidence of the poverty of Whitechapel is afforded by the fact that the district has a relatively large proportion of its population living in one and two roomed tenements, viz., 18.2 per cent. and 26.5 per cent. respectively. In other particulars its condition is altogether exceptional. It is the district of London to which alien immigrants especially resort, and it contains a number of workshops considerably above the average of the rest of London. Under these circumstances the need for a strong sanitary staff is obvious, but compared with other districts which more nearly approach to it in the character of the population and the condition of houses, the sanitary staff of Whitechapel is, notwithstanding recent increase, numerically weak. Dr. Hamer found much evidence of excellent work effected by the medical officer of health and the sanitary inspectors, but his report conclusively shows that the existing staff is unable sufficiently to cope with the conditions which exist in Whitechapel. The district much needs improvement in two directions—the removal of unhealthy houses in localities where ill-arrangement is conspicuous among the conditions demanding remedy, and the institution of a more complete system of inspection such as will ensure for the poorer parts a periodical remedy of defects which occur from time to time in houses occupied in the manner of Whitechapel houses. With respect to the latter, it may be pointed out that the powers given by the Public Health (London) Act for the registration and regulation of houses let in lodgings would, if the staff of inspectors were large enough, do much to raise the sanitary standard of houses of this class. The need, moreover, of regular inspection of workshops is made evident by Dr. Hamer's inquiry, and further indicates the necessity for the employment of a larger number of sanitary inspectors. Shirley F. Murphy, Medical Officer o f Health. Dr. Hamer's report. The area under the jurisdiction of the Whitechapel Board of Works comprises all but a very small part of the civil parish of Whitechapel, and eight other civil parishes, liberties, &c., and is nearly conterminous with the registration district of Whitechapel. It should be noted, however, that the Tower of London is "deemed to be in the Whitechapel district for purposes of registration of births, marriages, and deaths, but is said to form no part of the board of works district." Hence from the population returned as belonging to Whitechapel registration district (74,462 at the 1891 census), the populations of the Tower and of the small part of the civil parish of Whitechapel above referred to 2 (868 and 42 persons respectively at the 1891 census), require to be deducted, in order to obtain the population resident in the sanitary area under the jurisdiction of the Whitechapel Board (73,552 at the 1891 census). The rateable value of the Whitechapel Union (1894) is £413,157, and for the year (1893-94) the average rates in the parishes, liberties, &c., in the union amounted to 6s. in the £. Under the London Equalisation of Rates Act, 1894, the amount to be credited to the sanitary district will relieve the rates to the extent of about 2id. in the £ annually. The annexed table gives figures relating to the sanitary area, and is taken from the last census report— Sanitary Aeeas under the Various Authorities, and their Constituent Civil Parishes. Area in Statute Acres. Houses, 1891. Population. 1891. 1881. Inhabited. Uninhabited. Building. Males. Females Persons. Persons. Whitechapel Board of Works— Norton Polgate 10 180 12 3 716 733 1,449 1,528 Old Artillery Ground ft ] 50 9 — 1,067 1,071 2,138 2,516 Spitalfields 73 1,818 112 6 11,945 10.914 22,359 21,340 Mile End New Town 42 1,138 37 11 5,681 5,622 11,303 10,673 WhitechaDel,part of* 169 3,306 560 22 16,890 15,394 32,284 30,660 St. Botolph without Aldgate, or East Smithfield 34 599 70 1 1,522 1,449 2,971 2,883 Holy Trinity, Minories 4 20 1 2 159 142 301 449 St. Katherine by the Tower 14 7 — — 159 23 182 104 Old Tower Without 6 11 9 — 33 32 65 233 357 7,229 810 45 38,172 35,380 73,552 70,386 Density of population—The total area as given in the above table is 357 statute acres. This includes in respect of the constituent parishes of St. Botolph without Aldgate and St. Katherine by the Tower some 10 acres of non-tidal water. Dealing then with an area of 347 acres and with the estimated population† at the middle of 1894, the density of population in Whitechapel is found to be 215 persons per acre. An important consideration, however, which requires to be borne in mind, is the remarkable inequality of concentration of persons upon area in different parts of the district. Thus on the basis of the 1891 census populations there were 11 persons per acre in Old Tower Without and 428 persons per acre in Old Artillery Ground. These two districts are, however, both small. On considering the matter from a more comprehensive point of view, it may be noted that a considerable area in the southern part of Whitechapel is largely commercial in character, and an approximate idea of the density of population in residential Whitechapel can be obtained by exclusion of the last four divisions of the above table altogether. (No allowance is then made for the considerable areas of a nonresidential character in Whitechapel civil parish, notably that occupied by the London Tilbury and Southend Railway Company, but the data for making such allowance are not available.) The density of population of residential Whitechapel at the present time worked out on these lines will be found to be about 240 persons per acre. It may be added that in the large sub-district of Spitalfields the census figures give 313 persons per acre. In the annual report of the Council's medical officer for the year 1892 the density for the administrative county of London at the middle of that year is given as 57 persons to an acre, and of the various sanitary districts, St. George-the-Martyr, Southwark, has the greatest density of population (211 persons to an acre), Whitechapel occupying the second place. The density of population in residential Whitechapel, as above defined, is however appreciably greater than that of St. George-theMartyr, Southwark, and the modified Whitechapel is seen to be more densely populated than any sanitary district in London, and to have more than four times as many persons as are found per acre in the administrative county of London, taken as a whole. Poverty and associated conditions.—Mr. Charles Booth has tested London registration districts‡ in various ways in connection with poverty. The registration Whitechapel, as already seen, so nearly corresponds with the sanitary area, that his results may be used in illustration of the conditions which obtain in the latter. Mr. Booth gives the numerical order in which the districts stand when tested in six different ways, and then arranges them in a combined or mean order, noting how little this combined order varies from any of the six, and how little on the whole they vary among themselves. Whitechapel stands—7tli in respect of poverty. 3rd „ domestic crowding. 2nd „ excess of young married females. 1st ,, surplus unmarried males. 11th „ birth rate. 8th „ death rate. and 3rd in the combined or mean order. *Entire Parish of Whitechapel, except a small part, containing five inhabited houses and 42 population, which is included in the City of London. † The estimated population of the sanitary district (calculated on the census populations of the above table) works out at 74,611. ‡ Mr. Booth dealt with 27 districts. Of the 30 districts recognised by the Registrar-General, he combined three, viz., the Strand, St. Giles, and Soho, and he omitted the City. 3 Mr. Booth's method of estimating domestic crowding is based on the figures given in the last census report relating to tenements with less than five rooms, and the number of occupants of such tenements. The term "overcrowding" has been applied by the Registrar General to cases in which there arc more than two persons to a room in tenements of one, two, three and four rooms. Mr. Booth's term "domestic crowding" is employed in a similar sense. The census figures are made use of in the annual report of the Council's medical officer to determine the percentage of the population in the different sanitary districts living in tenements of one to four rooms with more than two occupants per room. St. Luke's and Whitechapel head the list when the districts are submitted to such examination, the percentage obtained in the case of the former being 44.24, and in that of the latter 43'50. In the same report the number of persons per house is given for the several sanitary districts. Whitechapel stands fifth in this respect, with 10'2 persons per house. It is clear therefore that when sanitary districts are tested in these various ways, Whitechapel always stands prominently forward, and having regard to the inclusion in the sanitary area of certain outlying districts which deviate markedly from the prevailing Whitechapel type, and which tend to modify the results obtained, the fact is the more significant. Growth of population.—The population of the sanitary area at the last census—73,552— considerably exceeds that of the same area at the 1881 census, viz., 70,386, but is less than the corresponding population at the 1871 census, which was 75,499. The increase of population in the last decade was thus less than the decrease which had taken place in the preceding decade. There have, however, been several large displacements of population in Whitechapel, such as those caused by clearances undertaken by the Metropolitan Board of Works and by the London Tilbury and Southend Railway Company ; and on the other band the old Whitechapel has been to a considerable extent superseded by lofty blocks of dwellings. Mr. Loane gives in his annual report for 1893 the total population inhabiting such dwellings as 13,336, the corresponding total in 1889 being 9,429, there was therefore during four years an increase of over 40 per cent. in the number of persons so housed. Character of population.—Mr. Charles Booth in his " Labour and Life of the People in London," says, "Whitechapel is the dwelling place of the Jews, tailors, bootmakers and tobacco workers, and the centre of trading both small and large." On dividing the population into sections according to the character of the employment of heads of families in Whitechapel, Mr. Booth found— 18¼ per cent, belonged to the section headed manufacture of dress. 6½ ,, ,, ,, cigar making and food preparation. 8 „ „ ,, street sellers and general dealers. 5⅓ „ „ ,, small employers. In Mr. Booth's division of the population into classes, according to means and position of heads of families, Whitechapel stands in striking contrast to the other East-end districts in respect of the proportion of the population belonging to the lowest class. Of this " lowest class of occasional labourers, loafers and semi-criminals" Whitechapel contained, according to Mr. Booth's estimate at the time of his enquiry, 3.32 per cent., a percentage more than twice as great as that in any of the other East-end districts. In 1893 there were 98 registered common lodging-houses in Whitechapel, and twelve shelters, indicating the existence of a large nomadio population. Mr. Loane, in his annual report for 1890, remarks upon the extent to which the district suffers by reason of the common lodging-houses. He says, "they often serve as halfway houses between places outside our boundary and the Whitechapel Union Infirmary,'' and in his later reports reference is made to the influence of shelters, and a table is given showing the number of admission orders into the Whitechapel Infirmary, supplied to lodgers from the various shelters in the district not subject to the Common Lodging Houses Acts. Unregistered "furnished apartments" are thickly distributed in some streets, the reputation of which they by no means tend to improve. At the last census 17,961 foreigners of all nationalities were enumerated in the Whitechapel registration district, of these 13,538 were Russians or Russian Poles. The corresponding total at the previous census was 9,660, and the number of Russians and Russian Poles at the 1881 census was 5,293. In the Board of Trade report on Immigration, 1894, it is stated that "The total number of the class with whom we are specially concerned, who arrived in London without through tickets to other countries, less those subsequently sent away by sanitary agencies, was in 1891 something over 7,000, in 1892 about 3,000, and in 1893 rather below this latter number. These figures then, setting off the early part of this year against that of 1891, have to be added to those of the census to arrive approximately at the numbers for the present time." On the last census night Whitechapel housed 13,538 Russians and Russian Poles as compared with 26,742 in the whole of London; on the assumption that the new arrivals for settlement during 1891-93 were distributed to Whitechapel in a like proportion, the census figures relating to the number of such persons in Whitechapel would require to be increased by upwards of 6,000 in order to make them applicable to the early part of the present year. Mr. Loane writes in his annual report that he was informed during 1893, of 3,886 immigrants received into the district under the protection of the committee of the Jewis shelter in Leman-street. "Investigation proved that over 1,926 of these persons settled in Whitechapel." This estimate is not, however, comparable with the figures of the Board of Trade report which takes account of emigration after temporary settlement. The number of newly arrived Russians and Russian Poles in Whitechapel is of special importance in connection with sanitary administration by reason of the fact that a considerable number of them find employment in the numerous tailors' and other workshops in the district; tailors' and bootmakers' workshops appear to be more thickly distributed in Whitechapel than in any other part of London. Age and sex distribution (1891 census).—The following table shows the proportion of the 4 population of each sex at certain age periods in the registration district of Whitechapel and in registration London— 1891. All ages. 0- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75 and upwards. Whitechapel— Males: Per cent, of total population 51.90 6.49 5.44 4.71 5.10 5.68 9.31 G.67 4.46 2.57 1.15 .32 Females: Per cent, of total population 48.10 6.83 5.49 4.79 5.03 5.31 7.80 7.80 3.73 2.27 1.21 .33 London— Males: Per cent, of total population 47.27 5.9.2 5.36 4.90 4.69 4.61 7.92 5.85 4.11 2.35 1.20 .37 Females: Per cent, of total population 52.73 5.99 5.42 4.99 521 5.5(3 9.11 0*49 4.04 2.92 1.72 .69 Birth rate, Marriage rate and Death rate.—Mr. Loane gives the corrected birth rate in Whitechapel during 1893 as 40*9 per 1,000 of population. In London the birth rate was 31. Mr. Booth, in placing Wliitchapel eleventh in order among registration districts in respect of high birth rate, was working on the basis of a ten years' average which gave the Whitechapel birth rate as 351. If the position of Whitechapel were determined by the figures of the last few years the district would stand higher on the list. The rise in the birth rate may have been influenced by the increase already referred to in the number of persons living in blocks of dwellings, and may again be associated with the increase in foreign immigration. The marriage rate for the year 1893 is 11.8 The percentage of married women under 25 to total population obtained from the census return is, in the Whitechapel district, exceptionally high (2.42) ; St. George-in-the-East alone among registration districts has a greater percentage (2.54). Mr. Booth adopts this as his test of the number of early marriages which he notes " are very numerous in St. George's East and Whitechapel." Whitechapel stands first in the list of registration districts in respect of its surplus of unmarried males between 15 and 45 years of age. The death rates per 1,000 living in 1891-2-3 for the Whitechapel district, when corrected for deaths occurring in hospitals and outlying institutions, are as follows— 25.3 in 1891, 24.8 in 1892, and 25.6 in 1893, the death rates for the County of London being— 21.0 in 1891, 20.3 in 1892, and 20.9 in 1893. If these figures be corrected for age and sex distribution by applying the factors for correction given on page 9 of the annual report of the medical officer of the Council for 1892, the following corrected death rates are obtained— 1891. 1892. 1893. Whitechapel London 2731 2239 268 21-6 2763 22-28 The deaths of infants under one year of age per 1,000 registered births in the Whitechapel district and in London respectively are as follows— 1891. 1892. 1893. Whitechapel 158 155 168 London 153 154 163 The zymotic death rates per 1,000 living in Whitechapel and in London during the same years are— 1891. 1892. 1893. Whitechapel 26 3.3 3.1 London 20 2.8 3.0 London and Whitechapel may be compared in yet another way by taking the mean birth rate and death rate of the three years 1891-2 and 3 and applying Dr. Bristowe's formula for determining approximately the expectation of life at birth. It will then be found that while the expectation of life at birth in London is 39.1 years, that in Whitechapel is only 30.9 years. Sanitary circumstances. Water supply.—The greater part of Whitechapel is supplied by the East London Waterworks Company. Portions of two of the four registration sub-districts are however supplied by the New River Company. Some difficulty has arisen in connection with the supply of water to the upper floors of lofty blocks of dwellings, and this difficulty has been attributed to the fact that the East London Company is only required by enactment to afford a constant supply up to a height of 40 feet above the level of the payement nearest the point at which such supply shall be required. During the dry summer of 1893 water was not, at all times of the day, furnished to a greater height than 40 feet, with result that in the case of buildings in which there was not adequate provision for the storage of water much inconvenience was caused. In consequence however of the experience of that time, storage cisterns of adequate capacity were constructed on the roofs of several blocks of dwellings, and during Jul}-, 1894, sufficient water was held in reserve in many instances to meet the requirements of those living on the upper floors of such buildings, during the period of the day when the pressure in the company's mains was not sufficient to carry water above the statutory height. In one block of dwellings, however, the storage was quite inadequate, with result that the three upper floors were without water during the greater part of the day, and on the occasions of my visits to this block of dwellings the water-closets on these upper floors were in consequence in a very offensive condition. 6 Results of inspection—I inspected 499 houses and 154 separate tenements in blocks of dwellings. In 291 of the houses defects were found to exist. In the report of the sanitary committee of the Jewish Board of Guardians for 1893, it is stated that the committee's inspector visited 733 houses in Whitechapel, of which the number found " defective and below standard of sanitary authority "was 486. The Inspector of the Jewish Board of Guardians thus found 66 per cent. of the houses visited by him defective, while the corresponding percentage obtained as the result of my inspection is 58 per cent. With regard to the nature of the defects found, the items of most common recurrence are dirty conditions of rooms and staircases and various forms of dilapidation. In some instances there was evidence that rooms had been reduced to their existing unwholesome condition within a few months of the execution of works of cleansing and repair, and abundant confirmation was obtained of the statement made in the report of the sanitary committee of the Jewish Board of Guardians that " it very frequently happens that after a house has been put in order its condition is upon subsequent inspection discovered, even before the year is closed, to be again defective." The statement quoted is adduced as evidence of the fact that " the manner in which the owners of property have the necessary repairs carried out, still leaves much to be desired." This is no doubt in some instances true, but there can be no question that the habits of the tenants are also largely responsible. As instances of the condition into which houses in Whitechapel tend to fall unless kept under constant supervision, I may refer to the following— Providence-place.—Five two-roomed houses each with a yard in which the water-closet is situated. The bedroom is approached by a staircase opening directly out of the living room. No. 1. Ground floor ceiling defective, paper falling off on staircase, upper room very dirty, trap in yard defective, pan of water-closet foul. No. 2. Dirty yard, paving defective, water-closet seat broken. No. 3. Ground floor room dirty, floor boards defective, yard very dirty. No. 4. Dirty yard, bedroom (according to statement of tenants) overcrowded at night. No. 5. Dirty ground floor room ; staircase badly broken, one stair quite gone ; upper room dirty; water-closet dilapidated, seat broken; ground floor room used as a slipper maker's workshop, protected persons employed, but no " notice " exhibited, much overcrowded; bedroom overcrowded at night. Vine-yard, Little Pearl-street—Nos. 2,3 and 4 are three-storey houses without through ventilation. Nos. 5, 6, 7 and 8 are being rebuilt, and are unoccupied. No. 9 is a double house without through ventilation, and is situated at the rear of a house in Little Pearl-street. There are two troughs, which serve to receive excreta, in a very filthy condition, no water is laid on to them, and the tenants do not flush them by hand. No. 2. Plaster falling off the walls, rooms very dirty. No. 4. Damp ground floor room, plaster defective, dirty staircase, dirty first floor room. No. 9. Door off hinges, plaster defective on stairs, rooms very dirty, damp wall in first floor room and a large hole in the floor, attic floor broken, roof defective—two women sleep here, the cubic capacity of the room is only 416 feet. This house I afterwards learned was under notice from the Whitechapel Board at the time of my visit. Defects in connection with water-closets I found of common occurrence. I noted 12 instances of choked water-closets, 9 instances of broken water-closet pans, 6 of total absence of fittings for supply of water, 65 in which the flushing apparatus was out of order, 29 foul pans, 17 instances in which the flush of water was inadequate, and 4 instances of broken water-closet seats. In many cases when defects of this kind exist the tenants do not take any steps to secure a remedy, for example, I found three closets full of excreta in a court yard surrounded by eleven houses; inquiry elicited the fact that these closets had been choked for several days; no complaint so far as I could learn had been made by the tenants, and but for the chance visit of the inspector and myself the condition of things might apparently have remained unremedied for an indefinite period. Other defects noted were dampness of walls of rooms, 25 instances ; defective yard-paving, 53; defective roofs, 23; defective traps in yards or cellars, 52; defective sink wastes, 12; defective rain water pipes or eaves guttering, 25; and 5 stopped yard drains. There were 39 instances of overcrowding* exclusive of 8 overcrowded rooms in blocks of dwellings, and of overcrowded workshops to be further alluded to. In determining whether or no a room was overcrowded reliance was necessarily placed upon the statement of the tenant, and it may be assumed that the true extent of overcrowding has been underestimated. Some of the most extreme instances of overcrowding were met with in the case of Russians or Russian Poles who had not long been in this country; thus at No. 3, New-court, Hanbury-street, a man, his wife and seven children were found occupying a single room of 800 cubic feet capacity; again two rooms in Plough-street-buildings were, it was admitted, occupied by a man and wife and their family consisting of a grown-up son, and his wife, and three children, two grown-up daughters and a second son. Extreme overcrowding was not, however, confined to foreign immigrants; for example, at No. 5, Green'splace, an English family of ten persons (man, wife and eight children, aged from 6 to 23, of both sexes), occupied two small rooms, and at No. 1, Lardner's-buildings (man, wife and eight children, aged from 5 to 20, of both sexes), were similarly accommodated. In two instances basements were found to be separately inhabited as dwellings in contravention of the law, in one of these cases, a basement in Plough-street-buildings, the caretaker had been previously cautioned by the officers of the sanitary authority as to the illegality of such occupation. In the course of my inspection I visited 73 workshops ; in 26 of these, although protected * The District Board's by-laws relating to houses let in lodgings require— 300 cubic feet per person in rooms used exclusively as sleeping rooms. 400 ,. „ „ not used exclusively as sleeping rooms. Two children under ten are reckoned as one adult. 6 persons were employed, the Home Office regulations were not exhibited, in 62 cases the occupier professed to be ignorant as to the number of persons he could employ, and denied having received any intimation from the inspector of the Whitechapel Board with respect to this matter, in 11 instances the workrooms were found overcrowded, and in 16 cases there was no separate water-closet accommodation for persons of the two sexes as required by section 38 of the Public Health (London), 1891, Act. In a few instances defective receptacles for dust were noted, and in some cases no receptacle was provided ; this was notably the case in the neighbourhood of Cox's-square, where house refuse had in some instances to be carried for considerable distances in order to be deposited in the uncovered common receptacle in the square. In a large number of houses visited a "sanitary bin " had been provided by the Board of Works, and the removal of dust appeared to be well carried out. Among the above defects it will be seen that faulty structural conditions, not admitting of easy remedy, have not been included. These, however, constitute by far the most serious defects of houses in many of the poorer parts of Whitechapel. In the numerous dark, confined, and ill-ventilated courts of the district are many houses the ground floors of which are below the level of the adjoining footway, and are constructed directly upon the earth without ventilation of the space beneath the floor boards ; there are moreover a considerable number of back to back houses. A very large amount of improvement has been effected by the efforts of the medical officer of health and his inspectors in this connection ; floors have been raised, the ground beneath them concreted, and the intervening space ventilated, and in many cases attempts to improve the ventilation of houses have been made by the construction of ventilating shafts, or by the introduction of skylights at the top of staircases ; openings for the admission of light and air have been devised, and much ingenuity has been displayed in obtaining some degree of improvement where it would have been thought no remedy was possible. Great benefit has accrued in this way, although it too often happens that the newly provided opening is blocked up by the tenant (who living in the closest of atmospheres explains that he is afraid of the draught), or in some other way the good effect designed is nullified. In Tewkesbury-buildings, for example, a ventilating shaft was converted by the tenants into a chimney; its limewhited walls were rapidly becoming grimy with smoke, and the openings from the various apartments into the shaft were tall carefully blocked with a view to preventing the smoke from the coko fire of the basement tenant entering the upper rooms and rendering them uninhabitable. No amount of ingenuity can, however, do much to remedy the closeness and bad arrangement of many of these courts which require more radical treatment than is possible by application of the provisions of the Public Health Act. Bakehouses.—There were 69 bakehouses in use in Whitechapel at the time of my inspection. I visited 32 of these places, and found them to be for the most part clean and well kept. Nineteen of the 32 visited were cellar bakehouses, and the means of ventilation in one of these appeared to me to be so unsatisfactory as to raise question as to the fitness of the place for use as a bakehouse. A few defects were noted in other bakehouses, but generally speaking the requirements of the existing law relating to bakehouses were enforced. Slaughterhouses, cowsheds and offensive trades.—I visited the 8 slaughterhouses, the 13 cowsheds and the offensive trade premises in the district, and found the requirements of the law generally observed. In the majority of the cowhouses, however, dung pits, though in conformity with the regulations made under the Dairies, Cowsheds, &c., Orders, did not conform with the by-laws made by the Council under sec. 39 (1) of the Public Health (London) Act. There was, moreover, evidence of the need of enforcement by the sanitary authority of the by-law under sec. 16 (2) of the same Act, relating to removal of offensive matter. Many of the premises visited were in objectionably close proximity to inhabited houses. Milkshops.—I visited 50 places in which milk was sold, and found many of the small retail shops in a dirty condition, and the waterclosets, yards, &c., in connection with them defective. In 11 instances the milk measures were found to be dirty. In a district like Whitechapel the procedure under the Dairies, Cowsheds, &c., Orders is attended by great difficulty, and often-repeated inspections are necessary. Registration is effected in respect of places very unsuitable for the sale of milk, and when improvement is insisted upon, the vendor changes his address. In many instances no application for registration is made until the inspector visits and points out the requirement of the law. Disinfection.—Sulphur fumigation is employed for the purpose of disinfecting rooms; in some cases the walls are washed with solution of perchloride of mercury. A steam disinfecting apparatus has been at work since May, 1893. The question of providing a shelter for the accommodation of persons during the disinfection of their rooms, as required by section 60 (4) of the Public Heath (London) Act is under consideration. Mortuary.—The district possesses a good mortuary in which separate accommodation is provided for the bodies of persons dying from non-infectious and infectious diseases. There is also separate provision for the Jews, with a watcher's room adjoining the mortuary chamber. There is moreover a well fitted post-mortem room. Sanitary administration. Whitechapel is divided for administrative purposes into two districts—north and south— separated one from another by the Whitechapel-road. Mr. Loane tells me the work of the four inspectors is arranged as follows—The senior inspector has general supervision over the others, and undertakes certain special inspections; he keeps the books of the northern part of the district, and purchases samples submitted to the public analyst under the Food and Drugs Acts. Two inspectors deal with the majority of complaints received, one taking, as a rule, those in the north district, and the other those in the south district. This latter inspector also keeps the books of the south district. The fourth inspector deals with notified cases of infectious disease, with notifications received from the Port Medical Officer of Health relating to the arrival of aliens in the district, and with workshops. There is a clerk, who sometimes does inspectorial work, and an assistant inspector has been temporarily 7 appointed; two men who are concerned with the work of conveying infected and disinfected articles to and from the disinfecting apparatus, and with the disinfection of rooms, render occasional assistance to the inspectors in the serving of notices, &c. For the last three years books have been kept recording house to house inspections, and the inspectors devote any spare time they may have to carrying out this work. Details relating to about 1,000 houses have been entered in the books. The inspectors in the course of their work are on the look out for workshops, and when they come across one they make a note of the same that the fourth inspector may deal with it. The other duties of this fourth inspector are, however, heavy, and little of his time is available for this purpose. Regulations with respect to houses let in lodgings were made by the Board, under section 35 of the Sanitary Act of 1866. Mr. Liddle, formerly medical officer for Whitechapel, in a report " Upon the necessity of retaining the present staff of four inspectors of nuisances," presented in 1868, refers to efforts which were made to carry out the special inspection of houses let out in separate tenements. The registration and systematic periodical inspection of such houses soon appears, however, to have been given up. The Board have now made by-laws relating to houses let in lodgings or occupied by members of more than one family, under section 94 of the Public Health (London) Act, 1891. These by-laws were confirmed on December 21st, 1893. Their systematic enforcement throughout the district would be productive of great benefit. The exemption clause however (2nd by-law) excludes unfurnished lodgings let at a rent exceeding 5s. per week, and furnished lodgings let at a rent exceeding 7s. 6d. a week. These limits will be found in practice to exclude rooms which it might be desirable to register. Bylaws have also been made by the Board under the following sections of the Public Health (London) Act, viz., section 16 (1) relating to cleansing streets and prevention of nuisances, and sections 39 (2) and 50 relating to the supply of water to water-closets and to the cleansing of cisterns respectively. On receipt of complaints each is numbered with a reference number and entered into an intimation book, the number of the preliminary notice served being also inserted. Hence the number of preliminary notices served is practically a guide to the number of complaints received. This number for the year 1893 is given by Mr. Loane in his annual report as 2,777. These are by no means all written complaints, indeed many of them would be verbal complaints or complaints entered on the inspectors' initiative. In dealing with complaints the inspectors do not limit their attention to the defects specified, but thoroughly examine the houses referred to, and insist upon improvements of a substantial character. The extensive drainage operations which have been carried out, and the radical transformation which has been effected in many sets of premises in the district cannot fail to impress anyone who visits a number of houses in Whitechapel. Having regard to the mass of complaints which are received by the sanitary department, and to the fact that the work found to be required in the premises visited is superintended in a thorough manner, it appears impossible for the two inspectors to find opportunity for extending their inquiries far beyond the particular houses to which their attention is directed. The temporary assistant and the clerk make inspections, but the more they help out of doors the less they can do in the office, and the clerical work of the department if relegated to them would certainly claim the whole of their attention. The chief inspector and the fourth inspector have their time occupied with special work. It thus comes about that but little can be done by the existing staff in the way of house-to-house inspection, that no systematic attempt can be made to carry out the by-laws relating to houses let in lodgings (and more particularly to enforce those of their provisions which relate to cleanliness and over-crowding,) and that it is impossible to bring under thorough control the large number of workshops. In a district like Whitechapel it is especially necessary that the strength of the staff should be sufficient to admit of the establishment of a system of periodical examination of every house, and of frequently repeated inspection of the majority of the houses. In the absence of such a system, and in the event of the best efforts of the staff remaining as they now are in great part absorbed in the attempt to make headway against the complaints, notifications, &c., received, but slow progress can be made, and it will continue to be impossible to bestow any greater share of attention upon parts of the district which, while they most need supervision, are those to which the attention of the Board is least likely to be called by the inhabitants themselves. W. H. Hamer, Assistant Medical Officer of Health. Appendix IX. London County Council. Public Health Department, Spring Gardens, S.W., 15th October, 1894. Report by the Medical Officer on the Sanitary Condition and Administration of Mile End Old Town. (Ordered to be printed by the Public Health and Housing Committee.) Dr. Hamer's inquiry into the sanitary condition and administration of the district of Mile End Old Town was undertaken in compliance with the instruction of the Committee of the 31st of May, that I should report on the sufficiency of the number of sanitary inspectors in that district, statements in the annual report for the year 1893 of the Sanitary Committee of the Jewish Board of Guardians having raised question as to the adequacy of the staff. Dr. Hamer's report shows that Mile End Old Town bears favourable comparison in several particulars with Whitechapel, the district which was the subject of his last report. Mile End Old Town is less crowded in respect both of houses and population; the number of ill-arranged courts is much fewer than in Whitechapel, and the population generally is less poor. Dr. Hamer refers to increase of the sanitary staff in Mile End Old Town in 1892 by the appointment of an additional inspector and a clerk, and to the improvements which have since been effected ; but he points out that as yet the sanitary authority have not seriously addressed themselves to the duty of registering and regulating houses let in lodgings, or occupied by members of more than one family, and that he does not think, without further increase of the staff, this work can be effectually carried out. With this view I concur, and inasmuch as I learn the vestry has now under consideration the framing of by-laws for this purpose in supersession of regulations made under the Sanitary Act of 1866, the question of increase of the staff must necessarily be considered in connection with the enforcement of those by-laws. Shirley F. Murphy, Medical Officer of Health. Dr. Hamer's Report. The appended figures relating to the sanitary area under the jurisdiction of the Vestry of Mile End Old Town are taken from the last census report. This area is identical with that of the registration district of Mile End Old Town. Sanitary areas under the various authorities and their constituent civil parishes. Area in statute acres. Houses, 1891. Population. 1891. 1881. Inhabited. Uninhabited. Building. Males. Females. Persons. Persons. Mile End Old Town Vestry—Entire Parish 677 14,066 525 22 52,340 55,252 107,592 105,613 The rateable value of the district (1894) is £376,205, and the rates for the year 1893-4 amounted to 6s. 6d. in the £. Under the London Equalisation of Rates Act, 1894, the amount to be credited to the sanitary district will relieve the rates to the extent of about 7£d. in the £ annually. It maybe noted that the number of persons per house in 1891, was 7.6, and the estimated population and the number of persons to an acre in the middle of 1894,108,242 and 160 respectively. Generally speaking, there is not in Mile End the same want of proportion between height of buildings and open space about them which obtains in Whitechapel. There are again comparatively few dark confined and ill ventilated courts, and there are, particularly in the north and east wards, a number of streets of good residential houses. Curiously enough many fairly wide streets in Mile End terminate blindly, and the existence of these cuts de sac is a serious defect in the laying out of portions of the district. Mr. Charles Booth (Labour and Life of the People), remarks that Mile End Old Town " looks very clean and new in spite of its name. Its streets, even the narrowest, look comparatively wide ; the air is fresh, and the squares and other small open spaces are frequent." Mr. Booth on applying his six tests to Mile End, found the numerical order in which the district stands on the list of London registration districts * to be as follows— 17th, in respect of poverty. 12th ,, ,, domestic crowding. 4th „ ,, excess of young married females. 11th „ „ surplus unmarried males. 4th „ „ birth rate. 11th „ ,, death rate. and 10th in the combined or mean order. Mr. Booth comments upon the position of Mile End as above defined in regard to poverty, and suspects that his result is " to some extent wrong." He adds, however, "Altogether it is undoubtedly much the least poverty-stricken of East End districts, even if its position in this respect is here somewhat exaggerated." * Mr. Booth dealt with 27 districts. Of the 30 districts recognised by the Registrar-General he combined three, viz., the Strand, St. Giles and Soho, and he omitted the City. No. 200. Price 2d. Sold by Edward Stanford, 26 and 27, Cockspurstreet Charing-cross, S.W. [1922 2 Mr. Booth's analysis in respect of poverty was made in 1887, and it is based on a division of the population into eight classes. He estimated that per cent. of those dwelling in the East End belonged to the lowest class (A) of "occasional labourers, street-sellers, loafers, criminals and semicriminals," and he found that .8 per cent. of the population of Mile End and 3.3 per cent. of the population of Whitechapel belonged to this class. The next class (B) comprises those on "casual earnings—very poor." Here Mile End with 6.8 per cent. and Whitechapel with 8.9 per cent. both fall below the mean percentage for the whole of the East End 11.2 per cent. The next class (C) comprises those on " intermittent earnings." Mile End now with 6 per cent. falls considerably below, while Whitechapel with 10.7 per cent. considerably exceeds the mean percentage for the whole of the East End 8 3 per cent. The percentages belonging to the remaining five classes are given in the appended table, which is abstracted from Table III., "Life and Labour of the People." Vol. I., p. 36— Mile End. Whitechapel. Whole Eastend District. A. Lowest class .8 3.3 1.2 B. Casual earnings, very poor 6.8 8.9 11.2 C. Intermittent earnings 6.0 10.7 8.3 D. Small regular earnings 12.6 16.3 14.5 E. Regular standard earnings 52.0 43.3 42.3 F. Higher class labour 14.9 11.3 13.6 G. Lower middle class 4.5 4.4 3.9 H. Upper middle.class 2.4 1.8 5.0 Sanitary administration is especially concerned with improvement of the houses of the poorer classes, and the percentages given in the above table are therefore deserving of study. The three poorest classes may be taken as representing the groups of population with which the sanitary inspector finds most of his work associated. Of these three poorest classes the East End contained 20 7 per cent., while Mile End contained 13.6 per cent., and Whitechapel 22.9 per cent. Having regard to the fact that the habits of persons of these three classes differ from those of the other classes, there can be no doubt that the small percentage of the population of Mile End belonging to the former has considerable influence upon the amount of supervision required to maintain a satisfactory standard in this district as compared with other parts of the East End. Ten per cent. of the population of Mile End live in tenements of one room. Of the population living in 1—4 rooms at the last census, the percentage with more than two occupants per room was 22.00—just less than half the corresponding percentage in Whitechapel. The growth of population in Mile End during the present century has been very rapid. The district as shown in a map of 1763 appears to be for the most part covered with fields, the only considerable grouping of houses occurring at points on the main road connecting Whitechapel with Bow. The enumerated population in 1801 was less than 10,000. In the course of the next twenty years the number of persons more than doubled, and successive enumerations have shown, with some fluctuations, a general tendency to diminution in the rate of increase, a diminution which has been marked in later decennia. decennia. The enumerated populations * at successive censuses, with the rates of increase per cent., are as follows— Census year. Population. Increase per cent. 1801 9,848 1811 14,465 47 1821 22,876 58 1831 33,898 48 1841 45,308 34 1851 56,602 25 1861 73,064 29 1871 93,152 27 1881 105,613 13 1891 107,592 2 The age and sex distribution of the population at the census of 1891 was as follows— 1891. All ages. 0- 5- 10- 15- 20- 25- 3d— 45- 5&- 65- 75 and upwards. Mile End Old Town— Males: Per cent, of total population 48.64 664 5'75 5.41 4.86 4.67 7.91 5.51 400 2.31 1.20 .38 Females: Per cent, of total population 51*36 6'73 5.88 5.33 4.95 5.05 7.98 5.78 4.34 2.80 1.73 .70 London— Males: Per cent, of total population 47.27 5.92 5.36 4.90 4.69 4.61 7.92 5.85 411 2.35 1.20 .37 Females: Per cent, of total population 52.73 5.99 5.42 4.99 5.21 5.56 911 6.49 4.64 2.92 1.72 .69 *The later figures relate to the registration district of Mile End Old Town, which was formed out of the Stepney district on the 1st October, 1857. The earlier figures relate to the corresponding area forming a subdivision of the Stepney district. 3 On dividing the population of Mile End into sections according to the character of the employment of heads of families, Mr. Booth found— 5.3 per cent. belonged to the section headed manufacture of dress. 5.3 „ „ „ „ clerks and agents. 5.6 ,, ,, ,, ,, building trades. There is, however, no very marked excess of any particular class of employment. As Mr. Booth says: "Mile End with a little of everything very closely represents the average of the whole district " (East London). The Russians and Russian Poles of Mile End, who numbered only 893 at the 1881 census, had increased to 3,140 at the 1891 census, and have almost certainly undergone further augmentation in the last few years. The percentage of persons associated with the manufacture of dress in Mile End given by Mr. Booth (53 per cent.), does not therefore, it may be assumed, adequately represent the now .existing percentage. It may be noted that these Russians and Russian Poles are especially numerous in the west ward of Mile End Old Town, the ward adjoining Whitechapel. Mr. Taylor, in his annual report for 1892, observes : " During the last year the alien population in this ward has much increased, but to what exact extent it is impossible to estimate." He adds: "One cannot help being struck by the thriftiness of these people, coming over as they do with a mere bundle, and in a few weeks' time seeing them carrying on their various businesses as though they had been here for years." Birth rate, marriage rate and death rate.—The birth rate in 1893 was 38'7 per 1,000, and that of 1892 was 38'2, while the ten years' average upon which Mr. Booth was working when he placed Mile End fourth in order of registration districts with respect to birth rate, was 383. The marriage rate in 1893 was 27.7. The death rates of the district per 1,000 living, corrected for outlying institution deaths, during the last three years are as follows— 213 in 1891, 23 1 in 1892, and 22 6 in 1893. The death rates for the county of London being— 210 in 1891, 20 3 in 1892, and 20 9 in 1893. If these figures be corrected for age and sex distribution by applying the factors for correction given on p. 9 of the annual report of the medical officer of the Council for 1892, the following corrected rates are obtained— 1891. 1892. 1893. Mile End Old Town London 2195 2239 23.80 21.60 23.29 22.28 The deaths of infants under one year of age per 1,000 registered births in Mile End and in London respectively are as follows— 1891. 1892. 1893. Mile End Old Town 149 153 149 London 153 154 163 The zymotic death rates per 1,000 living, in the district and in London, during the same years 1891. 1892. 1893. Mile End Old Town 1.9 3.6 3.35 London 2.0 2.8 3.04 On computing approximately the expectation of life at birth in Mile End by application of Dr. Bristowe's formula to the mean death rate and birth rate of the three years 1891-2-3, it will be found that the expectation of life at birth in Mile End is 34.2 years; the corresponding figure for London being 39.l years, and that for Whitechapel 30 9 years. Sanitary circumstances. Water supply.—The whole district is supplied by the East London Water Company. As there are comparatively few high buildings, the question of constant supply being afforded for the upper floors of such buildings did not assume in 1893 the prominence which it did in Whitechapel. Complaints have, however, been received this summer relative to the supply being altogether cut off at night time. This matter is indeed under the consideration of the Council at the time of writing this report. Results of inspection.—I inspected 507 houses in Mile End. In 165 of these defects were found to exist. In the report of the sanitary committee of the Jewish Board of Guardians for 1893 it is stated that the committee's inspector visited 298 houses in Mile End, of which the number found "defective and below standard of local authority "was 182. The inspector of the Jewish Board of Guardians thus found 61 per cent. of the houses visited by him defective, while the corresponding percentage, obtained as the result of my inspection, was 32 per cent. This discrepancy is at first sight startling, especially in view of the close correspondence of our results in the case of Whitechapel. I could not fail to note, however, the very large number of instances in which improvement had been effected in Mile End houses within the last two years; and when inspecting workshops in Mile End (at the end of 1892, and again on two occasions separated by some interval during 1893), it was obvious that great improvement in their condition was in progress. From the annual report of the vestry for 1892 it appears that during the early part of 1892 the sanitary staff was reorganised, and that, whereas at the end of 1891 there were only two sanitary inspectors, from June 1892 onwards the staff consisted of three inspectors and a clerk. There can be no doubt that there has been during the last two years a remarkable transformation in the sanitary condition of the district, and it may be that the differences between the results of inspection by the inspector of the Jewish Board of Guardians and myself are thus explained. As regards the nature of the defects noted during this year's inspection, I found dirty conditions and dilapidations in rather more than five per cent. of the houses visited. This class of defect is, as 4 might be anticipated, especially associated with particular parts of the district, and could be dealt with by the registration of the houses concerned and the systematic application to them of bylaws regulating houses let in lodgings. Defects in connection with water-closets were not uncommon. I found one water-closet choked, 5 instances of broken water-closet pans, one instance of total absence of fittings for the supply of water, 36 instances in which the flushing apparatus was out of order, 16 foul pans, 9 instances in which the flush of water was inadequate, and 3 instances of broken water-closet seats. A great deal of work has, however, been accomplished within the last two years in connection with water-closets. In a large number of instances improved forms 'of apparatus, which comply with the new by-laws of the Council, have been substituted in place of old or defective forms of apparatus. Other defects noted are dampness of walls of rooms (18); defective yard paving (21); defective roofs (9) ; defective traps in yards and cellars (9); defective sink wastes (3); defective rain-water pipes or eaves guttering (10); and a stopped yard drain. In a large number of instances there was evidence that the work of replacing old and defective traps by syphon traps, and of disconnecting sink waste pipes from direct communication with the drain, had been effected within the last two years. I found nine instances of overcrowding, i.e., more people in a room than would allow 300 cubic feet of air space per head in rooms used exclusively for sleeping purposes, and 350 cubic feet in rooms not used exclusively for sleeping purposes, two children under 10 being reckoned as one adult.* As an instance of the class of property requiring much supervision I may quote the following— Mary-buildings, Devonshire-street—A court, approached from Devonshire-street by an unpaved passage-way, containing eight two-storey houses, each of which has two rooms and a back addition room. The drains have recently been under reconstruction. No. 1—In the upper room (capacity rather more than 800 cubic feet) sleep man, wife, two girls over 10 years of age, and a young child. Roof defective, house dirty and in bad state of repair. No. 2—Ceiling of back addition room defective, house dirty and in bad state of repair. Nos. 3 and 4—No admission. No. 5—In the upper room (capacity about 800 cubic feet) sleep man, wife, and five children. House dirty and in bad state of repair. No. 6—No overcrowding here. Paper falling off walls in back addition room. No. 7—Upstairs room cubic capacity less than 800 cubic feet. Three adults sleep here. In the poorer parts of the central ward too I found evidence of the existence of conditions similar to the above. A good example of the improvement which can be effected in a very bad neighbourhood by the exercise of much perseverance is afforded by Knott-street, a street in this locality which has lately taken up much of the time of the vestry's officers. I visited 99 workshops, and found that with one exception all had been noted and dealt with by the inspectors. In one instance I found a workshop overcrowded. Separate watercloset accommodation had been provided in accordance with section 38 of the Public Health (London) Act, in cases where persons of the two sexes were employed. In Mr. Taylor's annual report for the year 1893, a table is given showing particulars for each workshop in the district as to position, trade carried on, number of workers for which the cubical capacity of the workroom is adapted, dates of inspection, condition of the workshop at the times of inspection, and work carried out during the year under the provisions of the Public Health (London) Act, 1891. Mr. Taylor observes that in 1892 he and his officers were endeavouring to carry out the duty of inspecting workshops, and, he continues, " since then great progress has been made as regards discovering the location of most of the workshops in our district, and also in organising systematic inspections, and in keeping a record of work done in connection therewith ; as will be seen by the detailed report, the major portion of them are in the west ward district, for which Mr. Twaits is inspector. The objects of inspection are, viz., (1) seeing that all workshops are kept in a cleanly state; (2) the detection of overcrowding; (3) the provision of suitable sanitary conveniences for both sexes. The whole of the workshops on our register is now over 200, and they have been inspected twice during the past year, in a number of instances various orders for cleansing and the abatement of overcrowding, &c., have been enforced." The great alteration which has been effected in the condition of the west ward of Mile End affords striking testimony to the care with which the method of dealing with these places has been thought out, and to the energy and ability with which it has been carried into execution by the inspector. The large amount of improvement which has been effected in streets such as Plumber's-row, Yalfordstreet and Greenfield-street, streets in which almost every house contains a workshop, could hardly have been so speedily and successfully accomplished unless there had also been in many instances a readiness on the part of occupiers of the workshops and owners of the houses to meet the requirements of the law. An organised attempt has been made in Mile End to carry out the order of the Secretary of State, of November, 1892, relating to outworkers in particular trades. In the early part of 1893 a circular letter was sent out to all employers of labour in the specified trades in Mile End. As result 620 addresses of outworkers were obtained, the addresses belonging to adjoining parishes were sent to the various sanitary authorities concerned, the premises situated in Mile End, 377 in number, were visited and reported upon. Mr. Taylor remarks, " One may regard this work as serving a very useful purpose to the community at large, as it ensures their wearing apparel being made in cleanly and properly ventilated workrooms ; and, in the event of infectious diseases taking place in these houses, we are enabled to communicate the fact directly to the employers, and so proper precautions can be taken before the clothing is either sent to the shop or sold to the public." He adds, " I find that we are one of a very few of the authorities that have made any attempt to grapple with this work." Mr. Taylor comments, however, upon the considerable amount of the time of the inspectors taken up by this duty, and observes *These are the limits imposed in the regulations made by the vestry under the Sanitary Act of 1866. 5 "unless we have a considerable increase in the staff of inspectors the order cannot be carried out in its entirety." I noted the absence or defective condition of receptacles for house refuse in nineteen instances, and in eight cases found on premises visited a considerable accumulation of dust; complaint was made by several persons that there was difficulty in securing the regular removal of house refuse. Faulty structural conditions not admitting of easy remedy have not been alluded to in the above category of defects, and do not assume anything approaching the degree of prominence which obtains in Whitechapel. There is of course a marked difference in the character of the two districts in this respect. Mile End Old Town possesses, however, a certain number of narrow streets and confined courts. The lower part of Romford.street has been particularly referred to by Mr. Taylor in his annual report for 1892, and in the same report mention is made of Knott.street and adjoining streets, and of Lewin's. buildings. In his annual report for 1898, Mr. Taylor speaks of Lomas.buildings as " one of the worst blots " in the district. This opinion my own experience of Mile End leads me to confirm. Mr. Taylor has made considerable use of the procedure of the Housing of the Working Classes Act to the great advantage of his district. Copies of representations made to the vestry of Mile End relating to more than 200 houses have been received by the Council since the passing of the 1890 Act, many of the houses in question have been under repair and are now inhabited, but in several instances after remaining closed for a time they have been ultimately demolished. Mr. Taylor writes in his annual report for 1892, " Although this method of dealing with insanitary houses involves considerable time, and trouble, the results prove to be very satisfactory." He adds that the premises in respect to which proceedings were taken under the Act were in such a dilapidated condition as to render it almost impossible to deal with them under the Public Health Act. Bakehouses.—Of the 82 bakehouses in Mile End, I inspected 29. Twelve were situated below the ground level. Speaking generally, the bakehouses were clean and well kept, and the existing law was enforced. Slaughterhouses, cowsheds, and offensive trades.—I visited the twelve licensed slaughterhouses, the twenty cowsheds, the offensive trade premises, and several milkshops in the district. The dung.pits of some of the cowhouses though in conformity with the regulations made under the Dairies, Cowsheds, &c., Orders, did not conform with the new bylaws made by the Council under section 39 (1) of the Public Health (London) 1891, Act. There was evidence of need too of the application by the sanitary authority of the bylaws relating to the removal of offensive matter. Considerable nuisance has latterly been experienced in Mile End from a blood.boiler's premises in Bow.common lane. The occupier was prosecuted and fined j£3 in August last, but the nuisance has since recurred, and the matter is being dealt with at the time of writing this report. Regent's canal.—I inspected the portion of the canal situated in Mile End, and found the water in a fair condition, no carcases of dead animals were seen floating upon it. The question of the drainage from the lock.keepers' houses had been dealt with. The drains formerly communicated with the canal; the water.closet at Mile End lock has now been connected with the sewer, and at Johnson's lock an earth.closet has been provided. There was formerly too pollution of the canal caused by a urinal on the east side of Rhodeswell.road ; a new urinal which is drained into the sewer has been constructed there. The condition of the towing.path has, moreover, been improved by laying down ballast. Disinfection—Disinfecting apparatus.—Sulphur dioxide fumigation is employed for the disinfection of rooms. In cases of small.pox the walls are washed with carbolic acid. The disinfecting apparatus is an old Fraser's oven which has been converted into a steam dis. infector. Articles are exposed to steam (not superheated steam, as the oven will not stand pressure) for about 25 minutes, and must then be left in the oven for an hour to dry. The apparatus appears to labour under considerable disadvantages as compared with the forms of steam apparatus which have been adopted by a number of London sanitary authorities. A shelter for the accommodation during disinfection of their dwelling of the members of any family in which dangerous infectious disease has appeared, has been provided in accordance with section 60 (4) of the Public Health (London) Act. Three separate rooms are kept for such use in the shelter, and there is a resident caretaker. I was told application to use the shelter is made on an average about once a week. Mortuary.—A new mortuary was being built at the time of my inspection. Sanitary administration. There are three sanitary inspectors, each of whom has charge of a particular district. The ward divisions of the parish form the basis for the mapping out of the districts. No. 1 district comprises the whole of the east ward and the portion of the north ward east of Globe.road. No. 2 district comprises the whole of the centre ward and the part of the north ward west of Globe.road. No. 3 district comprises the whole of the west and south wards. All three inspectors are appointed to take samples under the Food and Drugs Act in their respective districts. A clerk relieves the inspectors of a large share of their clerical work, and there are three men belonging to the surveyor's department, who are concerned with the work of disinfection, and who render occasional assistance to the inspectors when requested to do so. Mr. Taylor states in his annual report for 1891 that a system of house to house inspection " is the only proper method of inspecting a district thoroughly," and such a system has been adopted in Mile End Old Town since that year; at first with two inspectors progress seems to have been slow; but since June, 1892, 6 when the staff was increased, considerable advance has been made, a large number of streets having now been reported upon. The streets inspected are marked on a map which shows the localities dealt with in the course of each year. Mr. Taylor informs me that he anticipates the entire district will have been under house to house inspection in another year's time. In the event of this anticipation being realised, the first survey of Mile End will have occupied between four and five years. Mr. Taylor hopes that the second survey will be effected in a shorter time, both by reason of the substantial improvements which will have been carried out as result of the original house to house inspection, and because the greater part of the inspection in progress has been effected since June, 1892. The complaint book shows a marked falling off in the number of complaints this year ; dealing with complaints I am told does not at the present time absorb a large share of the inspectors' attention, and it seems as though the proportion of their time devoted to " work on complaint " will tend to further diminish. Each inspector performs the work in his own district in connection with notifications of infectious disease and with workshops. In all cases of diphtheriu and typhoid fever, drain testing is carried out and, if necessary, re.construction is insisted upon. The majority of the workshops are situated in No. 3 district (west and south wards). The great improvement which has been carried out in these places cannot fail to have most important and far.reaching influences. The contrast between the results as to overcrowding obtained on my inspection of workshops in Mile End at the end of 1892 and in August of this year is very marked, though allowance must be made for the fact that the first inspection was made at a busier time of year than the second, and that the second inspection covered wider ground than the first. Again, during the last two years separate water.closet accommodation for persons of the two sexes, in accordance with the requirement of section 38 of the Public Health (London) Act, has been provided in those instances in which men and women are employed on the same premises, and the law relating to this matter is now systematically enforced. ♦By.laws under section 94 of the Public Health (London) Act are under the consideration of the vestry. Some use has, I am told, been made of regulations as to houses let in lodgings, under the Sanitary Act of 1866 ; latterly, however, reliance has been solely placed on the carrying out of the system of house to house inspection. A large percentage of the houses in Mile End are let in lodgings or occupied by members of more than one family, and a complete survey of them would involve little short of a house to house inspection of the district. There are certain streets and groups of houses however in which frequent inspection is particularly needed, and for these by.laws under section 94 would be especially useful. To thoroughly carry out a complete system of periodical supervision of such houses would entail extra work, and as has been seen the time required for a complete house to house inspection of the district has not as yet been reduced within desirable limits. The statutory requirement that the vestry shall enforce by.laws for houses let in lodgings or occupied by members of more than one family will, when complied with, no doubt necessitate the strengthening of the staff. W. H. Hamer, Assistant Medical Officer of Health. * By.laws under sections 16 (1), 39 (2), and 60 of the Public Health London (1891) Act have been made by the vestry. Appendix X. London Country Council. Public Health Department, Spring Gardens, S.W., December 10th, 1894. Report by the Medical Officer of Health presenting a report by Dr. Young on the Sanitary Condition and Administration of the District of Bethnal.green. (Ordered by the Public Health and Housing Committee to be printed.) In presenting Dr. Young's report I beg to point out that whereas in London as a whole there is one sanitary inspector to some 20,000 inhabitants, in Bethnal.green there is one sanitary inspector to some 25,000 inhabitants. But while the staff of inspectors in Bethnal.green is below the London average, if the district be compared with other districts in London in respect of conditions which make claim on a sanitary authority it is found that these conditions more abundantly exist in Bethnal.green than in most other London districts. Thus the persons inhabiting one or two rooms constitute in Bethnal.green a larger proportion of the population than they do in two.thirds of the districts in London. I am satisfied, therefore, the advice given by Dr. Young that another inspector should be forthwith appointed, raising the total number of inspectors employed to six, deserves the approval of the Committee. Beyond this I may add that my own experience of the district, obtained by a detailed inspection in 1887, and by familiarity with its condition since I have held my present office, leads me to the conclusion that this number of inspectors with sufficient clerical assistance is the very smallest which will suffice for the administration of the district. The need of a shelter for persons during the disinfection of their rooms is also properly insisted upon by Dr. Young. Shirley F. Murphy, Medical Officer of Health. Dr. Young's Report. The parish of St. Matthew, Bethnal.green, which forms the sanitary district of Bethnal.green, is situated in the eastern part of the metropolis. It adjoins Whitechapel and Mile.end Old.town on the south, has Shoreditch and Hackney on the north.west, and Poplar on the east. The area of the parish is 755 acres, including about 17 acres of water, the latter being mainly composed of ornamental water in Victoria.park. The rateable value of the parish at the present time is £428,711. At the date of the last census in 1891 there were 16,542 inhabited houses in the parish; at the previous census in 1881 the number was 16,606. There has, therefore, during the decade, been a decrease of 64, which is probably to be accounted for, to a large extent, by the fact that business premises have replaced houses, and as the parish was already practically built over at the date of the earlier census, the decrease has not been compensated by the erection of new houses. Population—The parish of St. Matthew, Bethnal.green, forms a registration district, which is divided into three registration sub.districts, namely : north, south, and east. When the census was taken in 1891, the population was found to be 129,132; at the date of the previous census in 1881, it was 126,961; during the ten years there was, therefore, an increase of 2,171, or an increase of 1.7 per cent. in the number of persons residing in the whole district. The figures in the census report for each of the sub.districts are as follows— 1881. 1891. North 51,157 51,520 South 34,399 33,489 East 41,405 44,123 126,961 129,132 These figures show that the small increase which has taken place in the total population of the whole parish is due mainly to the change which has occurred in the east sub.district. In the south sub.district the population has diminished. Dr. George Paddock Bate, the medical officer of health of Bethnal.green, in his annual reports for the years 1892 and 1893, in dealing with the question of population, states, that since the census was taken in 1891, the number of persons residing in the parish has decreased, and he estimates that in the year 1892, the population was 127,030, which further decreased in 1893 to 123,000. He bases his opinion on the fact that during each of these years the number of registered births in the parish has been decreasing. Further, the demolition of houses upon the Boundary.street area, cleared by the London County Council under the Housing of the Working Classes Act, and the consequent removal of residents during the latter part of this period has probably No. 231. Price 2d. Sold by E. Stanford, 26, Cockspur.street, S.W. [2855 2 had the effect of causing emigration from Bethnal.green into the adjoining districts, though some have no doubt taken up their abode in other parts of the parish. As bearing upon this I would refer to Dr. Bate's report for 1898, in which he states that the north sub.district, in which the Boundary.street area is situated, had during this year lost 3,665 inhabitants, whereas in the south sub.district, in which during the previous ten years the population had been diminishing, there had been an increase of 1,800 residents. I extract from this report the following figures as to the estimated population of each sub. district, together with the population at the date of the last census. North South East... 1891. Census population. J 892. Estimated population, 1893. Estimated population. 51,520 33,489 44,123 129,132 51,250 31,175 44,615 127,040 47,585 32,975 42,440 123,000 The density of the population in Bethnal.green, as shown by the average number of persons per acre, and the average number of persons to each inhabited house at different census periods, is as follows— Number of persons per acre. Number of persons per inhabited house.[/####] 1861 139 7.1 1871 159 7.5 1881 168 7.6 1891 171 7.8 In registration London in 1891 there was an average of 56 persons to each acre, and 7.7 persons to each inhabited house. The character of the population residing in Bethnal.green will be seen from the following statements showing—(1) the age distribution of the population, (2) the condition of the population as to poverty, (3) the condition of the population as to habitations. (1) The proportion of persons at various age groups, and of each sex compared with the conditions which obtain in London generally. This is obtained from the figures contained in the census report for 1891. All ages. 0. 5. 10. 15. 20. 25. 35. 45. 55. 65. 75 and upwards. Bethnal.green— Males 49 03 6.79 6.23 5.81 5.12 4.43 7.52 5.60 3.89 2.16 1.14 .34 Females 50.97 7.15 6.27 5.62 5.22 4.73 7.39 5.78 406 2.56 1.56 .63 London— Males 47.27 5.92 5.36 4.90 4.69 4.61 7.92 5.85 4 11 2.35 1.20 .37 Females 52.73 5.99 5.42 4.99 5.21 5.56 911 6.49 4.64 2.92 1.72 .69 According to these figures the population of Bethnal.green contains a relatively greater number of males, as well as a larger proportion of young persons than that of London generally; the former difference is probably in a large measure accounted for by the fact that the chief industry which now prevails in the district of Bethnal.green, namely, furniture and cabinet.making, is one which gives occupation largely to young adult males, while the high birth rate (which is referred to later) doubtless explains to some extent the relative excess of persons in the earlier years of life, as compared with London generally. (2) The classification of the inhabitants into groups according to means, and position of heads of families. For this purpose I have taken the following figures from Mr. C. Booth's work on the " Life and Labour of the People in London " published in 1889— Very poor. Poor. Comfortable. Well.to.do. Lowest class. Casual earnings. Irregular earnings. Regular minimum. Ordinary standard earnings. Highly paid work. Lower middle class. Upper middle class. Bethnal.green 1.17 per cent. 15.99 per cent. 12.57 per cent. 14.87 per cent. 39.86 per cent. 11.32 per cent. 2.96 per cent. 1.26 per cent. East London and Hackney 1.23 per cent. 11.22 per cent. 8.33 per cent. 14.46 per cent. 42.28 per cent. 13.60 per cent. 3.86 per cent. 5.02 per cent. 3 These figures show that nearly half the total population of Bethnal.green belonged at that date to the two classes included under the headings poor and very poor, and that the condition of its inhabitants compared unfavourably with that of the population living in East London and Hackney. (3) The proportion of the population living in tenements varying from one to four rooms. The following figures which bear upon this matter are taken from the annual report of the medical officer of health of the administrative County of London for the year 1892. At the time of the census in 1891 it was found that— 17,211 persons occupied 6,561 one-room tenements, or 13'3 per cent, ot the population of Bethnal-green. 27,760 „ „ 6,694 two-room „ 21.5 „ „ 29,828 „ „ 6,059 three-room „ 23.1 „ „ 23.448 „ „ 4,080 four-room„ 18.2 „ „ In London the percentage of the population living in each of tnese groups of tenements respectively was 9 2, 16.4, 15.8, 14.1. Births, marriages and deaths.—The birth rates in Bethnal-green during recent years, calculated upon the population as estimated by Dr. Bate, are as follows; the rates for London given in the Registrar-General's annual summaries for the same year, are also given. Bethnal-green. London. 1885 39.97 32.6 1886 89.99 32.3 1887 38.41 31.7 1888 37.82 30.7 1889 37.70 30.3 1890 37.26 30.8 1891 38.70 31.8 1892 38.66 30.9 1893 38.67 30.9 The birth rate in Bethnal.green has therefore during all these years been considerably higher than in the metropolis and has been fairly well maintained. The marriage rates in Bethnal.green for the years 1891 and 1892 were 28'9 and 22'8 per 1,000 persons living, as compared with 17.7 and 17.4 in the Administrative County of London ; this excess over the London rate, although considerable, shows a marked decrease compared with former years, for in the year 1881 the marriage rate in Bethnal.green was 41, while the corresponding rate for London was 18. I quote the rates for 1881 from a report by Messrs. Cubitt Nicholls and Shirley F. Murphy, on the condition of Bethnal-green in 1887, which was presented to Parliament. According to the figures in the census return for 1891 I find that the proportion of married and widowed males and females under 25 years of age to the total married population in Bethnal.green and in registration London, is as follows— Bethnal.green London Males. Females. 705 5.06 10.8 8.1 In the following table are given the rates for deaths from all causes, from the principal zymotic diseases, and the infantile mortality in the parish of Bethnal.green. In calculating these rates I have made use of the figures which are given in the annual reports by Dr. Bate, and also his estimates as to the average number of persons living in the parish during each period. The infantile rates are calculated upon the number of registered births. The corresponding rates for the administrative County of London for the same periods are also The general death rates have been corrected for age and sex distribution. Deaths from all causes. Deaths from seven chief zymotic diseases. Infantile mortality. Bethnal-green. London. Bethnal-green. London. Bethnal-green. London. 1885-91 24.1 21.2 3.66 2.70 159 152 1892 24.5 21.6 4.14 2.80 159 154 1893 27.6 22.3 4.15 3.04 179 163 It will be seen that the mortality from all causes, from the seven principal zymotic diseases together and the infantile mortality is, in each case, greater in Bethnal.green than in London generally. The houses in the parish of Bethnal-green, except in the main thoroughfares, are, for the most part, buildings two storeys high; they are situated in streets which are generally of a width in fair proportion to the height of the buildings, and are provided with open space in the rear. Some small courts and alleys, in which the houses are not well arranged, still exist in the parish, and a few of the older houses are built back.to.back or have no through ventilation. Several courts were visited which are approached 4 from the street by a narrow passage, or an archway under a house; in some of these the houses were at the time in a fair condition owing to the fact that repairs had been effected within a recent period, in other cases the houses were old and worn out. During the inspection I visited 462 dwellings, and in 280 of these defective conditions were found to exist; these include dilapidations such as defective roofs and ceilings, broken plaster of the walls, defective flooring, guttering and stack.pipes, and unpaved or insufficiently paved yards and forecourts adjoining the houses. As a rule it was found that waterclosets were provided with separate flushing cisterns (the domestic water supply being generally obtained from the rising main), that drain inlets were provided with properly trapped gulleys, and that sinks situated within houses were aerially disconnected from the drains, and discharged over gulley traps outside the buildings. Although defective conditions of water. closets and traps were observed, it may be said that there was little ground for fault to be found in regard to these matters; the action of the vestry has apparently, during recent years, caused much improvement of the drainage of premises, and especially in maintaining house drains and fittings in a fair condition of repair. I found also that, with few exceptions, houses are well provided with movable dust receptacles consisting of galvanised iron pails, which, however, are not fitted with covers. These pails were originally distributed to all houses in the parish by the vestry, and can now be replaced by owners, when necessary, at a trifling cost. In many instances it was observed that the custom of keeping poultry and other animals tended to cause a dirty and untidy condition of the back yards. The condition, however, which was most noticeable, and which I found to exist in a large number of houses, especially in the older premises, was dampness of the walls in some cases extending up as high as the ceiling of the ground floor room. This is probably due in a great measure to some structural defect, such as the absence of a proper damp course ; in many of these houses, however, it was observed that the level of the ground floor was below that of the adjoining ground, and that the floors were often laid either directly on the soil without any intervening air space, or that the ground underneath the flooring was not covered with a layer of concrete. In some houses, owing to the action of the vestry, attempts have been made, with a fair amount of success, to remedy these conditions, by excavation of the ground beneath the floor and by the insertion of damp courses. As the result of proceedings under the Housing of the Working Classes Act much improvement has been, and is still being effected in some parts of the parish, especially where houses had been erected during the last few years in place of premises which the owners had demolished after closing orders had been obtained. Houses in Columbia.road, Ezra.street, Harts.lane, and Brady.street may be referred to as illustrations. In other instances, however, the results obtained under this Act had not been so satisfactory. This is probably due to the fact that attempts have been made to place the existing houses in a habitable condition, but either the repairs were not of a sufficiently substantial character, or else the condition of the premises was such as to render of little use any measures short of reconstruction, and the result has been that within a short period the premises have again fallen into a defective state. In this connection I may cite the case of a row of houses which had been closed under a magistrate's order a short time prior to my visit in order that they should be rendered fit for habitation, this was the second time within a period of about four years that it had been necessary to apply for closing orders with regard to these premises. Again I found a number of houses to be in a defective condition, with damp walls, defective paving, and dilapidations, yet these houses had some eighteen months previously been repaired to meet the requirements of a magistrate's closing order. Most of the houses which I visited, were occupied by more than one family. Some of these, evidently, had been originally designed for occupation by one family only, but some were recent buildings erected with a view to accommodate two or more families, and were provided with separate washhouse and water.closet for each tenement. Inquiry was made at many houses as to the number of residents, and in many instances it was found (more especially in single room tenements) that overcrowding existed, that is to say, the amount of cubic space per head was less than the minimum amount which is adopted as a standard in the model by-laws of the Local Government Board as to houses occupied by members of more than one family. These by.laws prescribe 400 cubic feet for each person in rooms occupied as living and sleeping rooms, and 300 cubic feet in rooms used as sleeping rooms only, two children under ten being regarded as equivalent to one adult. The following are a few instances of the conditions met with in single room tenements — a family consisting of father, mother and four children living in a room of about 960 cubic feet capacity; a father, mother and two children in a room of 980 cubic feet capacity ; father, mother and three children in a room of 710 cubic feet; father, mother and two children in a room of 740 cubic feet capacity. In connection with the subject of overcrowding I append the following table as regards Bethnal. green from the annual report of the medical officer of health of the administrative County of London. In this report it is pointed out that in the census report for 1891, the number of persons in each sanitary district occupying tenements of less than five rooms, and more than two persons in a room is taken as representing a condition of overcrowding. The following figures show the number of tenements thus occupied and the number of person3 and the percentage of the population of the parish dwelling in them. 1 room 2 rooms 3 rooms 4 rooms Number of 1 to 4 roomed tenements with more than two occupants per room. Number of occupiers of such tenements. Percentage of population in such tenements. 2,927 2,583 1,447 539 11,498 15,955 11,496 5,260 8.90 12.36 8.90 4.07 5 Nearly 35 per cent. of the population, therefore, live under this condition in this parish. This is only exceeded in the metropolis by the conditions prevailing in Whitechapel, St. George.in.the. East, St. Luke, Clerkenwell and Holborn, in which more than 35 per cent. of the respective populations live under similar conditions. Workshops.—I visited 145 workshops in the course of my inspection; this probably represents but a small proportion of the total number existing in the parish. The trade carried on in the greater number was that of cabinet.making, or work connected with the manufacture of furniture. Some workshops were occupied by bootmakers, and a few only (situated in that part of the parish adjoining Whitechapel and Mile.end), by tailors. Generally speaking, the means of light and ventilation in these workshops were adequate, but many were visited in which the walls and ceilings required cleansing or repair. The watercloset accommodation was also generally found to be sufficient for the number of workers, but instances were not wanting in which defective conditions of the flushing apparatus, or foul closet pans were noticed. In one group of workshops it was observed that the waterclosets opened directly out of the workshop, and in another the trough closet, common to a number of workshops, was found to be in a dirty condition, due in great part to insufficient flushing. Little evidence was found of the existence of overcrowding of workshops, but I have notes of the occurrence of this condition in five instances. The systematic inspection of workshops in the district was undertaken by the sanitary authority in 1893, when the vestry appointed an additional inspector, who devotes his time almost entirely to this work. A large number of workshops have been inspected and entered on the books of the vestry, but Dr. Bate informs me that he estimates that probably not more than one.fifth of the total number of workshops in the parish have been inspected. The fact that a large number are domestic workshops makes it almost a necessity that a house to house call should be made in order to ascertain all the workshops in the parish. Bakehouses.—The total number of bakehouses, according to the last annual report of the medical officer of health for the parish, is 106. Of these, 49 were visited ; 18 were found to be situated below the ground level. In eight bakehouses the means provided for ventilation were insufficient. The periodical cleansing and limewashing of the walls and ceilings appear to be well enforced, but in 12 instances a want of cleanliness, or an accumulation of sweepings underneath the troughs was observed. The water supply is in almost all instances taken direct from the rising main. Slaughterhouses, cowsheds, and milkshops.— There are 11 licensed slaughterhouses, and 24 cowsheds in Bethnal.green. I visited the majority of these, and found that they were cleanly and kept in compliance with the regulations applying to these trades. At one slaughterhouse, attached to a shop which is stated to be open on one day only throughout the week, the slaughterhouse premises were not kept in a cleanly condition. In this case and in one other the approach to the slaughterhouse is through the shop. In two cases the use of the slaughterhouse is limited to the killing of small animals. As regards the cowsheds, two were in need of limewashing at the date of my visit. In many cases new dungpits, constructed so as to comply with the by.laws of the Council, had been built owing to the action of the sanitary authority. Several of the sheds are situated in close proximity to inhabited houses, and in three cases the sheds abut upon the wall of a house. I also visited some milkshops, and found that the regulations as to cleanliness were generally complied with. Offensive trades.—The only businesses of this nature carried on in the parish are gut-scraping and tripe-boiling. For the former, two sets of premises are registered, for the latter one set; both the former were found in a satisfactory condition, and no effluvium was noticed outside the buildings. The tripe.boiling establishment was also in a satisfactory condition. Mortuary.—The vestry have provided a mortuary for the parish. This building, which was erected in 1880, is situated in St. Matthew's.churchyard, and contains two mortuary chambers, a post-mortem room, and lavatory accommodation. The caretaker lives in the old watch.house close to the mortuary. Disinfection.—For the purpose of disinfecting articles of clothing and bedding a steam. disinfecting oven has been provided at the vestry's yard in Digby-street. Two covered hand.carts are used for the removal of articles to and from the oven. No charge is made for disinfection. No special apparatus has been provided for the destruction of articles in cases where disinfection is considered undesirable; they are burned in the open yard after being saturated with paraffin, and I was informed when I visited the yard that in practice it is found necessary to destroy articles of bedding, &c., in this way about once in every three weeks. This procedure does not appear to give rise to complaint, although there are inhabited houses on all sides of the yard. The rooms in which cases of infectious disease have occurred are disinfected by the officers of the authority, sulphurous acid gas being used for the purpose. It is not customary, however, to strip the walls and cleanse the rooms after fumigation, but if the condition of the room is sufficiently bad to constitute a nuisance, notice is served upon the owner to cleanse. The vestry had not, at the time of the enquiry, fulfilled their statutory duty under section 60 of the Public Health (London) Act, 1891, which requires that a shelter shall be provided for the convenience of persons during the period necessary for the disinfection of their dwellings. Water supply.—The water supply of the parish is furnished by the East London Waterworks Company. It is almost universally the practice in the houses in this district for the domestic water supply to be drawn direct from the rising main, without the intervention of storage cisterns. Scavenging.—The collection and disposal of house refuse is done by contractors on behalf of the sanitary authority. The collection is made twice weekly from all houses. It is the custom in a large part of the parish to place the dust pails on the pavement in front of the house ; where this is not done the houses are called at. The vestry employ seven pail-men, who are under the supervision of the 6 sanitary inspectors. The system apparently acts well, as during the inspection in only exceptional instances were accumulations of house refuse noticed. The scavenging of the roads is also done by contract. Sanitary administration.—The sanitary staff appointed by the Vestry of Bethnal.green consists of— A medical officer of health, who is also engaged in the practice of his profession. 4 sanitary inspectors. 1 clerk, In addition there are two assistants employed in the disinfection of rooms and of articles of bedding and clothing, and seven " pail.men." The sanitary inspectors act under the supervision and control of the medical officer of health, who attends every week.day morning at the vestry offices in order to receive their reports and to give them instructions. To three of the inspectors a portion of the parish has been assigned, they perform all sanitary duties arising in it, and also carry out the duties arising in connection with the administration of the Food and Drugs Act. The fourth inspector, who was appointed as recently as December, 1898, is concerned with the inspection of workshops, bakehouses, slaughterhouses and cowsheds. Each sanitary inspector prepares his own notices. The clerk attached to the department keeps the complaint book in which is registered the action taken regarding each house which has come under the notice of the sanitary authority, the registers of infectious disease, which contain particulars as to each case occurring in the parish, and a workshops register which contains the results of inspections of workshops and the action taken. The vestry have delegated to a sanitary committee their powers for the sanitary administration of the parish, with the exception of those under the Housing of the Working Classes Act, 1890. In the administration of this Act, when premises are certified by the medical officer of health to be in such a condition as to render them dangerous or injurious to health, the vestry make an order that they shall be rendered fit for human habitation, and at the same time refer the matter to the sanitary committee to visit the premises and report what (if any) further proceedings should be taken. If the committee be of opinion that it is necessary to do so, application is made to a magistrate for a closing order. Much good work has been done by the sanitary authority and its medical officer of health under this Act, although, as has already been pointed out, the attempt of owners to repair houses has led in many instances only to temporary improvement. For such houses demolition and reconstruction of the buildings is needed. Demolition and rearrangement is, moreover, the only effectual remedy in the case of houses situated in any of the narrow streets and courts which will remain after the complete demolition of houses in the Boundary.street area, now in progress. Hitherto, however, the vestry have in only one instance made an order under the Housing of the Working Classes Act for the demolition of a house. The vestry have made by.laws under the Public Health (London) Act, 1891, with regard to (1) particular nuisances (2) the cleansing of cisterns, and (3) the provision of a proper water supply to water.closets, which have been confirmed by the Local Government Board. These by.laws are similar to those made by other London authorities. By.laws with regard to houses let in lodgings or occupied by members of more than one family have recently been forwarded for confirmation to the Local Government Board. In these by-laws the amount of cubic space required in living and sleeping rooms is the same as in the model by-laws. There is no clause for the exemption of houses in cases where the rent exceeds a fixed limit; the vestry, therefore, is able to exercise complete discretion with regard to the application of the by-laws to any house let in lodgings. A systematic house-to-house inspection, except in some of the poorest parts of the parish, has not been undertaken, indeed the time of the existing staff is entirely taken up with inspection upon complaint, and the re.inspection involved in supervising the execution of the consequent work. The inspectors require that newly laid drains shall be ventilated, the water test is applied before they are passed, and a careful and thorough supervision appears to be practised by the vestry's officers during the progress of the works. The results of this enquiry into the sanitary condition of Bethnal.green may be briefly summarised as follows— (1) The death rates in the parish, from all causes, from the seven chief zymotic diseases and the infant mortality, based upon the figures contained in the yearly reports of the local medical officer of health, are in excess of the corresponding rates relating to London generally. (2) There is evidence of much work having been done and considerable improvement having been effected in the parish, but in a large proportion of houses visited defective conditions have been found to exist. (3) Systematic house to house inspection throughout the district has not been undertaken, indeed the sanitary staff is not sufficiently large for this purpose. (4) No houses have been registered under the by.laws relating to premises occupied by members of more than one family, indeed by.laws for this purpose have only recently been made by the vestry and submitted for confirmation by the Local Government Board. (5) Although the inspection of workshops has been commenced it would appear that but a small proportion have yet been visited. (6) No shelter for the accommodation of persons during the disinfection of their rooms has been provided. In concluding this report I would refer to the fact that in the year 1888 a report as to the sanitary requirements of the parish of Bethnal.green by Messrs. Cubitt Nicholls and Shirley Murphy was presented to Parliament. There is little doubt that since the date of that report improvement has been effected in the condition of the parish, owing to the adoption of some of the recommendations which 7 were then made, more particularly the re-organisation of the sanitary department and its more complete supervision by the medical officer of health. Amongst other recommendations it was at that time considered needful that there should be an addition of two inspectors, making a total of four sanitary inspectors. The vestry, however, made at that time only one such appointment, a fourth inspector was not appointed till the end of the year 1893, when it was found necessary to increase the staff in order to cope with new duties which had been imposed upon sanitary authorities in London by recent legislation. The vestry have already recognised that this increase in the staff is inadequate for the purpose of dealing with the additional work entailed by the passing of the Public Health (London) Act, 1891, and since the commencement of my inquiry, have resolved that another sanitary inspector shall be appointed, making a total of five. I do not, however, think that five inspectors will be sufficient for carrying out the work which requires to be done in the parish. The character of the district, which is almost entirely inhabited by an industrial population, a large proportion of which belongs to the poorer classes, together with the condition of the dwellings observed during the inspection, show that there is great need for a systematic house to house inspection; again, nothing short of a complete inspection of the district in this sense will ensure an adequate supervision of workshops in Bethnal.green. Further, the proposed by.laws as to houses let in lodgings which have been deposited with the Local Government Board for confirmation will increase both the amount of inspection and the clerical work of the department. The addition of one other sanitary inspector, making a total of six for the parish, and additional clerical aid, will I think be necessary, in order that the work of the department may be efficiently carried out. The vestry should take steps to provide a shelter for persons during the disinfection of their rooms. C. W. F. Young, Assistant Medical Officer of Health. Appendix XI. London Country Council. Public Health Department, Spring Gardens, S.W. 10th December, 1894. SANITARY INSPECTORS. Report of the Medical Officer of Health, submitting a return showing particulars as to the Sanitary Inspectors in the several districts of the Administrative County of London. In April, 1893, I presented to the Public Health and Housing Committee a return showing the number of sanitary inspectors in the service of the several sanitary authorities in the Administrative County of London. A similar return had been prepared in 1889, but this return gave no information as to the number of these officers in the City and in Whitechapel. Hence, for the purpose of comparison between 1889 and 1893, it was necessary to deduct from the total of the latter year the number of sanitary inspectors employed in the two districts mentioned. The return I now present is based upon information received for the most part in June and July, 1894, but there was delay in receiving information concerning some districts. If this return be dealt with in the same manner comparison can be made between the numbers in the three years— 1889. 1893. 1894. Number of sanitary inspectors in London, excluding the City and Whitechapel, and the districts mentioned in Schedule C of the Metropolis Local Management Act 115 173 204 Number of sanitary inspectors in the whole of London, excluding the districts mentioned in Schedule C of the Metropolis Local Management Act — 188 219 The following changes are deserving of notice. The sanitary district of Hackney has been divided into the two sanitary districts of Hackney and Stoke Newington, and whereas seven inspectors were in 1893 employed for the total area, in 1894 seven inspectors were employed in Hackney and two in Stoke Newington. The 188 sanitary inspectors employed in 1893 included 17 temporary officers; the 219 employed in 1894 include only 8 temporary officers. In the following districts the staff has been increased— District. No. of additional inspectors. District. No. of additional inspectors. Kensington 1 Poplar 2 St. George, Hanover-square 1 St. George, Southwark 1 St. Marylebone 2 Newington 3 St. Pancras 1 Bermondsey 2 Islington 3 Wandsworth 2 Strand 4 Camberwell 5 Bethnal-green 1 Greenwich 3 Whitechapel 1 Lewisham 1 On the other hand, in the City and in Rotherhithe, there is in 1894 one sanitary inspector less than in 1893. and in St. Martin-in-the-Fields two less. The number oi sanitary inspectors (including temporary omcers) and the number of houses and population, to each sanitary inspector, in each district is shown in the following table— Number of Sanitary Inspectors. No. of inhabited houses to each Sanitary Inspector. No. of inhabitants to each Sanitary Inspector. Permanent. Temporary. Total. West— Kensington 7 — 7* 3,155 23,758 Hammersmith 6 — 6 2,341 16,206 Fulham 3 — 3 4,289 30,547 Paddington 3 — 3 4,824 39,282 Chelsea 3 — 3 4,071 32,084 St. George, Hanover-square 3 — 3 3,734 26,121 Westminster 3 — 3 1,861 18,513 St. James 2 — 2 1,296 12,497 North— St. Marylebone 6 2 8 1,923 17,800 Hampstead 4 — 4 2,379 17,104 St. Pancras 9 — 9 2,724 26,042 Islington 15 — 15 2,525 21,276 Hackney 4 3 7 4,060 28,372 Stoke Newington 2 — 2 2,383 15,468 * In addition to the above there are two female inspectors for the inspection of workshops and laundries, and two street inspectors are also employed. Sold by Edward Stanford, 26 and 27, Cockspur-street, Charing-cross, S. W. No. 208.—Price 3d. [1246—2801 2 Number of Sanitary Inspectors. No. of inhabited houses to each Sanitary Inspector. No. of inhabitants to each Sanitary Inspector. Permanent. Temporary. Total. Central— St. Giles 5 — 5 746 7,956 St. Martin-in-the-Fields 1 1 2 738 7,308 Strand 6 — 6 358 4,187 Holborn 3 — 3* 1,146 11,162 Clerkenwell 2 — 2 3,158 33,108 St. Luke 2 — 2 1,975 21,220 London, City of 10 — 10 575 3,750 East— Shoreditch 4 — 4 3,442 31,002 Bethnal Green 4 — 4 4,135 32,283 Whitechapel 4 1 5 1,446 14,710 St. George-in-the-East 3 — 3 1,765 15,265 Limehouse 3 — 3 2,380 19,125 Mile End Old Town 3 — 3 4,689 35,864 Poplar 7 — 7 3,140 22,392 South— St. Saviour, Southwark 2 — 2 1,367 13,588 St. George, Southwark 4 — 4 1,736 14,928 Newington 5 — 5 2,639 23,160 St. Olave, Southwark 1 — 1 2,083 12,723 Bermondsey 4 — 4 2,790 26,170 Rotherhithe 2 — 2 2,621 19,627 Lambeth 8 — 8 4,819 34,400 Battersea 7 — 7 2,968 21,508 Wandsworth 13 — 13 1,950 12,072 Camberwell 14 — 14 2,418 16,810 Greenwich 8 1 9 2,749 18,379 Lewisham 6 — 6 2,644 15,441 Woolwich 3 — 3 1,753 13,616 Plumstead 4 — 4 2,157 13,109 Lee 3 — 3 1,972 12,034 London 211 8 219 2,505 19,320 Districts mentioned in Schedule C of the Metropolis Local Management Act, 1855— Close of the Collegiate Church of St. Peter, Westminster 1 1 25 235 Gray's Inn... 1 — 1 49 258 Inner Temple 1 — 1 39 96 Middle Temple 1 — 1 30 95 Lincoln's Inn 1 — 1 12 27 Staple Inn Furnival's Inn Liberty of the Charterhouse 1 — 1 24 251 6 — 6 30 160 In connection with the sanitary administration of the places mentioned in Schedule C of the Metropolis Local Management Act, 1855, inspectors have been appointed as follows— One of the sanitary inspectors of the district of Westminster acts also for the Collegiate Church of St. Peter, Westminster. For the purposes of Gray's Inn the medical officer of health holds also the office of sanitary inspector. A sanitary inspector of the district of Clerkenwell acts also for the district of Furnival's Inn, Staple Inn and Liberty of the Charterhouse. Sanitary inspectors have also been appointed at nominal salaries to the districts of Lincoln's Inn and the Inner and Middle Temples. In the last instance the surveyor holds the office. Shirley F. Murphy, Medical Officer of Health. * One street inspector is also employed. 3 Return of replies received from Medical Officers of Health of the several distriots as to number of sanitary inspectors and particulars of their appointments and duties. Vestry or District Board. Rateable Value. Census Report, 1891 (Vol. II.) Number of Inspectors at date of last return, 24th April, 1893. Number of Inspectors at present time. Date of appointment of each Inspector. Present Salary. Whether Inspectors limited to the performance of any particular duty, if so, nature of such duty. Remarks. Population. Inhabited houses. £ WEST DISTRICT. Chelsea 676,528 96,253 12,214 1 and 1 vacancy 2 Jan., 1888 21st Feb., 1893 £160 p. ann. £125 p. ann. No The inspectors receive no clerical assistance. There are also 2 disinfectors. Chelsea (detached) ... 1 1 June, 1888 £150 p. ann. No With residence, gas, &c. Also acts as assistant surveyor for Kensal Town. Fulham 510,702 91,639 12,869 3 3 25th Mar., 1886 15th Oct., 1890 7tli Jan., 1891 £120 p. ann. £120 p. ann. £120 p. ann. No. Each inspector has a district allotted to him Uniform provided. The Medical Officer of Health in his annual report for the year 1893 states that "the present staff is quite inade. "quate to properly perform the "duties devolving upon the Sani. "tary Authority." Clerical assistance to inspectors provided. 4 5 Sanitary inspectors—Particulars of appointments and duties—(continued). Vestry or District Board. Rateable Value. Census Report, 1891 (Vol. II.) Number of Inspectors at date of last return, 24th April, 1893. Number of Inspectors at present time. Date of appointment of each Inspector. Present Salary. Whether Inspectors limited to the performance of any particular duty, if so, nature of such duty. Remarks. Population Inhabited houses. Hammersmith ₤ WEST DISTRICT—Continued. These appointments were made by the late Fulham District Board. The actual date of the appointments by the Hammersmith Vestry is 26th March, 1886. 523,149 97,239 14,049 5 and 1 vacancy 6 16th Dec., 1874 £2 5s. p. wk District assigned. 20th May, 1884 £2 5s. p. wk District assigned. 8th May, 1880 £2 5s. p. wk Yes. Removal of dust, and Food and Drugs Act. 15th April,1884 £2 5s. p. wk District assigned. Do. Do. 12th May, 1886. 16th Jan., 1893 £2 5s. p. wk. House to house inspector. Clerical assistance provided. 2 clerks. 16th Mar., 1893 £2 5s. p. wk. District assigned. Kensington 2,064,075 166,308 22,084 6 7 May, 1878 £125 p. ann. There are also two street inspectors whose duties include collection of samples of food, drugs and drink and inspection of mews and stables. One appointed Nov., 1890, at £78 and now receiving £90 per annum; the other appointed August, 1892, at £85 per annum. June, 1891 £115~ Rising by annual increments of £5 to £120. *Visits all cases of infectious disease and superintends all disinfection with assistance of a disinfector. He is also responsible for the inspection of a small part of the parish. Aug., 1892 £110 Aug., 1892 £110 Dec., 1893 *£100 June, 1894 £105 June, 1894 £2 a week for a period of l2months- There are also two female inspectors whose duty it is to visit workshops, work places and laundries where women are employed. One appointed Oct., 1893, at £60 and now receiving £75 per annum; the other appointed June, 1894, at £60 per annum. Paddington 1,251,371 117,846 14,473 3 3 4th Mar., 1873 £200 and an additional sum of £10 for duties in connection with General duties. The inspection of canal boats is exclusively performed by the inspector appointed in 1873. The parish is divided into three districts; each inspector being responsible for one. There is also a man employed to fumigate rooms and for disinfection of small articles of clothing. 16th July, 1889 6th July, 1891 canal boats £150 p. ann. £120 p. ann. The inspectors receive no clerical assistance. St. George, Hanover-sq. 1,716,455 78,364 11,204 2 3 June, 1891 £200 p. ann. No The inspectors receive no clerical assistance. July, 1892 £120 p. ann. rising to £150 p. a. May, 1893 £150 p. ann. St. James, Westminster 725,748 24,995 2,592 2 2 April, 1877 May, 1891 £175 p. ann. £140 p. ann. No The inspectors receive clerical assistance. St. Margaret and St. John, Westminster 805,338 55,539 5,583 3 3 13th Mar., 1889 £170 p. ann. rising to £200 p. a. 9th Mar., 1892 £160 p. ann. rising to £200 p. a. No Clerical assistance provided. 28th June, 1893 £130 p. ann. rising to £200 p. a. NORTH DISTRICT. Hackney 983,888 198,606 28,422 4 and 1 vacancy, also 2 temporary inspectors 4 and 3 temporary inspectors Oct., 1873 £130 p. ann. Complaints Clerical assistance provided. Jan., 1881 £106 10s. p.a. Inspection of premises in which infectious diseases occur. Feb., 1883 £10610s. p. a. Complaints and Food and Drugs Acts. April, 1891 £92 1s. 8d. p. ann. Complaints and inspection of canalboats. *17th May, 1893 £104 p. ann. 1. Inspection of premises after infectious disease. *Temporary inspectors. *23rd Apr.,1893 £104 p. ann. *23rd Apr.,1893 £104 p. ann. 2. Do. do. 3. Inspection of workshops, bakehouses, &c. Hampstead 663,752 68,416 9,517 4 4 March, 1881 £200 p. ann. Senior inspector—Management of summary proceedings, clerical work, duties in connection with infectious diseases, disinfection, cow-houses, slaughter-houses, bakehouses and dairies, factories and workshops, and smoke consumption Feb., 1892 £120 p. ann Divisional inspectors. Sept., 1892 £110 p. ann The parish is divided into districts, each inspector being responsible in his own district for such duties as are not specified for senior inspector. Sept., 1892 £110 p. ann. 6 7 Sanitary inspectors—Particulars of appointments and duties—(continued). Vestry or District Board. Rateable Value. Census Report, 1891, (Vol. II.) Number of Inspectors at date of last return 24th April 1893. Number of Inspectors at present time. Date of appointment of each Inspector. Present Salary. Whether Inspectors limited to the performance of any particular duty, if so, nature of such duty. Remarks. Population Inhabited houses. £ NORTH DISTRICT—Continued. Islington 1,643,664 319,143 37,875 8 and 4 temporary inspectors 15 25th July, 1890 £240 p. ann Superintendent and chief sanitary inspector. Re.appointed under the Public Health (London) Act, 1891, on 5th May, 1893. 30th May, 1871 £130 p. ann No 6th Feb., 1874 £130 p. ann The next five inspectors were reappointed under the Public Health (London) Act, 1891, on 17th June, 1892. 4th Jan., 1875 £130 p. ann 12th Feb., 1886 £130 p. anr 7th Nov., 1890 £117 p. ann 19th Feb., 1892 £117 p. ann 4th Mar., 1892 £117 p. ann . Clerical assistance is provided. 5th May, 1893 £110 10s. p. a 5th May, 1893 £110 10s. p. a 5th May, 1893 £110 10s. p. a 5th May, 1893 £110 10s. p. a 5th May, 1893 £110 10s. p. a 5th May, 1893 > £110 p. ann 2nd Mar., 1893 £104 p. ann St. Marylebone 1527,479 142,404 15,386 4 and 2 temporary inspectors 6 inspectors and 2 disinfec tors 30th Oct., 1884 ,£/3 DPT* wppl Each inspector carries out all the duties in the portion of the Parish which is allotted to him, with the exception of one inspector whose duty it is to inspect the factories and workshops in the parish, and also to investigate smoke nuisances. 20th May, 1886 *»t.' mvl it ulj £2 15s. p. w 20th May, 1886 £2 15s. p. w 30th Jan., 1890 £2 15s. p. w 29th June, 1893 £2 5s. p. w 29th June, 1893 £2 5s. p. w St. Pancras 1,535,103 234,379 24,443 8 9 Clerical assistance is provided. July, 1874 £140 p. ann Duties comprised in Order of Local In addition to the eight inspectors there are also three disinfectors. June, 1877 £140 p. ann Government Board of 8th December, 1891 Oct., 1885 £180 p. ann The clerical staff consists of a chief clerk, three assistant clerks, one temporary clerk and a messenger. Nov., 1892 £130 p. ann June, 1892 £130 p. ann July, 1892 £130 p. ann Oct., 1892 £130 p. ann June, 1894 £120 p. ann Oct., 1887 £78 p. ann Caretaker of mortuaries and disinfecting station, &c. Stoke Newington 184,885 30,936 4,767 ... 2 Mar., 1894 £100 Chief sanitary inspector Also receives £200 per annum as surveyor. Mar., 1894 £2 per week Assistant sanitary inspector The Vestry are proposing to employ a person, for 6 months at £2 per week, to make a house to house inspection, Ac. CENTRAL DISTRICT. City 4,124,227 37,504 (night popula. tion only) 5,750 11 10 Re-appointed annually in the month of February. Three at commencing salary of £200 per ann. This return does not include keeper of mortuary, engineer for steam disinfector, and three sanitary labourers. Three at commencing salary of £132 per ann. Assistants. Four at £150 to £300 per ann. Slaughter houses and meat. Clerkenwell 352,634 66,216 6,316 2 2 Aug., 1885 Jan., 1888 ₤182 p. ann. ₤173 p. ann. No The inspectors receive no clerical assistance. Holborn 376,834 33,485 3,437 2 and 1 temporary inspector 3 13th June, 1892 £130 p. ann. Clerical assistance provided. inrmAof at< t~\ rnTTin pn in fl.fl. 13th June, 1893 ₤120 p. ann. street inspector proviueu. m aiv* dition. 25th July, 1892 25s. per wk. A smoke inspector. St. Giles 94,112 39,782 3,729 5 5 22nd July, 1879 ₤150 p. ann. Two deal with nuisances on private Clerical assistance provided. 8th June, 1880 ₤2150 p. ann. property and perform duties in 6th June, 1883 ₤2150 p. ann. connection with the sale of Food 9th Jan., 1885 ₤293 12s. p.an. and Drugs Act. 2th April, 1892 ₤211912s. p. a. Two deal with nuisances on the public way. One devotes his time to dustbins. St. Luke 304,804 42,440 3,950 2 2 13th July, 1891 £105, rising by £5 annually to £120 Each inspector has special charge of a division of the parish. Clerical assistance provided. St. Martin.in.the.Fields 476,807 14,616 1,476 1 and 3 temporary inspectors 1 and 1 temporary inspector 27th Mar., 1893 do. do. Sept., 1871 £164 p. ann. No Clerical assistance provided. *Mar„ 1894 ... House to house inspection ♦Temporary inspector. Strand 562,660 25,122 2,148 2 6 4th Aug., 1884 £186 p. ann. The first and last two inspectors were appointed under the Public TT UL IT r>n/1nn\ A nf 1 QQ1 Mar, 1890 £120 p. ann. Nov., 1893 £104 p. ann. Inspector of workshops, and outworkers' houses. Health (.London; ^.ct, io»i. The inspectors receive no clerical assistance. Nov., 1893 £104 p. ann. Inspector for smoke nuisances and offences under by.laws relating to nuisances in streets, &c. Feb., 1894 £143 p. ann. Cleansing of streets and markets; disinfecting gullies; removal of dust. Feb., 1894 £143 p. ann. Do. do. 8 9 Sanitary inspectors—Particulars of appointments and duties—(continued). Vestry or District Board. Rateable Value. Census Report, 1891 (Vol. II.). Number of Inspectors at date of last return, 24th April, 1893. Number of Inspectors at present time. Date of appointment of each inspector. Present Salary. Whether Inspectors limited to the performance of any particular duty, if so, nature of such duty. Remarks. Population. Inhabited houses. £ EAST DISTRICT. No Three inspectors have a district under their care. Clerical assistance provided. Bethnal.green 428,711 129,132 16,542 3 4 Mar., 1862 £200 p. ann. Jan., 1886 £200 p. ann. Mar., 1890 £200 p. ann. Nov., 1893 £120 p. ann. Factory and workshops inspector. Limehouse 286,226 57,376 7,141 3 3 1856 £3 14s. 11d. per week No Clerical assistance provided. 1890 £150 p. ann. 1894 £2 2s. p. wk. Mile-end-Old-town 378,255 107,592 14,066 3 3 1884 £200 p. ann. General duties, and duties in connection with the Food and Drugs Acts. Each inspector is responsible for a district. Clerical assistance provided. May, 189S £120 each, rising by £10 annually to £150 No Two men are engaged in assisting the inspectors in drain testing, &c. There are also 4 men employed in disinfecting. Poplar 707,100 166,748 21,982 4 and 1 7 Oct., 1871 £250 p. ann. *Yes. Inspection of nuisances in manufactories, canal boats, and under Factory and Workshops Act. The first three inspectors were reappointed under the Public Health (London) Act, 1891, in June, 1893. Clerical assistance provided by three sanitary clerks. temporary Feb.. 1890 £150 p. ann. inspector Feb., 1890 £150 p. ann. June, 1893 £130 p. ann. June, 1893 £130 p. ann. July, 1893 £130 p. ann. Nov., 1893 £130 p. ann. St. George-in-the-East 191,631 45,795 5,296 3 3 Sept., 1887 £165 p. ann. No. Each inspector is responsible for a district. Clerical assistance provided. Feb., 1890 £ 140 p. ann. June, 1892 £120 p. ann. Shoreditch 660,718 124,009 13,768 4 4 Dec., 1873 £200 p. ann. The first inspector has general superintendence of other inspectors and of houses let in lodgings which are under by.laws. Each of the last three inspectors has a district of the parish under his care. One inspector is specially appointed to carry out the Food and Drugs Acts. Clerical assistance provided. Oct., 1884 . £150 p. ann. April, 1892 £130 p. ann. Mar., 1892 £115 p. ann. Whitechapel 391,915 73,552 7,229 4 4 and 1 20th July, 186 3 £190 p. ann. General duties; but senior inspector performs, in addition, duties under the Food and Drugs Acts. In addition there is also an office clerk at 20s. per week, and two men who perform disinfection work at an average salary of £2 per week each. assistant 26th Nov.. 188 3 £140 p. ann. inspector 5th Jan., 189 1 £140 p. ann. 18th July, 189 2 £130 p. ann. 12th Aug., 189 3 30s. p. wk. SOUTH DISTRICT. Battersea 795,864 150,558 20,779 5 and 2 appointments pending 1 chief and 9th Mar., 1892 6 district inspectors £170 p. ann. rising by £10 p. ann. to £200. No The first three inspectors were reappointed under the Public Health Nov., 1884 £115 p. ann., (London) Act, 1891, in March, 1892. rising by £5 p. ann. to £130. Inspectors perform duties in connection with the Food and Drugs Acts, Margarine Act, &c. July, 1892 £115 do. Clerical assistance provided (two clerks). Four disinfectors and drain testers. Mar., 1893 £110 do. Mar., 1893 £110 do. Mar., 1893 £110 do. July, 1893 £110 do. Bermondsey 416,102 84,682 11,152 2 4 April, 1876 £350 p. ann. No Also a clerk at 20s. per week. April, 1892 £150 p. ann. July, 1893 £130 p. ann. June, 1893 £100 p. ann. Camberwell 993,060 235,344 33,849 9 14 1878 £3 per week One is limited to inspection of houses let in lodgings. The parish is divided into five districts, two inspectors working in each, one having charge of complaints and reconstruction of drains, and the other infectious diseases and house to house inspection. There is also a clerk at £2 5s. per week employed in connection with the notification of infectious diseases, and four men employed on special work of disinfecting. 1884 £3 per week 1887 £3 per week 1888 £215s. p. wk. 1889 £210s. p. wk. 1890 £2 10s. p. wk. 1891 £2 5s. p. wk. 1891 £2 5s. p. wk. 1892 £2 5s. p. wk. 1892 £2 5s. p. wk. 1892 £2 5s. p. wk. 1892 £2 5s. p. wk. 1892 £2 5s. p. wk. 1893 £2 5s. p. wk. Greenwich District 847,598 165,413 24,743 5 and 1 assistant 8 and 1 disinfector Greenwich 293,539 57,240 8,987 2 and 1 assistant 3 and 1 disinfector Aug., 1890 £175 p. ann. General duties,and performs duties under the Food and Drugs Acts. General duties. The inspectors receive no clerical assistance. May, 1892 £150 p. ann. June, 189; £125 p. ann. Infectious disease (whole time). Disinfector. Feb., 1892 £91 p. ann. Deptford 554,059 108,173 15,756 3 5 May, 1881 £150 p. ann. General duties, with the exception of one of the inspectors who performs the duties in connection with infectious disease and the Sale of Food and Drugs Acts. The inspectors receive no clerical assistance. Oct., 1891 £150 p. ann. Feb., 1893 £125 p. ann. Feb., 1894 £125 p. ann. May, 1894 £125 p. ann. 10 11 Sanitary inspectors—Particulars of appointments and duties—(continued). Vestry or District Board. Rateable Value. Census Report, 1891 (Vol. II.) Number of Inspectors at date of last return, 24th April, 1893. Number of Inspectors at present time. Date of appointment of each Inspector. Present Salary. Whether Inspectors limited to the performance of any particular duty, if so, nature of such duty. Remarks. Population. Inhabited houses. £ SOUTH DISTRICT—Continued. Lambeth 1,466,257 275,203 38,556 8 8 June, 1864 £250 p. ann. No. May, 1869 £'170 p. ann. July, 1871 £170 p. ann. Oct., 1890 £140 p. ann. Oct., 1890 £140 p. ann. Oct., 1890 £140 p. ann. Oct., 1890 £140 p. ann. Aug., 1892 £150 p. ann. Smoke nuisances: Sale of Food and Drugs Acts. Lee District 263,480 36,103 5,915 3 3 Charlton 61,128 11,742 1,818 1 1 16th Mar., 1892 £2 p. wk. No Charlton parish. The inspector receives no clerical assistance. The opening of drains and removal of dust is superintended by the foreman of roads. Eltham 48,406 5,682 1,025 1 1 Nov., 1886 £75 p. ann. Eltham parish. Acts also as road foreman. The inspector occasionally receives clerical assistance in the keeping of registers and preparation of notices. Lee 123,319 16,381 2,799 1 1 July, 1892 £3 p. wk. General inspector Lee and Kidbrooke parishes. Superintends opening of existing drains; but not the removal of dust. No clerical assistance provided. Kidbrooke 20,627 2,298 273 Lewisham 591,910 92,647 15,866 3 and 2 temporary inspectors 6 Mar., 1879 £130 p. ann. No. May, 1888 £130 p. ann. Aug., 1893 £100 p. ann. Aug., 1893 £100 p. ann. June, 1894 £120 p. ann. June, 1894 £100 p. ann. Newington 455,895 115,804 13,198 2 5 19th May, 1869 £200 p. ann. No Clerical assistance provided. 18th Dec., 1889 £135 p. ann. 27th June, 1894 £100 p. ann. 27th June, 1894 £100 p. ann. 27th June, 1894 £100 p. ann. Assistant sanitary inspector To assist inspector having St. Peter's ward, which is double the size of the other wards. Plumstead 152,450 52,436 8,629 4 4 Jan., 1890 £150 p. ann. Chief inspector supervising other inspectors. Giving certificates as to water supply for new houses, <fcc. Clerical assistance Tendered by clerk to Public Health Department. Jan., 1894 £104p.ann. General duties. District divided between them. Jan., 1894 £104p.ann. May, 1890 £62 8s. ann. Devotes whole time to supervision of collection of dust. Hotherhithe 206,479 39,255 5,242 1 and 2 temporary inspectors 1 chief and 1 assistant Jan., 1894 £200 p. ann. Acts as inspector under Food and Drugs Acts; as inspector of smoke nuisances; streets inspector and superintendent of dust collection. Clerical assistance provided. Jan., 1876 £3 10s. p. wk. Carries out the orders of chief inspector. St. George the Martyr 269,242 59,712 6,946 2 and 1 assistant inspector 4 Nov., 1865 £210 p. ann. General duties; but the chief inspector carries out the provisions of the Food and Drugs Acts. There is also a disinfector at 35s. per week, and an assistant disinfector at 28s. per week, who also attends to mortuary and coroner's court. Dec., 1886 £150 p. ann. Dec., 1893 £120 p. ann. Dec., 1893 £120 p. ann. A youth at 25s. per week acts as sanitary clerk. St. Olave 201,317 12,723 2,083 1 1 15th Mar., 1892 £160 p. ann. rising £10 yearly to £200 p. an. No. Does duty under Sale of Food and Drugs Acts. The inspector receives no clerical assistance. St. Saviour 335,251 27,177 2,733 2 2 •July, 1889 £130 p. ann. The duties of these inspectors are limited to work under the Public Uniform, house, firing and gas provided. Wandsworth 1,020,818 156,942 25,350 8 and 3 assistant inspectors 13 fJan., 1892 £150 p. ann. Health (London) Act, 1891, and the Food and Drugs Acts. †Uniform provided. The inspectors receive no clerical assistance. Clapham Parish 261,613 43,698 6,994 3 3 April, 1884 £3 3.s. p. wk. No The senior inspector has charge of the work in connection with infectious diseases. The junior inspector has charge of the inspection of new house drains. Otherwise there is no definite division of their duties. Aug,, 1889 £2 17s. p.wk. Dec., 1891 £2 9s. p. wk. The inspectors receive no clerical assistance. S treat ham and 309,927 42,972 7,048 2 and 1 assistant inspector 5 (1 chief and 4 assistants Dec., 1891 £2 10s. p. wk. No No clerical assistance provided. July, 1893 £2 5s. p. wk. July, 188-' £115s. p. wk. Nov., 1893 £110s. p. wk. No. Tooting 26,690 5,784 1,085 1 J July, 1884 £1 10s. p. wk. Dust iuspector. Putney 157,442 17,771 2,967 1 1 2nd Sept., 1889 £3 p. wk. No. 12 Sanitary inspectors—Particulars of appointments and duties—(continued). Vestry or District Board. Rateable Value. Census Report, 1891 (Vol. II.) Number of Inspectors at date of last return, 24th April, 1893. Number of Inspectors at present time. Date of appointment of each Inspector. Present Salary. Whether Inspectors limited to the performance of any particular duty, if so, nature of such duty. Remarks. Population. Inhabited houses. Wandsworth £ 46,717 7,256 3 (1 chief and 2 assistant inspectors) SOUTH DISTRICT—Continued. A division of the sub-district is assigned to each inspector, the chief inspector undertaking the duties in connection with infectious disease, inquiries into special complaints with supervision of whole sanitary procedure. There is also an officer who devotes his whole time to the supervision of the dust collection. Clerical assistance provided. The inspectors receive no clerical assistance. 265,146 4 (1 chief 3rd July, 1891 £2 15s. p. wk. and 3 30th Nov., 1892 £2 2s. p. wk. assistants) 30th Nov., 1892 £1 2s. p. wk. 14th Aug., 1893 (temporary) £2 p. wk. Duties consist chiefly in house to house inspection. Woolwich 181,028 40,848 5,259 3 3 Aug., 1866 £2 7s. p. wk. One inspector superintends the removal of house and other refuse, also carries out the Smoke Nuisance Act, and inspects the common and registered lodginghouses. Dec., 1889 £2 5s. p. wk. Aug., 1892 £2 p. wk. Sanitary Districts mentioned in Schedule C of the Metropolis Local Management Act, 1855. Close of the Collegiate Church of St. Peter, Westminster 3,833 235 25 1 Nov., 1892 £5 5s. p. ann. No. Gray's-inn 16,020 258 49 1 23rd Mar., 1892 £25 p. ann. Also medical officer of health of district. Inner Temple 22,805 96 39 1 1st Jan., 1893 £20 p. ann. No. Lincoln's-inn 20,904 27 12 1 Feb., 1893 £10 p. ann. No. Middle Temple 14,782 95 30 1 18th Jan., 1893 £5 p. ann. Is surveyor of the district. Staple Inn, Furnival's-inn, and Liberty of the Charterhouse 19,456 251 24 1 7th Sept., 1892 £30 p. ann. No.