43/3 London County Council. Lcc. 6. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE ADMINISTRATIVE COUNTY OF LONDON. 1897. (Ordered by the Council to be printed.) printed for THE LONDON COUNTY COUNCIL by jas. truscott and son, And may be purchased, either directly or through any Bookseller, from P. S. KING AND SON, 2 and 4, Great Smith-street, Westminster, S.W., Agents for the sale of the Publications of the London County Council. TABLE OF CONTENTS. Statistics- page Population 5 Marriages 5 Marriages of minors in London, 1897 5 Births 6 Deaths 7 London mortality in the seven years 1891-7 compared with the decennium 1881-90 9 Infant mortality 13 Deaths from several classes of disease 15 Principal zymotic diseases 16 Smallpox and vaccination 18 London vaccination returns 23 Measles 23 Scarlet fever 27 Scarlet fever and elementary schools 29 Proportion of cases and deaths in hospitals 30 Age and sex distribution 31 Seasonal variation in age distribution 31 Seasonal variation in fatality 32 Diphtheria 33 Diphtheria and elementary schools 35 Proportion of cases and deaths in hospitals 37 Bacteriology as an aid to diagnosis 37 Age and sex distribution 37 Use of anti-toxic serum 37 Seasonal variation in age distribution 38 Seasonal variation in fatality 39 Whooping cough 39 Typhus 40 Enteric fever 41 Age and sex distribution 43 Diarrhoea 44 Cholera 45 Erysipelas 46 Puerperal fever 47 Influenza, bronchitis and pneumonia 47 Phthisis 47 Phthisis and overcrowding 48 Cancer 49 Glanders 50 Anthrax 50 Meteorology 50 Administration- Dairies, cowsheds and milkshops 51 Offensive businesses 51 Unregistered offensive businesses 52 Complaints to the London County Council 52 Nuisances 52 Trade nuisances 52 Smoke nuisances 53 Nuisance from stable manure 53 Removal of offensive refuse 54 Removal of house refuse 55 Disposal of house refuse 58 Nuisance from sewer ventilators 58 Flooding from sewers 59 House drainage 60 Housing of the Working Classes 61 Schemes undertaken by the Council under Part I. of the Act 61 Schemes undertaken by the Council with contributions by district authorities 61 Schemes undertaken by district authorities with contributions by the Council 61 Other proceedings under the Housing of the Working Classes Act 61 Proceedings in respect of houses represented as unfit for human habitation 62 Areas specially described in the reports of medical officers of health 63 The regulation of houses let in lodgings 64 Common lodging-houses 68 Customs and Inland Revenue Acts, 1890 and 1891 70 Underground rooms 70 Factories and workshops 70 The inspection of bakehouses 72 Unsound food 73 Sewage-contaminated oysters and other shell fish 74 Disinfection 74 Provision for shelter during disinfection 75 4 page Hospital provision for infectious disease 75 The Cleansing of Persons Act 75 Mortuaries 76 Water supply 77 Proceedings of the Council 78 Royal Commission on London water supply 79 Welsh scheme of water supply 79 Legislation 80 Insufficiency of water supply 80 Constant supply 80 Flooding from the Lea 80 Infant Life Protection Act, 1897 81 The London Equalization of Rates Act, 1894 81 Sanitary administration of districts 82 Medical officers of health and sanitary inspectors 83 Appendices- I.-Report on diphtheria and elementary schools. II.-Report on the operation of by-laws dealing with houses let in lodgings in the several London sanitary districts. III.-Report on the accommodation for women and children in common lodging-houses and shelters in London. IV.-Report on the sanitary condition of Clerkenwell. V.-Report on the sanitary condition of St. Luke. LIST OF DIAGRAMS. to face page Diagram I.-Marriages, 1851-97 5 „ II.-Births, 1851-97 5 „ III-Deaths, 1841-97 7 „ IV.-Smallpox, 1841-97 18 „ V.-Measles, 1841-97 23 „ VI.-Scarlet fever, 1859-97 27 „ VII:-Scarlet fever; weekly notifications at certain age periods, 1897 30 „ VIII.-Scarlet fever; admissions to and deaths in hospitals of Metropolitan Asylums Board, per cent. of total cases and deaths in London 27 „ IX.-Scarlet fever; monthly notifications and case mortality, 1891-97 32 „ X.-Diphtheria and croup, 1859-97 33 „ XI.-Diphtheria; weekly notifications at certain age periods, 1897 36 „ XII.-Diphtheria; admissions to and deaths in hospitals of Metropolitan Asylums Board, per cent. of total cases and deaths in London 33 „ XIII.-Diphtheria; monthly notifications and case mortality, 1891-97 38 „ XIV.-Whooping cough, 1841-97 89 „ XV.-Typhus, 1869-97 40 „ XVI.-Enteric fever, 1869-97 41 „ XVII.-Enteric fever; weekly notifications, 1897, and mean weekly notifications, 1890-97 42 „ XVIII.-Diarrhoea in relation to mean temperature (summer quarter), 1841-97 41 „ XIX.-Phthisis and overcrowding 49 Diagram I Marriages. Diagram II Births. Administrative County of London REPORT OF THE MEDICAL OFFICER OF HEALTH. 1897. STATISTICS. Population. The population of the Administrative County of London, estimated to the middle of 1897, was 4,484,717. The estimated population of each of the 43 sanitary districts comprised in the administrative county is shown in the following table- Sanitary district. Estimated population, 1897. Sanitary district. Estimated population, 1897. Sanitary district. Estimated Population 1897. Paddington 126,161 St. Giles 37,840 St. George, Southwark 60,388 Kensington 171,427 St. Martin-in-the-Fields 12,711 Newington 122,191 Hammersmith 105,959 Strand 23,552 St. Olave, Southwark 11,480 Fulham 120,040 Holborn 30,493 Bermondsey 85,629 Chelsea 96,692 Clerkenwell 66,162 Rotherhithe 40,643 St. George, Hanoversquare 80,330 St. Luke 41,279 Lambeth 300,048 City of London 30,228 Battersea 168,677 Westminster 53,027 Shoreditch 121,883 Wandsworth 195,612 St. James, Westminster 22,576 Bethnal-green 129,098 Camberwell 257,575 Marylebone 140,808 Whitechapel 79,724 Greenwich 178,367 Hampstead 77,275 St. George-in-the-East 47,917 Lee 39,215 St. Pancras 242,255 Limehouse 58,508 Lewisham 107,700 Islington 341,134 Mile-end Old-town 111,883 Woolwich 41,409 Stoke Newington 34,136 Poplar 169,811 Plumstead 61,057 Hackney 216,698 St. Saviour, Southwark 24,919 The population of London was enumerated on the 29th March, 1896, in accordance with the provisions of the Equalisation of Rates Act, 1894. A statement of the increase or decrease of population of each sanitary district between the two census years 1891 and 1896 will be found in my annual report for the year 1895. Marriages. The number of marriages in the registration County of London in 1897 (52 weeks) was 41,223, giving an annual rate of persons married of 18.5 per 1,000 living, this being the highest marriage rate since 1878. The marriage rate since 1870 has been as follows- 1871 19.5 1878 18.5 1885 17.4 1892 17.4 1872 19.9 1879 18.0 1886 17.2 1893 17.2 1873 19.8 1880 18.1 1887 16.9 1894 17.0 1874 19.4 1881 18.1 1888 16.9 1895 17.2 1875 19.6 1882 18.4 1889 17.1 1896 18.0 1876 19.2 1883 18.1 1890 17.6 1897 18.5 1877 18.7 1884 17.9 1891 17.7 The accompanying diagram (I.) shows the marriage rate in each year since 1850 in relation to the mean marriage rate of the period 1851-97. In the year 1897 among the males 4.57 per cent. married were under 21 years of age, and among the females 16.16 per cent. The proportions in preceding periods are shown in the following table; the proportions in England and Wales are also given for the purpose of comparison- Marriages of minors per cent. of total marriages. London. England and Wales. 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 1894 4.68 16.79 5.46 18.06 1895 4.37 15.85 5.20 17.42 1896 4.89 16.07 5.27 17.39 6 Births. The number of births registered in the Administrative County of London in 1897 was 134,111, giving a birth rate per annum of 30.0 per 1,000 persons living. The birth rate since 1870 has been as follows- 1871 34.5 1878 35.5 1885 33.4 1892 30.9* 1872 35.6 1879 35.5 1886 33.4 1893 31.0* 1873 35.3 1880 35.3 1887 32.9 1894 30.1* 1874 35.6 1881 34.7 1888 32.1 1895 30.6* 1875 35.4 1882 34.5 1889 31.9 1896 30.2* 1876 35.9 1883 34.5 1890 30.7 1897 30.0* 1877 35.6 1884 34.3 1891 31.8* The corresponding figures for England and Wales are as follows- 1871 35.0 1878 35.6 1885 32.9 1891 31.4 1872 35.6 1879 34.7 1886 32.8 1892 30.5 1873 35.4 1880 34.2 1887 31.9 1893 30.8 1874 36.0 1881 33.9 1888 31.2 1894 29.6 1875 35.4 1882 33.8 1889 31.1 1895 30.4 1876 36.3 1883 33.5 1890 30.2 1896 29.7 1877 36.0 1884 33.6 The accompanying diagram (II.) shows the London birth rate in each year in relation to the mean of the period 1851-97. During the year the eastern group of districts had the highest birth rate (36.9); the western the lowest (25.5); the southern, central, and northern groups having birth rates respectively of 311, 28.4, and 28.5. As in the preceding year, the district having the highest birth rate was St. Luke (45.2), and the district having the lowest birth rate was St. Martin-in-the-Fields (13.3). The following table shows the birth rate in each district in 1897, calculated per 1,000 population and per 100 females aged 15-45 years. Sanitary district. Births. Birth rate per 1,000 living. Births per 100 females aged 15-45. Paddington 3,018 24.0 7.2 Kensington 3,683 21.5 6.1 Hammersmith 3,139 29.7 11.0 Fulham 4,106 34.3 13.2 †Chelsea 2,549 26.4 9.8 St. George, Hanover-square 1,369 17.1 4.9 Westminster 1,237 23.4 8.8 St. James 459 20.4 7.0 †Marylebone 4,135 29.5 9.4 Hampstead 1,479 19.2 5.3 Pancras 7,017 29.0 11.2 Islington 9,845 28.9 11.0 Stoke Newington 835 24.5 8.1 Hackney 6,312 29.2 11.0 †St. Giles 981 26.0 9.2 St. Martin.in-the-Fields 169 13.3 4.6 Strand 570 24.3 8.9 Holborn 781 25.7 10.2 Clerkenwell 2,092 31.7 13.0 †St. Luke 1,860 45.2 18.7 London, City of 478 15.9 6.0 Shoreditch 4,314 35.5 15.0 Bethnal-green 4,818 37.4 16.2 Whitechapel 3,150 39.6 16.9 St. George-in-the-East 2,029 42.5 18.6 Limehouse 1,997 34.2 15.3 †Mile-end Old-town 4,257 38.2 16.1 Poplar 5,849 34.5 15.7 St. Saviour, Southwark 769 30.9 14.0 St. George, Southwark 2,114 35.1 14.8 Newington 4,248 34.9 14.8 St. Olave 434 37.9 16.1 Bermondsey 3,176 37.2 16.5 Rotherhithe 1,258 31.0 14.6 †Lambeth 9,388 31.4 12.1 Battersea 5,266 31.3 13.1 Wandsworth 5,042 25.8 8.9 Camberwell 7,483 29.1 11.6 Greenwich 5,563 31.3 13.0 Lewisham 2,679 24.9 8.5 Woolwich 1,307 31.7 15.7 Lee 881 22.5 7.4 Plumstead 1,975 32.4 14.5 London 134,111 30.0 11.3 *The rates for these years relate to the Administrative County of London, the rates shown for years previous to 1891 relate to the Registration County of London. †Lying-in hospitals are situated in these districts. Diagram III DeathS {AllCauses} 7 Deaths. The number of deaths registered in the Administrative County of London in 1897 (52 weeks) was 79,209, giving an annual death rate of 17.7 per 1,000 living. Since the year 1870 the London death rate has been as follows- 1871 24.6 1878 23.1 1885 20.4 1892 20.31 1872 21.5 1879 22.6 1886 20.6 1893 21.01 1873 22.4 1880 21.7 1887 20.3 1894 17.41 1874 22.4 1881 21.3 1888 19.3 1895 19.51 1875 23.6 1882 21.5 1889 18.4 1896 18.11 1876 21.9 1883 20.8 1890 21.4 1897 17.71 1877 21.6 1884 20.9 1891 21.01 The death rate since 1840 in relation to the mean of the period 1841.97, is shown in diagram III. 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 which exceeded 200,000 persons at the census of 1891. The columns showing "death rates corrected for age and sex distribution" have been obtained by multiplying the crude death rates by the "factor for correction" published by the Registrar. General in the Annual Summary for 1897. All causes. Towns. Estimated population middle of 1897. Crude death rate per 1,000 living. Death rate per 1,000 living (corrected for age and sex distribution). 1887-96. 1897. 1887-96. 1897. London 4,463,169 19.9 18.22 21.2 19.4 Manchester 534,299 25.3 23.1 28.7 26.2 Liverpool 633,078 25.7 24.4 28.2 26.8 Birmingham 505,772 20.7 21.6 22.9 23.9 Leeds 409,472 20.9 19.9 23.2 22.1 Sheffield 351,848 21.5 21.2 23.9 23.6 West Ham 273,682 17.8 15.7 19.2 16.9 Bristol 232,242 18.9 17.2 19.7 18.0 Nottingham 232,934 19.0 18.8 20.4 20.2 Bradford 231,260 19.9 17.4 22.8 19.9 Hull 225,045 20.0 18.6 21.0 19.5 Salford 213,190 24.7 23.9 27.8 26.9 London had therefore (comparing the corrected death rates) in 1897 a lower death rate than any of these towns except West Ham and Bristol, and in the period 1887-96, a lower death rate than any except West Ham, Bristol, Nottingham and Hull. The following table enables comparison to be made of the death rate of London with the death rates of several foreign cities*- All causes-Death rate per 1,000 living. Towns. 1887-96. 1897. Towns. 1887-96. 1897. London 19.9 18.22 St. Petersburg 29.7 29.0 Paris 22.0 18.6 Berlin 20.4 17.7 Brussels 20.2 16.6 Vienna 23.9 20.9 Amsterdam 20.2 15.8 Rome 22.6 16.9 Copenhagen 20.5 17.5 New York 24.2 19.4 Stockholm 19.3 16.7 It will be seen that whereas the London death rate in 1887-96 was lower than any of these cities except Stockholm, in 1897 it exceeded the death rates, of Brussels, Amsterdam, Copenhagen, Stockholm, Berlin and Rome. The following table shows the crude death rates and the death rates, corrected for differences in the age and sex constitution of the populations, obtaining in each of the sanitary districts of London for the year 1897 (52 weeks), and the period 1887-96- 1 These death rates are fully corrected for institutions, i.e. by the exclusion of deaths of persons not belonging to but occurring in institutions situated within London, and by the inclusion of deaths of persons belonging to but occurring in London institutions situated outside the administrative County. 2 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. * All death rates in this report relating to foreign cities are calculated upon figures published by the Registrar-General. 8 Crude and corrected death rates1 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, 1887-96. Corrected death rate, 1887-96. Comparative mortality figure, 1887-96. (London 1,000.) Crude death rate, 1897. Corrected death rate, 1897. Comparative mortality figure, 1897. (London 1,000.) England and Wales 19.15 - - - - - - - London 17.96 1.06626 19.6 20.9 1,000 17.7 18.9 1,000 Battersea 17.80 1.07584 - - - 16.2 17.4 921 Bermondsey 18.10 1.05801 22.3 23.6 1,129 22.1 23.4 1,238 Bethnal-green 18.39 1.04133 23.0 24.0 1,148 21.4 22.3 1,180 Camberwell 18.10 1.05801 18.3 19.4 928 16.6 17.6 931 Chelsea 17.95 1.06685 20.0 21.3 1,019 17.8 19.0 1,005 Clerkenwell 17.28 1.10822 23.0 25.5 1,220 22.1 24.5 1,296 Fulham 18.27 1.04817 - - - 17.0 17.8 942 Greenwich 18.63 1.02791 19.2 19.7 943 17.2 17.7 937 Hackney 18.30 1.04645 - - - 16.5 17.3 915 Hammersmith 18.05 1.06094 - - - 16.7 17.7 937 Hampstead 16.63 1.15153 12.3 14.2 679 11.8 13.6 720 Holborn 17.62 1.08683 25.4 27.6 1,321 23.1 25.1 1,828 Islington 17.90 1.06983 18.0 19.8 923 15.8 16.9 894 Kensington 17.88 1.10184 17.0 18.7 895 15.7 17.3 915 Lambeth 18.24 1.04989 19.2 20.2 967 17.5 18.4 974 Lee 17.67 1.08376 - - - 18.2 14.3 757 Lewisham 17.92 1.06864 14.0 15.0 718 12.4 13.3 704 Limehouse 17.59 1.08869 25.5 27.8 1,330 25.1 27.8 1,444 City of London 16.65 1.15015 22.2 25.5 1,220 21.3 24.5 1,296 Mile-end Old-town 18.58 1.03068 21.3 22.0 1,053 18.7 19.3 1,021 Newington 18.32 1.04531 22.3 23.8 1,115 21.2 22.2 1,175 Paddington 17.72 1.08070 16.5 17.8 852 14.4 15.6 825 Plumstead 19.09 1.00314 - - .- 13.7 13.7 725 Poplar 18.49 1.08569 21.2 22.0 1,053 19.8 20.5 1,085 Rotherhithe 18.49 1.03569 21.3 22.1 1,057 18.9 19.6 1,037 St. George, Hanover-square 17.34 1.10438 15.9 17.6 842 18.2 14.6 772 St. George-in-the-East 18.43 1.03907 28.3 29.4 1,407 26.4 27.4 1,450 St. George, Southwark 17.35 1.10375 25.5 28.1 1,344 23.7 26.2 1,386 St. Giles 17.27 1.10886 23.0 25.5 1,220 18.4 20.4 1,079 St. James 17.6 1.11597 18.6 20.8 995 17.5 19.5 1,032 St. Luke 17.72 1.08070 26.9 29.1 1,892 25.7 27.8 1,471 St. Martin-in-the-Fields 15.74 1.21665 20.6 25.1 1,201 16.8 19.8 1,048 St. Marylebone 17.82 1.07464 20.8 22.4 1,072 18.3 19.7 1,042 St. Olave 18.42 1.03963 24.4 25.4 1,215 22.1 23.0 1,217 St. Pancras 17.89 1.07043 20.2 21.6 1,083 18.7 20.0 1,058 St. Saviour 18.29 1.04702 25.6 26.8 1,282 24.6 25.8 1,365 Shoreditch 18.45 1.03794 22.9 23.8 1,139 21.6 22.4 1,185 Stoke Newington 17.85 1 07283 - - - 14.3 15.3 810 Strand 16.24 1.17919 25.4 30.0 1,435 21.8 25.1 1,328 Wandsworth 17.93 1.06804 - - - 13.4 14.3 757 Westminster 16.94 1.13046 21.7 24.5 1,172 19.0 21.5 1,138 Whitechapel 17.74 1.07948 23.0 24.8 1,187 20.4 22.0 1,164 Woolwich 16.99 1.12713 20.3 22.9 1,096 17.8 20.1 1,068 The death rates of Battersea, Wandsworth, Hammersmith, Fulham, Stoke Newington, Hackney, Lee and Plumstead cannot be given for the period 1887-96, 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 deatb rate, 1887-36. Corrected death rate, 1887-96. Comparative mortality figure, 1887-96. [London 1,000.] Wandsworth (combined with Battersea) 17.86 1.07223 16.3 17.5 837 Fulham (combined with Hammersmith) 1815 1.05510 19.1 20.2 967 Hackney (combined with Stoke Newington) 18.23 1.05047 16.9 17.8 852 Plumstead (combined with Lee) 18.51 1.03458 15.0 15.5 742 All the eastern and central districts had, therefore, in the year 1897 corrected death rates above the average of London. The district of St. Luke, as in the preceding year, had the highest death rate (27.8), and the district of Lewisham the lowest (13.3). 1 All death rates in this report relating to London sanitary districts are fully corrected for institutions. (See footnote (1), page 7.) 9 The following table shows the number of deaths1 occurring at several age-periods in each of the sanitary districts of the administrative county during the year 1897 (365 days). All causes. Age-period. 0- 1- 2- 3- 4- Total under 5. 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- All ages. Paddingrton 457 76 38 34 23 628 62 17 22 40 98 142 177 205 229 155 48 1,823 Kensington 616 161 75 45 24 921 79 26 44 62 154 252 249 295 307 228 75 2,692 Hammersmith 537 109 39 29 22 736 26 23 35 41 89 115 155 156 179 152 56 1,763 Fulham 669 143 67 39 18 936 64 36 31 38 121 193 181 159 147 107 26 2,039 Chelsea 415 97 34 37 17 600 39 21 28 39 98 144 183 188 185 149 39 1,713 St. George, Hanover square 181 51 14 10 8 264 22 10 21 23 57 99 120 148 157 119 24 1,064 Westminster 207 68 19 13 18 325 24 10 9 23 66 114 115 125 114 78 22 1,025 St. James 75 26 13 5 4 123 8 3 11 9 22 44 51 51 38 25 6 391 Marylebone 564 142 42 24 11 783 58 21 34 65 160 243 292 294 326 229 59 2,564 Hampstead 190 43 22 13 12 280 16 11 12 15 57 73 84 100 116 118 32 914 Pancras 1,182 330 105 78 51 1,746 110 61 54 105 242 446 466 467 429 319 83 4,528 Islington 1,336 372 141 101 68 2,018 143 58 97 134 293 468 499 558 583 447 95 5,393 Stoke Newington 102 20 12 5 6 145 13 5 7 16 33 46 45 49 53 58 18 488 Hackney 932 282 132 72 56 1,474 126 41 62 74 219 250 303 305 373 300 59 3,586 St. Giles 142 33 20 11 6 212 12 10 10 20 48 70 87 94 80 44 11 698 St. Martin - in - the Fields 30 5 10 1 46 6 6 2 24 24 18 29 28 14 10 207 Strand 94 26 9 6 1 136 15 9 7 6 41 75 61 61 46 35 499 Holborn 143 62 21 10 3 239 12 6 15 12 50 75 69 75 102 40 11 706 Clerkenwell 385 127 56 29 30 627 52 13 28 32 97 121 124 143 125 86 13 1,461 St. Luke 277 94 55 14 20 460 22 14 15 19 52 84 114 94 97 62 20 1,053 London, City of 62 24 16 3 4 109 18 11 6 18 51 66 80 93 83 83 23 641 Shoreditch 788 243 95 66 46 1,238 56 32 34 38 132 218 269 230 216 134 27 2,624 Bethnal-green 824 254 94 60 36 1,268 68 30 54 48 130 219 240 243 239 173 49 2,761 Whitechapel 465 146 45 30 16 702 45 16 26 27 101 151 174 174 134 68 13 1,631 St. George-in-the-East 398 141 60 37 25 661 35 9 16 27 66 104 86 102 92 47 14 1,259 Limehouse 384 152 77 31 16 660 37 16 22 33 69 131 144 139 122 78 13 1,464 Mile-end Old-town 632 196 81 40 30 979 43 32 26 48 112 156 191 175 177 115 37 2,091 Poplar 998 298 123 76 50 1.545 101 58 55 55 190 268 291 294 300 181 29 3,367 St. Saviour, Southwark 151 60 26 14 8 259 10 9 15 5 41 61 61 52 62 30 7 612 St. George, Southwark 403 156 72 30 19 680 37 17 28 22 77 142 153 132 95 44 8 1,435 Newington 751 251 98 51 24 1,175 62 32 39 58 146 219 223 231 218 149 38 2,590 St. Olave 62 21 9 3 4 99 6 3 5 6 17 20 33 28 19 12 4 252 Bermondsey 607 186 74 46 42 955 49 25 34 34 98 129 150 167 124 90 29 1,884 Rotherhithe 218 66 25 15 8 332 27 19 18 24 31 63 68 72 56 52 8 770 Lambeth 1,427 385 139 94 53 2,098 123 72 77 119 339 412 461 515 542 407 107 5,272 Battersea 857 232 114 50 38 1,291 90 40 50 51 164 227 224 224 220 131 30 2,742 Wandsworth 679 150 64 40 35 968 90 29 47 61 126 200 209 268 317 247 58 2,620 Camberwell 1,191 351 145 97 72 1,856 138 66 53 84 230 289 381 419 400 294 69 4,279 Greenwich 870 215 67 43 44 1,239 77 41 58 63 175 227 241 283 340 245 63 3,052 Lewisham 335 79 37 13 15 479 38 26 28 23 79 112 112 127 143 142 53 1,362 Woolwich 206 46 19 11 9 291 22 10 15 18 48 59 77 62 83 39 14 738 Lee 116 20 8 5 6 155 11 7 8 9 34 32 36 69 65 73 20 519 Plumstead 230 54 14 21 10 329 22 13 16 21 62 64 71 84 92 44 18 836 London 21,188 5,993 2,426 1,451 1,009 32,067 2,114 1,008 1,278 1,667 4,539 6,647 7,367 7,780 7,852 5,644 1,445 79,408 London mortality in the seven years 1891-7 compared with the decennium 1881-90. The following table shows the mean death rates obtaining in London at the several age-periods and for each sex in the decennium 1881-90, and the seven years 1891-97- Age period. Males. Females. Mean death rate 1881-90. Mean death rate 1891-97. Differences per cent. Mean death rate 1881-90. Mean death rate 1891-97. Difference per cent. 0- 73.09 70.47 - 3.6 63.26 60.55 - 4.3 5- 5.93 5.17 -12.8 5.82 5.37 - 7.7 10- 2.92 2.56 -12.3 2.89 2.55 -11.8 15- 4.05 3.68 - 9.1 3.58 3.11 -131 20- 5.44 4.88 -10.3 4.40 3.72 -15.5 25- 8.65 7.69 -11.1 6.82 5.97 -12.5 35- 14.96 14.49 - 3.1 11.42 11.00 - 3.7 45- 23.87 23.57 - 1.3 17.23 16.91 - 1.9 55- 41.33 41.63 + 0.7 30.77 30.83 + 0.2 65- 77.97 76.28 - 2.2 63.28 61.43 - 4.5 75- 155.93 153.81 - 1.4 134.28 133.33 - 0.7 85 and upwards 297.63 275.79 - 7.3 264.77 259.59 - 2.0 All ages. 22.10 20.94 - 5.2 18.83 17.88 - 5.0 It will be seen from this table that, with the exception of males and females aged 55-65, the death rates in the period 1891-7 are lower than in the decennium 1881-90. 1 See footnote (1), page 7. [2] 10 In previous annual reports it has been shown that a more accurate estimate of the effect on the community of fluctuations of mortality could be obtained by the use of a "life table" and the following figures, calculated from the Ex and Qx columns of the life table for London, 1881-90,* were utilized for this purpose- Table I. Mean future lifetime of males and females in groups of ages (calculated from London life tables, 1881-90.) Age groups. Males. Females. Age groups. Males. Females. Tears. Years. Years. Years. 0- 49.06 52.69 35- 24.19 27.24 5- 48.94 52.68 45- 1815 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 1891-7 with the deaths which would have occurred at these age-periods if the death rates of 1881-90 had still been maintained, the difference 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 showing in the following table- Table II. groups. Deaths calculated according to mean rates 1881-90. Mean deaths occurring in the seven years 1891-7. Mean annual gain (+) or loss (-) of lives in the seven years 1891-7 by fluctuations of mortality. Mean annual gain (+) or loss (-) of "life capital" in the seven years 1891-7 by fluctuations of mortality. Males. Years. 0- 18,783 18,110 + 673 +33,017 5- 1,381 1,203 + 178 + 8,711 10- 621 545 + 76 + 3,424 15- 824 747 + 77 + 3,141 20- 1,089 977 + 112 + 4,110 25- 2,975 2,647 + 328 + 10,181 35- 3,797 3,678 + 119 + 2,879 45- 4,259 4,206 + 53 + 962 55- 4,208 4,238 - 30 - 388 65- 4,051 3,964 + 87 + 773 75- 2,261 2,231 + 30 + 190 85 and upwards 463 429 + 34 + 93 All ages 44,712 42,975 + 1,737 +67,093 Females. Years. 0- 16,453 15,748 + 705 +37,146 5- 1,369 1,263 + 106 + 5,584 10- 626 553 + 73 + 3,562 15- 810 703 + 107 + 4,767 20- 1,063 898 + 165 + 6,664 25- 2,698 2,361 + 337 +11,640 35- 3,219 3,101 + 118 + 3,214 45- 3,471 3,406 + 65 + 1,337 55- 3,894 3,902 - 8 - 116 65- 4,717 4,579 + 138 + 1,350 75- 3,474 3,450 + 24 + 162 85 and upwards 987 967 + 20 + 57 All ages 42,781 40,931 +1,850 +75,367 Total 87,493 83,906 + 3,587 + 142,460 * See Annual Report of the Medical Officer of Health, 1893, p. 10. 11 This table shews, therefore, that during the period 1891-7, as compared with the decennium 1881-90, there has been a mean annual saving of 3,587 lives, and that this represents a mean annual saving of 142,460 years of "life capital." In previous annual reports I have similarly dealt with the mortality figures of the periods 1891-4, 1891-5, and 1891-6, and it is interesting to compare the results obtained for the four periods, viz.- Table III. Periods compared with 1881-90. Mean annual number of lives gained. Mean annual amount of "life capital" gained. Proportion of "life capital" gained to each life gained. years. years. 1891-4 1,042 79,606 76.4 1891-5 1,304 85,519 65.6 1891-6 2,461 104,742 42.6 1891-7 3,587 142,460 39.7 It will thus be seen that the mean annual number of lives saved has increased in each period, while the amount of "life capital" in proportion to the number of lives saved has decreased, this decrease being particularly marked in the periods 1891-6 and 1891-7. The following table, showing the death rates at each age period in 1891-4, 1895, 1896, and 1897 will serve to make the explanation of these facts more clear. Table IV. Males. Death rates per 1,000 living. Increase or decrease per cent. (compared with death rates in 1881-90). 1891-4. 1895. 1896. 1897. 1891-4. 1895. 1896. 1897. All ages 21.53 21.00 19.90 19.58 - 2.6 - 5.0 - 10.0 - 11.4 0- 70.87 72.72 71.30 65.63 - 3.0 - 0.5 - 2.4 - 10.2 5- 5.46 4.51 5.47 4.37 - 7.9 - 23.9 - 7.8 - 26.3 10- 2.63 2.52 2.43 2.47 - 9.9 - 13.7 - 16.8 - 15.4 15- 3.90 3.39 3.39 3.38 - 3.7 - 16.3 - 16.3 - 16.5 20- 5.06 4.67 4.59 4.66 - 7.0 - 14.2 - 15.6 - 14.3 25- 8.08 7.59 6.94 7.03 - 6.6 - 12.3 - 19.8 - 18.7 35- 15.23 13.45 12.99 14.07 + 1.8 - 10.1 - 13.2 - 5.9 45- 24.61 23.21 20.86 22.54 + 3.1 - 2.8 - 12.6 - 5.6 55- 43.15 41.87 37.10 39.87 + 4.4 + 1.3 - 10.2 - 3.5 65- 80.58 76.92 67.15 67.90 + 3.3 - 1.3 - 13.9 - 12.9 75- 156.05 160.08 143.38 148.83 + o.1 + 2.7 - 8.0 - 4.6 85 and upwards 288.41 288.99 232.81 256.25 - 3.1 - 2.9 - 21.8 - 13.9 Females. Death rates per 1,000 living. Increase or decrease per cent. (compared with death rates in 1881-90). 1891-4. 1895. 1896. 1897. 1891-4. 1895. 1896. 1897. All ages 18.46 18.23 16.83 16.27 -2.0 -3.2 -10.6 -13.6 0- 60.96 62.10 62.07 55.69 - 3.6 - 1.8 - 1.9 - 12.0 5- 5.72 4.79 5.36 4.58 - 1.7 - 17.7 - 7.9 - 21.3 10- 2.66 2.57 2.42 2.25 - 8.0 - 1l.l - 16.3 - 22.1 15- 3.32 2.94 2.82 2.77 - 7.3 - 17.9 - 21.2 - 22.6 20- 4.01 3.72 3.13 3.16 - 8.9 - 15.5 - 28.9 - 28.2 25- 6.33 5.77 5.41 5.30 - 7.2 - 15.4 - 20.7 - 22.3 35- 11.41 10.59 10.41 10.40 - 0.1 - 7.3 - 8.8 - 8.9 45- 17.53 17.03 15.34 15.86 + 1.7 - 1.2 - 110 - 8.0 55- 32.44 31.83 26.83 27.51 + 5.4 + 3.4 - 12.8 - 10.6 65- 65.80 64.13 50.17 52.93 + 4.0 + 13 - 20.7 - 16.4 75- 136.60 146.18 117.59 123.15 + 1.7 + 89 - 12.4 - 8.3 85 and upwards 260.67 278.84 231.82 262.79 - 1.5 + 5.3 - 12.4 - 0.7 It will be seen from this table that the death rate at "all ages" for each sex has progressively declined in each of the periods shown in the table. When the figures for separate age groups are considered, however, there is seen to be considerable variation in the percentage differences, some ages actually showing an increased death rate. Thus in the period 1891-4 the death rate at "all ages," when compared with the death rate obtaining for the period 1881-90, shows a decline of 2.6 per cent. for males and 2.0 per cent. for females, while the percentage differences shown for the several age groups range from -9.9 to + 4.4 in the case of males and -8.9 to + 5.4 in the case of females; similarly in 1895 the percentage differences range from 12 -23.9 to + 2.7 (males) and - 17.9 to + 8.9 (females); in 1896 from -21.8 to -2.4 (males) and -28.9 to- 1.9 (females); and in 1897 from -26.3 to -3.5 (males) and -28.2 to -0.7 (females). It will also be seen that the period 1891-4 occupies a somewhat unique position, whether compared with the period 1881-90 or succeeding years, in respect of the high death rates obtaining at the later age-periods shown in the table; thus, among males, at the age-periods 35-, 45-, 55-, 65- and 75-, the increases per cent. over the death rates of 1881-90 range from 0.1 to 4.4, while among females at ages 45-, 55-, 65- and 75-, the increases per cent. range from 1.7 to 5.4. In connection with the subject under consideration, the effect of the high death rates at these ages in 1891-4 has been to largely reduce the number of lives gained at "all ages." The amount of "life capital" gained, however, has not been reduced in similar proportion owing to the fact that the expectation of life at these ages (see Table I., p. 10) is relatively short. The following table (F.) showing the number of lives and the amount of "life capital" gained or lost at each age-period in 1891-4,* 1895, 1896, and 1897, compared with 1881-90, shows more clearly the exceptional character of the period 1891-4 in this respect. The columns of the table showing the number of lives gained or lost in each period have been obtained in the following manner:-The death rates of the period 1881-90 have been applied to the populations living at each age-period in 1891-4, 1895, 1896 and 1897, in order to obtain the estimated number of deaths which would have occurred in each of the four periods had the death rates of 1881-90 been maintained. The estimated number of deaths thus obtained have been subtracted from the number of deaths actually occurring and the resulting differences shown in the table (cols. 1-4) represent the estimated gain or loss of lives at each age-group in each of the four periods compared with the decennium 1881-90. The figures shown in cols. 5-8 have been obtained by applying the mean expectation of life at each age-group (see Table I.) to the number of lives gained or lost. Table V. Age-period. Number of lives gained (+) or lost (-) by fluctuations of mortality in the undermentioned periods compared with the decennium 1881-90, Amount of "life capital" gained (+) or lost (-) by fluctuations of mortality in the undermentioned periods compared with the decennium 1881-90. 1891-4 (mean). 1895. 1896. 1897. 1891-4 (mean). 1895. 1896. 1897. Column. 1. 2. 3. 4. 5. 6. 7. 8. Males. Years. Years. Years. Years. All ages + 528 + 1,629 + 3,944 + 4,652 + 38,117 + 58,384 + 97,972 + 166,348 0- +563 + 95 + 469 + 1,971 + 27,621 + 4,661 + 23,009 + 96,697 5- + 108 + 334 + 108 + 374 + 5,286 + 16,346 + 5,286 + 18,304 10- + 61 + 86 + 105 + 98 + 2,748 + 3,874 + 4,730 + 4,415 15- + 31 + 136 + 136 + 139 + 1,264 + 5,547 + 5,547 + 5,670 20- + 74 + 155 + 173 + 160 + 2,716 + 5,688 + 6,349 + 5,872 25- + 194 + 366 + 600 + 572 + 6,022 + 11,361 + 18,624 + 17,755 35- - 68 + 386 + 508 + 231 - 1,645 + 9,337 + 12,289 + 5,588 45- - 130 + 118 + 546 + 244 - 2,359 + 2,142 + 9,910 + 4,429 55- - 183 - 55 + 439 + 153 - 2,370 - 712 + 5,685 + 1,981 65- - 134 + 55 + 572 + 538 - 1,191 + 489 + 5,085 + 4,783 75- -2 - 61 + 185 + 106 - 13 - 387 + 1,175 + 673 85 and upwards + 14 + 14 + 103 + 66 + 38 + 38 + 283 + 181 Females. Years. Years. Years. Years. All ages + 514 + 1,064 + 4,330 + 5,684 + 41,489 + 62,432 + 103,844 + 201,467 0- + 591 + 304 + 314 + 2,025 + 31,139 + 16,018 + 16,545 + 106,697 5- + 24 + 244 + 111 + 299 + 1,264 + 12,854 + 5,847 + 15,751 10- + 50 + 69 + 105 + 142 + 2,440 + 3,367 + 5,124 + 6,930 15- + 58 + 147 + 176 + 189 + 2,584 + 6,549 + 7,841 + 8,420 20- + 93 + 167 + 313 + 308 + 3,756 + 6,745 + 12,642 + 12,440 25- + 193 + 420 + 567 + 619 + 6,660 + 14,494 + 19,567 + 21,362 35- + 3 + 235 + 289 + 297 + 82 + 6,401 + 7,872 + 8,090 45- - 60 + 41 + 387 + 283 - 1,234 + 843 + 7,961 + 5,821 55- - 208 - 135 + 507 + 424 - 3,028 - 1,966 + 7,382 + 6,173 65- - 186 - 64 + 996 + 794 - 1,819 - 626 + 9,741 + 7,765 75- - 59 - 311 + 440 + 296 - 398 - 2,096 + 2,966 + 1,995 85 and upwards + 15 - 53 + 125 + 8 + 43 - 151 + 356 + 23 Total + 1,042 + 2,693 + 8,274 + 10,336 + 79,606 + 120,816 + 201,816 + 367,815 It will thus be seen that, compared with the period 1881-90, the number of lives and the amount of "life capital" gained at "all ages" in 1891-4, 1895, 1896 and 1897 have progressively increased, although the increase in "life capital" does not bear any constant proportion to the increase in the number of lives gained ; the explanation of this fact is more apparent when the number of lives and * It should be pointed out that all figures relating to the period 1891-4 are mean annual, 13 amount of "life capital" gained or lost is shown for the age groups "under 25 years" and "25 years and upwards" in each of the periods under consideration. The following figures are obtained, by addition, from the preceding table- Table VI. Period. Number of lives gained ( + ) or lost (-) by fluctuations of mortality (compared with the period 1881-90). Amount of "life capital" gained (+) or lost (-) by fluctuations of mortality (compared with the period 1881-90). Ages. Under 25. Ages. 25 and upwards. All ages. Ages. Under 25. Ages. 25 and upwards. All ages. Years. Years. Years. 1891-4 + 1,653 - 611 + 1,042 + 80,818 - 1,212 + 79,606 1895 + 1,737 + 956 + 2,693 + 81,649 + 39,167 + 120,816 1896 + 2,010 + 6,264 + 8,274 + 92,920 + 108,896 + 201,816 1897 + 5,705 + 4,631 + 10,336 + 281,196 + 86,619 + 367,815 The most striking feature of this table is the extent of the variations exhibited by the figures relating to ages "25 and upwards," the figures for the period 1891-4 showing a mean annual loss of 611 lives at these ages, while the corresponding figures for the year 1896 show a gain of 6,264 lives. Another point worthy of note is the large increase in the number of lives gained in the year 1897 at ages "under 25," and it will be seen on reference to Table V. that this increase is most marked at the age period 0-5 years. Referring again to Table III., shown on page 11, in which the decreasing proportion of "life capital" gained to each life gained in the periods 1891-4, 1891-5, 1891-6, and 1891-7 is shown, it will readily be seen from the preceding analysis of the mortality figures for the years 1895, 1896, and 1897 that the successive addition of these figures to those relating to the period 1891-4-a period which in respect of the large proportion of "life capital" gained to each life gained has been shown to be exceptional-has caused a progressive reduction in this proportion in each of the periods 1891-5, 1891-6, and 1891-7. In the foregoing statement it has been necessary to use figures relating to deaths actually registered in London. In the following table are shown the figures obtained after exclusion of the deaths of persons, not resident in London, occurring in public institutions, and the inclusion of the death of Londoners occurring in public institutions belonging to London, but situated outside the county. It will be observed that the effect of distribution is to reduce the number of deaths at the earlier ages, and to increase the number at the later ages shown in the table. The effect of this correction on the death rates is, however, but trifling. Deaths and death rates during 1897 in London from "all causes" at certain age-periods (1) before distribution, and (2) after distribution, of deaths occurring in public institutions- Age-period. Deaths. Difference. Death rates per 1,000 living. Before distribution. After distribution. Before distribution. After distribution. All ages 79,613 79,408 -205 17.84 17.79 0- 32,228 32,067 -161 60.63 60.33 5- 2,155 2,114 -41 4.48 4.39 10- 1,042 1,008 -34 2.36 2.28 15- 1,351 1,278 -73 3.06 2.89 20- 1,744 1,667 -77 3.84 3.67 25- 4,642 4,539 -103 6.11 5.97 35- 6,684 6,647 -37 12.14 12.07 45- 7,420 7,367 -53 19.00 18.86 55- 7,752 7,780 +28 33.02 33.14 65- 7,683 7,852 +169 59.08 60.38 75- 5,495 5,644 +149 132.37 135.96 85 and upwards 1,417 1,445 +28 260.86 266.02 Infant mortality. The deaths of children under one year of age in the Administrative County of London during 1897 numbered 21,157, being in the proportion of 158 per 1,000 births. 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- 14 Deaths under one year of age per 1,000 births. Towns. 1887-96. 1897. Towns. 1887-96. 1897 London 155 1591 West Ham 154 172 Manchester 184 195 Bristol 144 149 Liverpool 188 200 Nottingham 170 206 Birmingham 176 214 Bradford 171 179 Leeds 176 190 Hull 171 181 Sheffield 178 198 Salford 195 219 London had therefore, in the period 1887-96, a lower infant mortality than any of these towns except West Ham and Bristol, and in 1897 a lower infant mortality than any except Bristol. The infant mortality in 1897 and in the period 1887-96 in the several London sanitary districts may be seen from the following table- Sanitary district Deaths under 1 year of age, 1897. Deaths under one year of age per 1,000 births. 1887-96. 1897. Paddington 449 145 149 Kensington 613 166 166 Hammersmith 538 163 171 Fulham 664 168 162 Chelsea 411 155 161 St. George, Hanover-square 182 139 133 Westminster 205 166 166 St. James 75 158 163 Marylebone 563 138 136 Hampstead 188 116 127 Pancras 1,176 160 168 Islington 1,337 147 136 Stoke Newington 101 137 121 Hackney 929 147 St. Giles 143 151 146 St. Martin-in-the-Fields 30 196 178 Strand 92 199 161 Holborn 144 204 184 Clerkenwell 385 175 184 St. Luke 277 150 149 London, City of 62 151 130 Shoreditch 791 173 183 Bethnal-green 822 161 171 Whitechapel 466 160 148 St. George-in-the-East 399 190 197 Limehouse 386 186 193 Mile-end Old-town 633 153 149 Poplar 995 158 170 St. Saviour, Southwark 150 187 195 St. George, Southwark 400 187 189 Newington 754 172 177 St. Olave 67 171 154 Bermondsey 605 159 190 Rotherhithe 219 158 174 Lambeth 1,421 144 151 Battersea 853 159 162 Wandsworth 683 131 135 Camberwell 1,188 151 159 Greenwich 872 149 157 Lewisham 334 137 125 Woolwich 206 152 158 Lee 119 118 135 Plumstead 230 116 London 21,157 155 1582 The eastern group of districts had the highest infant mortality (170), the northern the lowest (145), the infant mortality of the southern, western, and central groups being 158, 160, and 163 respectively. Of the districts, St. George-in-the-East had the highest (197,), and Plumstead the lowest infant mortality (116). 1 See footnote (2), page 7. 2 See footnote (1), page 7. 15 Deaths from several classes of disease. 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 1897- Causes of death. Corrected annual average 1887-96. 1897. Zymotic diseases 14,778 13,357 Parasitic „ 79 47 Dietetic „ 549 694 Constitutional diseases 17,007 16,487 Developmental „ 5,563 5,727 Nervous „ 9,524 8,041 Diseases of organs of special sense 152 207 Diseases of the circulatory system 7,117 6,967 Respiratory diseases 18,897 13,987 Diseases of the Digestive system 4,902 5,837 „ „ Lymphatic „ 116 98 „ „ Urinary „ 2,289 2,424 „ „ Generative „ 544 537 „ „ Locomotive „ 338 244 „ „ Integumentary system 303 320 Violence (accident) 2,825 2,959 Violence (other than accident) 519 510 Other causes 3,092 2,500 All Causes 88,594 80,943 The following table gives more detailed information concerning the principal diseases included in the constitutional, nervous, and respiratory groups- Causes of death. Corrected annual average 1887-96. 1897. Rheumatic fever, rheumatism of heart 413 368 Rheumatism 114 95 Gout 168 134 Rickets 269 260 Cancer 3,433 3,908 Tabes mesenterica 1,303 989 Tubercular meningitis 1,260 1,208 Phthisis 8,390 7,864 Scrofula, tuberculosis 1,011 923 Other constitutional diseases 646 738 Apoplexy 2,260 2,212 Epilepsy 402 321 Convulsions 2,289 1,681 Other diseases of the brain and nervous system 4,573 3,827 Croup 358 72 Bronchitis 10,754 7,408 Pneumonia 5,962 5,053 Pleurisy 315 271 Other diseases of the respiratory system 1,508 1,183 With a view to enabling more exact comparison to be made of certain causes of death in London sanitary districts, the following table has been prepared, showing the death rates, per 1,000 living, from rheumatic fever, cancer, tabes mesenterica, tubercular meningitis, phthisis, other tubercular diseases and respiratory diseases. It should be pointed out, however, that these death rates are uncorrected for differences in the age and sex constitution of the populations. 16 Administrative County of London-Year 1897 (365 days). Death rates1 per 100,000 living from all causes and from several causes in each sanitary area. Sanitary area. Rheumatic fever. Cancer. Tabes mesenterica. Tubercular meningitis. Phthisis. Other tubercular diseases. Respiratory diseases. Other causes. All causes. Paddington 4 94 14 19 115 12 240 947 1,445 Kensington 6 101 10 22 148 27 263 993 1,570 Hammersmith 12 82 25 29 137 25 295 1,059 1.664 Fulham 15 76 22 24 154 11 309 1,088 1,699 Chelsea 10 90 7 27 176 20 314 1,128 1,772 St. George, Hanover-square 5 97 10 21 118 14 213 847 1,325 Westminster 4 94 25 25 273 19 324 1,169 1,933 St. James - 84 13 40 226 22 292 1,055 1,732 Marylebone 9 118 15 26 175 21 332 1,125 1,821 Hampstead 4 97 8 28 76 10 175 785 1,183 Pancras 14 72 18 27 202 25 339 1,172 1,869 Islington 8 94 26 24 145 19 282 983 1,581 Stoke Newington 15 88 6 23 117 12 193 976 1,430 Hackney 10 81 21 24 143 20 270 1,086 1,655 St. Giles 11 82 26 21 307 18 304 1,076 1,845 St. Martin-in-the-Fields - 102 - 8 260 8 244 1,007 1,629 Strand 17 76 13 34 323 30 361 1,265 2,119 Holborn 16 89 10 26 272 33 515 1,354 2,315 Clerkenwell 5 53 23 35 233 30 429 1,400 2,208 St. Luke 5 99 19 46 310 29 555 1,488 2,551 London, City of 3 119 3 40 185 23 364 1,384 2,121 Shoreditch 15 70 29 30 206 21 400 1,382 2,153 Bethnal-green 6 66 42 31 200 15 445 1,334 2,139 Whitechapel 6 73 29 40 255 15 460 1,168 2,046 St. George-in-the-East 4 56 46 27 278 35 566 1,615 2.627 Limehouse 9 82 26 26 253 27 436 1,643 2,502 Mile-end Old-town 5 68 21 29 139 24 308 1,275 1,869 Poplar 6 80 38 27 192 20 351 1,269 1,983 St. Saviour, Southwark 16 100 52 60 325 24 450 1,429 2,456 St. George, Sonthwark 7 68 41 31 291 18 517 1,403 2,376 Newington 7 86 31 36 222 26 370 1,342 2,120 St. Olave 17 157 9 26 270 35 418 1,263 2,195 Bermondsey 9 77 37 35 204 20 425 1,393 2,200 Rotherhithe 12 66 12 25 162 27 376 1,215 1,895 Lambeth. 14 86 15 30 165 18 283 1,146 1,757 Battersea 11 62 16 27 150 24 242 1,092 1,624 Wandsworth 8 83 12 22 113 12 190 899 1,339 Camberwell 7 87 17 23 150 18 303 1,056 1,661 Greenwich 10 87 26 16 146 17 253 1,156 1,711 Lewisham 6 93 16 18 97 14 161 860 1,265 Woolwich 5 75 29 17 193 22 285 1,156 1,782 Lee 5 92 23 23 112 18 163 887 1,323 Plumstead 2 56 21 15 161 16 197 901 1,369 London 9 84 21 26 172 20 309 1,130 1,771 Principal Zymotic Diseases. The number of deaths in the Administrative County of London from the principal zymotic diseases, viz., smallpox, measles, scarlet fever, diphtheria, whooping cough, typhus, enteric and illdefined fevers and diarrhoea during 1897 was 11,486, giving an annual death rate of 2.56 per 1,000 living. The death rates since 1890 have been as follows- Death rate from Year. principal zymotic diseases. 1891 2.271 1892 2.801 1893 3041 1894 2.651 1895 2.621 1896 3.111 1897 2.561 It will be seen from the following table that London in the period 1887.96 had a lower death rate from the principal zymotic diseases than any of the undermentioned towns except Birmingham, Leeds, Bristol, Nottingham, Bradford and Hull, and in 1897 a lower death rate than any except Bristol and Bradford. 1 See footnote (1), page 7. 17 Principal zymotic diseases-Death rates per 1,000 living. Towns. 1887-96. 1897. Towns. 1887-96. 1897. London 2.76 2581 Bristol 1.98 1.83 Manchester 3.50 3.81 Nottingham 2.39 2.81 Liverpool 3.52 383 Bradford 2.40 2.22 Birmingham 2.76 3.88 Hull 2.64 3.25 Leeds 2.62 2.80 Salford 4.40 5.50 Sheffield 3.27 3.49 West Ham 3.00 2.61 The following table shows that the London death rate from the first six of these principal zymotic diseases, viz., smallpox, measles, scarlet fever, diphtheria, whooping cough and fever was in 1887.96 higher than that of Paris, Brussels, Amsterdam, Copenhagen, Berlin, Vienna and Rome, and in the year 1897 was only exceeded by that of St. Petersburg- Six principal zymotic diseases-Death rates per 1,000 living. Towns. 1887-96. 1897. Towns. 1887-96. 1897. London 2.09 1.66 St. Petersburg 3.14 4.54 Paris 1.55 0.68 Berlin 1.53 0.88 Brussels 1.07 0.51 Vienna 1.77 1.16 Amsterdam 1.20 0.59 Rome 1.87 0.65 Copenhagen 2.05 0.57 New York 2.34 1.44 Stockholm 2.28 0.60 The death rates from the principal zymotic diseases in the several sanitary districts of London in 1897 and the period 1887-96 are shown in the following table- Sanitary district. Deaths in 1897. Death rate per 1,000 living. Sanitary district. Deaths in 1897. Death rate per 1,000 living. 1887-96. 1897. 1887-96.  Paddington 243 2.02 1.94 Shoreditch 496 3.69 4.07 Kensington 304 2.15 1.78 Bethnal-green 439 3.76 3.41 Hammersmith 211 3.15 1.99 Whitechapel 171 2.99 2.16 Fulham 362 3.04 St. George.in.the-East 204 4.41 4.27 Chelsea 244 2.73 2.55 Limehouse 206 4.15 3.54 St. George, Hanoversquare 89 1.60 1.10 Mile-end Old-town 330 3.42 2.97 Poplar 519 3.27 3.07 Westminster 131 2.47 2.47 St. Saviour, Southwark 91 3.34 3.66 St. James 42 1.91 1.87 St. George, Southwark 262 3.78 4.35 Marylebone 227 2.27 1.61 Newington 439 3.21 3.59 Hampstead 90 1.34 1.16 St. Olave 34 3.15 2.96 Pancras 597 2.66 2.47 Bermondsey 371 3.20 4.35 Islington 653 2.60 1.91 Roth erhithe 132 3.13 3.26 Stoke Newington 72 2.47 2.12 Lambeth 791 2.61 2.65 Hackney 626 2.90 Battersea 470 2.54 2.79 St. Giles 61 2.38 1.63 Wandsworth 370 1.91 St. Martin-in-theFields 15 1.94 1.19 Camberwell 750 2.76 2.91 Greenwich 405 2.85 2.27 Strand 48 2.51 2.06 Lewisham 180 1.67 1.66 Holborn 85 2.94 2.79 Woolwich 105 2.23 2.54 Clerkenwell 238 3.61 3.61 Lee 56 2.08 1.43 St. Luke 157 3.78 3.82 Plumstead 120 1.97 London, City of 50 1.43 1.66 London 11.486 2.75 2.562 The eastern group of districts had in 1897 the highest mortality from the principal zymotic diseases, viz., 330 per 1,000 living, the western group the lowest (2.10). Among the sanitary districts, St. George-the-Martyr and Bermondsey had the highest death rates in 1897 (4.35) and St. GeorgeHanover-square, the lowest (1.10). 1 See footnote (2), page 7. 2 See footnote (1), page 7. [3] 18 Smallpox and Vaccination. The deaths from smallpox in the Administrative County of London numbered 16 in 1897, and 8 deaths were attributed to cowpox and effects of vaccination. Ihe death rates from smallpox in successive periods have been as follows- Period. Smallpox death rate per 1,000 living. Period. Smallpox death rate per 1,000 living.[/##] 1851-60 0.28 1892 0.0071 1861-70 0.28 1893 0.0401 1871-80 0.46 1894 0.0201 1881-90 0.14 1895 0.0121 1891 1 1896 0.0021 1897 0.0041 The death rate in each year in relation to the mean death rate of the period 1841-97 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 the various sanitary districts comprised in the administrative county has been as follows- Year. Cases notified. Case rate per 1,000 1890 60 0.014 1891 114 0.027 1892 425 0.100 1893 2,815 0.653 1894 1,193 0.274 1895 980 0.223 1896 225 0.050 1897 104 0.023 If the London smallpox death rate be compared with the death rate of the following large English towns, it will be seen that in the period 1887-96 the London death rate was exceeded by the death-rates of all except Liverpool, Leeds, Nottingham and Salford, while in 1897 in none of these towns were sufficient deaths registered to give an appreciable death rate. Smallpox-Death-rates per 1,000 living. Towns. 1887-96. 1897. Towns. 1887-96. 1897. London 0.01 0.002 Bristol 0.04 0.00 Manchester 0.02 - Nottingham 0.01 - Liverpool 0.01 - Bradford 0.07 - Birmingham 0.05 - Hull 0.02 0.00 Leeds 0.01 - Salford 0.01 - Sheffield 0.23 - West Ham 0.05 - If the London smallpox death rate be compared with the death rates of the following foreign cities, it will be seen that in the period 1887-96 the London rate was exceeded by all these cities except Amsterdam, Copenhagen, Stockholm and Berlin, and in 1897 by that of St. Petersburg and New York only. Smallpox-Death-rates per 1,000 living. Towns. 1887-96. 1897. Towns. 1887-96. 1897. London .01 .002 St. Petersburg .13 .12 Paris .06 .00 Berlin .00 .00 Brussels .10 .00 Vienna .06 .00 Amsterdam .00 .00 Rome .14 .00 Copenhagen .00 .00 New York .03 .01 Stockholm .00 .00 The following table shows the number of cases of and deaths from smallpox belonging to each district in 1897, the case rate of each district in the period 1891-6 and in 1897, and the death rate of each district in the period 1887-96 and in 1897. 1 See footnote (1), page 7. 2See footnote (2), page 7. Diagram IV Smallpox. 19 Sanitary district. Cases, 1897. Case rate per 1,000 living. Deaths, 1897. Death rate per 1,000 living. 1891-6. 1897. 1887-96. 1897. Paddington 1 .16 .01 — .008 — Kensington — .15 — — .007 — Hammersmith — .07 — — .005 — Fulham — .12 — — — Chelsea — .12 — — .003 — St. George, Hanover-square 1 .09 .01 — .006 — Westminster — .18 — — — — St. James 3 .45 .13 — .008 — Marylebone 4 .72 .03 — .031 — Hampstead — .08 —. — .007 — Pancras 3 .19 .01 1 .009 .004 Islington 3 .16 .01 1 .003 .003 Stoke Newington 2 .11 .06 — .003 — Hackney 3 .01 — — St. Giles 3 .43 .08 — .020 — St. Martin-in-the-Fields 1 .19 .08 1 .021 .079 Strand 8 .33 .34 2 .016 .085 Holborn — .38 — — .006 — Clerkenwell — .11 — 1 — .015 St. Luke — .18 — — .014 — London, City of 2 .21 .07 1 .011 .033 Shoreditch 1 .22 .01 1 .010 .008 Bethnal-green 2 .39 .02 — .018 — Whitechapel — .52 — — .013 — St. George-in-the-East 1 .30 .02 — .006 — Limehouse — .36 — — .017 — Mile-end Old-town — .35 — — .014 — Poplar 9 .37 .05 — .014 — St. Saviour, Southwark — .18 — — — — St. George, Southwark 1 .39 .02 1 .012 .017 Newington — .14 — — .011 — St. Olave 1 .18 .09 — .008 — Bermondsey 1 .16 .01 — .006 — Rotherhithe — .66 — — .038 — Lambeth 2 .13 .01 — .005 — Battersea 5 .17 .03 — .006 . — Wandsworth 1 .06 .01 — — Camberwell 32 .19 .12 5 .010 .019 Greenwich 1 .29 .01 2 .015 .011 Lewisham — .07 — — .006 — Woolwich 2 .25 .05 — .012 — Lee 1 .25 .03 — .16 — Plumstead — — — — Port of London 10 — — — — .— London 104 22 02 16 .009 .0041 The cases notified in the administrative county were distributed throughout the year as follows— No. of week. Week ending No. of cases of smallpox notified. No. of week. Week ending No. of cases of Small pox notified. No. of week. Weekending No. of cases of smallpox notified. 1 9 January 3 19 15 May 5 36 11 September __ 2 16 „ 1 20 22 „ 2 37 18 „ 1 3 23 „ — 21 29 „ — 38 25„ — 4 30 „ 4 22 5 June — 39 2 October — 5 6 February 8 23 12 „ 1 40 9 „ — 6 13 „ 23 24 19 „ 1 41 16 „ — 7 20 „ 3 25 26 „ 2 42 23 „ 1 8 27 „ 14 26 3 July — 43 30 „ 1 9 6 March — 27 10 „ 3 44 6 November — 10 13 „ 2 28 17 „ 1 45 13 ,, 2 11 20 „ 1 29 24 „ — 46 20 „ 1 12 27 „ 2 30 31 „ 3 47 27 „ — 13 3 April 3 31 7 August — 48 4 December — 14 10 „ 2 32 14 „ — 49 11 „ — 15 17 „ 1 33 21 „ — 50 18 „ — 16 24 „ 3 34 28 „ 1 51 25 „ — 17 1 May 5 35 4 September — 52 1 January 1 18 8 „ 3 1 See footnote ('), page 7. 20 The following table shows the number of cases notified in successive periods of four weeks in each of the several sanitary districts— Sanitary district. Four weeks ended Jan. 30. Feb. 27. Mar. 27. Apr. 24. May 22. June 19. July 17. Aug. 14. Sept. 11. Oct. 9. Nov. 6. Dec. 4. Jan. 1. Total 1897. Paddington ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 Kensington ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hammersmith ... • •• ... ... ... ... ... • •• ... ... ... ... Fulham ... ... ... ... ... ... ... ... ... ... ... ... ... Chelsea ... ... ... ... ... ... ... ... ... ... ... ... ... St. George, Hanoversquare ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 Westminster • •• ... • •• ... ... ... ... ... ... ... ... ... ... ... St. James ... ... ... ... 3 ... ... ... ... ... ... ... ... 3 Marylebone 1 • •• ... ... 2 ... 1 ... ... ... ... ... ... 4 Hampstead ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pancras ... 1 ... ... ... ... ... ... 1 1 ... ... ... 3 Islington ... ... ... ... 2 ... ... 1 ... ... ... ... ... 3 Stoke Newington ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 Hackney ... • •• 1 1 ... ... 1 ... ... ... ... ... ... 3 St. Giles 2 1 ... ... ... ... ... ... ... ... ... ... ... 3 St.Martin-in-the-Fields 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 Strand ... 6 ... 2 ... ... ... ... ... ... ... ... ... 8 Holborn ... ... ... ... ... ... ... ... ... ... ... ... ... ... Clerkenwell ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Luke ... ... ... ... ... ... ... ... ... ... ... ... ... ... London, City of ... ... ... ... ... ... ... 2 • •• ... ... ... ... 2 Shoreditch ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Bethnal-green ... ... ... ... ... ... 1 ... ... ... 1 ... ... 2 Whitechapel ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. George-in-the-East ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Limehouse ... ... ... ... ... ... ... ... ... ... ... ... ... ... Mile-end Old-town ... ... • •• ... ... ... ... ... ... ... ... ... Poplar 1 1 1 2 3 ... ... ... ... ... ... 1 ... 9 St. Saviour, Southwark ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. George, Southwark ... ... • •• ... • •• ... ... ... ... ... ... 1 1 Newington ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Olave ... ... ... ... 1 ... ... ... ... ... ... ... 1 Bermondsey ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Rotherhithe ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lambeth 2 ... ... ... ... ... ... ... ... ... ... 2 Battersea ... ... ... 1 1 "2 ... ... ... ... ... l ... 5 Wandsworth ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Camberwell 1 29 1 1 ... ... ... ... ... ... ... ... ... 32 Greenwich I ... ... ... ... ... ... ... ... ... ... ... ... 1 Lewisham ... ... ... ... ... ... ... ... ... ... ... ... ... ... Woolwich ... ... 2 ... ... ... ... ... ... ... ... ... ... 2 Lee ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Plumstead ... ... ... ... ... ... ... ... ... ... ... ... ... Port of London l 5 ... 1 1 ... 1 ... ... ... ... 1 ... 10 London 8 48 5 9 15 2 6 3 1 1 2 3 1 104 The reports of the medical officers of health supply the following more detailed information as to cases of smallpox occurring in 1897— Paddington.—The single case of supposed smallpox was erroneously diagnosed, and was sent home from hospital the day after removal. Fulham.—Six persons were certified to be suffering from smallpox. In each case it was found that the diagnosis was incorrect. Five proved to be chicken-pox and one erythema. St. James, Westminster.—Three cases of smallpox, all adults, were removed to hospital from one house. Marylebone.—The medical officer of health in his monthly report for May makes the following statement— "A curious sequence of cases of smallpox occurred from a St. Marylebone centre. Two ladies from Paris resided from the 2nd to the 14th of April at a house tenanted by a medical practitioner in the parish, and went away ill on or about the 14th of April. The nature of the illness does not seem to be known. On April 15th the wife of the medical man, it is said, was down with some eruption and pneumonia; on the same date the servant was ill, and the doctor considered she was suffering from chicken-pox, and isolated the case at the top of the house. He allowed her mother, who lived in another parish, to come and nurse her; the girl's sister was also in the same house. On or about April 29th, the mother of the servant was taken ill in another parish and ultimately sent to the hospital, on the 10th of May, as smallpox. The servant's sister developed smallpox, also mistaken for chicken-pox, 21 about the same date. On the 12th of May the groom, a youth of 18, developed the same disorder. On the 16th of May, a man who had communication with the house some time or other, the exact date not clear, and who had shaken or beaten a stair carpet, was sent also to hospital as smallpox." St. Pancras.—Two cases of smallpox were notified, the one in the Gray's-inn-lane, the other in the Kentish-town sub-districts. The report of the medical officer of health of St. Martin-in-the-Fields refers to the attack by smallpox of a tailor, formerly resident in that district, who had for two months before his attack been an inmate of the Central Sick Asylum, Cleveland-street, St. Pancras. He states that he "learnt that a man about that time (February) had been admitted into the Cleveland-street Asylum suffering from supposed erysipelas, which later on proved to be smallpox; this man infected several inmates of the asylum along with the case notified to me." Islington.—Three cases of smallpox were notified in different houses. One of these cases, a child aged one year, died. The Registrar-General includes the case among those concerning whose condition as to vaccination there was no statement. Stoke Newington.—The medical officer of health writes— A case of smallpox was notified early in the year. The patient was a young seamstress, who made up some sleeves while in bed, suffering from what was thought to be a bad bilious attack. These sleeves were subsequently passed on to another person to fit and sew into bodices three days before the supposed bilious attack was diagnosed as smallpox. In the family (to which these sleeves were sent, was a boy who, unlike its other three members, had never been vaccinated. He alone caught the complaint and suffered from a severe attack. * * * It was thought probable that the first case contracted the disease in Islington, as there were three cases in a neighbourhood in which she sometimes visited, but it was quite impossible to trace the origin of the infection with any precision. Hackney.—Four persons were certified to be suffering from smallpox. In three cases the disease proved to be chicken-pox. The case of smallpox occurred in the person of a young woman whose condition as to vaccination and the source of whose infection were unknown. St. Giles.—Four persons were certified to be suffering from smallpox, in one case the disease proved to be chicken-pox, the other three were adults, living in one private lodging-house. St. Ma/rtin-in-the-Fields.—-A tailor, previously resident in this district, and suffering from phthisis, was removed to the Central Sick Asylum, Cleveland-street, St. Pancras, where, two months after his admission, he contracted smallpox. This patient died in the Castalia. Another case occurred in Long-acre, was removed to hospital, and recovered. (See also "Strand.") Strand.—The medical officer of health writes as follows— A series of eight cases occurred in the month of February. A man living in a common lodginghouse in Vere-street, employed in carrying an advertisement board in Bond-street, was sent to the Central Sick Asylum in Cleveland-street, suffering from what was thought to be erysipelas; the complaint proved to be smallpox, and five persons belonging to this district who were inmates of the ward to which he was admitted subsequently developed the same. The lodging-house where he had been staying for some time had 40 other lodgers, five of whom slept in the same room with him. All refused to be re-vaccinated, and two took the disease, one dying therefrom. Fortunately the men at this house were regular lodgers; had they been of the tramp class the disease might readily have been carried to other parts of London, and even into the country. The sanitary authority possesses no power whereby these men could have been detained and isolated during the period that smallpox is latent in the system. In order to prevent any of the men going to other lodgings while the rooms were being disinfected, those that had to be removed were accommodated at the Board's shelter. The house was visited morning and evening, and the men examined for any suspicious symptoms. The officers of the County Council who control common lodging-houses, rendered every assistance, with the result that none of the men left, and the disease was confined to the one house in the district, and the Strand Guardians also co-operated by promptly isolating any suspicious case in one of their wards at Bear-yard. Clerkenwell.—A child previously resident in Holborn was, an hour after removal with its parents to Clerkenwell, taken to St. Bartholomew's Hospital. The child died in course of transit. An inquest was held and a verdict returned of "death from natural causes, probably smallpox." The house physician of the hospital stated that the appearances were not sufficiently clear to enable him to give a definite opinion. "Enquiries discovered no likely source of smallpox infection, but measles existed in the block of dwellings in Holborn from which the child had just been removed." City.—The report of the medical officer of health contains tables showing that two cases of smallpox were notified and that there were two deaths from this disease. Shoreditch.—The medical officer of health thus writes— One case of this dangerous malady was notified in Shoreditch, during the year. On May 16th a young man, aged 22, residing at a house in Shepherdess-walk, where he was a lodger, was certified to be suffering from smallpox, and removed to the ship Castalia. He was a carpet-planner by trade and worked for a firm in Stanhope-street. Euston-road. From inquiries made he appears to have beaten carpets belonging to a house in the West-End where some cases of illness had occurred, which were subsequently found to be cases of smallpox. This patient had been vaccinated in infancy. The case was one of the hcemorrhagic variety and terminated fatally in a few days. Bethnal-green.—In this district two persons were erroneously certified to be suffering from smallpox, their malady being chicken-pox. The medical officer of health expresses the opinion that the requirement of notification should extend to chicken-pox, on account of the difficulty in diagnosis felt by inexperienced practitioners. St. George-in-the-East.—A case of chicken-pox was erroneously certified to be smallpox. Poplar (north district).—Two cases of smallpox occurred in one house and four in another. (south district)—Three cases of smallpox occurred, one admitted into the sick asylum from Greenwich Hospital, and two who were sailors in the Scandinavian Sailors' Home. St. Mary, Newington.—No case of true smallpox is known to have occurred, but two or three certificates were received of cases which were subsequently found not to be smallpox. 22 St. Olave.—The only person known to be attacked with smallpox was the house surgeon of a hospital. Lambeth.—Of two cases certified to be smallpox, one was probably chicken-pox. Battersea.—Of five cases certified to be smallpox, only one was a genuine case. The patient was a man employed at the docks, where the disease was probably contracted. Wandsworth (Putney and Roehampton).—A man who had contracted his disease on the passage from India was certified to be suffering from smallpox. (Streatham) —One case was certified in this district. Camberwell.—The report of the medical officer of health contains an account of an outbreak of smallpox having its orgin in the attack by smallpox of an unvaccinated boy, aged six years, who was admitted from 128, Glengall-road into the Camberwell Infirmary on the 22nd January, under the mistaken impression that he was suffering from meningitis. The medical officer of health thus refers to subsequent cases. Between the 3rd and 20th February there were sixteen cases notified from the infirmary, and in addition to these there were four persons attacked, who either had been engaged there as workers, or who had been recently discharged. Moreover, while these events were going on at the infirmary, the disease was spreading in the house whence the boy had been removed to the infirmary, and not only in the house but also at 138 in the same road, which was inhabited by relatives of the family in No. 128. In Downes-street, too, an unvaccinated boy, who had been discharged from the infirmary on February 5th, was first of all considered to be suffering from scarlet fever on February 9th, but it was afterwards found to be a case of smallpox. He was removed on February 9th, but not before he had infected a brother and sister, both unvaccinated, who were removed later in the month. Two cases were removed from No. 25. Bridson-street. On making inquiry at this house I discovered that about a fortnight before, a child had died from supposed measles, but before her death she had, according to her friends' statement, spots about her. Looking at the subsequent result it is most likely that this was unrecognised smallpox. Greenwich.—One case of smallpox was notified in each of the parishes of Greenwich and Deptford. Lee (Eltham).—A child, aged two years, was certified to be suffering from smallpox and removed to hospital, but immediately discharged. The medical officer of health expresses doubt as to the diagnosis. Woolwich.—Two persons were certified to be suffering from smallpox, the diagnosis of one case was erroneous. Since 1880 the Registrar-General has classified the deaths from smallpox under three heads, viz., "vaccinated," "unvaccinated," and " no statement." The totals of the 17 years 1881-97 are as follows— Smallpox deaths, London, 1881-97. Age-period. All ages. 0-1 1-5 5-20 20-40 40-60 60-80 80 and upwards. Vaccinated 1,282 22 33 229 730 226 39 3 Unvaccinated 2,031 337 486 669 415 105 18 1 No statement 1,906 244 227 455 666 249 62 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 age incidence of the 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 2.6 17.9 57.0 17.6 3.0 0.2 Unvaccinated 100 16.6 23.9 33.0 20.4 5.2 0.9 0.0 No statement 100 12.8 11.9 23.8 34.9 13.1 3.3 0.2 " Vaccinated" and, "no statement" combined. "Vaccinated" and "No statement" 100 8.3 8.2 21.4 43.8 14.9 3.2 0.2 Unvaccinated 100 16.6 23.9 33.0 20.4 5.2 0.9 0.0 The report of the Statistical Committee of the Metropolitan Asylums Board for 1897 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— Diagram V. Measles. Mean Death rete 1847-97 581 per million 23 Age-period. Vaccinated. No evidence as to vaccination. * Vaccination cicatrices absent. Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. 0— — — — — — — 1— — — — — — — 2— — — — — — — 3— — — — — 1 1 4— — — — — 1 1 5— — — — — 1 — 6— — — — — 1 — 7— — — — — 1 1 8— 1 — — — 2 1 9— — — — — — 10— 1 1 — — 1 — 11— — — — — 1 — 12— 1 — — — — — 13— — — — — 1 — 14— 1 — — — — — 15— 7 — — — 1 — 20— 8 1 1 1 — — 25— 7 — 1 — — — 30— 7 — — — — 1 35— 4 1 — — — — 40— 7 — 1 1 — — 50 and upwards 9 2 1 1 2 — All ages 53 5 4 3 13 5 The table shows that the unvaccinated smallpox patients are of younger age than the vaccinated, and that the mortality of the former has been much greater than that of the latter. I have in recent reports referred to the increasing proportion of children born in London, who appear in the vaccination returns as "not finally accounted for," a proportion which has especially increased since the appointment of the Royal Commission on Vaccination. The proportion in successive years has been as follows ; the figures foretell numerous deaths from smallpox— London vaccination returns. Year. Children not finally accounted for (including cases postponed) per cent, of total births. Year. Children not finally accounted for (including cases postponed) per cent. of total births. 1872 8.8 1884 6.8 1873 8.7 1885 7.0 1874 8.8 1886 7.8 1875 9.3 1887 9.0 1876 6.5 1888 10.3 1877 7.1 1889 11.6 1878 7.1 1890 13.9 1879 7.8 1891 16.4 1880 7.0 1892 18.4 1881 5.7 1893 18.2 1882 6.6 1894 20.6 1883 6.5 1895 24.9 Measles. The deaths from measles in the Administrative County of London in 1897 numbered 1,933 as compared with 3,697 in 1896, 2,630 in 1895 and 3,303 in 1894. The death rates from this disease per 1,000 living in 1897 and preceding periods have been as follows— 1851-60 0.53 1892 0.791 1861-70 0.58 1893 0.381 1871-80 0.51 1894 0.761 1881-90 0.64 1895 0.601 1891 0.431 1896 0.821 1897 0.431 The death rate in each year since 1840, in relation to the mean of the period 1841-97, is shown in diagram V. * Thes e 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 natare of the eruption or other cause prevented any observation of the marks, if any existed. i See footnote ('), page 7. 24 If the London death rate be compared with the death rates of other large towns in England having more than 200,000 inhabitants, it will be seen that in the period 1887-96 the London death rate exceeded that of any of these towns except Manchester, Liverpool, West Ham and Salford, while in 1897 the London death rate was lower than that of any except Leeds, Bristol, Nottingham, Bradford and Hull. Measles—Death rates per 1,000 living. Towns. 1887-96. 1897. Towns. 1887-96. 1897. London 0.64 0.431 West Ham 0.68 0.51 Manchester 0.87 1.18 Bristol 0.51 0.25 Liverpool 0.77 0.54 Nottingham 0.41 0.21 Birmingham 0.49 0.79 Bradford 0.49 0.35 Leeds 0.57 0.40 Hull 0.53 0.11 Sheffield 0.59 0.56 Salford 0.94 2.22 The following table shows that the measles death rate in London was higher than that of any of the undermentioned foreign cities in the period 1887-96, except St. Petersburg, and in 1897 was higher than that of any except St. Petersburg and Vienna— Measles—Death rates per 1,000 living. Towns. 1887-96. 1897. Towns. 1887-96. 1897. London .64 .431 St. Petersburg .65 .85 Paris .43 .33 Berlin .18 .17 Brussels .39 .12 Vienna .57 .53 Amsterdam .36 .02 Rome .47 .21 Copenhagen .42 .14 New York .38 .20 Stockholm .45 .10 In the distribution of measles mortality in London during the year as a whole, the eastern group of districts had the highest death rate, the western the lowest. Of the districts St. George-inthe-East suffered the most, Paddington the least. During the first and second quarters of the year the measles mortality was above the average of London in the eastern and central groups of districts ; in the third quarter of the year the mortality of all the groups of districts except the northern and western exceeded the average of London; in the fourth quarter the average measles mortality had risen considerably, and that of the eastern and southern groups of districts exceeded the average of London. The death rates in each sanitary district of London in the period 1887-96 and in 1897 are shown in the following table— Sanitary district. Deaths in 1897. Death rate per 1,000 living. Sanitary district. Deaths in 1897. Death rate per 1,000 living. 1887-96. 1897. 1887-96. 1897. Paddington 2 .41 .02 Whitechapel 45 .74 .57 Kensington 32 .52 .19 St. George - in - the - East 68 1.09 1.42 Hammersmith 5 .73 .05 Fulham 51 .43 Limehouse 63 1.11 1.08 Chelsea 18 .64 .19 Mile-end Old-town 77 .77 .69 St. George, Hanoversquare 17 .34 .21 Poplar 83 .79 .49 St. Saviour, Southwark 32 .93 1.29 Westminster 26 .58 .49 St. James 13 .53 .58 St. George, Southwark 67 .97 1.11 Marylebone 9 .61 .06 Hampstead 9 .28 .12 Newington 85 .78 .70 Pancras 87 .62 .36 St. Olave 6 .81 .12 Islington 99 .63 .29 Bermondsey 76 .83 .89 Stoke Newington 7 .48 .21 Rotherhithe 21 .64 .52 Hackney 127 .59 Lambeth 140 .56 .47 St. Giles 9 .64 .24 Battersea 79 .57 .47 St. Martin - in - the Fields 1 .47 .08 Wandsworth 27 .14 Camberwell 141 .61 .55 Strand 10 .69 .43 Greenwich 35 .63 .20 Holborn 6 .84 .20 Lewisham 23 .30 .21 Clerkenwell 49 .98 .74 Woolwich 2 .65 .05 St. Luke 40 1.07 .97 Lee 6 .46 .15 London, City of 7 .29 .23 Plumstead 3 .05 Shoreditch ... 116 .85 .95 London 1,933 .64 432 Bethnal-green 114 .90 .89 1 See footnote (2), page 7. 2 See footnote ('), page 7. 25 The prevalence of measles among school children is referred to in the reports relating to the following districts— Fulham.—The disease was mainly prevalent among very young children, as while 455 children attending the infants' departments of the various board schools in Fulham were reported by the teachers as absent owing to their having measles, only 39 were reported as so suffering in the girls' and boys' departments, though a large number were excluded on account of the existence of measles in their homes. The disease appeared to have been very prevalent among children too young to attend school before it showed itself to any extent among the school children. The infants' department of the Lillie-road school and some of the infant classes of the Langford-road school were, by arrangement with the medical officer of the School Board, closed for a short time. In the case of several other board schools, the fact that the prevalence did not manifest itself until near the approach of the Christmas holiday rendered closing of the departments unnecessary. Westminster.—The most serious outbreak of measles occurred at St. Mary's Schools, Hide-place. On September 26th the disease began to show itself in these schools, mainly in the infants'department. Eighty-nine children were attacked and ten died ; the ages of the children attacked ranged from three to seven years. The disease began to abate on October 22nd and then gradually declined. The medical officer of health thought it inadvisable to close the school on account of the amount of intercourse which went on between the families of those attacked and of the early infectiousness of the disease. "All due precautions were taken as to disinfecting, and the daily examination of children attending the schools." Hampstead.—In December of 1897 there was recrudescence of the disease, and it spread with great rapidity among children attending elementary schools. The closing of the schools for the Christmas vacation did not seem to have much effect in checking the progress of the malady, probably because the mischief had already been done by the children taking the complaint home to the other young children. Islington.—The sanitary authority required the closing of the infants' departments of the Richard-street, Poole's-park and Upper Hornsey-road Board Schools, and of St. Anne's Church School on account of prevalence of measles. The medical officer of health states that information as to the existence of measles among the scholars of the first of these schools only accidentally came to his knowledge, and that there had been failure to give him notice as required by the " code of regulations and instructions for the guidance of managers, correspondents and teachers." He recommended that the infants' department of the Richard-street school should be closed for three weeks, and he asked the School Board to supply him with the names and addresses of the scholars in order that he might make inquiry at each scholar's house as to the existence of measles in the house so that he might be in a position to furnish the School Board with the names and addresses of scholars whom it was desirable to exclude from school for a longer period than that for which the school was closed. This information was refused him. Subsequent to the closing of the infants' department of the Poole's-park school, he asked for the names and addresses of the children in that department of the Poole's-park school. This information was at first refused him, but was the following day supplied to him by authority of the vice-chairman of the School Management Committee. The medical officer of health states that this information has been supplied ever since, and that it has proved of the greatest value in determining whether a school should be re-opened at the end of three weeks or be kept closed for a further short period. Stoke Newington.—The medical officer of health states that he did not find it necessary to close any school, but that, thanks to the co-operation of the head teachers, he was able to learn from day to day the number of absentees on account of measles and whooping cough. He considers it, however, "matter for regret that the regulation of the School Board for London, requiring that the medical officer of health of the district shall be informed of a child's exclusion on account of symptoms of infectious disease, is not given effect to as a routine practice." He further writes—"If, then, we are to reap the greatest benefit in the direction of checking the spread of measles through schools, it appears to me that we must act up to the knowledge we now possess, i.e., that several infectious diseases largely spread through schools. The scholars in each school would then be examined by a medical man, at frequent intervals during even inter-epidemic periods, and almost daily during epidemic prevalence; all suspects would be sent home and requested to see a doctor, and all absentees visited, and the true cause of their absence ascertained." Hackney.—There was especial prevalence of measles in the fourth quarter, particularly in south-east Hackney, in which district the Gainsborough-road Board school is situated. On the 20th November the medical officer of health received from the medical officer of the School Board a letter stating that 120 children were absent from this school suffering from measles, and 36 absent because of the disease being in their homes. The medical officer suggested the closing of the infants' department for 14 days. This letter, the medical officer of health writes, was the first intimation he received, and he coincided at once with the proposal to close the infants' department. He ascertained that at first the disease was confined to the youngest class for nearly three weeks, and subsequently spread through the other classes of the school. The result of closure was satisfactory. He thinks that the principle of closure might usefully be applied to classes in the infants' department at a much earlier stage of an epidemic of infectious disease, but for such purpose it would be necessary to receive prompt information from the headmistress of absentees either suffering from disease or having disease in their homes. He refers to the regulations of the School Board requiring this information to be sent, and publishes a letter from the clerk of the School Board whom he had addressed on the subject. This letter, which is dated the 21st December, 1897, states that in their " Official Gazette " of that week the Board had directed the attention of teachers generally and of the Plumstead teachers in particular to the requirement of the regulations which they pointed out applied to all infectious ailments, and not only those which are notifiable under the Public Health (London) Act. The letter further states that it is the intention of the Board that the teachers shall notify measles and whooping cough to the medical officer of health. 4 26 Strand.—On account of the prevalence of measles in the latter part of the year it became necessary to take steps to require the exclusion from school of children from infected houses, and St. Patrick's School was closed a fortnight before the usual Christmas holidays. Returns were obtained from all the schools in Soho of those who were absent, and the houses of absentees in that parish visited and leaflets distributed giving necessary instructions. Poplar (south district).—Measles was especially prevalent among the children of the infant department of the Bromley, St. Leonard's, national schools. The first information of this prevalence which the medical officer of health received came from the vicar of Bromley. Lambeth.—The part played by schools in disseminating measles is discussed in the report of the medical officer of health. He gives account of four schools the infants' departments of which were closed on account of prevalence of measles. In these schools the proportions of children absent before closure were 40, 25, 43 and 46 per cent. respectively. The number of days during which the schools were closed was 18, 21 and 35 in the case of three of the schools, and in the case of the fourth a longer period elapsed owing to the occurrence of the Christmas holidays. The results in each case were completely satisfactory. He expresses the opinion that the shortest period for which a school is closed on account of measles should be three weeks "owing to the average incubation and duration of this particular disease being ten days and three weeks respectively." Plumstead.—The medical officer of health thus writes— "In my last report reference was made to my unsuccessful efforts to arrange for a school notification of measles. I have now found that the School Board Code already provided for this, but, owing to the paragraph in which it is contained being somewhat ambiguously worded, teachers generally were unaware of their duty in this respect. On my recommendation the vestry wrote to the School Board, calling their attention to the fact that teachers did not understand the rule concerning notification of absentees on account of infectious diseases, to apply to diseases which, like measles, were non-notifiable; and asking the Board to call their attention to their duty in this respect. This the Board has done, but I regret to say there are still a large number of teachers who pay no attention to the Board's instructions. I have, however, already received a large number of notifications, and I have reason to hope that the action I have been able to take upon them has materially contributed to lessen the spread of the measles epidemic now prevailing." The subject of notification of measles is referred to in several of the annual reports of medical officers of health, thus— Kensington. "It would be of little or no use to have notification of measles unless hospital "accommodation were provided on a large scale for the use of the sufferers therefrom, and of this there "is no present prospect." Fulham.—Referring to the carelessness of parents, who often make no effort to prevent their children, while suffering from measles, from associating with others and from attending school, it is stated that the vestry had sought the notification of measles, and the Local Government Board and London County Council had been communicated with. The opinion is expressed that a modified system of notification of measles should be tried, by which the first attack in every house invaded shall be notified, but no subsequent case occurring in the same house within thirty days. Inasmuch as frequently there is no medical man in attendance, the duty of notifying should be imposed on the parent or guardian as well as on the medical practitioner. The need of hospital accommodation is urged, less for the purpose of isolation than for the treatment of patients under home conditions unfavourable to their recovery. St. George, Hanover-square.—The medical officer of health presented a special report, in which he recommended the vestry not to apply for the notification of measles. He points out that where notification had been tried in other communities, it had not been found to produce advantageous results. He recommends the closing of the infants' departments of schools in which outbreaks occur. Stoke Newington.—The medical officer of heaith is of opinion that in rural districts and in small isolated communities notification of measles may be useful if every advantage is taken of the information thus obtained, if efforts also be made to detect unnotified cases, and the means of effectual isolation be provided; but in large communities, especially when not adopted in neighbouring districts, the measure is not to be recommended in the absence of sufficient isolation provision, a large permanent staff, and the adoption of other means than "notification" of bringing the existence of cases to the knowledge of the sanitary authority. St. Giles.—The medical officer of health considers notification of measles is desirable as it would enable the sanitary authority to visit, with a view of excluding children from infected houses from attendance at public schools. Holborn.— The medical officer of health is of opinion that notification of measle9 by the head of the family should be compulsory, and that children from affected houses should not be allowed to attend school. Bethnal-green.—The medical officer of health writes that he would limit medical certification to the first case in each household and impose the duty of reporting subsequent cases on the parent or guardian. Poplar (north district).—The medical officer of health is inclined to modify his opinion that notification must be accompanied by hospital accommodation, and states that he is satisfied measles should be notified. St. George, Southward.—The medical officer of health states that the compulsory notification of measles throughout London, and subsequent hospital treatment and disinfection, could not fail in a poor parish like that of St. r~eorge to result in a great saving of life. Newington.—The medical officer of health recommends the notification of measles on the ground that it would cause greater care to be exercised in dealing with cases of this disease. Battersea.—The medical officer of health regards the fact that the deaths from measles and whooping-cough are more numerous than the deaths from the diseases which are notified, constitutes a strong argument in favour of the notification of all infectious diseases. Diagram. VI Scarlet Fever. 27 Scarlet Fever. The cases of scarlet fever notified in the Administrative County of London during 1897 numbered 22,904, compared with 25,758 in 1896. The number of deaths registered from this cause in 1897 was 778. giving a death rate of 0.17 per 1,000 living: per annum. The London rates in 1897 and preceding periods are shown in the following table— Scarlet fever. Period. Death rate per 1,000 living. Case rate per 1,000 living. Case mortality per cent. 1861-70 1.13 * — 1871-80 0.60 * — 1881-90 0.33 * — 1891 0.141 2.7 5.1 1892 0.271 6.4 4.3 1893 0.37] 8.6 4.3 1894 0.221 4.3 5.2 1895 0.191 4.5 4.2 1896 0.211 5.7 3.7 1897 0.171 5.1 3.0 The death rate in each year in relation to the mean death rate of the period 1859-97 is shown in diagram VI. It will be seen from the following table that in the period 1887-96 the London scarlet fever death rate exceeded the rates of Birmingham, Leeds, Bristol, Nottingham and Hull, and in 1897 the rates of West Ham, Bristol, Nottingham and Bradford— Scarlet fever—Death rates per 1,000 living. Towns. 1887-96. 1897. Towns. 1887-96. 1897. London .25 .182 West Ham .25 .11 Manchester .39 .23 Bristol .24 .08 Liverpool .48 .33 Nottingham .18 .15 Birmingham .22 .18 Bradford .29 .04 Leeds .21 .23 Hull .18 .27 Sheffield .41 .26 Salford .52 .29 If the London scarlet fever death rate be compared with the death rates of the undermentioned foreign cities it will be seen that in the period 1887-96 the London death rate was higher than those of Paris, Brussels, Amsterdam, Berlin, and Rome; and in 1897 exceeded those of Paris, Brussels, Amsterdam, Copenhagen, Berlin, Vienna and Rome— Scarlet fever—Death rates per 1,000 living. Towns. 1887-96. 1897. Towns. 1887-96. 1897. London .25 .182 St. Petersburg .70 .71 Paris .08 .02 Berlin .23 .13 Brussels .04 .04 Vienna .25 .16 Amsterdam .04 .02 Rome .04 .01 Copenhagen .30 .06 New York .45 .25 Stockholm .66 .24 In the distribution of the scarlet fever mortality in London, the central group of districts had the highest death rate during the year as a whole, and the northern the lowest. Of the districts, Rotherhithe suffered most, and Marylebone and Stoke Newington were least affected. During the first quarter of the year the central and western groups of districts had the highest death rate, and the eastern the lowest; during the second quarter the western, northern and central groups suffered in like proportion, all being below the average of London, and the southern group had the highest mortality; in the third quarter of the year there was a general rise of the mortality in all the groups of districts, the northern having the lowest and the central the highest death rate; and during the fourth quarter but one group, the northern, was below the average of London, the central being the highest of the groups and greatly above the average of London for the whole year. * The Infectious Diseases (Notification) Act only came into force in 1889. 1 See footnote (!), page 7. 2 See footnote (2), page 7. 28 The case rate of each district in 1891-6 and in 1897, and the death rate of each district in 1887-96 and 1897 are shown in the following table— Sanitary district. Cases, 1897. Case rate per 1,000 living. Deaths, 1897. Death rate per 1,000 living. 1891-96. 1897. .1887-96. 1897. Paddington 489 4.2 3.9 21 .15 .17 Kensington 747 3.9 4.4 30 .19 .18 Hammersmith 396 4.3 3.7 11 .23 .10 Fulham 759 4.6 6.3 26 .22 Chelsea 488 4.8 5.1 17 .22 .18 St. George, Hanover-square 177 4.1 2.2 7 .16 .09 Westminster 181 4.2 3.4 13 .23 .25 St. James 131 3.2 5.8 8 .17 .36 Marylebone 397 4.5 2.8 9 .21 .06 Hampstead 224 4.2 2.9 6 .12 .08 Pancras 942 5.6 3.9 24 .21 .10 Islington 1,577 5.4 4.6 6J .19 .18 Stoke Newington 108 6.3 3.2 2 .23 .06 Hackney 1,373 6.5 37 .17 St. Giles 209 4.0 5.5 1 .18 .19 St. Martin-in-the-Fields 44 3.8 3.5 2 .23 .16 Strand 125 4.0 5.3 3 .23 .13 Holborn 120 5.4 3.9 4 .24 .13 Clerkenwell 366 6.1 5.5 14 .30 .21 St. Luke 238 5.1 5.8 13 .38 .32 London, City of 95 5.1 3.2 8 .19 .27 Shoreditch 625 5.4 5.1 29 .28 .24 Bethnal-green 723 7.1 5.6 25 .39 .19 Whitechapel 500 6.2 6.3 15 .27 .19 St. George-in-the-East 242 6.2 5.1 14 .34 .29 Limehouse 427 7.2 7.3 12 .39 .21 Mile-end Old-town 816 6.7 7.3 12 .33 .11 Poplar 1,041 6.6 6.1 28 .30 .17 St. Saviour, Southwark 131 4.8 5.3 7 .35 .28 St. George, Southwark 381 5.5 6.3 14 .44 .23 Newington 768 5.6 6.3 33 .33 .27 St. Olave 88 4.9 7.7 2 .35 .17 Bermondsey 507 5.3 5.9 34 .33 .40 Rotherhithe 288 5.7 7.1 22 .27 .54 Lambeth 1,388 5.3 4.6 42 .25 .14 Battersea 1,585 6.4 9.4 47 .19 .28 Wandsworth 1,024 4.8 5.2 29 .15 Camberwell 1,191 4.8 4.6 32 .26 .12 Greenwich 817 6.3 4.6 32 .25 .18 Lewisham 354 3.6 3.3 9 .11 .08 Woolwich 224 4.0 5.4 8 .21 .19 Lee 210 6.3 5.4 3 .21 .08 Plumstead 373 6.1 6 .10 Port of London 15 — — — — — London 22,904 5.3 5.1 778 24 .171 The reports of medical officers of health show that prosecutions for the wilful exposure of a scarlet fever patient in a public place or public conveyance were successfully instituted in Kensington, Chelsea, Westminster, St. Giles, and Wandsworth, and of a parent for neglecting to notify the illness of his child were instituted, in one instance in Kensington and in three instances in Fulham. A magistrate's order was obtained for the compulsory removal to hospital of a child who was suffering from scarlet fever in a gipsy's van in Battersea. The insufficiency of hospital accommodation for cases of scarlet fever is referred to in the reports relating to Kensington, Fulham, Chelsea, St. Marylebone, Stoke Newington, Hackney, Holborn, Clerkenwell, St. George-in-the-East, Mile-end Old-town, Poplar, St. George, Southwark, St. Olave, Wandsworth and Woolwich. Some of the reports state that there was less difficulty in securing the removal of infected persons than in previous years, and this difficulty, which occurred in July, September, and October, appears to have practically disappeared after the opening of the Park Hospital at Hither-green. The occurrence of "return cases" of scarlet fever, i.e., the occurrence of fresh cases following the return home of a patient who had been removed to hospital, is discussed in several of the reports. The medical officer of health of Paddington gives in tabular form account of fourteen so-called "return cases. In five of these cases the patient returned from hospital presented conditions of ill-health, especially nasal discharge. One was desquamating on the soles of the feet. In one case it was thought that the disinfection might have failed. In three cases no cause could be assigned, and in four there was not sufficient opportunity for investigation. The medical officer of health of Islington in his report for the first quarter of 1897 gives account of the occurrence of cases of scarlet fever in an orphanage eight days after the return from hospital of a girl who had been in the hospital 52 days. See footnote ('), page 7. 29 The medical officer of health of Stoke Newington states that in three cases there were the strongest possible reasons for believing that the infection was communicated by a patient recently dismissed from a fever hospital. In Fulham, in twelve instances the disease recurred in the household within ten days after the return of the patient. In Wandsworth (Clapham) there were four return cases. In two of these no cause was assignable, in two there was discharge from the ears of the patient who had returned. In the report relating to Wandsworth parish the particulars of fourteen households in which return cases occurred are given. In four cases the returned patient was desquamating or had discharge from the nose. In some of these households re-infections occurred a second and third time. In Plumstead five cases were noted. In one of these cases the child had a severe cold, with running from the nose and roughness of the skin of the hands and legs; in another there were sores on the face and nose, and in a third a sore on and discharge from the nostril. The patients had all been away a considerable time, one as long as twelve weeks. Scarlet fever and elementary schools. Reference to the subject of infection through school attendance is found in the reports relating to the following districts— Kensington.—The medical officer of health gives the following account of the infection of a number of children attending the Buckingham-terrace Board School— In the tenth (monthly) report I reported the absence of 17 children ill with scarlet fever, other 58 children living at the infected houses being excluded from the school. J ust at this time a child who had been in attendance for nine days was found to be peeling. Two other children in the family had been previously removed to hospital. This child's case had not been notified, and only came to light upon an examination of her hands by the head teacher, resulting from a communication received from a mother excusing her own girl's non-attendance upon the ground that she didn't want her to come into contact with the infected child: it was obvious, therefore, that the parents could not have been in ignorance of the peeling and the cause of it. Chelsea.—The closure of the schools was followed by a very small fall in the notified cases in August. In Kensal-town there was increase in the number of cases in the four weeks of holiday as compared with the number in the four preceding and four subsequent weeks. Westminster.—"Several cases occurred in children attending St. Mary's Schools, Hide-place, in July, but by keeping a strict watch on and examining the children attending the school from the houses in which the cases occurred, the number of cases speedily decreased." Islington.—In his report, the medical officer of health considers the mean prevalence of scarlet fever in each week of the period 1890-97 in three sections of the Islington population, viz., those under three years of age, those from three to fourteen and those aged fourteen and upwards. The results are stated diagrammatically. He shows that whereas in the first and third section there was increase of scarlet fever in the month of August, there was in children of school age some decrease; and that whereas in September there was increase of cases among children of pre-school age from 145 in August to 158, and in persons of past school age decrease from 210 in August to 189, the number of cases in children of school age rose from 778 in August to 1,155 in September. He concludes that school infection alone affords explanation of these figures. Stoke Newington.—"School attendance was ascribed as the origin of the infection in fifteen cases; infection in a preceding case (apart from school) in four." The medical officer of health states that the practice in the Board schools of giving medals to those who have punctually attended school the greatest possible number of times during the school year leads to children attending while suffering from sore throat and to the concealment of infectious disease in houses. Limehouse.—The annual report contains an account of scarlet fever in a family which was brought to the knowledge of the medical officer of health by the headmistress of the Collingwoodstreet Board School, who informed him that she had sent home a girl because her hands were desquamating. On the medical officer visiting the home of this girl, whose parents kept a sweetstuff shop, he found three other children, in the absence of the parents, in charge of the shop, and all bearing evidence of recent scarlet fever. The parents were found, and with them two other children who were suffering from scarlet fever. One of the girls was a monitor in the Board School and handed round the books. These books, with the consent of that Board, were destroyed, as were also the contents of the shop. The children were removed to hospital, and, pending the disinfection of the house, the parents were removed to a shelter. The headmistress was requested by the medical officer to daily examine children attending the school, and, as a result, several other cases of scarlet fever were discovered. Battersea.—Several class-rooms in the Winstanley-road School were disinfected on account of the prevalence of scarlet fever among the pupils. The investigation of a complaint as to scarlet fever prevalence among the pupils of the St. George's Schools led the medical officer of health to conclude there was no undue incidence on these pupils. Elthnm.—An outbreak, chiefly among the pupils of the Roper-street National School, and affecting thirty persons, is reported. The first case was that of a child who visited a shop in Eltham, the occupier of which became infected. He (the occupier) was removed to a neighbouring street, where other children became infected. The disease appears then to have been introduced into the school. Owing to the want of accommodation only about half the cases could be removed to hospital. Later there was a smaller outbreak among the children at the Board School at Pope-street, which was apparently stopped by the exclusion from school of children who lived in infected houses. Flumstead.—The report of the medical officer of health contains the following statement— Between the 3rd and 28th June, 12 cases of scarlet fever were reported to me. all living in the isolated group of streets known as the Slade district; eight houses were affected, and children from all these houses attended the Slade Board School; nine of the patients were themselves scholars at the school. Milk was supplied to the above-mentioned houses from five different sources, and there were exceptionally few cases of scarlet fever outside this district. I made inquiries at five ho.lses and, with one exception, could find no connection between the cases besides the common school. The exception was that the mother of one patient had visited frequently next door, where another case occurred. 30 In pursuit of what I conceived to be my duty, under these circumstances I visited the school, and asked leave of the head teacher to examine the children, with a view to the detection of any mild and unsuspected cases of scarlet fever. The examination consisted solely of viewing the face, ears, throat and hands of each child. Among the 30 children I examined, I discovered two with unhealthy throats, and one with a discharge from the ear, who I requested might be excluded from school as possible conveyers of infection. The teacher now requested me to desist, saying she thought she had better consult the School Board before submitting any further children for examination. Consequently, no more children were examined, but whether as a result of the action taken or not, no more cases occurred in connection with this school. The outcome of the teacher's communicating with the Board was a letter to your vestry, severely censuring my action in examining the school children, and stating that the Board could not allow mo or any other medical officer of health to examine children in their schools. I reported the above facts to your vestry at the time, and, on your order, the following reply was sent to the School Board:—"In reply to your letter of 15th July, the vestry desire me to enclose a copy of a report received from their medical officer, and say that, in view of what is contained therein, they consider the action of their medical officer was taken in the interests of the public health, and with due consideration to the orders under which he acts. They cons;der the examination of children in the board schools, as occasion arises, an important and indispensable means of arresting infection, and under present conditions, and until the School Board is in a position to undertake it, it would appear that the responsibility for such examinations must fall on medical officers of health. They gladly recognize the great services of the School Board to elementary education, and their willingness hitherto to co-operate with sanitary authorities in all measures for preventing infectious diseases, and they hope the Board will reconsider their decision and again, as in the past, give all facilities to medical officers of health in investigating and putting a stop to infectious diseases." It is interesting in view of the School Board's letters to record the fact that this school was closed in 1894 on the recommendation of Dr. Priestley, my locum tenens, on acoount of an outbreak of scarlet fever. At that time, on different occasions, Dr. Priestley and I examined children in the school and detected cases of scarlet fever in actual attendance. On the reassembling of the school I examined the whole of the children to see that they were free of infection. No objection was then taken to such examinations being made, and it is obvious that in the interests of education as well as of health it is desirable that any unsuspected cases of infectious disease should be detected, and so the necessity of closure of the school be prevented. If the parents objected, or were likely to object to such examinations, it will be reasonable for the Board to exercise their undoubted right to refuse them; but my experience convinces me that nine-tenths of the parents are only too glad for such measures to be taken; I have never heard of any objection beiug made except by those whose children were detected at school in an infectious state and consequently prevented from attending, and their objections must surely not be regarded. I have little doubt that when the School Board comes to seriously study this subject the above considerations must have due weight with them, and I think there is good reason to hope that they will in future, as in the past, seek to facilitate the examination of school children by health officers, or perhaps they may adopt an even better course and appoint certain special medical men to systematically examine children in schools as is done in New York and other places, for it cannot be denied that schools are largely concerned in the spread of the infection of many diseases besides scarlet fever. There were a few cases of scarlet fever at Conway-road School, and 1 visited the school and examined several cases by request of the teachers as on previous occasions. (Since the School Board letter I have, of course, abstained from making such examinations.) Of other matters discussed in the annual reports may be mentioned the occurrence of several cases of scarlet fever in the married soldiers' quarters at Victoria and Wellington houses, in Westminster. The medical officer of health of the district comments upon the need for premises belonging to the Crown being made subject to the provisions of the Public Health Act. The report of the medical officer of health of Paddington contains an interesting record of the results of inquiry into the behaviour of scarlet fever in houses in his district. He found that one case occurred in each of 280 houses, two in each of 56, three in each of 21, four in each of 6, and five in each of 2 houses. As in previous reports, I have shown in diagram VII. the number of cases of scarlet fever appearing in each weekly notification list in relation to the mean of the year. The summer holiday of the London School Board schools began in 1897 at noon on Thursday, the 22nd July, or the latter part of the 29th week, and the schools re-opened on Monday, the 23rd August, or the beginning of the 34th week. If the number of cases notified in the four weeks, which would be most subject to holiday influence, be compared with the four preceding and four subsequent weeks, the following results are obtained— Scarlet fever—Notified cases, 1897. Period. Notified cases—Ages. Increase or decrease per cent. 0—3 3—13 13 and upwards. 0—3 3—13 13 and upwards. Four weeks preceding weeks of holiday influence (27th to 30th). 260 1,416 335 - - - Four weeks of holiday influence (31st to 34th) 233 1,240 318 —10.4 —12.4 — 5.1 Four weeks following weeks of holiday influence (35th to 38th). 249 1,803 327 + 6.9 +45.4 + 2.8 It will be seen that the decrease in the number of cases notified during the period of holiday influence and the subsequent increase in the following period is most marked at the school age. Scarlet fever—Proportion of cases and deaths in hospitals. It will be seen by reference to diagram VIII. (page 27) that the proportion of cases admitted to, and deaths occurring in, the hospitals of the Metropolitan Asylums Board during 1897 was greater than in any previous year. NOTIFIED CASES. Diagram VII Scarlet Fever 1897. 31 Scarlet fever, 1897—Age and sex distribution. The following table shows the case rates, death rates and fatality of scarlet fever at several ages and for each sex in London during the year 1897. The case rate of males was very slightly less than that of females, differing in this respect from the preceding year. The death rate and the case mortality among males were greater than those among females. The greatest incidence of attack was upon children four years of age both in the case of males and females, the greatest incidence of death was on males of two years of age and on females of three years of age. Scarlet fever* 1897. 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. Death*. All ages. 10,783 413 3.8 511 20 12,065 372 3.1 513 16 0— 187 25 13.4 327 44 185 27 14.6 318 46 1— 471 56 11.9 920 109 435 48 11.0 842 93 2— 778 88 11.3 1,453 164 821 63 7.7 1,527 117 3— 1,075 78 7.3 2,073 150 1,084 76 7.0 2,042 143 4— 1,145 42 3.7 2,270 83 1,221 42 3.4 2,410 83 5— 4,191 78 1.9 1,751 33 4,847 87 1.8 2,004 36 10— 1,761 19 1.1 806 9 2,065 14 0.7 927 6 15— 645 10 1.6 308 5 604 4 0.7 260 2 20— 256 11 4.3 124 5 343 3 0.9 138 1 25— 201 3 1.5 57 1 342 4 1.2 84 1 35— 49 3 6.1 19 1 89 1 1.1 31 — 45— 18 - - 10 — 19 2 10.5 9 1 55 and Upwards 6 - - 3 - 10 1 10.0 4 — Scarlet fever—Seasonal variation in age distribution. In my last report I stated that the London notification statistics afforded reason for thinking there was seasonal variation in the age distribution of scarlet fever. I now publish the figures supplied by the period 1892-97. It will be seen that children under five years of age constitute a greater proportion of total cases at the early part of the year, and that this proportion falls to a minimum in September, subsequently rising to the end of the year. There is arrest of this fall in the month of August due to the fact that children of the school age are not then contracting disease in school, and the children under five, therefore, constitute a larger proportion of the total cases. Scarlet fever, 1892-7. Notified cases, 1892-7. Month. All ages. 0— 1— 2— 3— 4— Under 5. 5— 10— 15— 20 and upwards. January 8,976 152 372 623 805 861 2,813 3,502 1,543 512 606 February 7,196 102 297 469 606 747 2,221 2,801 1,222 425 527 March 7,842 114 337 544 719 741 2,455 2,946 1,379 491 571 April 8,122 133 331 541 705 787 2,497 3,064 1,428 503 630 May 10,377 160 411 717 918 973 3,179 3,912 l,871 653 762 June 12,018 202 462 806 1,075 1,114 3,659 4,777 2,035 745 802 July 14,987 220 534 965 1,267 1,423 4,409 5,884 2,779 913 1,002 August 14,513 252 632 1,082 1,315 1,354 4,635 5,311 2,570 1,015 982 September 18,148 272 625 1,076 1,579 1,697 5,249 7,646 3,281 978 994 October 18,825 304 672 1,213 1,639 1,738 5,566 7,726 3,383 1,055 1,095 November 15,756 291 597 1,016 1,380 1,471 4,755 6,222 2,823 960 996 December 10,883 196 428 736 1,015 1,065 3,440 4,192 1,858 609 784 * In the preparation of this table, the question whether the persons, who were attacked and who died, be onged 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 proportionately. 32 Scarlet fever—Seasonal variation in fatality. In my last two reports I published tables which gave strong indications that scarlet fever had a definite seasonal fatality, and in my report for 1895, when correction was made for differences in age and sex distribution of the cases notified in the several months of the year, it was found that such differences were insufficient to account for the variations shown in the fatality. I now supply the figures of the year 1897 and of the period 1892-7, which are uncorrected for differences in age and sex. It will be seen that the fatality is greatest at the beginning of the year, that it practically falls from the beginning of the year until September or October is reached, and subsequently increases. There is arrest of this fall in August, due to the fact that schools are closed at that time, leading to a diminution in the number of cases among children at school age, and a consequent increase in the proportion of the cases occurring in early life, when the fatality is high. Scarlet fever—Case mortality, 1897. Month. No. of weeks. Cases. Deaths. Case mortality per cent. Mean case mortality taken as 100. January 4 1,439 56 3.89 114 February 4 1,288 46 3.57 105 March 5 1,472 55 3.74 110 April 4 1,206 39 3.23 95 May 4 1,372 50 3.64 107 June 5 1,856 67 3.61 106 July 4 2,020 62 3.07 90 August 4 1,803 61 3.38 99 September 5 3,154 94 2.98 88 October 4 2,980 76 2.55 75 November 4 2,287 94 4.11 121 December 5 1,971 76 3.86 114 Scarlet fever—Case mortality, 1892-97. Month. Cases. Deaths. Case mortality per cent. Mean case mortality taken as 100. January 9,177 496 5.40 130 February 7,366 373 5.06 122 March 8,000 428 5.35 129 April 8,280 410 4.95 119 May 10,589 466 4.40 106 June 12,265 521 4.25 102 July 15,309 582 3.80 91 August 14,850 622 4.19 101 September 18,523 586 3.16 76 October 19,178 586 3.06 74 November 16,057 652 4.06 98 December 11.092 542 4.89 118 Month. "All ages" taken as 1,000. All ages. 0— 1— 2— 3- 4— Under 5. 5— 10— 15— 20 and upwards. January 1,000 17 41 69 90 96 313 390 172 57 68 February 1,000 14 41 65 84 104 308 390 170 59 73 March 1,000 15 43 69 92 94 313 376 176 62 73 April 1,000 16 41 67 87 97 308 377 176 62 77 May 1,000 15 40 69 88 94 306 377 180 63 74 June 1,000 17 38 67 90 93 305 398 169 62 66 July 1,000 15 36 64 84 95 294 393 185 61 67 August 1,000 17 44 74 91 93 319 366 177 70 68 September 1,000 15 34 59 87 94 289 421 181 54 55 October 1,000 16 36 64 87 92 295 411 180 56 58 November 1,000 18 38 65 88 93 302 395 179 61 63 December 1,000 18 39 68 93 98 316 385 171 56 72 Diagram XI Scarlet Fever. Diagram x Diphtheria. Diagram XII Deaths occuring in the Admissions to hospitals hospitals of the Metropol" of the Metropolitan Asylums Asylums Board, per cent Board per cent of total cases of total deaths in London notified in London. 1888.-97. 1890-97. 33 Diagram IX. shows the number of cases notified in each month during the years 1891-7 in relation to the mean of that period, and the case mortality of each month, also in relation to the mean. No correction has been made for differences in age and sex constitution of the cases notified in the several months. Diphtheria. The cases of diphtheria notified in the Administrative County of London in 1897 numbered 13,217, compared with 13,825 in 1896. The number of deaths registered from this cause in 1897 was 2,245, compared with 2,666 in 1896. The figures quoted for 1897 give an annual case rate of 3.0 and an annual death rate of 0.50 per 1,000 living. The diphtheria case and death rates in 1897 and preceding 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 0.311 1.5 22.5 1892 0.441 2.0 22.2 1893 0.741 3.2 23.3 1894 0.611 2.6 23.6 1895 0.521 2.6 20.4 1896 0.591 3.1 19.3 1897 0.501 3.0 17.0 The death rate in each year since 1858 in relation to the mean death rate of the period 1859-97 is shown for diphtheria, and for diphtheria and croup combined, in diagram X. There was decrease of death rate, case rate, and fatality in 1897 compared with the rates of 1896. If the London death rate from diphtheria be compared with the death rates of other large towns in England having populations of more than 200,000 persons, it will be seen that in the period 1887-96 and in 1897 the London rate exceeded the rates of any of these towns. Diphtheria—Death rates per 1,000 living. Towns. 1887-96. 1897. Towns. 1887-96. 1897. London .45 .512 West Ham .43 .37 Manchester .27 .09 Bristol .13 .15 Liverpool .16 .20 Nottingham .07 .09 Birmingham .19 .29 Bradford .07 .07 Leeds .10 .16 Hull .11 .14 Sheffield .15 .13 Salford .41 .15 It will be seen from the following table that the London death rate from diphtheria was in the period 1887-96 lower than the death rates of any of the undermentioned foreign cities, except Brussels, Amsterdam and Rome, while in 1897 the London death rate was only exceeded by the death rates of St. Petersburg and New York. Diphtheria—Death rates per 1,000 living. Towns. 1887-96. 1897. Towns. 1887-96. 1897. London .45 .512 St. Petersburg .59 1.77 Paris .53† .12† Berlin .74 .29 Brussels .13† .07† Vienna .72† .36† Amsterdam .32 .25 Rome .32 .04 Copenhagen .79 .18 New York 1.01 .68 Stockholm .79† .15† In the distribution of diphtheria mortality the eastern districts suffered most, and the western least during the year 1897. Of the several districts Woolwich had the highest death rate, 0.80 per 1,000 living, and St. James, Westminster, the lowest, 0.13 per 1,000 living. In the first quarter the eastern group of districts had the highest, the central the lowest death rate. In the second quarter the eastern group had the highest, the northern the lowest. In the third quarter the central group had the highest, the northern the lowest. In the fourth quarter the eastern again had the highest, and the western the lowest. * The Infectious Diseases (Notification) Act only came into force in 1889. † Including deaths from croup. 1 See footnote (1), page 7. 2 See footnote (2), page 7. [5] 34 The case rate of each district in 1891-6 and in 1897, and the death rates in 1887-96 and 1897 are shown in the following table— Sanitary district. Cases, 1897 Case rate per 1,000 living. Deaths, 1897. Death rate per 1,000 living. 1891-6. 1897. 1887-96. 1897. Paddington 324 2.1 2.6 64 .43 .51 Kensington 332 1.8 1.9 81 .39 .47 Hammersmith 154 2.5 1.5 30 .50 .28 Fulham 388 2.5 3.2 63 .53 Chelsea 312 2.9 3.2 54 .46 .56 St. George, Hanover-square 120 1.4 1.5 17 .31 .21 Westminster 110 1.7 2.1 23 .42 .43 St. James 51 1.5 2.3 3 .25 .13 Marylebone 221 1.9 1.6 46 .31 .33 Hampstead 107 1.9 1.4 17 .29 .22 Pancras 542 2.2 2.2 114 .45 .47 Islington 733 2.5 2.2 129 .43 .38 Stoke Newington 54 2.7 1.6 19 .45 .56 Hackney 780 3.6 134 .62 St. Giles 56 1.4 1.5 7 .38 .19 St. Martin-in-the-Fields 14 1.3 1.1 3 .35 .24 Strand 41 1.6 1.7 5 .33 .21 Holborn 161 2.1 5.3 16 .41 .53 Clerkenwell 349 2.8 5.3 48 .49 .73 St. Luke 186 2.2 4.5 21 .43 .51 London, City of 63 1.7 2.1 10 .30 .33 Shoreditch 371 2.6 3.1 78 .52 .64 Bethnal-green 549 4.0 4.3 84 .71 .65 Whitechapel 301 3.2 3.8 34 .58 .43 St. George-in-the-East 191 3.9 4.0 28 .75 .59 Limehouse 193 3.1 3.3 29 .62 .50 Mile-end Old-town 445 3.2 4.0 62 .58 .56 Poplar 704 4.3 4.2 120 .52 .71 St. Saviour, Southwark 104 2.6 4.2 12 .46 .48 St. George, Southwark 191 2.3 3.2 28 .44 .46 Newington 331 2.5 2.7 65 .42 .53 St. Olave 29 2.1 2.5 2 .34 .17 Bermondsey 278 2.1 3.3 62 .42 .73 Rotherhithe 86 2.5 2.1 21 .44 .52 Lambeth 741 2.2 2.5 144 .44 .48 Battersea 621 2.8 3.7 106 .40 .63 Wandsworth 573 1.8 2.9 111 .57 Camberwell 1,170 2.8 4.6 170 .48 .66 Greenwich 600 3.1 3.4 70 .51 .39 Lewisham 244 2.0 2.3 41 .32 .38 Woolwich 148 0.9 3.6 33 .22 .80 Lee 110 1.9 2.8 17 .44 .43 Plumstead 135 2.2 24 .39 Port of London 4 — — — — — London 13,217 25 3.0 2,245 .45 .501 The following more detailed information is contained in the reports of medical officers of health— Paddington.—Account is given of an outbreak in the Victoria Orphanage. The source of infection of the first case, an inmate, could not be traced. He appears to have infected three other children at varying intervals, and after recovery was sent to the branch home at Hampstead. Some two months later, six children were removed from this branch to the Paddington institution, all suffering from diphtheria. Kensington.—A child, aged three years, died from diphtheria. She was apparently infected by her father, whose ailment had been regarded as common sore throat. "The family medical attendant contracted the disease and died, having been infected by either the child or her father, whose illness apparently originated in the City at offices found to be in an insanitary condition. Two of this gentleman's clerks had previously suffered from sore throats, the presumably specific character of which had not been recognised." St. George, Hanover-square.—Five cases of diphtheria occurred in June in the nursery at Fulham-road workhouse, the disease having been introduced by one of the children, who was frequently taken out by its mother. Bethnal-green.—The medical officer of health reports a case of diphtheria in the person of a hairdresser whom he found at work after the man's disease had been notified. The medical officer states, "I warned him of the consequences of his behaviour, but ineffectually, since the inspector found him two days afterwards still at his business, and a source of infection, for two cases were traced to this cause. When this man was free from infection he was summoned to Worship-street, where he was 1 See footnote (1), page 7. 35 fined twenty shillings and three shillings costs, a somewhat inadequate penalty for such reckless behaviour." Diphtheria and elementary schools. The annual reports of medical officers of health contain the following references to diphtheria in connection with school attendance— Paddington.—A series of cases occurred in the area west of Queen's-road, many of the sufferers being scholars of St. Matthew's Church School. This was the only instance during the twelve months of any special spread of disease among the children of any one school, and even in this there were so many other factors to be considered that it is not certain that the school should be indicted. Kensington.—Ten cases occurred in connection with the Board school in Allen-street. The dates of notification of the cases extended from the 29th August to the 25th October. Fulham.—"In May there was an outbreak of diphtheria among the girls in the second standard at Harwood-road Board school, six children living in Fulham and one living in Chelsea being notified as suffering from diphtheria." The Vestry of Fulham, acting on the recommendation of the medical officer of health, made an order for the closing of the class-room for fourteen days. The result was satisfactory, as apart from secondary cases occurring in houses already invaded there were only two other cases among the children attending the school. The medical officer of health however states that later four "children residing in a house in New King's-road were notified as suffering from diphtheria, and on investigation it was ascertained that another member of the family who was in the second standard in the girl's department at Harwood-road school had been ill with a sore throat about a fortnight or three weeks before, but the illness had been of so mild a character that no medical practitioner had been called in. This child had probably had a mild attack of diphtheria, and as she was attending school up to May 26th, when the school was closed, it is quite possible that the outbreak in the particular class-room originated with her." Chelsea.—"The fall in notified cases following the closure of the schools was not at all marked until the thirty-third week of the year, but from the thirty-third to the thirty-fifth week only three cases at school age were notified, as against eleven in the preceding three weeks. The diminution of diphtheria notifications in London usually commences in the thirty-third week and continues to the thirty-sixth, and is, no doubt, dependent on antecedent school closure in the thirtieth week. In 1897 the Board schools closed on July 22nd, which is about a week earlier than usual." St. Pancras.—In reply to inquiry as to the cause of increase of diphtheria in St. Pancras in October, the medical officer of health informed me that the increase was due to an outbreak in the National Schools, Islip-street, Kentish-town, and that the sanitary authority had made an order for the closing of the schools from October 20th to the 9th November; at the same time one of the managers promised to stop during this period the meeting of children connected with the school and various societies, including the Band of Hope, Sunday school, and the mothers' meetings. The medical officer of health also requested the managers of the Leighton-road Mission-hall and St. Barnabas Sunday school, both of which some of the children attended, to take the same course. Islington.—The medical officer of health considers the prevalence of diphtheria in Islington in the period 1890-7, and classifies his cases in three age groups, 0-3 years, the pre-school age; 3-14 years, the school age; and 14 years and upwards, the post-school age. He shows that in the months of June, July, August and September, the number of cases notified respectively were 56, 48, 62 and 49 at the pre-school age; 98, 136, 139, and 188 at the school age; and 247, 256, 247 and 325 at the post-school age. He urges the necessity of excluding from school, children with throat illness, and to the necessity of strict compliance with the rules for the guidance of teachers in the Code of Regulations of the School Board. He instances as a case of breach of regulations the action of a teacher in allowing two children to attend school from a house in which a case of diphtheria was known to have occurred. The two children were kept in a room separate from that occupied at the time by other children, but the class-room was used by other children when they had gone. Stoke Newington.—School attendance is either alleged by the parents, or surmised by the medical officer of health, on good grounds, to be the cause of four attacks during the year, and to be responsible for 7.5 per cent. of the cases, as against 12.7 per cent. in the preceding year. Hackney.—The medical officer of health reports that in 1897 schools have not appeared to be conspicuous in causing the disease. Holborn.—Reference is made to an outbreak of diphtheria confined to that part of the district between the Gray's-inn-road and the Farringdon-road, the medical officer of health writes:—"There was a much greater incidence on children of school age, and a large diminution in the number of cases in the month of August, following closure of the schools for the holidays." Shoreditch.—"Of the cases investigated, in 130 instances the patient was a school-going child. In 105, the child had been attending school within one week of the onset of symptoms. In 95 cases, the patients were not school-going children, but children, members of the same family or living under the same roof, were attending school." Poplar (South district).—The medical officer of health discusses prevalence of diphtheria in the Isle of Dogs, and states that "Cubitt-town was the principal sub-division on the island where the inhabitants suffered mostly from the complaint. The Cubitt-town and Glengall-road Board schools were the schools in the affected area, but most of the cases were in attendance at the former school." He communicated with the medical officer of the School Board with a view to each child having his or her slate with pencil attached, so as to limit any infection. He adds—"Fortunately there was no need to close any part of the school and after the Christmas holidays the disease much diminished in the island." In connection with his expression of desire to have bacteriological examination of cases he says—"During the prevalence of the disease children were known to have suffered from bad throats and yet have not been notified as suffering from dipththeria. Subsequently the common symptoms which occur after diphtheria set in thus clearly proving the patient had had the complaint." Referring to the amount of space provided in Board schools for children, he states that—"The London School 36 Board have given in a general school-room, 10 square feet of floor space per scholar, and the height was ordered to be 13 feet, making 130 cubic feet." Assuming that a child requires 1,500 cubic feet of air per hour, half the amount that is said to be required for an adult, to keep down the carbonic acid impurity to permissible limits, he points out that the atmosphere would be required to be changed eleven times, and that in temperate climates and under ordinary circumstances more than three changes per hour produce cold currents of air and draughts. Wandsworth (Clapham).—The number of cases notified in each month is stated, and the medical officer of health writes—"This shows a gradual increase from the beginning of the year to a maximum in September and October, checked only by a slight fall in August, associated probably with the school holidays." (Wandsworth).—The report of the medical officer of health contains an interesting account of two outbreaks of diphtheria in that parish. In October and November, 1896, there had been an outbreak of diphtheria among the children attending the National school in Roehampton. In January, 1897, of 8 cases, 5 occurred in one family, and one of these children attended the Roehampton School, while the other 4 attended a Board school in Ward I. of Wandsworth parish. In February and March, 20 and 17 cases occurred respectively in this parish. In 23 households invaded, the first sufferer in 9 instances was an attendant at this Board school, and in 13 instances an attendant at a National school in the same ward, and in 2 instances the children infected had not been to any school. The distribution of the affected children in the different departments of the two schools is stated. Children in all departments appear to have been affected, and often considerable intervals occurred between successive cases. Later, children who attended a Sunday school but not a day school, were found to be affected; this school was held in the National school buildings. The conclusion arrived at was that the National school, and not the Board school, was responsible for the disease, and was closed for 14 days, "with the almost immediate effect of checking the outbreak." The medical officer of health adds," the fact that the outbreak was checked by the closure of the school affords strong grounds for the belief that, at any rate in the later cases, the infection was received at school, principally at Sunday school, where the same control is not possible as far as overcrowding is concerned." The second outbreak was limited to children attending one school in No. 3 Ward, and the infection was traced to the attendance at school of a child suffering from the disease on the afternoon of March 2nd. As many as 31 cases occurred and 13 deaths resulted. The school was closed on the 8th March for 21 days, and after that date 13 cases were notified, 4 of which were in houses previously infected. Woolwich.—The medical officer of health publishes a table showing that in successive years from 1892 to 1897 the number of cases of diphtheria notified were, respectively, 17, 24, 49, 67, 99 and 150. He states that "the most careful investigation has been made with the view of determining the cause of the increased prevalence of diphtheria, but with no satisfactory result. In no single instance could any possibility of infection at school be found." Lewisham.—The medical officer of health reports that "a large number of the cases in Lewisham occurred in the early part of the year, and were part of the epidemic which occurred in the later months of the year." This epidemic it will be recollected was shown by Dr. Hamer to be due to infection of children in a Board and a National school. The medical officer of health writes, "I had occasion to order the fumigation of two Board schools in the district during 1897. This was done with the consent of Dr. Smith, the medical officer of the School Board, and in each case there were no fresh cases of diphtheria notified after the fumigation had taken place." Plumstead.—The medical officer of health writes, "the Slade school was most affected, and after it Burrage-grove, High-street and Ancona-road. No cases occurred at Eglinton-road schools, and only three at Bloomfield-road." For the purpose of ascertaining whether, as in previous years, there was decrease of diphtheria prevalence among children of school ages during the summer holiday, Diagram XI. has been prepared. The summer holiday of the schools of the London School Board began at noon on Thursday, 22nd July, or the latter part of the 29th week, and the schools re-opened on Monday the 23rd August, or the beginning of the 34th week. The diagram shows a marked fall in the number of notified cases at ages 3-13, extending over the 31st-34th weeks; there is also a noticeable decline in the number of notified cases, at ages 0-3 and 13 and upwards, but this decline is later than and does not correspond in point of time with, the decline shown at ages 3-13. If the number of cases in the four weeks most subject to the influence of the holidays be compared with numbers during the four weeks preceding and subsequent to the holidays, the following results are obtained for the three age-periods mentioned— Diphtheria—Notified cases, 1897. Period. Notified cases—Ages. Increase or decrease per cent. 0—3 3—13 13 and upwards. 0—3 3—13 13 and upwards. Four weeks preceding weeks of holiday influence (27th to 30th) 168 707 284 — — — Four weeks of holiday influence (31st to 34th) 153 504 250 —8.9 —28.7 —12.0 Four weeks following weeks of holiday influence (35th to 38th) 152 657 266 —0.7 +30.4 +6.4 NOTIFIED CASES Diphtheria. 1897. 37 It will be seen that the decrease in the number of cases notified during the period of holiday influence, and the subsequent increase in the following period, is most marked at the school age. The influence of schools in the dissemination of diphtheria is more fully discussed in an appendix to this report (see Appendix I). Diphtheria—Proportion of cases and deaths in hospitals. Diagram XII. shows the proportion of London cases of diphtheria admitted into the hospitals of the Metropolitan Asylums Board in 1897, and the proportion of the deaths from this disease which occurred in these institutions during the year. It will be seen that these proportions were greater in the year 1897 than in any previous year. Bacteriology as an aid, to diagnosis. In my last report I stated that arrangements had been made by the sanitary authorities of St. Marylebone, St. Pancras, Holborn and St. Olave, by which facilities were afforded to medical practitioners for the bacteriological examination of material from doubtful cases of diphtheria. The reports of medical officers of health for the year 1897 now show that similar arrangements, mostly with the British Institute of Preventive Medicine, have been made by the authorities of Fulham, Strand and Clerkenwell, and that in Poplar the matter is under consideration of the district board. The medical officers of health of Paddington, Stoke Newington, Bethnalgreen, St. George, Southwark, Lambeth, Wandsworth parish, Woolwich and Plumstead express opinions in favour of the value of such aid. The medical of health of Marylebone states that the opportunities given by the vestry have not been much utilised, that the number of cases thus examined was 42, and that of these 12 were considered diphtheritic. In St. Pancras the corresponding numbers during seven months were 42 and 22 respectively, in Fulham 48 and 30 respectively, in Holborn 37 and 18 respectively, and in St. Olave, a district which had made arrangements with Guy's Hospital, 2 specimens were sent for examination. Diphtheria—Age and sex distribution. The age and sex distribution of the cases of diphtheria notified in London during 1897 are shown in the following table. It will be seen that as in previous years the incidence of attack at "all ages" was greater on females than males, but the incidence of death at "all ages" was, as before, greater on males than on females, but to a less extent than in 1896. The fatality (case mortality) of the disease was greater at "all ages" among males than among females, and it will be seen from the table that this higher fatality among males is practically confined to ages 5 and upwards. Diphtheria* 1897. 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. 5,915 1,093 18.5 280 52 7,277 1,189 16.3 309 51 0— 160 56 35.0 280 98 158 76 48.1 271 131 1— 433 176 40.6 846 344 402 187 46.5 778 362 2— 597 204 34.2 1,115 381 546 171 31.3 1,015 318 3— 703 176 25.0 1,355 339 675 190 28.1 1,271 358 4— 609 124 20.4 1,207 246 703 149 21.2 1,388 294 5— 1,888 282 14.9 789 118 2,264 333 14.7 936 138 10— 696 40 5.7 318 18 916 38 4.1 411 17 15— 320 11 3.4 153 5 452 8 1.8 194 3 20— 190 10 5.3 92 5 376 5 1.3 151 2 25— 223 8 3.6 63 2 498 16 3.2 122 4 35— 69 4 5.8 26 2 185 8 4.3 64 3 45— 20 — — 11 — 71 2 2.8 34 1 55 and upwards. 7 2 28.6 4 1 31 6 19.4 13 3 Diphtheria—Use of anti-toxic serum. The use of anti-toxic serum and its effect upon the fatality of diphtheria is discussed in the reports of medical officers of health. The reports relating to Hackney, Eltham and Plumstead state that the sanitary authorities authorised their medical officers of health to keep a stock of serum so that it might, on application, be supplied locally to medical practitioners. In December, the Metropolitan Asylums Board made arrangements by which, in the event of the Managers being unable to receive cases of diphtheria into their hospitals, the medical officers of health should be able to supply practitioners, attending such cases, with serum for their immediate treatment. The opening of the Park Hospital, however, rendered such action unnecessary. The following table shows the case mortality of diphtheria at certain ages and for each sex for each of the years 1893-7 inclusive— * See footnote, page 31. 38 Age-period. Case mortality per cent. Males. Females. 1893. 1894. 1895. 1896. 1897. 1893. 1894. 1895. 1896. 1897. All ages. 26.4 25.8 22.7 21.0 18.5 21.8 23.1 19.6 18.0 16.3 0— 66.9 56.0 52.6 52.3 35.0 57.6 58.3 52.8 50.4 48.1 1— 65.8 59.5 48.5 50.8 40.6 67.2 58.6 50.0 45.3 46.5 2— 53.2 44.4 41.6 37.8 34.2 43.9 50.5 41.0 38.7 31.3 3— 45.9 40.5 33.0 25.7 25.0 45.3 37.5 31.9 28.2 28.1 4— 38.5 31.5 30.4 24.5 20.4 37.0 36.5 30.5 26.7 21.2 5— 20.9 18.5 15.6 15.8 14.9 24.2 21.6 17.7 17.0 14.7 10— 6.6 8.4 6.0 6.4 5.7 6.1 6.3 6.5 5.3 4.1 15— 2.8 3.9 2.0 3.0 3.4 3.3 2.9 4.0 2.4 1.8 20— 3.2 4.5 3.0 1.3 5.3 1.9 2.5 1.8 1.6 1.3 25— 2.8 2.4 1.7 3.2 3.6 2.9 2.9 1.5 2.2 3.2 Diphtheria—Seasonal variation in age distribution. Examination of the figures supplied by diphtheria notifications for the years 1892-7 inclusive, shows that the largest proportion of cases at ages 0-5 occur in the months of March and April, the proportion gradually approaching a minimum in September; the proportion in the month of August, however, as in the case of scarlet fever (see page 31) appears to be unduly high, a fact which is due to the closure of the schools in that month. Diphtheria, 1892-7. Month. Notified cases, 1892-7. All ages. 0— 1— 2— 3— 4— Under 5. 5— 10— 15— 20 and upwards. January 5,176 156 371 462 563 503 2,055 1,513 541 302 765 February 4,301 122 314 396 447 438 1,717 1,272 465 226 621 March 4,743 137 364 412 494 515 1,922 1,411 509 234 667 April 4,401 130 311 378 490 482 1,791 1,258 437 245 670 May 5,366 137 388 459 553 522 2,059 1,542 612 345 808 June 5,666 110 363 469 547 571 2,060 1,659 664 369 914 July 6,474 139 363 459 599 624 2,184 1,922 827 459 1,082 August 5,748 148 342 481 570 483 2,024 1,412 704 485 1,123 September 7,180 136 368 496 648 667 2,315 2,178 898 553 1,236 October 7,726 176 445 566 697 715 2,599 2,304 965 508 1,350 November 7,050 158 444 563 712 688 2,565 2,120 776 455 1,134 December 6,350 152 398 566 691 619 2,426 1,920 728 377 899 Month. "All ages" taken as 1,000. All ages. 0— 1— 2— 3— 4— Under 5. 5— 10— 15— 20 and upwards. January 1,000 30 72 89 109 97 397 292 105 58 148 February 1,000 28 73 92 104 102 399 296 108 53 144 March 1,000 29 77 87 104 109 406 298 107 49 140 April 1,000 30 71 86 111 109 407 286 99 56 152 May 1,000 26 72 86 103 97 384 287 114 64 151 June 1,000 19 64 83 97 101 364 293 117 65 161 July 1,000 21 56 71 93 96 337 297 128 71 167 August 1,000 26 59 84 99 84 352 246 123 84 195 September 1,000 19 51 69 90 93 322 304 125 77 172 October 1,000 23 58 73 90 92 336 298 125 66 175 November 1,000 22 63 80 101 98 364 301 110 64 161 December 1,000 24 63 89 109 97 382 302 115 59 142 Diagram XIII Diphtheria. Diagram XIV. Whooping Cough. 39 Diphtheria—Seasonal variation in fatality. The following tables shows the seasonal variation in fatality in diphtheria during 1897 and 1891-7, uncorrected for differences of age and sex distribution. It will be observed that, as in the preceding year, the fatality is greater at the beginning and end of the year, the fatality curve being strikingly regular. In the period 1891-7 the interruption of the curve in the month of August due to the closure of the schools is well marked. Diagram XIII. shows the notified cases and fatality in each month of the years 1891-7 in relation to the mean of that period. Diphtheria— Case mortality, 1897. Month. No. of weeks. Cases. Deaths. Case mortality per cent. Mean case mortality taken as 100. January 4 971 213 21.94 130 February 4 967 179 18.51 110 March 5 1,129 194 17.18 102 April 4 739 135 18.27 109 May 4 849 142 16.73 99 June 5 1,127 167 14.82 88 July 4 1,171 159 13.58 81 August 4 918 130 14.16 84 September 5 1,386 205 14.79 88 October 4 1,369 221 16.14 96 November 4 1,204 195 16.20 96 December 5 1,362 279 20.48 122 Diphtheria—Case mortality, 1891-97. Month. Cases. Deaths. Case mortality per cent. Mean casemortality taken as 100. January 5,678 1,322 23.28 111 February 4,856 1,104 22.73 108 March 5,271 1,173 22.25 106 April 4,997 1,082 21.65 103 May 5,821 1,212 20.82 99 June 6,103 1,208 19.79 94 July 7,086 1,356 19.14 91 August 6,253 1,282 20.50 98 September 7,967 1,545 19.39 92 October 8,453 1,685 19.93 95 November 7,762 1,638 21.10 101 December 7,111 1,626 22.87 109 Whooping Cough. The deaths from whooping cough in the Administrative County of London in 1897 numbered 1,848, compared with 2,934 in 1896. The death rates from this disease in 1897 and preceding periods were as follows — Whooping cough. Period. Death rate per 1,000 living. Period. Death rate per 1,000 living. 1851-60 0.88 1893 0.541 1861-70 0.88 1894 0.491 1871-80 0.81 1895 0.341 1881-90 0.69 1896 0.651 1891 0.681 1897 0.411 1892 0.581 The death rate in each year in relation to the mean death rate of the period 1841-97 is shown in diagram XIV. It will be seen from the following table that the London death rate from whooping cough exceeded the death rate of any of the undermentioned towns, except Manchester, Liverpool, Birmingham, West Ham and Salford in 1887-96, and in the year 1897 exceeded that of any except Manchester, Liverpool, Birmingham, Bristol, Nottingham and Salford. 1 See footnote (1), page 7. 40 Whooping cough—Death rate per 1,000 living. Towns. 1887-96. 1897. Towns. 1887-96. 1897. London 0.59 0.411 West Ham 0.59 0.36 Manchester 0.61 0.56 Bristol 0.46 0.50 Liverpool 0.64 0.56 Nottingham 0.46 0.49 Birmingham 0.60 0.44 Bradford 0.49 0.19 Leeds 0.45 0.24 Hull 0.39 0.25 Sheffield 0.53 0.40 Salford 0.73 0.53 The following table shows that the London death rate from whooping cough exceeded the death rates of all the undermentioned foreign cities, both in the period 1887-96 and in the year 1897. Whooping cough—Death rate per 1,000 living. Towns. 1887-96. 1897. Towns. 1887-96. 1897. London .59 .411 St. Petersburg .25 .09 Paris .16 .11 Berlin .29 .25 Brussels .19 .10 Vienna .10 .06 Amsterdam .36 .23 Rome .08 .06 Copenhagen .44 .13 New York .25 .15 Stockholm .25 .04 In the distribution of this disease during the year the mortality has been highest in the central group of districts, and lowest in the western group. During the year, Clerkenwell suffered most heavily of all the districts, and Kensington was least affected. In the first and second quarters the mortality was highest in the central group, and lowest in the western; in the third quarter, the central group had again the highest death rate, while the southern had the lowest; and in the fourth quarter the mortality was highest in the eastern group of districts and lowest in the western group. The death rate of each district in 1897 and in the preceding ten years is shown in the following table:— Sanitary district. Deaths in 1897. Death rate per 1,000 living. Sanitary district. Deaths in 1897. Death rate per 1,000 living. 1887-96. 1897. 1887-96. 1897. Paddington 44 .39 .35 Shoreditch 63 .87 .52 Kensington 19 .43 .11 Bethnal-green 57 .79 .44 Hammersmith 28 .62 .26 Whitechapel 16 .47 .20 Fulham 61 .51 St. George-in-the-East 24 .60 .50 Chelsea 41 .58 .43 Limehouse 37 .95 .63 St. George, Hanoversquare 13 .30 .16 Mile-end Old-town 58 .73 .52 Poplar 83 .75 .49 Westminster 16 .50 .30 St. Saviour, Southwark 12 .71 .48 St. James 6 .38 .27 St. George, Southwark 32 .88 .53 Marylebone 41 .45 .29 Newington 82 .78 .67 Hampstead 25 .28 .32 St. Olave 8 .60 .70 Pancras 124 .58 .51 Bermondsey 62 .73 .73 Islington 134 .60 .39 Rotherhithe 17 .67 .42 Stoke Newington 15 .54 .44 Lambeth 144 .57 .48 Hackney 97 .45 Battersea 79 .58 .47 St. Giles 18 .45 .48 Wandsworth 42 .22 St. Martin - in - the Fields 5 .34 .39 Camberwell 111 .63 .43 Greenwich 57 .62 .32 Strand 6 .52 .26 Lewisham 30 .42 .28 Holborn 19 .65 .62 Woolwich 8 .47 .19 Clerkenwell 49 .72 .74 Lee 5 .44 .13 St. Luke 28 .70 .68 Plumstead 22 .36 London, City of 10 .25 .33 London 1,848 .59 .412 Typhus. During the year 1897 four cases of typhus were notified, and one death from this cause was registered in the administrative County of London. The death rates from this disease per 1,000 living in 1897 and in preceding periods are as follows— 1871-80 0.55 1881-90 0.08 1891 .0022 1892 .0032 1893 .0012 1894 .0012 1895 .0012 1896 .0012 1897 .0002 1 See footnote (2), page 7. 2 See footnote (1), page 7. Diagram XV. Diagram XVI Enteric Fever. Diagram XVIII Diarrhœa. 41 The death rate in each year since 1868 in relation to the mean death rate of the period 1869-97 is shown in diagram XV. Of the four cases notified as typhus fever during 1897, one was not removed to the hospital. The patient died, and the medical officer of health who made inquiry into the matter could find no evidence to confirm the diagnosis. The remaining three were removed to the South-Eastern hospital of the Metropolitan Asylums Board, but only in regard to one of the cases was the diagnosis of typhus fever confirmed. In addition to this case, however, it should be stated that a case notified as enteric fever was diagnosed after admission to hospital as a case of typhus fever. The following are the particulars, concerning the five cases referred to— A female, æi. 40, the wife of a Russian, living in Whitechapel, was certified to be suffering from typhus fever on February 16th, and was removed to the South-Eastern hospital on the following day. No source of infection could be traced. The case was not regarded at the hospital as one of typhus. A man, æt. 26, a dock labourer, living in St. George-in-the-East, was removed to hospital on June 21st. The case was regarded at the hospital as one of typhus. The man began to be ill on June 14th. The house in which he lived was in a cleanly condition, and no source of infection was traced. On August 9th, a man, aged 35, living in Battersea, was certified to be suffering from typhus; he was removed to the South-Eastern hospital on August 11th, and his malady was then diagnosed as pneumonia. A wood carver, aged 72, living in Bethnal-green, was certified to be suffering from typhus on October 16th; he died on that day. Inquiry was made concerning the illness by the medical officer of health, but he found nothing to confirm the diagnosis. A boy, aged 12, living in Bermondsey, was admitted to the South-Eastern hospital on November 4th, certified to be suffering from enteric fever. The disease was diagnosed at the hospital as typhus fever. The medical officer of health of Bermondsey was unable to trace any source of infection. Enteric Fever. The number of cases of enteric fever notified in the Administrative County of London in 1897 (52 weeks) was 3,113, and the number of deaths belonging to the administrative county was 559, compared with 3,196 cases and 564 deaths in 1896 (53 weeks). The rates in 1897 and preceding periods are as follows— Enteric fever. Period. Death rate per 1,000 living. Case rate per 1,000 living. Case mortality per cent. 1871-80 0.24 – – 1881-90 0.19 — — 1891 0.121 0.8 15.6 1892 0.101 0.6 17.2 1893 0.161 0.9 18.4 1894 0.141 0.8 18.1 1895 0.141 0.8 17.0 1896 0.121 0.7 17.6 1897 0.131 0.7 18.0 The death rate from this disease in each year since 1868, in relation to the mean death rate of the period 1869-97, is shown in diagram XVI. Diagram XVII. shews the seasonal notification curve of enteric fever for the period 1890-97 and the year 1897. It will be seen that the maximum of the 1897 curve occurs a week later than the maximum of the mean curve of the period 1890-97. There is, however, in 1897 no exceptional divergence from the mean curve such as occurred at the end of the year 1894, and is referred to in an appendix to my annual report for that year. In the distribution of enteric fever mortality during the year, the central group of districts had the highest, the southern group the lowest death rate. Of the several districts the City suffered most, and Rotherhithe and Plumstead least during the year as a whole. During the first quarter of the year the central and eastern groups of districts had the highest, the western and southern the lowest mortality; during the second quarter, the northern group had the highest, the southern again the lowest death rate; during the third quarter the central group had the highest and the western the lowest mortality; during the fourth quarter the eastern group had the highest and the southern the lowest mortality. The case rate of each sanitary district in 1891-6 and in 1897, and the death rate in 1887-96 and in 1897 is shewn in the following table— 1 See footnote (1), page 7. [6] 42 Sanitary district. Cases, 1896. Case rate per 1,000 living. Deaths, 1897. Death rate per 1,000 living. 1891-96. 1897. 1887-96. 1897. Paddington 46 .5 .4 9 .12 .07 Kensington 116 .5 .7 21 .11 .12 Hammersmith 45 .5 .4 8 .12 .08 Fulham 53 .5 .4 12 .10 Chelsea 52 .7 .5 14 .13 .15 St. George, Hanover-square 39 .6 .5 10 .11 .12 Westminster 28 .6 .5 6 .10 .11 St. James 13 .7 .6 3 .19 .13 Marylebone 88 .7 .6 14 .13 .10 Hampstead 32 .7 .4 5 .09 .06 Pancras 223 .7 .9 38 .14 .16 Islington 259 .7 .8 45 .13 .13 Stoke Newington 37 1.0 1.1 10 .17 .29 Hackney 209 1.0 35 .16 St. Giles 32 .7 .8 6 .16 .16 St. Martin-in-the-Fields 5 .8 .4 1 .13 .08 Strand 19 .6 .8 4 .18 .17 Holborn 26 1.1 .9 5 .17 .16 Clerkenwell 64 .9 1.0 11 .16 .17 St. Luke 41 .6 1.0 4 .15 .10 London, City of 23 .8 .8 9 .14 .30 Shoreditch 107 .8 .9 20 .15 .16 Bethnal-green 106 1.0 .8 17 .17 .13 Whitechapel 55 .6 .7 8 .13 .10 St. George-in-the-East 43 .9 .9 10 .16 .21 Limehouse 52 1.0 .9 4 .17 .07 Mile-end Old-town 83 .9 .7 23 .17 .21 Poplar 195 1.3 1.2 30 .20 .18 St. Saviour, Southwark 16 .4 .6 2 .10 .08 St. George, Southwark 40 .6 .7 10 .11 .17 Newington 79 .6 .6 9 .13 .07 St. Olave 10 .6 .9 1 .14 .09 Bermondsey 61 .6 .7 13 .14 .15 Rotherhithe 24 1.2 .6 2 .20 .05 Lambeth 183 .6 .6 26 .12 .09 Battersea 93 .7 .6 19 .12 .11 Wandsworth 98 .6 .5 16 .08 Camberwell 149 .6 .6 31 .12 .12 Greenwich 144 1.2 .8 29 .16 .16 Lewisham 56 .5 .5 9 .09 .08 Woolwich 18 .5 .4 4 .13 .10 Lee 17 .8 .4 3 .10 .08 Plumstead 25 .4 3 .05 Port of London 9 — — — — – London 3,113 .7 .7 559 .14 .131 The reports of the medical officers of health contain the following references to cases of enteric fever in their districts, and to the cause of the disease where it was possible to ascertain it— Paddington.—"Of the 45 cases recorded during the year, three appeared to have been due to the patients nursing other cases and two to eating oysters (origin unknown). In two cases there were histories of consumption of ice-cream and mussels, but the information was too unreliable to be accepted without reservation." Fulham.—Of 53 cases, "there were no cases attributable to the Maidstone epidemic, but in six cases the disease was contracted outside London, and in three cases in other sanitary districts of the metropolis. In three cases the disease was thought to have been due to the consumption of shellfish." Chelsea.—Of 53 cases, "there were no cases attributable to the Maidstone epidemic, but in one case the infection was probably acquired while the patient was in residence at King's Lynn. In three other cases the infection was probably acquired outside the parish, whilst in three cases the patients were inmates of nursing homes in the parish, and were infected outside the parish." St. George, Hanover-square.—Three persons contracted their disease at Maidstone. Of the cases occurring in the last five months of the year, nine persons contracted their disease outside the parish. Marylebone.—"A few of the cases were imported from Maidstone and elsewhere. In one case the circumstances, aided by bacteriological examination, pointed strongly to specifically contaminated oysters." Hampstead.—Two persons contracted their disease at Maidstone. St. Pancras.—An outbreak occurred in University College Hospital. Investigation as to the cause led to the conclusion that it was due to contamination of the water in a cistern from a tank in which soiled linen was steeped. 1 See footnote (1), page 7. Diagram XVII. Enteric Fever. 43 Islington.—Nine cases occurred in the Islington Workhouse schools, which was attributed by the medical officer of health to the use by the boys, as a urinal, of a water-safe tray placed under a water-tap. The tray had formerly been connected with the drain by a pipe some 25 feet long, and had subsequently been sealed at the junction. The pipe was thus charged with urine, to the emanations from which the disease was attributed. It is supposed that a boy who was suffering from enteric fever used this water-safe tray and so infected the urine in the pipe. Stoke Newington.—Of 38 cases "four were doubtless imported and five were ascribed by the sufferers to the eating of oysters." Hackney.—"Of the 203 cases no less than 14 appear to have been contracted outside the district, and only one case seemed to be associated with oyster-eating; but this latter may have been a coincidence only." Strand.—"At least six of the cases (18) appear to have arisen from eating uncooked shellfish, five of them at a seaside resort. Two cases were tramps recently arrived in the district. No cases appeared to be connected with the Maidstone epidemic." Holborn.—"Of the 25 cases notified as typhoid fever seven were probably not contracted in the district, five of these seven having been contracted when out of London." Three of the seven cases were probably due to the eating of oysters. Shoreditch.—"In one instance it is possible that infection may have been conveyed through eating a portion of a pear which had been handled by a patient who was suffering from enteric fever. In two cases in which it is probable that the disease was contracted outside the parish it was thought that some oysters which had been consumed might have been the cause, but the evidence as to this was not conclusive." St. George-in-the-East.—Reference is made to a coffee house having sanitary defects "to which could be traced four cases of this disease." No case was traced to the Maidstone outbreak. Limehouse.—One case was due to infection received at Maidstone. Poplar (North district).—Reference is made to the risk of enteric fever caused by the existence of a watercress bed in Bow. The water was found to be largely polluted with sewage. The owner gave an undertaking to the medical officer of health, in writing, to abolish the bed. Newington.—"In no case could the disease be in any way connected with the Maidstone epidemic, and in only two cases could the disease be said to be due, with almost certainty, to oysters." St. Olave.—One case was a nurse who had been in attendance on a person suffering from enteric fever in Guy's Hospital. Four cases were probably not contracted in the district, one of which was apparently caused by the consumption of infected oysters while at Southend. Wandsworth parish.—Two cases were definitely traced to the eating of oysters at Clacton. Another was attributed to the eating of oysters in a restaurant in the City. One case had come from Maidstone on the 18th September, and subsequently died, and a fifth had been working for five weeks previous to the onset at the Croydon sewage works. Lambeth.—A few of the cases were traced to Maidstone and also to other parts of the kingdom. Lee (Eltham).—One case was attributable to the Maidstone outbreak. Plumstead.—In one instance the patient had eaten whelks eight days before his attack. In November, 1897, I made inquiry as to the number of cases of enteric fever notified in London which were traceable to a severe outbreak of the disease at Maidstone, due to a polluted water supply. Information concerning thirty cases thus contracted was communicated to me. Enteric fever—Age and sex distribution. In 1897 it will be seen from the following table that males had a greater attack and death rate from this disease than females, and this greater incidence on males is manifested at each age-period, except 5-10, when the incidence of death was greater on females, and at age 0-5, when the incidence of mortality was equal. The case mortality of males at all ages was greater than that of females, this being due to the higher case mortality of males above ten years of age. Enteric fever, * 1897. 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. 1,702 353 20.7 81 17 1,403 226 16.1 60 10 0— 1 2 16.9 29 5 3 2 17.8 27 5 1— 10 1 6 2 2— 19 3 23 2 3— 22 3 23 2 4— 25 4 18 5 5— 202 13 6.4 84 5 160 17 10.6 66 7 10— 276 29 10.5 126 13 206 12 5.8 92 5 15— 241 56 23.2 115 27 217 27 12.4 93 12 20— 279 63 22.6 136 31 208 38 18.3 84 15 25— 349 97 27.8 99 27 314 61 19.4 77 15 35— 157 33 21.0 60 13 142 35 24.6 49 12 45— 82 32 39.0 45 17 62 13 21.0 30 6 55 and upwards. 39 17 43.6 22 10 21 10 47.6 9 4 * See footnote page 31. 44 Diarrhœa. The deaths in the Administrative County of London attributed to diarrhœa and dysentery in the year 1897 numbered 4,098, compared with 3,199 in 1896. The death rates per 1,000 living in 1897 and preceding periods were as follows— 1851-60 1.03 1861-70 1.04 1871-80 0.95 1881-90 0.75 1891 0.571 1892 0.601 1893 0.801 1894 0.411 1895 0.821 1896 0.711 1897 0.921 The diarrhœa death rate in each year since 1840 in relation to the mean death rate of the period 1841-97, is shown in diagram XVIII. The mean temperature of the summer quarter of each year in relation to the mean of the period 1841-97 is also shown. The intimate relation between the temperature of the summer quarter and the amount of diarrhoea mortality will be seen. The age distribution of the deaths from this disease in the registration bounty of London in 1897 was as follows— Under 1 year. 1-5. 5-20. 20-40. 40-60. 60-80. 80 and upwards. 3,240 552 16 27 50 170 49 It will be seen from the following table that the London death rate from diarrhœa was lower than that of any of the undermentioned towns, except Bristol, both in the period 1887-96 and in the year 1897. Diarrhœa—Death rates per 1,000 living. Towns. 1887-96. 1897. Towns. 1887-96. 1897. London .67 .922 Bristol .49 .65 Manchester 1.07 1.56 Nottingham .95 1.66 Liverpool 1.10 1.93 Bradford .83 1.44 Birmingham 1.05 2.00 Hull 1.18 2.23 Leeds 1.05 1.57 Salford 1.37 2.00 Sheffield 1.13 1.83 West Ham .77 1.08 In the whole year the eastern group of districts had the highest death rate, the northern the lowest. Of the districts St. George, Southwark, suffered most, and St. Martin-in-the-Fields was least affected. During the first quarter of the year the southern group had the highest death rate, the death rate being above the average of London as a whole; during the second quarter the eastern group had the highest death rate, and the death rates of this and the western group were above the London average; during the third quarter there was a rise in the mortality, and the eastern had again the highest death rate; during the fourth quarter the central had the highest death rate, and the northern the lowest The death rate of each sanitary district in the period 1887-96 and in 1897 will be seen from the following table— Sanitary district. Deaths, 1897. Death rate per 1,000 living. Sanitary district. Deaths, 1897. Death rate per 1,000 living. 1887—96. 1897. 1887—96. 1897. Paddington 102 .51 .81 Shoreditch 189 1.00 1.55 Kensington 120 .49 .70 Bethnal-green 140 .77 1.09 Hammersmith 128 .93 1.21 Whitechapel 53 .78 .67 Fulham 148 1.24 St. George-in-the-East 60 1.46 1.26 Chelsea 100 .68 1.04 Limehouse 61 .88 1.05 St. George, Hanoversquare 25 .36 .31 Mile-end Old-town 98 .82 .88 .89 Poplar 175 .69 1.03 Westminster 47 .63 St. Saviour, Southwark 26 .78 1.05 St. James 9 .37 .40 St. George, Southwark 109 .92 1.81 Marylebone 108 .52 .77 Newington 165 .75 1.35 Hampstead 28 .27 .36 St. Olave 15 .87 1.31 Pancras 209 .65 .87 Bermondsey 124 .73 1.45 Islington 184 .60 .54 Rotherhithe 49 .86 1.21 Stoke Newington 19 .59 .56 Lambeth 295 .65 .99 Hackney 196 .91 Battersea 140 .66 .83 St. Giles 14 .54 .37 Wandsworth 144 .74 St. Martin - in - the Fields 2 .37 .16 Camberwell 260 .64 1.01 Greenwich 180 .66 1.01 Strand 18 .54 .77 Lewisham 68 .42 .63 Holborn 35 .62 1.15 Woolwich 50 .53 1.21 Clerkenwell 66 .95 1.00 Lee 22 .41 .56 St. Luke 51 1.02 1.24 Plumstead 61 1.00 London, City of 5 .24 .17 London 4,098 .67 .921 1 See footnote (1), page 7. 2 See footnote (2), page 7. 45 In reference to the causation of diarrhœa, the part played by the artificial feeding of infants is discussed by many of the medical officers of health, thus in the reports relating to Paddington, Kensington, Stoke Newington, Strand, St. Luke, and Greenwich this cause is mentioned. In Kensington the medical officer of health inquired into the circumstances of 43 consecutive deaths of infants due to diarrhoea, and found only three were suckled by their mothers, while 24 were first children, a fact suggesting maternal inexperience. In the Strand each of the infants who died from this disease was bottle-fed. Want of cleanliness either in the dwelling or the streets, the crowding of buildings on area, find a prominent place among the causes to which the disease is attributed. In his analysis of the circumstances of the 43 children referred to the medical officer of health of Kensington states that about half the mothers went out to work. The family occupied the entire house in six instances, four rooms in four instances, three rooms in eight instances, two rooms in sixteen instances, and one room in nine instances. The top floor was occupied in fifteen cases, the first floor in ten, the ground floor in six, and the basement in six cases. Cholera. The number of deaths attributed to cholera and choleraic diarrhoea during 1897 was 115, as compared with 95 in 1896, and the number of cases of "cholera" was 38 during the same period. In Paddington one case of cholera was notified which the medical officer of health describes as one of severe diarrhœa and vomiting. "There were other illnesses of an indefinite character among the members of his family." In Kensington two persons were received who had been passengers on board the hired transport Nubia from Ceylon to Plymouth, cholera having occurred on board during the voyage. Notice was sent to the medical officer of health of Kensington, who reports that the passengers were well on arrival and so continued. One person proceeded to Battersea from the s.s. Britannia from Bombay, a vessel on which cholera had occurred during the voyage. "The person and premises were kept under due observation during the period of incubation, without any symptoms of the disease appearing." The report of the medical officer of health of the Port of London shows that the s.s. Nubia, referred to above, arrived at Gravesend on the 13th January. On the 1st January, while the vessel was at Malta, a soldier on board was attacked with cholera and died the same day. On the 2nd another case occurred which recovered. On the same day another soldier was attacked and died on the 6th, another man taken ill on the same day died on the 9th, on the 9th another man was attacked and died after the vessel's arrival at Plymouth. There were also four suspicious cases of diarrhoea on the 3rd which recovered. The medical officer writes "the troops were carried in the 'tween decks, a space usually filled with cargo, which was specially fitted for the purpose. The scuppers from this space instead of running through the side of the ship or being blocked up, as is usual with troopships, ran straight down into the bilges. This should never be allowed. No openings or pipes should pass from any space used for living purposes directly into the bilges." The report of the medical officer of the Port of London also relates particulars of the following ships, which during their voyage had had cholera on board. On the 18th January the s.s. Athens, of London, from Alexandria, arrived at Gravesend, when it was found that there had been during the voyage four cases of sickness, which from their history appeared to be choleraic diarrhœa; on the 13th March the s.s. Beeswing, of Newcastle, from Buenos Ayres, arrived at Gravesend and reported a death from cholera on the voyage; on the 21st July the s.s. Wanderer, of Liverpool, from Calcutta, arrived at Gravesend and reported six cases (two fatal) of cholera during the voyage; and on the 27th August the s.s. Britannia, of Greenock, from Bombay, arrived at Gravesend, having had two cases of cholera on board during the voyage. All necessary steps were taken in each case. During the summer of 1897, as in previous years, inquiry was made by the Public Health Department concerning cases of cholera and choleraic diarrhoea, and in three instances material was submitted to Dr. Klein for bacteriological examination, but in each of these instances the results of such examination were negative so far as the cholera vibrio was concerned. The three cases were— (i) A. R. S., æt. 17, living in Somerford-street, Bethnal-green, went as usual to her work on August 11th. She was employed as a paper-sorter at a wharf in Horseferry-road. During the dinner hour she ate an ice from a barrow in the street, and then had for dinner meat pie, greens and potatoes. At supper at 10 p.m. she had bread-and-butter and tomatoes and some ale, and after supper she went out and is said to have partaken of fried potatoes and apples. She went to bed at 11.30 p.m. At 1 a.m. on the 12th vomiting and purging set in, and when the doctor who was summoned saw her at 10.45 a.m., he found her collapsed, and she died at 4.30 p.m. A post-mortem examination was made on the 13th by the medical attendant, who found "the brain full of ecchymoses also ecchymoses on the apex of the heart and in the right auricle; the pericardium was empty, the blood tarry, the lungs collapsed, the spleen and kidneys congested, and the stomach full of fluid ; the intestinal canal contained a green, creamy-coloured material with floccules in parts; the bladder was empty." An inquest was held at the Bethnal-green coroner's court on the 14th, and the jury found that death was due to English cholera. In some of the notices of the inquest which appeared in the press the case was, however, stated to have been one of cholera, and some alarmist rumours were circulated. Dr. Klein was therefore asked to make a bacteriological examination, and he reported that the cholera vibrio was not found. (ii.) J. F., æt. 30, of Picton-street, Camberwell, was admitted to the Camberwell Infirmary between 5 and 6 p.m. on August 21st. Early in the morning of that day he had been attacked with diarrhoea, vomiting and abdominal pain. Later, in the course of hie illness, he had some pain in the thighs, but no characteristic cramps. On admission he was in a state of collapse. The stools after admission became first green and then white and 46 milky. On the 22nd his voice was noticed to be weak, and he passed no urine for some time before death unless it was with his motions. He died at 8.15 a.m. on the 23rd. A postmortem examination was made on the same day, when it was found that there was no conspicuous deviation from the normal in the appearance of the intestines and the intestinal contents. The lungs were extensively adherent. A piece of ileum was taken to Dr. Klein, who obtained a negative result as regards the cholera vibrio. (iii.). J G., æt. 30, inmate of the Holborn Union Workhouse, was a tailor by trade, who had been tramping about. He was admitted early on the morning of the 22nd August to the workhouse under the influence of liquor, and suffering from diarrhœa and vomiting. He soon became collapsed and his voice was reduced to a whisper. The case was notified as "cholera," and Dr. Bryett, medical officer of health of Shoreditch, who saw him on the morning of the 23rd, learnt that the material evacuated from the bowel was regarded as presenting a suspicious appearance. Dr. Bryett procured a specimen of this material—a thick milky fluid, faintly tinged with green. The specimen was forwarded to Dr. Klein, who obtained a negative result as regards the cholera vibrio. Erysipelas. The deaths attributed to erysipelas in the registration County of London, in 1897, numbered 184; the corrected annual average of the preceding ten years being 269. The number of cases notified and the number of deaths registered in the registration County of London during the last seven years have been as follows— Erysipelas. Year. Cases. Case rate per 1,000 living. Deaths.1 Death rate per 1,000 living. 1891 4,764 1.13 214 .05 1892 6,934 1.63 292 .07 1893 9,700 2.26 424 .10 1894 6,080 1.40 221 .05 1895 5,660 1.30 179 .04 1896 6,436 1.43 207 .05 1897 5,794 1.30 184 .04 The case rate and death rate were therefore less than the rates of the preceding year. The number of cases notified and the case rate of 1897, together with the mean case rate or the period 1891-6, for each district of the Administrative County, are shown in the following table— Sanitary district. Cases, 1897. Case rate per 1,000 living. Sanitary district. Cases, 1897. Case rate per 1,000 living. 1891-96. 1897. 1891-96. 1897. Paddington 136 1.1 1.1 Whitechapel 119 1.7 1.5 Kensington 237 1.3 1.4 St. George's-in-the-East 85 1.6 1.8 Hammersmith 92 1.1 0.9 Limehouse 87 1.8 1.5 Fulham 134 1.0 1.1 Mile-end Old Town 145 1.8 1.3 Chelsea 98 1.6 1.0 Poplar 261 2.1 1.5 St. George, Hanover-sq. 51 0.8 0.6 St. Saviour, Southwark 28 1.4 1.1 Westminster 66 1.1 1.2 St. George, Southwark 88 1.5 1.5 St. James 24 0.9 1.1 Newington 159 1.6 1.3 Marylebone 254 1.8 1.8 St. Olave 10 1.6 0.9 Hampstead 40 0.8 0.5 Bermondsey 94 1.6 1.1 Pancras 388 1.9 1.6 Rotherhithe 73 2.3 1.8 Islington 313 1.4 0.9 Lambeth 322 1.3 1.1 Stoke Newington 23 1.4 0.7 Battersea 211 1.8 1.3 Hackney 273 1.3 Wandsworth 239 1.5 1.2 St. Giles 94 2.0 2.5 Camberwell 297 1.3 1.2 St. Martin-in-the-Fields 17 0.8 1.3 Greenwich 239 1.5 1.3 Strand 17 0.7 0.7 Lewisham 91 1.1 0.8 Holborn 47 2.2 1.5 Woolwich 36 0.7 0.9 Clerkenwell 96 2.1 1.5 Lee 51 0.9 1.3 St. Luke 86 2.5 2.1 Plumstead 46 0.8 London, City of 26 1.2 0.9 Port of London 2 — — Shoreditch 226 1.9 1.9 London 5,804 1.5 1.3 Bethnal-green 383 2.3 3.0 1 See footnote (2), page 7. 47 Puerperal Fever. The deaths attributed to puerperal fever in 1897 numbered 215 in the registration County of London, the corrected annual aver age of the preceding ten years being 272. The number of cases notified and the number of deaths registered in the registration County of London have been as follows— Puerperal fever. Year. Cases. Deaths.1[/####] 1891 221 222 1892 337 313 1893 397 352 1894 253 210 1895 236 208 1896 277 225 1897 264 215 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 rate1 per 1,000 living. Death rate1 per 1,000 births. 1891 .05 1.64 .05 1.65 1892 .08 2.55 .07 2.37 1893 .09 2.98 .08 2.65 1894 .06 1.92 .05 1.60 1895 .05 1.76 .05 1.56 1896 .06 2.04 .05 1.66 1897 .06 1.98 .05 1.61 There is therefore in 1897, as compared with 1896, a decrease in the case rate and death rate calculated on the births. Comparison of the rates of puerperal fever and those of erysipelas during the last seven years show a correspondence between the two diseases which is suggestive. As in previous years the number of cases notified only slightly exceeded the number of deaths. The medical officer of health of Bethnal-green gives account of two cases in which the first intimation he received was the entry of the death in the weekly return of the district registrar. He thus writes— In the first of these two cases the death was certified to be caused by "peritonitis after labour, 12 days." I felt sure that this must be a case of puerperal fever as the medical practitioner who signed the certificate had a few weeks previously notified to me a similar case on the day the patient died; accordingly I wrote to this gentleman to ask why he had failed to report the case; he answered apologising for his neglect, which he sought to excuse on the ground that the illness and death of his patient so upset him that he had forgotten to send the certificate. The medical attendant was summoned before the magistrate. He was not present at the hearing but sent a representative who was prepared to admit the offence and pay such penalty as might be inflicted. The medical officer of health was unable to give evidence that peritonitis following labour was invariably due to puerperal fever, and the defendant's letter was not received as evidence as to his signature. The prosecution was not sustained. Influenza, Bronchitis and Pneumonia. The deaths from influenza, which in 1896 numbered 496, rose in 1897 to 671, the corrected annual average for the preceding ten years being 1,069. The deaths attributed to bronchitis and also to pneumonia were below the corrected average for the preceding ten years. The deaths from these diseases since 1889 have been as follows— Year. Influenza. Bronchitis. Pneumonia. Deaths.1 Corrected annual average for preceding ten years. Deaths.1 Corrected annual average for preceding ten years. Deaths.1 Corrected annual average for preceding ten years. 1890 652 7.0 12,448 11,342.8 6,224 4,925.0 1891 2,336 74.0 13,136 10,887.3 6,915 4,883.0 1892 2, 264 318.7 11,183 11,230.0 6,164 5,171.9 1893 1,526 556.2 10,413 11,250.0 7,198 5,341.6 1894 750 715.5 7,816 11,292.3 5,321 5,632.5 1895 2,156 795.2 10,633 11,167.1 5,989 5,755.7 1896 496 1,039.0 7,558 11,385.0 5,537 5,996.0 1897 671 1,069.0 7,408 10,754.0 5,053 5,962.0 Phthisis. The deaths from phthisis in the Administrative County of London during 1897 numbered 7,645. The death rates of this disease per 1,000 living in the registration County of London in successive periods have been as follows— Phthisis. 1851-60 2.86 1893 1.91 1861-70 2.84 1894 1.74 1871-80 2.51 1895 1.83 1881-90 2.09 1896 1.73 1891 2.02 1897 1.771 1892 1.89 See footnote (2), page 7. 48 The Registrar-General in the annual summaries for 1894, 1895, 1896 and 1897 relating to London, has distributed the deaths from phthisis occurring in public institutions belonging to London to the sanitary districts to which they belong, and it is therefore possible to compare the phthisis death rates of the various sanitary districts. The death1 rates in the several groups of districts since 1893 have been as follows— 1894. 1895. 1896. 1897. Central group .. 2.58 2.65 2.53 2.69 East ,, 2.00 2.05 1.89 2.03 South „ 1.54 1.70 1.60 1.62 North „ 1.60 1.63 1.58 1.55 West ,, 1.55 1.55 1.54 1.53 The following table shows the number ol deaths and the death rate per 1,000 living in 1897 in the several sanitary districts of London — Sanitary district. Deaths, 1897. Death rate per 1,000 living. Sanitary district. Deaths, 1897. Death rate per 1,000 living. Paddington 142 1.13 Bethnal-green 255 1.98 Kensington 247 1.44 Whitechapel 200 2.52 Hammersmith 146 1.38 St. George-in-the-East 132 2.76 Fulham 184 1.54 Limehouse 149 2.55 Chelsea 175 1.81 Mile-end Old-town 156 1.40 St. George, Hanover-sq. 93 1.16 Poplar 319 1.88 Westminster 143 2.70 St. Saviour, Southwark 80 3.22 St. James 51 2.27 St. George, Southwark 171 2.84 Marylebone 246 1.75 Newington 269 2.21 Hampstead 57 0.74 St. Olave 33 2.88 Pancras 486 2.01 Bermondsey 174 2.04 Islington 491 1.44 Rotherhithe 64 1.58 Stoke Newington 40 1.17 Lambeth 500 1.67 Hackney 310 1.43 Battersea 251 1.49 St. Giles 113 2.99 Wandsworth 222 1.14 St. Martin-in-the-Fields 33 2.60 Camberwell 386 1.50 Strand 79 3.36 Greenwich 263 1.48 Holborn 84 2.76 Lewisham 97 0.90 Clerkenwell 155 2.35 Woolwich 79 1.91 St. Luke 128 3.11 Lee 43 1.10 London, City of 57 1.89 Plumstead 95 1.56 Shoreditch 247 2.03 London 7,645 1711 It will therefore be seen that in the several districts the death rate from phthisis varied from 0.74 (Hampstead) to 3.36 (Strand). In the distribution of phthisis mortality in London during the whole of the year, the central group of districts suffered most severely, and the western group suffered least. During each of the four quarters of the year the central group also had the highest death rate. The western had the lowest death rate during the first two quarters, and the northern during the third and fourth quarters. Phthisis Mid 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 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 was shown in my annual report for 1894 (page 42) that the phthisis death rate in these groups of districts followed the order of overcrowding. The following table shows the results obtained from similar treatment of the figures relating to 1895, 1896 and 1897, the figures of 1894 are reproduced for purposes of comparison. Phthisis, 1894-7. Proportion of total population living more than two in a room (in tenements of less than five rooms). Death rates1 per 1,000 living. 1894. 1895. 1896. 1897. Districts with under 10 per cent. 1.07 1.18 1.07 1.14 „ „ 10 to 15 „ 1.38 1.49 1.46 1.42 „ „ 15 to 20 „ 1.57 1.64 1.61 1.63 „ „ 20 to 25 „ 1.81 1.83 1.67 1.75 „ „ 25 to 30 „ 2.11 2.09 2.06 2.10 „ „ 30 to 35 „ 2.26 2.42 2.13 2.32 „ „ over 35 „ 2.46 2.66 2.55 2.64 1 See footnote (1), page 7. 49 It will be seen that the figures for each year are remarkably consistent. It is not, of course, possible to say whether, or to what extent, the high death rates in the overcrowded groups of districts may be due to overcrowding per se or to other adverse social conditions with which overcrowding is usually associated. The consistency of the figures, however, points to the operation of some constant cause or causes. It is conceivable that the more overcrowded groups of districts may be less favourably situated with regard to the age constitution of their populations than those with less overcrowding, but it will be seen from the following table, relating to the year 1897, showing the death rates in each of these groups of districts at several age-periods that, speaking generally, the more overcrowded groups have higher death rates at each age-period than the less overcrowded, and this is especially marked at those ageperiods which are most susceptible to phthisis. Phthisis—Death rates1 per 1,000 living 1897. Proportion of total population living more than two in a room. (In tenements of less than five rooms.) 0- 5- 20- 25- 35- 45- 55 and upwards. Districts with under 10 per cent. 0.32 0.38 1.07 1.82 2.36 2.19 1.23 „ „ 10 to 15 „ 0.53 0.41 1.14 2.03 2.86 3.05 1.83 „ „ 15 to 20 „ 0.51 0.40 1.34 2.13 3.41 3.20 2.27 „ „ 20 to 25 „ 0.41 0.36 1.58 2.10 4.02 3.98 2.60 „ ,, 25 to 30 „ 0.60 0.44 1.52 2.16 4.85 4.54 3.13 „ „ 30 to 35 „ 0.62 0.37 1.35 3.03 5.48 6.44 3.73 „ „ over 35 „ 0.91 0.46 1.79 3.66 6.15 5.23 4.51 Phthisis—Comparative death rates—Death rates in least overcrowded group at each age-period taken as 100. Proportion of total population living more than two in a room. (In tenements of less than five rooms.) 0- 5- 20- 25- 35- 45- 55 and upwards. Districts with under 10 percent. 100 100 100 100 100 100 100 „ „ 10 to 15 „ 166 108 107 112 121 139 149 „ „ 15 to 20 „ 159 105 125 117 144 146 185 „ „ 20 to 25 „ 128 95 148 115 170 182 211 „ „ 25 to 30 „ 187 116 142 119 206 207 254 „ „ 30 to 35 „ 194 97 126 166 232 294 303 „ „ over 35 „ 284 121 167 201 261 239 367 It will be seen from the table of comparative death rates, in which the death rate at each age-period of the least overcrowded group of districts is taken as 100, that the death rates at ages 0-5 in some degree follow the order of overcrowding; with regard to the age-period 5-20 the differences in the death rates in the several groups of districts are comparatively trifling and no particular order in relation to overcrowding is observable ; the death rates for the subsequent age-periods, however, follow with slight exception the order of overcrowding, and the most noteworthy point in connection with the table is that the increases in the death rates become more marked at each successive age-period. The accompanying diagram (xix) illustrates this more clearly. The consistency of these figures leads to the conclusion that the results are not accidental and the reason of the increasing effect of overcrowding or some associated condition on the phthisis death rates at the later age periods shown in the table, is certainly a matter which merits further investigation. Cancer. The deaths from cancer in the registration County of London in 1897 numbered 3,908, the corrected annual average for the preceding 10 years being 3,433. The death rates of this disease per 1,000 living in successive periods have been as follows— 1851-60 .42 1893 .80 1861-70 .48 1894 .79 1871-80 .55 1895 .83 1881-90 .68 1896 .86 1891 .78 1897 .882 1892 .75 The following table shows the number of deaths from cancer at several age-periods in each of the sanitary districts of the Administrative County. For the purposes of this table, deaths occurring in public institutions belonging to London have been distributed to the sanitary area6 in which the deceased had previously resided. See footnote (1), page 7. 1 See footnote (1) page 7. » Bee footnote (2) page 7. [7] 50 Cancer—Deaths, 1897. Sanitary district. 0- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- All ages. Paddington 1 - - 1 2 5 8 30 36 20 14 2 119 Kensington 3 1 - - - 4 23 30 51 48 11 2 173 Hammersmith - 1 1 - - 2 9 16 23 24 10 1 87 Fulham 1 - - - - 1 15 28 27 14 5 - 91 Chelsea 1 - - 1 1 4 7 23 22 21 7 - 87 St. George, Hanover-square 1 - - - 1 2 3 18 27 20 6 - 78 Westminster 1 - - - - - 4 12 10 18 5 - 50 St. James - - - - - - 1 8 3 6 1 - 19 Marylebone 4 - - - - 3 15 44 36 40 21 3 166 Hampstead - - - - 1 1 13 12 19 19 10 - 75 Pancras - - 1 3 1 6 26 41 44 34 18 1 175 Islington 1 1 3 3 4 11 37 76 82 73 27 4 322 Stoke Newington - - - - - - 2 11 8 6 3 - 30 Hackney - - 1 - 1 9 14 48 48 37 17 1 176 St. Giles 1 - - 1 - 2 2 10 8 5 2 - 31 St. Martin-in-the-Fields - - - - - 1 2 - 3 5 2 - 13 Strand - - - - - - 1 8 3 4 2 - 18 Holborn - - 1 - - 1 3 6 5 10 1 - 27 Clerkenwell - - - 1 1 2 4 8 8 10 1 - 35 St. Luke - - - - 1 3 6 6 12 7 6 - 41 London, City of - - - - - 1 3 6 14 7 4 1 36 Shoreditch 1 1 - 2 - 2 12 21 22 14 9 1 85 Bethnal-green 1 - - - 1 - 12 22 27 16 6 - 85 Whitechapel - - - 1 - - 7 19 20 7 4 - 58 St. George in-the-East - - - - - 1 5 5 11 3 2 - 27 Limehouse - - - - - 5 2 17 8 10 6 - 48 Mile-end Old-town 1 - - - - 2 11 16 20 17 8 1 76 Poplar 1 1 - 2 - 8 19 40 31 24 9 1 136 St. Saviour, Southwark - - - 1 - - 5 4 3 9 3 - 25 St. George, Southwark 1 - 1 1 - 1 7 6 14 6 4 - 41 Newington 2 - - 1 1 4 7 28 28 24 10 - 105 St. Olave - - - - - 1 3 8 2 3 1 - 18 Bermondsey 1 - - - - 2 9 13 22 15 4 - 66 Rotherhithe - - - 1 - - 4 7 7 6 2 - 27 Lambeth - - - - 3 14 30 58 60 62 30 1 258 Battersea 3 - - 1 - 4 11 28 28 19 10 1 105 Wandsworth - - 1 1 - 4 20 26 43 45 21 1 162 Camberwell - 1 - 1 1 9 16 53 69 46 27 - 223 Greenwich 2 - - 1 1 4 14 23 51 41 17 1 155 Lewisham - 1 - - 1 3 9 20 29 25 10 2 100 Woolwich - - - - - 3 3 6 8 9 2 - 31 Lee - - - 1 - 1 4 4 12 8 6 - 36 Plumstead - - - - - 1 4 12 8 7 2 - 34 London 27 7 9 24 21 127 412 877 1,012 844 366 24 3,750 Glanders. Two deaths in London were caused by glanders during 1897, one of a man in Fulham, who the medical officer of health reports, had been employed in some stables in New King's-road, where a number of horses were affected with the disease; the other of a man in Camberwell, who, the medical officer of health reports, worked in a stable. Anthrax. The medical officer of health of St. Olave reports that eight cases of anthrax occurred in Guy's Hospital, one of which was considered either a very mild or doubtful case. All but one recovered after operation. Five of the eight, including the doubtful case, were employed in the district. Meteorology. The tables published in the Annual Summary of the Registrar-General, and prepared by Mr. J. Glaisher, F.R.S., from observations at Greenwich, shew that the mean temperature of the air in 1897 was 50.3 degrees Fahrenheit or 1.6 degrees above the average of the 126 years, 1771-1896. The rainfall during the year amounted to 2213 inches and was 2 83 inches less than the mean of 82 years. The temperature and rainfall in each month of 1897 are shewn in the following table— 51 Month. Temperature of the air. Departure from average of 126 years, 1771-1896. 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 48.3 23.8 35.4 — 1.3 17 1.61 February 58.6 30.0 43.0 + 4.3 14 2.39 March 62.2 29.9 45.0 + 3.9 17 3.35 April 67.8 29.9 46.0 — 0.2 16 1.62 May 77.6 33.6 52.3 — 0.3 11 1.25 June 90.2 44.4 61.1 + 2.7 12 1.93 July 84.7 44.0 64.5 + 2.8 7 0.73 August 89.5 50.0 62.9 + 2.0 20 2.86 September 71.0 38.2 55.2 — 1.4 16 2.70 October 67.2 33.0 51.0 + 1.6 11 0.48 November 59.0 28.9 45.7 + 3.2 10 1.07 December 55.7 23.3 41.4 + 2.4 18 2.14 ADMINISTRATION. Dairies, Cowsheds and Milkshops. During 1897 the Council's inspectors made 21,284 inspections of dairies and milkshops. In 26 instances legal proceedings were instituted under the Dairies, Cowsheds, and Milkshops Order, and penalties amounting to £71 16s. 6d. were imposed by the magistrates. In 230 instances cases of infectious disease occurred at registered milkshop premises and dealt with by the Council's inspectors, the numbers of cases of each disease being 123 of scarlet fever, 82 of diphtheria, 15 of enteric fever, 3 of erysipelas, 1 of puerperal fever and 6 of measles. In all cases the inspectors visited the premises with a view to ensuring the adoption of measures to prevent contamination of the milk. The number of applications for renewal of existing licences to cowsheds was 379, of which 374 were granted. Daring the year the Public Health Committee had under consideration the need of amended regulations which, inter alia, proposed to prevent the sale of tuberculous milk. The Local Government Board was communicated with, and it was decided to postpone the farther consideration of the subject until the Royal Commission on Tuberculosis had reported. Offensive businesses. During 1897 the Council's inspectors made 5,688 inspections of premises upon which offensive businesses were carried on, including that of a slaughterer of cattle. In 9 instances legal proceedings were instituted, and in 6 cases penalties were imposed by the magistrates amounting in the aggregate to £577 3s. In the case of Messrs. Bone and Oak, who were convicted on two occasions for establishing anew the business of a knacker, fines amounting to £528 were imposed and £42 costs. In reference to these proceedings the Public Health Committee presented the following report to the Council on the 25th January, 1898. On 9th February last we reported to the Council that proceedings had been taken against Messrs. Bone and Oak, horse slaughterers, of Plaistow, for illegally carrying on the business of a knacker at 107, Old Kent-road, Borough. The evidence disclosed circumstances of great cruelty, and after a protracted hearing the magistrate fined each of the two defendants £6 a day for 12 days i.e., £72, and £10 10s. costs each, and in default he sentenced them to two months' imprisonment. The money was paid. It was subsequently reported to us that the same premises were still being used illegally as a place for slaughtering horses, under the same circumstances of cruelty as before, and we accordingly instructed the solicitor to take further proceedings against Messrs. Bone and Oak, and also to oppose the renewal of their licence as horse slaughterers at Plaistow. The solicitor took out two summonses against each defendant, one for days on which actual killing could be proved, and the other for days on which actual killing could not be proved, with the object of getting a decision that it is not necessary to prove actual killing in order to prove the carrying on of a knacker's business. The case was heard at the Southwark police-court by Mr. Penwick on 2nd, 8th and 15th December, Mr. Horace Avory appearing for the Council, and the defendants being represented by their solicitor. In the result, Mr. Fenwick convicted each defendant on both summonses, and fined each of them £192 with £10 10s. costs, £405 in all. The solicitor has also under our instructions taken certain steps as to opposing the renewal of the licence at Plaistow granted to Messrs. Bone and Oak by the Corporation of West Ham, and we propose to report the result of this action to the Council in due course. The number of applications for renewal of slaughterhouse licences was 460, of which 456 were granted. The number of applications for renewal of licences to knackers' yards was 5, all of which were Granted. The number of applications for the licence of slaughterhouses and the number granted in each of the last seven years is shown in the following table— Year. No. of applications received. No. of licences granted. 1891 656 651 1892 547 537 1893 542 529 1894 518 506 1895 497 485 1896 478 470 1897 460 456 52 The large reduction in the number of applications in 1892 was no doubt due to the making of new by-laws, with which the licensees were unable or unwilling to comply. In 1897 I presented to the Public Health Committee a report suggesting a scheme for the provision of public slaughterhouses in substitution for private slaughterhouses, so as to give opportunity for the inspection of meat. It is perfectly obvious that so long as animals are killed in numerous private slaughterhouses, there can be no inspection at the time of slaughter, the only time when inspection can be effectual, nor indeed can London claim special facilities for the inspection of dead meat coming into London from other parts of the country and which is not taken in the first instance to the markets of the City Corporation. For years large quantities of meat unfit for human food were sold in Holborn, in the neighbourhood the City Corporation's market. Had such meat been taken into the Corporation's market it would have been unhesitatingly condemned. The action of the Holborn District Board in appointing a special meat inspector has done much to prevent in Holborn the continued existence of this dangerous-meat market, but no system exists to prevent meat of this unwholesome and dangerous quality being introduced into London and conveyed to the premises of those who trade in it. There is urgent necessity for the institution of an administrative system which shall serve to protect the poor, who especially are the purchasers of cheap meat. London should be in a position to claim that all dead meat coming into the Administrative County, which has not been killed in public slaughterhouses under the inspection of other municipal authorities, and which does not pass through the Corporation's market, shall be made subject to special inspection. So long, however, as the continuance of a system is permitted which allows meat killed in London to be exempt from inspection at the time of slaughter no such claim as that I have indicated can be made, and the London population, especially the poorer portion, will continue to receive meat unfit for human food. Unregistered offensive businesses. During the year the Council's attention was directed by the London School Board to nuisance experienced in that part of Wandsworth in which are situated the Garrett-lane and Merton-road Board schools. Careful inquiry was made into this matter by the Council's inspector, and a copy of the letter from the London School Board was forwarded to the Wandsworth Board of Works. Some of the offensive trade premises in these localities have been the cause of complaint from time to time for some years past, and such action as it has been possible to take has been taken by the Council in respect of breaches of the by-laws regulating the trades in question. In several instances question was raised as to whether certain trades carried on in different parts of London were not offensive businesses within the meaning of section 19 of the Public Health (London) Act. Thus, in Deptford complaint was made of nuisance from offal brought from the Foreign Cattle Market to premises in the neighbourhood; it did not appear, however, that there was infringement of section 19 of the Act, but that the remedy lay in enforcement of the by-laws relating to the removal of offensive matter through London. In Hackney complaint was made regarding the business of a fish-skin dresser, a business which is no doubt ejusdem generis with the businesses which are offensive businesses within the meaning of the Act, but which has not hitherto been declared an offensive business. In the event of difficulty being experienced in preventing nuisance from this trade, it might become necessary to seek for special powers to regulate the conduct of this business. Up to the present time no sufficient reason for taking such action has been, however, forthcoming. In Bethnal-green the attention of the Council's inspector was directed to two or three establishments in which the business of a whalebone cutter was carried on. This business is clearly not the business of a bone-boiler, whalebone having, of course, nothing to do with the whale's bones, but being derived from the horny plates which are developed in the whale's mouth. It appeared that the business process carried on at the premises in Bethnal-green consisted in boiling the whalebone to render it soft, then cutting it into strips, and scraping, drying and polishing these for the purposes of ladies' corsets. If this business were found to be productive of nuisance, the sanitary authority could deal with it under section 21 of the Public Health (London) Act; or if it were thought desirable, the Council could ask the Local Government Board to make an order declaring the business an offensive business. Complaints to the London County Council. During 1897, the Council received 1,221 applications for assistance in securing the removal of insanitary conditions. In cases in which representation had not already been made to the sanitary authority the applicants were advised to make such representation. In other cases the sanitary authorities were communicated with. In all cases the matter was kept under observation until the conditions complained of were remedied. In connection with these applications 1,471 inspections were made by the Council's inspector. Nuisances. Trade nuisances. Marine stores.—The medical officer of health of Kensington states that at his instance the Vestry of Kensington in 1883 made applications to the Metropolitan Board of Works and in 1896 made applications to the County Council to schedule this business as an offensive business. These applications were unsuccessful. The medical officer of health of the Strand district states that he investigated a complaint that dripping was sold from marine stores, but found that the practice had been discontinued in that district. Brick-burning.—The only reference to brick-burning is found in the report of the medical officer of health of Kensington, who states that during the last three years, since the successful proceedings taken by the vestry, no complaint has been made by parishioners of nuisance arising in the conduct of the business of a brickmaker. 53 Other trade nuisances referred to in the reports of medical officers of health are as follows— Hammersmith.—Nuisance from factories in the neighbourhood of Fulham - palace - road. Nuisance from emission of dust from the shaft of the Brook-green Carpet Cleaning Works. Poplar.—Nuisance from oil boiling, the vapours from oil pots being allowed to escape into the atmosphere. Escape of sulphuretted hydrogen from main shaft of sulphate of ammonia works. Nuisance from smoke holes used for fish curing. Nuisance from indiarubber works, sulphuric acid works, nitric acid works, asphalte works, tar works, varnish works, cocoanut oil works, and from premises where fish skins are scraped and dried. Battersea.—Nuisance from the roasting of barley and coffee, especially the former. Barley is placed in a revolving drum, to which naked gas jets are applied, the barley being almost burnt to a cinder. "When sufficiently charred, it is removed on to the concrete floor of the building, from which volumes of smoke of a pungent character are given out." Emission of vapour from works in which cyanide of potassium is manufactured. "Numerous buildings in the vicinity of the works had been coated with a substance resembling Prussian blue." Nuisance from the scraping and drying of skate skins " which is effected by allowing the skins to become somewhat putrid, in order that the particles of flesh adhering thereto, may be more easily removed; the skins are then stretched on boards and exposed in the open air." Smoke nuisances. Reference to the subject of smoke nuisances is found in the majority of the annual reports relating to London districts, thus— Holborn.—There are 67 furnaces and boilers on the register which are periodically inspected. There are 10 kinds of smoke consumers in the district. The number of furnaces and boilers with smoke consumers is 39, and without, 28; this is an increase of 8 smoke consumers during the year. The number of notices served during the year was 6. City.—The report of the medical officer of health contains an interesting chapter on the subject of smoke nuisances. A special inspector is employed, and photography is used to fix upon the exact source of the nuisance. In 63 cases notices were served or warnings given, and in 6 cases legal proceedings were instituted. " Of 6 cases heard before a magistrate, 5 were dismissed with an abatement order, and no fine inflicted, although some of them were old offenders and had been previously convicted, and in the face of the clearest evidence, that the nuisance was a recurring one, in spite of many warnings from the smoke inspector before legal proceedings were resorted to." During the year the medical officer of health was instructed to "advise upon the best means to adopt with a view of stopping the nuisance of smoke from the City restaurants." He states that there are in the City 614 establishments in which food is cooked for sale, this number not including places where gas stoves are used, and he observes that " the substitution of gas stoves for the present clumsy way of firing with soft bituminous coal would, under proper regulations as to ventilation, &c., render the escape of black smoke into the atmosphere impossible, and ensure greater cleanliness and economy." He refers also to the Siemen's method of burning coke with ordinary coal gas. Shoreditch.—Eight intimations were received from the London County Council, and in 25 cases notices were served. Poplar.—In 43 instances smoke nuisance was dealt with, stated to be due to defective apparatus and burning of inferior fuel. Bermondsey—Reports have been received of 497 cases in which chimneys and shafts have been kept under observation. Statutory notices were served in 46 cases, and 10 summonses were taken out. Lambeth.—The London County Council drew the attention of the Lambeth Vestry to smoke nuisance on 32 occasions, the communications relating to 15 premises; there were 15 other premises in connection with which action was specially taken. Nine of the Council's complaints were in connection with the potteries on the Albert-embankment. Plumstead.—Nuisance by black smoke from the Arsenal chimneys was not so pronounced as in some former years, but more than there should be. The number of cases of smoke nuisance dealt with in other districts was as follows: Hammersmith, "several"; St. George, Hanover-square, 10; Westminster, 43; St. James, Westminster, 4 ; Marylebone, 18; St. Pancras, 17 ; Islington, 879 " visits " ; Hackney, 27 ; Clerkenwell, 4; Bethnal-green, 7 ; Whitechapel, 6; St. George-in-the-East, 14 ; Limehouse, 23; Mile-end Old-town, 7; St. George, Southwark, 6; St. Olave, 3; Rotherhithe, 23 ; Camberwell, 59 ; Greenwich, 57 ; Battersea, 36 ; Wandsworth, 3. Nuisance from stable manure. Nuisance from stable manure is referred to in several of the reports of medical officers of health, the increased use of peat-moss litter for horses having given rise to much complaint, thus— Paddington.—"There was the usual recurrent difficulty in connection with the manure during the summer months, hay-harvest-time. With that exception there was no cause for complaint except of effluvia from the removal of peat-moss manure. There is no doubt that the use of this litter should be put under more restrictive regulations. It is saturated with urine and dung when removed from the stall (the excremental matters forming a far larger proportion of peat than of straw manure), and emits a particularly nauseating odour when turned over." Kensington.—Owing to the operation of the Council's by-law complaints are now few in number, as the sunken dung-pit is now almost a thing of the past. " Nuisance often arises from the storage, and still more in the removal and transit through the streets of horse-dung manure, especially when peat moss litter is used." The medical officer of health refers to a letter which I was instructed by the Public Health Committee of the London County Council to address to medical officers of health inquiring as to the need of an amendment of the law which would empower sanitary authorities to charge for the removal of manure, and he states that he is of opinion that in the interests of the public health it should be made a statutory duty to remove manure, and that they should be authorised to charge the 54 owner a reasonable sum for the service. The Sanitary Committee of the Vestry reported that they were of opinion that the time had arrived when the vestry should on sanitary grounds undertake the removal of manure, but the Wharves and Plant Committee were of opinion on financial grounds that such a scheme was at the present time impracticable, and this view was adopted by the vestry. Fulham.—The medical officer of health, discussing the same subject, states that the vestry expressed an opinion in favour of the proposal contained in the letter above referred to. Concerning smell from peat-moss manure, which he says is " of a most vile description," he states that nuisance might be avoided if the manure were loaded direct from the stables into covered carts, which should be removed when full, and he has suggested that the vestry might be able to enforce this under section 21 of the Public Health (London) Act. The solicitor to the vestry was of opinion such proceedings could be instituted, and the vestry resolved to institute such proceedings should occasion arise. St. George, Hanover-square.—The mews in the district are generally satisfactory, except during the summer months, when there is great difficulty in getting rid of the dung, because the farmers are too busy to fetch it away. Westminster.—In many instances owners of stables have complained of their inability to get contractors to remove stable manure. Proceedings were instituted in six cases for non-removal of manure. Hampstead.—"The complaints of non-removal of manure were more numerous during the past than in any former year, and action had to be taken by the inspectors in 264 cases. There are various establishments in the parish wherein large numbers of horses are kept and in which the use of peat litter, from motives of economy, is very general. This material becomes highly charged with urine, and quickly offensive, especially when disturbed for removal in hot weather. It is necessary to insist that this refuse should be placed at once, on removal from the stable, into the vehicle in which it is to be taken away from the premises. A more liberal use of the peat, where this material is used, is advised, it being the habit of the horse-keeper to remove only the soiled portion and to rake up the rest under the manger during the daytime for night use." St. Pancras.—The vestry expressed the opinion that power should be given to charge for the removal of manure when called on by the owner to undertake this duty. Discussing the question whether the cost of removal of manure when generally effected by the sanitary authority should fall on the owners of the manure or on the public, the medical officer of health expressed the opinion that it would be more equitable for this to be borne by the owners. He recommends that manure should be placed direct into moveable receptacles on wheels, and states that it would be a boon if a by-law could be made requiring this to be done. Islington.—The removal of manure from the premises of tramway car and omnibus companies has been an annoyance to people in the neighbourhood. The manure should be deposited in properly constructed vans as soon as removed from the stalls. Hackney.—" Peat moss is used until it is thoroughly saturated with urine, then deposited in the pit, and after remaining there a sufficient time to set up decomposition of the urea, is disturbed during the course of removal, to the great annoyance of the neighbourhood, and the remedy is a simple one. For the dung pit, which is never cleaned out, I would substitute a van or portable dung pit, into which the stable refuse, direct from the stable, is placed, and when full, have it removed without any further disturbance of the manure into the country or to the railway depot, the van at the same time being thoroughly cleaned ; in fact, convert the fixed into a portable dung receptacle." The medical officer of health states that he has suggested this method to the North Metropolitan Tramway Company for their stables at Stamford-hill, but they have not adopted it. St. George-in-the-East.—The vestry is of opinion that there would be advantage if they were empowered to charge for the removal of manure. Lambeth.—The medical officer of health states that two railway sidings " are used in the district as outlets for offensive matters, chiefly manure, and in connection with these (especially in the summer) complaints havo been from time to time received." Referring to the necessity for outlets for manure he writes—" This particular business is therefore an essential one, and provided due precaution is taken to prevent accumulation, &c., and to minimise any nuisance which may arise in connection therewith, I am unable to advise any further action on behalf of the vestry, with a view to having such business stopped or interfered with, always provided that the place or places where such businesses are carried on are suitable and reasonably removed from dwelling-houses and crowded thoroughfares." He refers to the proviso in section 2 of the Public Health (London) Act, which is to the effect that " Any accumulation or deposit necessary for the effectual carrying on of any business or manufacture shall not be punishable as a nuisance under this section if it be proved to the satisfaction of the court that the accumulation or deposit has not been kept longer than is necessary for the purposes of the business or manufacture, and that the best available means have been taken for preventing injury thereby to the public health." Battersea.—The medical officer of health refers to the power of the sanitary authority to employ or contract with scavengers to collect or remove the manure and other refuse matter from any stables or cowhouses within their district, the occupiers of which signify their consent in writing to such removal, and states that there would be advantage if the authority were empowered to charge for this service. liemoval of offensive refuse. The removal of offensive refuse either in prohibited hours or in a vehicle or vessel not properly constructed was the subject of proceedings in the following districts—Fulham, Chelsea, Marylebone, Hackney, Mile-end Old-town and Wandsworth. During the year difficulty was experienced by persons who remove the offal from fish and poulterers' shops, owing to prosecutions instituted by the police for the enforcement of the law in the metropolitan police area outside the administrative County of London, which in respect of the hours of 55 removal of offensive matter is in conflict with the by-law of the Council operating within the administrative county. The Public Health Committee reported on this subject to the Council as follows— Onr attention has been called to a difficulty which is experienced with regard to the removal of offensive matter owing to the hours during which such removal must be effected being different in the County of London from those in that part of the Metropolitan Police District which is outside the county. Before the by-laws made by the Council under section 16 of the Public Health (London) Act, 1891, prescribing the times for removal and carriage of offensive matter, came into force, times were prescribed by section 60 of the Police Act, 1839. Section 142 and the fourth schedule of the Public Health (London) Act, 1891, provide that the part of section 60 of the Police Act dealing with this subject shall be repealed as from the coming into operation of by-laws made for the like object. This provision of the Police Act was operative over the Metropolitan Police District, but the Council's by-laws only cause its repeal within the County of London. The Council's by-laws require the removal of offensive matter to be effected between 4 a.m. and 10 a.m. in the summer, and between 6 a.m. and 12 noon in winter, while in the portion of the Metropolitan Police District still subject to section 60 of the Police Act. removal is prohibited between 6 a.m. and 8 p.m. all the year round. The result of this is that it is impossible to effect the removal of offensive matter from within to without London in the winter without contravening either the Council's by-laws or the Police Act. A person may not start removing in London until 6 a.m., and as soon as he gets outside the county he is within the portion of the police district in which section 60 of the Police Act is in force, and as it must by that time be after 6 o'clock he at once becomes liable to a penalty for infringing that Act, which does not allow him to remove in that district after 6 a.m. We have received letters from Messrs. S. Hempleman and Co., stating that carmen employed by them in removing fish offal from premises in London have been prosecuted and convicted at the West Ham Police court for infringing section 60 of the Police Act, and they point out the impossibility of complying with both the Council's by-laws and that section. They further state that they have called the attention of the Commissioner of Police to the difficulty, but have received a reply to the effect that the duties of the police are merely administrative, and that they are bound to see that both the Act of Parliament and the by-laws are observed in their respective districts. The Commissioner suggested that the provision of a receptacle for offal within the County of London might overcome the difficulty, but Messrs. Hempleman point out that it would be some time before such a depot could be found, and that it would probably be objected to by both the Council and the local sanitary authority. We think it is very important that this refuse should be removed with the utmost possible dispatch, and that it is undesirable that it should be stored in depots ; in fact such storage for more than twentyfour hours would be in contravention of another of the Council's by-laws. We may point out that when the Council's by-laws under the Public Health Act were being drafted the Local Government Board expressed a strong view that offensive refuse should not be removed during the night time, when proper supervision could not 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. In all the circumstances we think the proper course would be (1) to amend the Police Act, so far as it deals with the circular area outside the County of London in the manner in which it has already been amended, so far as the County of London is itself concerned, by the Public Health (London) Act, 1891; (2) to make it obligatory upon sanitary authorities of districts within the circular area mentioned to make by-laws such as the Councd now makes as regards London. We accordingly propose that the Council should ask the Local Government Board to introduce a bill with this object, and should inform the Commissioner of Police of the course taken with a view to his considering whether, pending the decision of the Local Government Board, he would desire that no further proceedings should be taken under section 60 of the Police Act in relation to hours of removal of offensive matter. We recommend— (a) That a letter be addressed to the Local Government Board, calling their attention to the difficulty experienced with regard to the hours of removal of offensive matter, and asking them to introduce a bill— (1.) To amend the Police Act, 1839, so far as it deals with the circular area outside the County of London, in the manner in which it has already been amended, so far as the County of London is itself concerned, by the Public Health (London) Act, 1891. (2.) To make it obligatory upon sanitary authorities of districts within the circular area mentioned to make by-laws such as the Council now makes as regards London. (b) That the Commissioner of Police be informed of the action taken with a view to his considering whether, pending the decision of the Local Government Board, he would desire that no further proceedings should be taken under section 60 of the Police Act in relation to the hours of removal of offensive matter. The Public Health Committee of the Westminster Vestry, in consequence of complaints having been made to them by tradesmen, of the difficulty experienced in obtaining the removal of fish offal produced on their premises, ordered that facilities should be afforded tradesmen for shooting fish offal at the vestry's wharf, Grosvenor-road ; a small charge being made for this service. Removal of house ref use. During the year the Public Health Department continued its investigations into the manner in which London sanitary authorities were effecting the removal of house refuse so as to comply with the requirements of the Council's by-law that this refuse should be removed not less frequently than once in each week. In February I reported to the Public Health Committee that further inquiry by the Council's inspector at 247 houses in Holborn showed that there were accumulations of two weeks and upwards in 10 per cent. of houses situated in streets in which a weekly call was made by the dust collectors at each house, and in 57 per cent. of houses at which a weekly call was not made, but the occupiers had to depend upon the exhibition of a D card in the window or upon hailing the collectors as they perambulated the streets. The district board having issued a notice card to inhabitants that the dust collector would call at each house each week, the inquiry was not pursued further, but in May was resumed and 876 houses visited. The Council's inspector found that the majority of houses were called at by the dust collector, but there were accumulations of two weeks and upwards in 14 8 per cent., a result which he attributed to the dust collector not calling on the appointed day, to the collection from business premises being inconvenient to the house occupiers if made after 10 a.m., and to the continued 56 existence of old brick dust-bins, which are usually allowed to be completely filled before being emptied. The result of the inquiry was communicated to the district board. There is no power to require the removal of a fixed brick receptacle, even when a moveable receptacle has been provided, under such circumstances the Council's by-law prohibits the use of the fixed receptacle, but power to require its removal is desirable. In April, I presented to the Public Health Committee the results obtained by inquiry at houses in Marylebone. From a very limited number of houses there was a daily collection, pails containing the house refuse being placed outside the house and emptied every morning. In certain of the better class streets a weekly call was made at every house. In 730 houses visited by the Council's inspector there were 70 accumulations of two or more weeks. In the poor streets there was no house to house call, D cards were exhibited, and the administration was very inefficient. In 1,556 such houses in the southern part of the district visited by the Council's inspector, 681 accumulations of from 2 to 12 weeks were found. In many of these cases the dust was overflowing from the receptacles and lying on the ground. In May the results obtained by inquiry in the northern part of the district were presented to the Committee. In 975 houses at which the dust collectors profess to call weekly there were found 135 accumulations of two weeks and upwards, or 13-8 per cent., and 1,274 houses in which the occupiers depended upon the exhibition of a D card or upon hailing the collector in the street, there were 617 such accumulations, or 48.4 per cent. The action taken by the Council upon these reports is shown in the following reports which the Committee presented to the Council. We have for some considerable time been in correspondence with the Vestry of St. Marylebone on the subject of the arrangements for the collection of bouse refuse in the parish. The system of employing contractors for the purpose is adopted in this parish. The by-laws made by the Council under the Public Health (London) Act, 1891, require each sanitary authority to cause to be removed not less frequently than once in every week the house refuse produced on all premises within its district; and so long ago as 9th May, 1894, we pointed out to the vestry that it did not appear to be the practice to call at all houses in the parish at least once a week for the purpose of effecting the removal of the refuse, and we asked the vestry to arrange for this to be done. The vestry replied that they were unable to secure the due removal of house refuse in this manner, as no penalty against the occupier was enforceable, and that they considered that the removal was satisfactorily effected in St. Marylebone. Inquiry made by the Council's inspector at a large number of houses in the parish having proved that the arrangements were still unsatisfactory, a further letter was addressed to the vestry on 4th October, 1894, and the vestry's attention was at the same time called to section 116 (a) of the Public Health (London) Act, 1891, which provides for a penalty against any person who wilfully obstructs any member or officer of a sanitary authority or any person duly employed in the execution of the Act. The vestry stated, in reply, that they did not consider this section to be applicable in relation to the removal of house refuse. Any doubt which might exist on this point has been since removed by the case of Borrow v. Howland, in which it was held on appeal that persons refusing to allow the scavengers of the sanitary authority to enter premises for the purpose of removing house refuse are liable to the penalty for "wilfully obstructing" within the meaning of the section in question. Particulars of this case were communicated to the vestry on 9th June, 1896. After the proceedings by the Council against the Lambeth "Vestry respecting the removal of house refuse had terminated (the Council's object having been attained so far as that parish was concerned), we thought it well that the Council's inspector should make further inquiries in the parish of St. Marylebone, in order to ascertain whether any improvement had been made in the vestry's arrangements for the collection of the refuse. Inquiry during the present year was first made in the southern part of the parish, and we regret to say that the result is to show that there seems to be no regular method of collection of house refuse uniformly in operation. It appears that as regards the poorer streets there is no regular day for even visiting them, and no house-to-house call seems evor attempted. In some few cases D cards appear to have been provided and are put up, but no notice seems to be taken of them ; in some other cases the householders hail the men when they see them in the street, but the men are said to usually make some excuse and not go, and it is generally necessary to write or send to the vestry each time before the dust is removed, and even then the requests are not always attended to. One hundred and fifty persons complained of having had to write to the vestry several times, and there were many complaints of dustmen demanding money. A very large number of accumulations of refuse due to non-removal for periods of from two to twelve weeks were observed, and in many of these cases the dust was overflowing from the receptacle and lying on the ground. We at once informed the vestry of the result of the inquiry, and stated that we felt that ample time had been given to it in which to make satisfactory arrangements to secure the removal of house refuse in the manner required by the Act and by-laws. We also stated that unless an intimation was received from the vestry within one month that it had taken steps to secure a house-to-house call being made at all premises in the parish not less frequently than once a week, and to ensure the removal of the refuse, we should feel it our duty to recommend the Council to apply to the Local Government Board for its consent to the Council taking proceedings against the vestry. The month has now expired, and the only reply we have received is a letter from the vestry clerk to say that the vestry, being in recess, might not be able to come to a decision in the matter before the expiration of the period indicated, in which case it was presumed that the Council would not proceed before hearing the vestry's views. Meanwhile, the results of the inquiries made by the Council's inspector in the northern part of the parish have been submitted to us, and they show a similar state of affairs to that in the southern portion. In all the circumstances of the case, and having regard to the fact that proceedings cannot be taken after the expiration of six months from the time of the inquiries, we think the Council should at once apply to the Local Government Board for its sanction to proceedings against the vestry under the Act. We accordingly recommend— (a) That application be made to the Local Government Board for its sanction to the Council taking proceedings against the Vestry of St. Marylebone under the Public Health (London) Act, 1891, for not securing the due removal at proper periods of house refuse from premises in the parish. (b) That, in the event of the sanction of the Local Government Board being obtained, the solicitor be instructed to take proceedings against the vestry under the Act. The above recommendations of the Committee marked (a), (b) were subsequently withdrawn for reasons which appear in the following report submitted to the Council on the 1st June, 1897. On the 18th instant we submitted to the Council a report recommending that application should be made to the Local Government Board for its sanction to the Council taking proceedings against the 57 Vestry of St. Marylebone under the Public Health (London) Act, 1891, for not securing the due removal at proper periods of house refuse from premises in the parish. The consideration of this report was postponed, at the suggestion of our chairman, in consequence of the receipt of a letter from the vestry clerk, stating that the vestry would, on the 20th instant, resume debate on the motion for the adoption of the following recommendation from a committee, viz. :—" That arrangements be made for a house-to- house call for the removal of house refuse from all premises in the parish at least once a week, and that the Council's Public Health Committee be informed accordingly." We are now glad to report that a further letter has been received from the vestry, stating that they have adopted the above recommendation, and in the circumstances we have requested our chairman to to ask leave to withdraw our report which is still before the Council. We have informed the vestry that we shall be glad to hear when the new arrangements have been brought into force; and we hope at a later date to be able to report that these arrangements have effected the improvement which is needed. Inquiry had been made into the subject of dust collection in St. Luke in 1896, and the Vestry of St. Luke was communicated with. The results of a further inquiry was submitted to the Public Health Committee in July. The Council's inspector came to the conclusion that each house was called at every week by the collector, but in 313 of 1,331 houses he visited, or 23.5 per cent., he found accumulations of two weeks and upwards. This was a marked improvement upon the results obtained by inquiry in 1896. In December I presented to the Public Health Committee the results of similar inquiry in Hackney. It was found there were accumulations of refuse of two or more weeks in 2,834 houses of 10,119 houses at which inquiry was made, or 28.1 per cent. In this district the dust collectors call at each house every week, and failure to remove the refuse is due to the obstruction of the householders. Progress is being made in London in connection with the more frequent removal of house refuse. Sanitary authorities are increasingly re-arranging their administration so as to secure that this removal shall be effected not less frequently than once a week in compliance with the requirement of the Council's by-law. Fixed receptacles are gradually giving way to moveable receptacles. A weekly call of the dust collector at each house is being more generally made, and by degrees the London householder is falling into line with this requirement, and is giving facilities for the removal of his refuse. Much has, however, yet to be done to secure the co-operation of the public, and there is need for the institution of proceedings for penalty for obstruction in well selected cases, so as to obtain compliance with a system which alone can ensure the proper scavenging of London. The steps taken in a number of the districts is shown in the annual reports of medical officers of health thus— Kensington.—" The work of collection of ashes and miscellaneous rubbish from over 23,000 inhabited houses has been systematized by division of the parish into districts, and provision has been made for inspection of dustbins and oversight of the dusting gangs, the arrangements being under the supervision of the surveyor. A call is or should be made at every house once a week—twice a week in Notting-dale district." Fulham.—" The weekly service of the removal of house refuse has been fairly satisfactory, though some method of making up for the loss of time caused by holidays, after which complaints respecting the delay in removal are always very numerous, is still wanting." The medical officer of health had recommended that, at any rate during the summer months, dust should be collected from " flats" at least twice a week, owing to the receptacles being usually placed near windows. This recommendation has not been adopted. Marylebone.—" The weekly collection of dust has worked far smoother than under the old ' contract. Complaints of non-removal made by the householders against the contractor may be said generally to have been replaced by complaints by the contractor against the householder of refusal to have the dust removed. With the exception of a few cases of neglect, the refuse has been removed regularly and the contracts efficiently performed." St. Pancras.—The average number of refusals per week under a system of " permissive " weekly collections was 32 percent. in June and 5 per cent. in November. The medical officer of health states that sooner or later it will become a question for certain parts of St. Pancras to have a daily collection of house refuse. He calls attention to the provisions of the Council's by-law relating to daily collections. Islington.—The medical officer of health states that the weekly removal of refuse has been one of the greatest sanitary reforms ever effected in Islington. The number of applications of householders for removal of their refuse has decreased from 10,138 in 1891 to 312 in 1897. Hackney.—The number of requests received for the removal of house refuse has decreased to an almost insignificant figure. " This satisfactory result has followed from the introduction of the system of calling weekly at each house in the district." The medical officer of health gives the following account of the system adopted in this district— For the purposes of dust removal, the whole district is sub-divided into sub-districts, to each of which one of the vestry's dustmen is appointed with two vans, horses and carman supplied by the contractors. It is the dustman's duty to call at every occupied house in his sub-district, and, if possible, remove the dust at least once a week. In order to learn where the dustmen are refused admission, or where no replies to their calls are made, each dustman is supplied with a sheet, on which he marks the number of the house under its appropriate heading of " refusal" or " no answer." These sheets are handed into the Public Health Office every morning and tabulated. If a complaint of non-removal of dust is made, we can, by turning to the sheets, see whether it is the fault of the householder or dustman. The fulness of the loads is checked by men appointed by the vestry, before delivery of the refuse at the shoot or place of deposit. It would, in my opinion, be more satisfactory if each van-load were weighed, and payment made per ton. Holborn.—" The number of notices for the removal of dust continues to diminish, only 802 notices were received last year, whereas in 1896 the number was 1,361, and in 1895 as many as 2,114. Since the 25th March, 1896, the Board's contract has provided for the removal of house refuse at least once a week. These complaints that dust has not been removed show that the contract is not strictly carried out, and the contractor's attention to the matter has frequently been requested by the Board." [8] 58 Clerkenwell.—The medical officer of health reports that the Works Committee applied for and received from the vestry the necessary powers to establish the system of weekly collection from every house in the district, and he states that " considering the short time the system has been in use it works smoothly and well, and complaints which used to be so numerous are now few and far between." St. Luke.—"As regards the collection of house refuse the dustmen call at all houses once in each week in order to remove the contents of the ashpits, but inquiries made of householders during the inspection appear to show that collection depends to some extent upon whether the householder considers there is or is not sufficient accumulation for removal at the time that the dustmen call, the result being that in some cases the refuse, only small in amount, and probably filling only part of the receptacle, is allowed to remain on the premises till the next week." City.—The medical officer of health states that the skip system, which was adopted experimentally in 1892, " has been gradually extended until at the end of 1897 no less than 747 had been supplied at the public expense.' So far, he says, the system has been confined almost exclusively to property of the tenement class, and that it would be a great advantage from a public health point of view if the adoption of this plan could be extended to the whole of the City. If this is not done he suggests that the prohibition of the Commissioner of Police of the removal of refuse between 10 a.m. and 7 p.m. which now applies to certain streets should be extended to other streets. He refers to a report he presented to the Commissioners of Sewers in 1892 in which he pointed out that public dustbins were misused by the deposit in them of trade refuse, and in which he stated that " The remedy for this evil will be found in the extension of the skip system and the entire removal of all the public dustbins throughout the City." St. Olave.—The annual report states that dust removal continues to be carried out regularly and efficiently, and that for the fourth year in succession not a single complaint of neglect or inattention was received, but in 612 instances the dustmen reported failure to obtain the removal of house refuse and in 44 of these, notices were served. Woolwich.—" The pail system continues to work most satisfactorily. The dust is removed weekly from every house in the district, and from some of the streets in the poorer parts of the town twice or thrice weekly." Plumstead.—The medical officer of health reports that under a former contractor the removal was unsatisfactory, but " since the contract was transferred, matters have been far worse, and came to a crisis at Christmas-time, when the collection quite broke down, and in a large number of streets the dust was not collected for three weeks." "The Works Committee instructed the surveyor to employ men and carts to collect the dust at the contractor's expense, if he did not re-establish a proper collection before a certain date. This threat had the desired effect, and since then the collection has been more satisfactory, though there is still much room for improvement." Disposal of house refuse. In referring to the subject of disposal of house refuse, the medical officer of health of Kensington points out that the time must ultimately come when the refuse will have to be cremated in or near the parish, and that the " vestry now possess a site in Wood-lane, where presumably a destructor and an electric light installation may be advantageously located." The medical officer of health of Fulham writes that the vestry have finally decided to proceed at once with the erection of a dust destructor, and to utilise the heat generated by the cremation of the refuse for the production of electric light. The medical officer of health of Hackney states that he regards the presence of the large accumulation of filth at the shoot in the neighbourhood of Hackney Wick " as a menace to this and neighbouring districts," and that he would desire to see the Hackney refuse burned in a well-designed destructor. In St. Luke " the refuse is at the present time taken to a wharf in the City-road basin of the Regent's-canal and thence removed by barge; but this method of disposal will shortly cease on the completion of the dust destructor which is being erected for the use of the district." In Woolwich " the destructor, provided by the Board, works very satisfactorily both by day and night." In Rotherhithe the vestry has approved the detailed plans of a destructor and invited tenders. The medical officer of health of Lambeth states that he advised the vestry to "take legal proceedings against the City of London and Clerkenwell Vestry in respect of the way in which their respective depots were being kept," and he refers to " the old fashioned, but disgusting and degrading method of human beings sorting and sifting the rubbish—the workers standing waist-deep for several hours at a time—both at the City of London and the Clerkenwell dust yards in the Commercial-road, Lambeth." The report of the medical officer of health of Battersea contains reference to the Mill Pond-bridge wharf, Nine Elms-lane, where house refuse is sorted and sifted by men and women, and from which nuisance was experienced, for the abatement of which notice was served. In Plumstead steps were taken to prevent the continuance of the shooting of house refuse " on Wright's estate, High-street, within 100 yards of houses." The medical officer of the north district of Poplar discusses the use as a dust shoot of land at the bottom of Marshgate-lane. Nuisance from sewer ventilators. The subject of nuisance from sewer ventilators is discussed in several of the reports of medical officers of health In the early part of 1898 a conference of the engineers and surveyors of the several vestries and district boards was held at the County Hall. The conference was presided over by the Council's chief engineer, and the following resolutions were adopted— 1. That the closing of 6ewer ventilators in response to complaints increases the general evil, the diminution of which is to be attained by the multiplication of the ventilators at regular frequent intervals. 2. That in connection with any interceptor hereafter fixed on a main house drain it is advisable to carry up a ventilating pipe from the sewer side of the interceptor, up the front, side, or back of the house, to the satisfaction of the local sanitary authority, and that the outlet drain from the interceptor shall not be flap-trapped in sewer, unless required by the local sanitary authority. 3. That pipe ventilators up buildings, or otherwise where possible, should always be adopted, in addition to surface ventilation. 59 The medical officer of health of Kensington gives account of the action taken by his authority in connection with the nuisance from sewers. The following report was received from a sub-committee of the law committee and adopted by present committee and vestry. Tour sub-committee have had before them the correspondence between the vestry and the London County Council on this subject, and the report of the medical officer of health on " offensive smells in streets." They have also considered the various sections in different Acts of Parliament bearing on the same subject, and advise the Committee that, as to gullies, traps and ventilators of sewers, the property of the vestry, there is a clear liability upon the vestry in respect of nuisance arising therefrom. It must not be forgotten that the duty to cleanse every grating or gully in a street (except in streets cleansed by the Council), whether the gratings and gullies belong to the Council or the vestry, is by the London County Council (General Powers) Act, 1894, transferred to the vestry. As to sewers vested in the London County Council, the obligation to cover and keep so as not to be a nuisance or injurious to health is upon the Council under section 135 of the Act of 1855. Power is given to the vestry (but only with the consent of and after notice to the Council) to prevent effluvia from exhaling from main sewers, and in respect of these London County Council sewers we advise that the London County Council are liable for nuisance occasioned by smells, and not the vestry. We recommend that the Works and Sanitary Committee be informed— I. That they are bound to prevent the vestry sewers, gully-holes and traps from being a nuisance, and must take all precautions to avoid the same, otherwise the vestry may be liable at the suit of anyone showing injury, or the vestry may be ordered to comply with their statutory duty by mandamus. II. With regard to the London County Council sewers, the vestry may, upon a flagrant case of nuisance being proved, through the Attorney-General proceed against the London County Council by information, or in the alternative apply for a mandamus to compel the Council to comply with section 135 above referred to. It has been suggested that a Council sewer (looking to the width of the definition clause) may come within the term premises in section 2 of the Act of 1891, but, without giving a contrary opinion, we consider that a recent decision leaves it in considerable doubt whether the nuisance section in this Act alters or adds anything to the previous law as to sewers. Before taking action against the Council the Works Committee would probably recommend that a further communication be addressed to the Council, pointing out the gravity of the nuisance and the obligation the vestry feel themselves under to protect residents by any means which they may be advised are available. The medical officer of health reminds the vestry that in 1896 he had recommended that in mews all gullies be effectually trapped, surface sewer gratings abolished, and ventilating shafts erected in suitable positions. The medical officer of health of Fulham states that the surveyor has succeeded in obtaining permission to erect fifty shafts during the year, with the result that complaints respecting the offensive smells arising from the manholes and surface ventilators have not been quite so numerous as heretofore. He refers to the action taken by his authority against the Council requiring the Council to comply with an order to abate the nuisance caused by the emission of sewer gas from certain ventilators and states that this case was tried in the Divisional Court of the Queen's Bench Division before Mr. Justice Day and Mr. Justice Lawrence, who held that the Public Health (London) Act, 1891, was not intended to apply to public works belonging to a public authority, and dismissed the appeal with costs. In the City, the medical officer of health reports, during 1897 seven shafts were fixed in front of adjacent buildings, making in all 301 spread over the City. In Plumstead "Twenty-one new ventilating shafts have been erected, and fifteen open manholes have been closed." It will be seen from the above that remedy for nuisance from sewers is being sought in the substitution of shafts for road-level air gratings. It is much to be hoped that the action of the several authorities will be directed to exact inquiry into the circumstances which give rise to nuisance from sewers and where this depends upon retention of sewage either from deposit in the sewer, or from faulty construction of the sewer, or depends upon the admission into the sewer of matters which it should not properly receive, that these matters will receive the attention they deserve. Flooding from sewers. The subject of flooding of basements with sewage is referred to in several reports. The medical officer of health of Kensington writes that the matter " formed last year the subject of a conference with the sanitary authorities of the adjoining parishes of Chelsea, Fulham, and Hammersmith. The County Council was approached and the final outcome is that the Council have decided to proceed with the construction of a new pumping-station at Lot's-road, Chelsea, at a total cost of £60,000, and to apply to the Secretary of State for consent to the compulsory acquisition of the land required for the purpose." The medical officer of health of Hackney refers to severe storms on the 21st July, 1897, in the north and north-eastern parts of London, and states that from the known capacity of the sewers in the district (Hackney), it is clear that flooding must result, and indeed a large number of houses in the district—chiefly houses with basements—were flooded with sewage. It is unnecessary to say that the health of the inmates of these houses was endangered." He gives account of the measures which, on his advice, were adopted—the removal of the foul deposit left by the flood, the cleansing and disinfection of the floors, and removal of the polluted soil beneath—and states that the eastern part of the district suffered most, that Hackney Wick was much flooded, and would have suffered more had not the marsh sewer burst, thus leading to the flooding of a large part of the marsh, and so relieving Hackney Wick. He says, "I have in former reports referred to the small amount of fall in the sewers of this part of the district, and the need of relief; and 1 am informed that the scheme formulated by the London County Council is making progress, not of a very rapid character it is true, but with a reasonable amount of certainty that the scheme will be carried out shortly." He also especially calls attention to the flooding of basements of houses in an area situated at the most eastern part of Clapton-park, stretching from Glyn-road on the west to the Hackney-cut on the east, and from Millfields-road in the north to Blinco-road and Redwald-road in the couth. He made inquiry into the 60 cause, and he includes in his report a tabular statement, showing the size, gradient, &c., of the sewers in the several roads in the area, his conclusion being— 1. That the whole of the sewage of the above district is carried off by the marsh sewer, which receives also the sewage from Tottenham, and that now its dry weather flow is about 18 inches. This leads to the result that a considerable length of the main sewers conveying the sewage from the eastern section of Clapton-park is charged with backed-up sewage. 2. The gradients of many of the branch sewers are too small for the effectual conveyance away of the sewage. 3. That owing to the presence of basements in certain streets, the gradients are still further reduced, the consequence being that the house drains are almost flat. 4. That most of the basemented houses of this locality are flooded with backed-up sewage during periods of storms. He then discusses the risk to the inhabitants, and points out that the population is a growing one, and contains a large proportion of young persons; and he thus concludes— The remedy, of course, is an engineering one, which can only be applied by the London County Council. The time is opportune for drawing their attention to this matter, because they are considering a scheme for the relief of Hackney Wick, and some modification of this scheme to relieve Clapton-park might now be made more easily than at a later period; and I would most strongly urge that their attention should be called to this area, and that they be asked to improve, if possible, its sewage arrangements to prevent the recurrence of similar floods to that noted above. The medical officer of health of Poplar and Bromley writes that on the 30th of May various parts of the district were flooded. " The sanitary committee, which met on the 1st July, referred the various claimants for compensation to the London County Council, and at the committee meeting it was recommended that the Council be urged to take immediate steps to cleanse their sewers in Highstreet, Poplar." The medical officer of health of Lambeth reports that serious floodings occurred on the 7th and 24th June in Norwood and Gipsy-hill, due to the surcharging of the London County Council sewer. "The boards of the houses were taken up and the sewage-contaminated water and debris removed, chloride of lime being freely used afterwards, with the result that no apparent injury to health accrued, so far as one could judge during a house-to-house visitation which was made by the inspector." He states that the work necessary for the prevention of these floodings has since been decided on and commenced by the London County Council. The medical officer of health of Charlton thus refers to flooding of houses in his district: " This nuisance is repeated as frequently as ever, and the past year has been no exception to previous years. I believe it to be due entirely to the inadequacy of the County Council sewer to carry off the storm water which is the cause of an enormous amount of damage and annoyance to the inhabitants." The medical officer of health of Plumstead states that during some of the heavy rainfalls which occurred in the summer of 1897, floodings occurred at certain houses, more especially at Raglan-road and Crescent-road. The medical officer of health of Battersea writes that the sanitary inspector reported on the alleged offensive condition of the creek at Messrs. Prices' premises, York-road, and stated that " after the creek pumping-station had been working for the purpose of pumping storm water into the river from the creek and main low-level sewers, a considerable amount of sewage matter which necessarily passed out with such storm water became largely mixed with the mud, &c., at the bottom of the creek, and caused the same to become offensive." This condition occurred when there were three or four feet of water in the creek, and the material did not find its way rapidly into the river. He recommended that the storm overflow should have a covered culvert laid down through the creek and discharge into the river at low water, or that the bottom of the creek should be concreted and suitably sloped so as to be thoroughly scoured during the ebb of the tide. House drainage. During 1897 the Public Health Committee had under consideration the preparation of by-laws regulating the construction of house drains under section 202 of the Metropolis Local Management Act. By-laws were in 1896 drafted and communicated to the vestries and district boards from whom suggestions were subsequently received. These suggestions were considered by the Committee, and the drafts amended with a view to meeting as far as possible the views of the sanitary authorities. After further examination by the Local Government Board it may be expected that the by-laws will be made and confirmed. The subject of combined drains is referred to in the reports of the medical officers of health of Kensington, Fulham, Marylebone, Strand, Shoreditch, Whitechapel, Battersea, Charlton and Plumstead. A conference of sanitary authorities was held at the Holborn Town Hall in connection with the bill which the London County Council was asked to introduce into Parliament. The subsequent action taken by the Council is shown in the following report of the Parliamentary Committee, dated 1st July, 1897— We were instructed on 26th January last to re-introdnce this bill, which it will be remembered was prepared last year to give effect to the decision of the Council on 12th February, 1895, to apply to Parliament for an amendment of the definition of the words sewer and drain in the Metropolis Local Management Act. We have met with considerable difficulty in dealing with the matter. In the first place it was only after much trouble and delay that we were able to obtain the consent of members of Parliament to allow their names to be placed on the back of the bill, and we have altogether failed in our efforts to get any member to take charge of and introduce it. The agent informs us that he has had an opportunity of discussing the matter with the secretary and some members of the conference who dealt with it on behalf of the vestries and district boards, and that it was quite agreed that the bill could not possibly pass this session. Under these circumstances it appears to us that it will be best to afford time for a further consideration of the matter, and we recommend— That no further action be taken this session with respect to the Metropolitan Sewers and Drains Bill, and that a circular letter be addressed to the various local authorities who took part in the conference which led to the preparation of the bill, informing them of the difficulties which have been met with in introducing it and which have led to its being dropped. 61 Housing of the Working Classes. During 1897 the following steps were taken under the Housing of the Working Classes Act— Schemes undertaken by the Council under Part I. of the Act. Boundary-street, Bethnal-green—Further progress was made in the work of erecting block dwellings on this area and the following buildings came into occupation during the year—Hurleybuildings with accommodation for 50 persons, Sandford for 50, Henley and Walton for 700, Marlow for 258, Shiplake for 212, Taplow for 250, Sunbury for 390, and Chertsey for 108 persons. The erection of the following buildings was commenced—Iffley for 90 persons at a cost of £4,205, Clifton for 404 persons at a cost of £17,251, and Molesey for 124 persons at a cost of £5,040 10s. Plans for the remaining blocks were approved. Churchway, St. Pancras—The provisional order sanctioning this scheme was received in January, 1897, and the confirming bill passed through Parliament in due course. The acquirement of the property was being proceeded wit h at the close of the year. Clare-marlcet, Strand—In the case of this area also the necessary parliamentary powers were obtained during the year and it was then possible to proceed with the acquirement of the property. Trafalgar-road, Greenwich—During the year plans for two-storey cottages to be erected on the Trafalgar-road site, Greenwich, were prepared. This site had been cleared under Lord Cross's Act. Schemes undertaken by the Council with contributions by district authorities. Ann-street, Poplar—During the year the plans of dwellings which the East End Dwellings Company proposed to erect upon this site were under the consideration of the Local Government Board, the Council, and the company. Falcon-court, Southwark—The arrangements for rehousing in connection with this scheme were proceeded with. Plans showing accommodation for 300 persons upon the Borough-road site were prepared, and it was decided to purchase a further piece of land in Green-street and Pocock-street, Southwark, in order to make sufficient provision to meet the rehousing requirements of the scheme. The order sanctioning the Falcon-court scheme was not made during 1897, but at the close of the year the Local Government Board intimated that they would proceed to issue an order sanctioning the scheme. Mill-lane, Deptford—A local inquiry as to a proposed modification of this scheme, involving reduction of the number of persons to be rehoused to 300 so as to admit of the erection of cottage dwellings instead of blocks of buildings, was held by an inspector of the Local Government Board in July. The Board subsequently intimated its willingness to reduce the number to be accommodated on the area to 272, subject to provision being made by the Council upon other sites in the neighbourhood for the remaining 278 persons required to be rehoused under the original scheme. Schemes undertaken by district authorities with contributions by the Council. Brantome-place and Propert-terrace, St. Pancras—The local inquiries regarding these areas were held in March. The Local Government Board expressed the opinion that sites outside the areas of the schemes should be acquired with a view to making provision for rehousing a number of persons larger than the number it was practicable to rehouse on the areas themselves as contemplated by the vestry. The opening up of this question led to delay in carrying out these schemes. Fulford-street and Braddon-street, Rotherhithe—A local inquiry with regard to this area was held in July. Subsequently a draft order, sanctioning the scheme on condition that accommodation for 240 persons should be provided on the area and for 310 persons on another site or sites in the neighbourhood, was received. King John's-court, Limehouse—An inquiry as to this area was held in November. The scheme provides for the demolition of two courts and the erection of cottages on the cleared area. The total cost is estimated at £16,300. Moira-place and Plumbers'-place, Shoreditch—This scheme is being carried out by the Shoreditch Vestry with a contribution by the Council of £27,500. The roads required under the scheme had not been completed up to the end of the year. Plans for the erection of artizans' dwellings were approved. Other proceedings under the Housing of the Working Classes Act. The blocks of dwellings, the erection of which had been commenced in March, 1896, upon the Green-street and Gun-street sites, purchased by the Council under Part III. of the Housing of the Working Classes Act from the Vestry of St. George-the-Martyr, Southwark, were during 1897 completed and opened. The work of laying out the Millbank site, purchased by the Council under Part III. of the Act, was proceeded with in accordance with the plan adopted by the Council at the end of 1896. A representation was made by the medical officer of health of Clerkenwell witli regard to an area situated in the neighbourhood of St. John's-square, Clerkenwell. The representation with regard to this Aylesbury-place area, as it was termed, was under the consideration of the Housing of the Working Classes Committee at the close of the year. Bell-lane area, Whitechapel—The following report of the Housing of the Working Classes Committee, presented to the Council in February, 1897, shows the steps that have been taken with respect to this area— The attention of the Council has been directed from time to time to an insanitary area in Whitechapel, known as the Bell-lane area. This area formed the subject of a representation under the Artizans' Dwelling Acts in 1877, but no scheme was framed by the Metropolitan Board of Works for dealing with it, and after careful consideration of the matter in 1890 we informed the Council that we were unable to see our way to recommend the adoption of so large a scheme as would be involved in the widening of Bell-lane and Sandy's-row, combined with clearance of the central area. The Council subsequently resolved to widen Sandy's-row which partly bounded the represented area on the west side as a street improvement— and this has to a small extent improved the condition of the area. We are now glad to be able to report that an opportunity presents itself of making a clearance of all the courts and alleys on that part of the 62 area which lies between Bell-lane and Sandy's-row. We have been in communication with Sir Algernon Osborn, the freeholder of the Osborn estate, which includes the area above mentioned, and he is prepared to co-operate with the Council in improving and developing his estate, subject to the Council agreeing to sell for a reasonable sum the frontages abutting on Sandy's-row, and assisting to expedite the formation of the new roads and the closing of the several courts and alleys. It is proposed to close all existing courts and alleys, and to form a 40 feet street from Wentworth-street parallel to Sandy's-row and Bell-lane, continuing the street round Tripe-yard into Sandy's-row, and to widen Cobb's-yard into a 40| feet street. Upon the formation of the roads, the land remaining will be utilised for shops and domestic dwellings. The clearance of most of the properties can be effected at once, but a small portion is held on leases which expire in 1922 and 1930. Sir A. Osborn's agents hope to be able to come to terms with the tenants of these properties for a surrender of their interests before the expiry of their leases. In the event, however, of an arrangement not being come to on this point, we propose that the Council should co-operate with Sir A. Osborn by putting in force the provisions of the Housing of the Working Classes Act, 1890, with a view to acquiring compulsorily such of the leasehold interests as he may be unable to obtain possession of within a reasonable time, the Council being reimbursed the cost of such acquisition. We have been in communication with the Corporate Property Committee with regard to the disposal of the frontages on Sandy's-row, and have ascertained that they are prepared to recommend the Council to sell the whole of the surplus land on the east side of Sandy's-row at 10s. per square foot, and that they will report to this effect at the same time that this report is made. We are informed that a slightly higher price might be realised for some of the land by dealing with it in separate plots than by selling it at once for the purposes of the suggested scheme, but we are of opinion that the Council would be well advised to sell the land in this way rather than to incur unaided the far heavier expenditure of dealing with the area under a schema. We desire to recogaise the readiness which Sir A. Osborn has shown in meeting our views with regard to this area, which has had our very anxious consideration for some considerable time. We recommend— That, subject to an agreement to be prepared by the solicitor, the Council do approve of the scheme put forward on behalf of Sir Algernon Osborn, and do authorise the Committee to take such steps as may be necessary to carry such scheme into effect, including the preparation of a scheme under the Housing of the Working Classes Act, 1890. In July the Committee informed the Council that for that year they did not find it necessary to recommend the adoption of a scheme in respect of that area. 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 to the 31st December, 1897— Local Authority. Total number of houseconcerning which the Council has received information that representations have been made from the 1/1/1)7 to the 31/12/97. 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 - - - - - - - - - - - Bethnal-green 87 11 11 11 33 - 13 - 13 - 41 Camberwell - - - - - - - - - - - Chelsea - - - - - - - - - - Clerkenwell - - - - - - - - - - - Fulham - - - - - - - - - - Greenwich - - - - - - - - - - - Hackney - - - - - - - - - - - Hammersmith - - - - - - - - - - - Hampstead - - - - - - - - - - - Holborn - - - - - - - - - - - Islington - - - - - - - - - - - Kensington - - - - - - - - - - - Lambeth 40 4 3 26 33 2 2 2 6 - 1 Lee ~ - - - - - - - - Lewisham - - - - - - - - - - - Limehouse - - - - - - - - - - - Mile-end Old-town 20 1 - 9 10 - - - - - 10 Newington - - - - - - - - - - - Paddington - - - - - - - - - - - Plumstead - - - - - - - - - - - Poplar - - - - - - - - - - - Rotherhithe 1 - - 1 1 - - - - - - St. George, Hanover-square - - - - - - - - - - - St. George-in-the-East - - - - - - - - - - - St. George, Southwark 58 - - - - - - - - - 58 St. Giles 4 2 - 2 4 - - - - - - St. .Tames, Westminster - - - - - - - - - - - St. Luke - — - - - - - - - - — St. Martin-in-the-Fields - - - - - - - - - - St. Marylebone 8 - - - - - - 6 6 - 2 St. Olave, Southwark - - - - - - - - - - - St. Pancras - - - - - - - - - - - St. Saviour, Southwark - - - - - - - - - - - Shoreditch - - - - - - - - - - - Strand - - - - - - - - - - - Wandsworth 1 - - - - - - - - - 1 Westminster 22 1 - - 1 13 4 4 21 - — Whitechapel - - - - - - - - - - - Woolwich 4 - - 4 4 - - - - - - Total 245 19 14 53 86 15 19 12 46 - 113 63 Areas specially described in the reports of medical officers of health. The medical officer of health of Kensington reports on the Notting-dale area. Acting on his advice the Vestry of Kensington had requested the Council to acquire the houses under Part III. of the Housing of the Working Classes Act, 1870, " with a view to their utilisation as lodging-houses for the working classes subject to regulations passed in accordance with the provisions of section 62." In reply the Council stated that they were of opinion that Part III. of the Act being designed to facilitate the provision of dwellings for the accommodation of persons of the working class in districts where the need for such accommodation is felt would not be applicable to the Notting-dale area, and suggested that the exercise by the vestry of powers of inspection and regulation of houses let in lodgings under section 94 of the Public Health (London) Act was the proper course to adopt. The medical officer of health states that " a further communication was addressed to the Council pointing out that the powers referred to had been exercised and having been found to be inadequate for the purpose, the aid of the Council as local authority under the Housing Act was desired," but this further request was not complied with. He states the steps taken to improve the condition of the roads, yards and houses, and says " the houses are, upon the whole, fairly well sanitated," and that the few houses not on the register of houses let in lodgings have now been registered. In connection with this area he reminds his authority that in 1893, on the recommendation of the sanitary committee, an additional sanitary inspector was appointed to take exclusive charge of the area, but in 1896 a vacancy occurred in the staff of inspectors and this was not filled up. " In July the sanitary committee, having ordered the issue of some 220 notices in respect of houses in Notting-dale it was proposed to appoint two additional inspectors, for one month, to assist in supervising the execution of the required works, but the proposal was negatived by the committee." In conclusion, he expresses the opinion that the vestry should have powers to put Part III. of the Housing of the Working Classes Act in operation. The medical officer of health of St. Pancras, discusses in connection with the Brantome-place and Prospect-terrace Improvement Schemes, the requirements of the Local Government Board as to rehousing. He writes— The amount of cubic space to be allowed for persons occupying the new buildings proposed will average probably double that occupied by persons now inhabiting the buildings. It follows that if the higher standard were now adopted and applied to the existing buildings it would mean turning out onehalf of the population. This, however, cannot be so applied as there is no legal machinery for applying such a standard to old buildings. It therefore follows that, to put in force the Housing of the Working Classes Act, the authority must practically provide double the amount of cubic space for the same population, or to put it in another form, must rehouse twice the population they displace. The medical officer of health of Bethnal-green states that in the south registration sub-district are " three unhealthy areas which are veritable plague spots, and handicap all our attempts to reduce the general death rate of an otherwise fairly healthy parish. In one of these areas the average death rate of the past three years was no less than 40 per 1,000." He describes the condition of houses in Collingwood-street, one of the unhealthy areas referred to, and which he represented under Part II. of the Housing of the Working Classes Act. The houses represented, 29 in all, were closed under the Act. A second area, consisting of 29 houses in Faith-street, was the subject of a special report by the medical officer of health, who recommended that the houses should be demolished and the site cleared. A copy of this report was forwarded to the Council, who suggested that the vestry should take the necessary steps to obtain closing and demolition orders. " Temporary repairs," he writes, " have been done to some of the houses, but the scheme still remains under consideration." A third area having 86 houses with a population of 451 rooms was the subject of a special report. The houses are situated in Pitt-street, Lucas-street, Archer-street and the east side of Pott-street, and concerning these he writes that they " are so dilapidated and decayed as to be quite unfit for habitation, and that he is of opinion that their continued occupation is injurious to the health of the inhabitants of these houses and the neighbouring buildings," moreover " the sanitary defects thereof cannot be effectually remedied otherwise than by an improvement scheme for the re-arrangement and re-construction of the streets and houses within the area." He adds that the matter is still under consideration and will form the subject of a further report. The medical officer of health of Whitechapel regrets the delay in effecting the improvement of the Bell-lane area and says that it remains in a worse state than ever, and that he fears it will be necessary for him to ask the district board to intervene with regard to some parts of it. The medical officer of health of Limehouse gives account of the steps taken in connection with the King John's-court area, and states that he has made representations tinder Part II. of the Act concerning houses in the Chusan-place area, some of which have been demolished. The medical officer of health of Mile-end Oi l-town thus writes concerning the Lomas-buildings area which it was proposed to improve under the Housing of the Working Classes Act— With reference to the scheme of Lomas-buildings, which his been from time to time before you, I hoped to be able to chronicle in this report that this insanitary area had been demolished; but I have, I regret to say, to allude to the fact that, owing to ths refusal of the Local Government Board to sanction it, the whole scheme has fallen through. This refusal was entirely due to the stipulation that new buildings should be erected to provide for the people who would be displaced. The present and past sanitary committees have, during the last few years, done all in their power to obtain the demolition. The County Council consented to contribute half the cost, the vestry contributing the other half, and all that was wanting was the sanction of the Local Government Board, but that body has evidently laid down a hard and fast rule that in such cases new dwellings should be erected. It has been pointed out to that body that there is ample accommodation in the immediate locality for more than all these people, and that the vestry was not prepared to erect new dwellings. This condition of affairs is much to be regretted, as this insanitary area is the greatest blot we have in the district. There is nothing which tends to demoralise the working classes more than narrow, badly-lighted and unventilated courts. The medical officer of health of St. George, Southwark states that he has " suggested that two areas should be dealt with as ' unhealthy' as defined by the Act. These areas are (1) Grotto place, 64 Lower Grotto-place, Goldsmith's-place, and Lant-place; (2) area bounded by (a) Pocock-street, (6) King's Bench-walk, (c) Wellington-place, and (d) the new buildings of the London County Council in Green-street, and by the Pocock-street Board school." The medical officer of health of Lambeth states that of 40 houses represented by him under the Housing of the Working Classes Act, 27 in one area, comprising Fountain, Francis, and Paved courts, still remain empty. He suggests that the site should be acquired for the purpose of providing an open space or playground for children. The medical officer of health of Camber well reports on a memorial received by the vestry, and directing attention to an area " lying between Wyndham-road and Avenue-road, and between Camberwell-road and Pitman-street, and including the following streets—Sultan-street, Hollington-street, Crown-street, Gange-street, Beckett-street, and Toulon-street." In 1896 he recommended (1) that as many as possible of the houses should be placed under regulations for houses let in lodgings, and the by-laws rigidly carried out; (2) that a routine inspection of all the houses be made twice a year, so that there may be no long continuance of defects. In his annual report for the year 1897 he writes— " While admitting the fact that in this area there are isolated blocks of houses which it would be a great advantage to remove, I am strongly of opinion that the district as a whole does not come within the meaning of an insanitary area, and I do not feel myself to be in a position to give the certificate required under the Housing of the Working Classes Act." He states that, acting on an instruction of the sanitary committee in May, he again reported on the area, and he indicated certain blocks of houses with which it would be an advantage to deal under Part II. of the Housing of the Working Classes Act, viz., Mayhew's-buildings, 34, 35, 36, 37 and 38 ; Beckett-street, the whole of Gurneyterrace, Laurel-terrace, and Nos. 1, 2, 3, 4, 5, 6, 7 and 8, Sultan-street. The committee, he reports, decided not to proceed with a scheme, but that notices should be served under the Public Health Act. The Regulation of Houses Let in Lodgings. At the end of the year 1896 I was directed by the Council to make a further report at Midsummer, 1897, as to the extent to which by-laws or regulations dealing with houses let in lodgings were enforced in the several sanitary districts of London with a view to the Council making a representation to the Local Government Board under section 101 of the Public Health (London) Act, 1891, in the case of any sanitary authority which by that time was not carrying out the provisions of section 94 of the Act. I accordingly obtained from London medical officers of health information as to the number of houses then on the register in the several districts, and Dr. Hamer made inquiry in all districts except the City as to the progress made by each sanitary authority in fulfilment of the statutory obligation of making and enforcing by-laws for houses let in lodgings. In September I presented to the Committee a report on this subject, to which is appended Dr. Hamer's report. (See Appendix II.) The Council adopted the following report of the Public Health Committee, but authorised the committee to delay forwarding to the Local Government Board the complaint as to Bethnal-green so as to give the vestry an opportunity of further considering the matter. By section 94 of the Public Health (London) Act, 1891, every sanitary authority is required to make and enforce such by-laws as are requisite for the following matters ; that is to say— " (a) For fixing the number of persons who may occupy a house or part of a house which is let " in lodgings or occupied by members of more than one family, and for the separation of the sexes " in a house so let or occupied; " (b) For the registration of houses so let or occupied ; " (c) For the inspection of such houses ; " (d) For enforcing drainage for such houses, and for promoting cleanliness and ventilation in " such houses; " (e) For the cleansing and lime-washing at stated times of the premises ; " (f) For the taking of precautions in case of any infectious disease." A report by the medical officer which we submitted to the Council on 28th July, 1896, showed that, though by-laws under the above section or regulations under the Sanitary Act of 1866 with respect to houses let in lodgings had been made in every London district, in only a limited number of districts was any considerable effort made to enforce them. The medical officer pointed out that the inquiries showed that in every district where by-laws or regulations had been given a fair trial, the opinions of those best qualified to judge were strongly in favour of that method of dealing with such houses. Any difficulty which had been anticipated in thus regulating the houses had always disappeared when the work was seriously undertaken and a sufficient staff provided for the purpose. The very fact that a house had been registered, and was subjected to inspection, had been found to be productive of good, and there was no doubt that still better results would have been attained if larger use had been made of the power conferred by by-laws to proceed directly for penalty instead of adopting the method of serving notices. This would be particularly the case when the condition to be dealt with was that of overcrowding. Copies of the report were sent to each sanitary authority with a request for their observations upon it, and as from the replies received it appeared that in many districts the by-laws or regulations remained practically a dead letter, the Council on 1st December, 1896, on our recommendation, passed the following resolutions— " (1) That the medical officer be instructed to make a further inquiry at Midsummer, 1897, as to " the extent to which by-laws or regulations dealing with houses let in lodgings are enforced in the " several sanitary districts of London with a view to the Council making a representation to the Local " Government Board under section 101 of the Public Health (London) Act, 1891, in the case of any " sanitary authority which is not by that time carrying out the provisions of section 94 of the Act. " (2) That a copy of this report and of the Council's resolution thereon be sent to each of the " London sanitary authorities." A further inquiry has accordingly been made and a further report has been prepared by the medical officer, a printed copy of which has been sent to each member of the Council. The report shows that in 31 districts the number of houses on the register ranges between 6 (in Plumstead) and 1,500 (in Kensington). In Bethnal-green, Lambeth, Lee, Paddington, Newington. Poplar, St. Saviour, Southwark, Stoke Newington, Battersea, and Chelsea, no houses were regulated at the time of the inquiry. In Lambeth the by-laws have only recently been confirmed. In Paddington an inspector has lately been appointed to deal with the subject. In some of the parishes of Lee, houses are mostly occupied by one 65 family. In Battersea a large number of houses had been entered in a register, but no action taken to make them subject to by-laws. In the other districts mentioned there is no evidence that the sanitary authorities will comply with the requirement of the Public Health Act. There are several districts where but a trifling number of houses have been registered and some others where better, though still insufficient, progress has been made, the inadequacy of the sanitary staff appearing in some of these instances to be an explanation of this laxity. In all cases but one in which by-laws have been made and confirmed under the Public Health Act, 400 cubic feet psr adult person are required in rooms occupied by day and by night, but in Clerken. well, the exception referred to, the amount is 350. This is to be regretted, and we propose to call the attention of the Local Government Board to the matter. In a few districts the rent of tenements, which excludes the houses from being subject to the by-laws, is so low as to militate against their usefulness. This is also a point to which we propose to direct the special attention of the Local Government Board. In view of the fact that the statutory requirement that the by-laws relating to houses let in lodgings shall be enforced is still so much neglected in many districts in London, we think the Council should now make a complaint to the Local Government Board, as provided for in section 101 of the Public Health (London) Act, 1891. The sanitary authority, with regard to which we think this course should in the first instance be taken, is that of Bethnal-green, as that authority do not seem to have attempted to take any action with regard to houses let in lodgings. We shall, if necessary, make recommendations with regard to other districts later. The section provides that "where a complaint is made by the County Council to the Local Govern" ment Board that a sanitary authority have made default in executing or enforcing any provisions " which it is their duty to execute or enforce of this Act, or of any by-law made in pursuance thereof, " the Local Government Board, if satisfied after due inquiry that the authority have been guilty of the " alleged default, and that the complaint cannot be remedied under the other provisions of this Act, " shall make an order limiting a time for the performance of the duty of such authority in the matter of " such complaint. If such duty is not performed by the time limited in the order, the order may be " enforced by writ of mandamus, or the Local Government Board may appoint the County Council to " perform such duty," and the expenses incurred may be recovered from the sanitary authority." We have given directions that the report of the medical officer, which contains detailed information as to the arrangements in each district, shall be printed and published, and we propose that copies shall be sent to each sanitary authority, together with a copy of our report and of the Council's resolution thereon. We accordingly recommend— (a) That complaint be made by the Council to the Local Government Board, pursuant to section 101 of the Public Health (London) Act, 1891, that the Vestry of Bethnal-green have made default in executing the provisions of section 94 of the Act with regard to the enforcement of by-laws relating to houses let in lodgings. (b) That copies of the medical officer's further report on this question, and of the Committee's report and the Council's resolution thereon, be sent to each of the London sanitary authorities. The reports of medical officers of health contain the following references to this subject— Paddington—The registration of houses was commenced about the middle of the year, an additional inspector being appointed temporarily for the work. By the end of the year 311 houses were visited for the purposes of registration, 168 demands for particulars issued, and 1,235 rooms measured up and their cubic contents calculated. At the end of the year 86 houses were on the register. " It was noticed in going through the second street selected for registration, that many families displaced from the first street had migrated to the second, some to make a further move on as the houses in the second street were registered." The report states that the work had gone on smoothly, and on the whole had co-operation of the house owners. Kensinqton—Regulations made under the Sanitary Acts of 1866 and 1874 were enforced in this district; by-laws under the Act of 1891 have more recently been drafted, but question was raised by the Local Government Board as to some of them, particularly the Board had expressed doubts as to the legality of a proposed by-law requiring the landlord of a registered house to give notice to the sanitary authority when intending to carry out the annual cleansing so as to enable the sanitary inspector to supervise the execution of the work. In October, 1897, the Sanitary Committee, on the recommendation of the medical officer of health advised the vestry to submit to the Local Government Board for approval a draft by-law requiring the landlord or keeper of a registered house let in furnished lodgings to cause the bedding and other articles in the rooms to be at all times maintained in a clean and wholesome condition and free from noxious insects. In respect to overcrowding, the vestry on the recommendation of the medical officer of health, applied to the Local Government Board for sanction to a by-law requiring the keeper of a registered house to report over-crowding. Hammersmith—During 1897, 216 houses were registered. The Public Health Committee decided not to instruct the inspectors to inspect registered houses once in each quarter. The medical officer of health states that he has no doubt that it will be found to be absolutely necessary to employ a separate inspector to carry out this work. Fulham Little has been done in this district, only 24 houses having as yet been registered. The medical officer of health continues to urge upon the vestry the appointment of a special inspector for this purpose. St. Georqe, Hanover-square—"There are 95 registered houses let in lodgings, they have been inspected and the regulations as to cleansing complied with." Westminster—" During the year the inspection of these houses has taken up a considerable amount of time and much good work has been done. In may cases the drainage has been entirely reconstructed, and additional w.c. accommodation provided for the lodgers in these houses. In two cases for failing to comply with the by-laws, proceedings were taken and fines amounting to £7 and 21s. costs were imposed. Several other houses have been registered during the year in the various wards of the district." Marylebone—1,266 inspections were made. Hampstead—The number of houses registered is 840. " Our experience in dealing with houses let in lodgings by means of by-laws is entirely favourable and on the whole a marked improvement is manifested in this class of house. St Pancras—The number of houses registered is 152. [9] 66 Islington—The medical officer of health regrets that there are only 393 houses on the register. Registration, he urges, protects the occupiers against the supineness of the owners in remedying sanitary defects, and also secures the latter against the carelessness and sometimes the misconduct of the occupiers. He is of opinion there should be power under by-law to compel persons who let their houses in tenements but who do not reside in them to appoint one of their tenants as caretaker. After referring to overcrowding, and the difficulty of the poor to find accommodation he writes " the state of affairs in Islington at the present moment points to the necessity of further houses being put on the register and to the appointment of an additional inspector." Hackney—Owing to sudden and exceptional demands being made upon the sanitary staff, the expectations of the medical officer of health as to the number of houses which would be registered at the end of 1897 have not been realised. The vestry has now agreed to appoint two additional inspectors. St. Giles—The number of houses on the register in this district is 575, the regulations "have been continuously employed with the most satisfactory results." Two owners were convicted of breach of regulations, the fines and costs amounted to £63 2s. 6d. and £56 2s. St. Martin-in-the-Fields—The sanitary inspector appointed permanently to inspect these houses, has regularly carried out this duty. Strand—The number of registered houses was increased by four during the year, while four have been closed. "Much good has been effected by raising the standard of cleanliness in many houses which, while not being insanitary in construction, were not originally built to accommodate more than one family, and even now, with fair use, need not become insanitary. The object of these by-laws is to do two things, to prevent overcrowding, and to make the persons living in the houses acquire cleanly habits." Writing of the effect of the by-laws in causing improvement in the habits of people, the medical officer of health says " to an extent the by-laws give the opportunity for this to be done, the weekly visit of the inspector, together with the advice he is able to offer, has an excellent effect especially when it is known that failure to adopt it may lead to an appearance in the police court." In only one case was it necessary to institute proceedings before a magistrate. The medical officer of health discusses the need for sanitary authorities making greater effort to educate the poor in matters affecting health, and expresses the opinion that the employment of women for this purpose would be useful. Holborn—" During the year closing orders were obtained for four of these houses. Eight houses were also closed voluntarily, and four of these were rebuilt. The number of these houses on the register at the end of last year was 29. As another sanitary inspector has been appointed, the number of these houses will probably be increased this year." Clerkenwell—" Towards the end of 1896 new by-laws for houses let in lodgings were introduced. Slow but steady progress has been made with the work of placing suitable houses on the register, the present number being 86. Originally 350 cubic feet were allowed for rooms used as dwelling rooms as well as sleeping apartments, this, however, has since been altered to 400 cubic feet, the alteration bringing us into line with all other districts." St. Luke—In discussing Dr. Young's report on the condition and sanitary administration of the district (see appendix Y.) the medical officer of health writes, " I consider it desirable that the by-laws for the registration of houses let in lodgings should be made practicable and be put into operation as soon as possible, because the class of houses to which it is desirable to apply them are of necessity subject to recurring nuisances of a nature which could be more expeditiously dealt with in the manner proposed than by any other which has hitherto been suggested." For this purpose he recommends the appointment of an additional sanitary inspector. City—The by-laws which were confirmed in 1896 are now in operation. A notice 'was served upon the owner of every house coming within the scope of the regulations. Shoreditch—There are now 114 houses on the register, 34 houses having been registered during the year. Bethnal-green—The medical officer of health gives account of the views of the Bethnal-green Vestry which had led them to decline to enforce the by-laws for houses let in lodgings. With the chief sanitary inspector he attended a meeting of the Council's Public Health Committee and expressed the views of his authority to the committee. Briefly stated, they were that the by-laws were harsh and oppressive, that they were impracticable, that magistrates would not convict, that an increase of the staff would be required, that the time taken up in the necessary inspections and the keeping of the register could be more profitably occupied, and that the by-laws are in no sense a remedy for overcrowding. He expresses favourable views as to the usefulness of the by-laws, and states that this opinion was supported by that of the chief sanitary inspector, who had had practical experience of their working in Chelsea. He thus sums up the advantages which may be expected if the by-laws are put in force— " (1) Increased facility for ensuring and maintaining the proper cleanliness of passages, staircases, rooms, and yards of tenement houses. (2) The improvement of the ventilation and lighting of the rooms of such houses. (3) The more early and certain detection of sanitary defects such as bad water suppy and choked drains, by means of regular periodical inspections. (4) The early isolation and removal of infectious cases. (5) The definition and detection of overcrowding and indecent occupation." St. George-in-the-East—The medical officer of health states that the sanitary committee of the vestry had under consideration the report which I presented to the Council's Public Health Committee on this subject. The number of houses on the register has now been increased to 56, and he points out that this includes, so far as he is aware, all the tenement houses in the parish which by reason of the rents come within the scope of the regulations. 67 He says, " I think on the whole, registration has been a success in all the cases which, until now have come under the operation of the by-laws ; the condition of the houses comparing most favourably with what obtained previous to registration. Should the committee recommend an extension of the number, it would certainly bring about an enforced cleanliness, and an improved general sanitary condition of the houses so registered, entailing also, should the number be considerably increased, the appointment of an additional inspector, who, of course, would have to deal with the difficult question of overcrowding by night inspection, which should certainly not be made except in cases where there is very good reason to suspect the evil to exist.'' St. George, Southwark—The number of houses on the register is 399. " In this parish, houses built on the so-called 'model' or block system, and accommodating upwards of 12,800 inmates, at present escape the salutary provisions of the new by-laws. These dwellings, often inhabited by the uneducated and unruly poor, are for the most part badly supervised." Newington—There were no registered houses in this district in 1897, although the medical officer of health has on many occasions submitted a list of houses which he was of opinion should be dealt with. "Many meetings have been held, and owners have over and over again been requested to furnish the particulars referred to in the regulations, and many of the owners have attended before the sub-committee to state their objections, yet still nothing definite in the way of registration has taken place." He combats the view that houses of the better class will be registered, and points out that " it would only be the debased property always more or less out of repair that would be registered," and that night visits would be infrequent. He believes " that this alarm about houses being placed under the regulations for houses let in lodgings would entirely disappear if a reasonable quantity of houses were operated upon, and that within twelve months, as far as objections are concerned, the whole matter would have been forgotten." Since writing his report, two houses have been put upon the register. St. Olave—The number of houses registered during the year was 18. Bermondsey—There were 300 houses on the register, none were registered during 1897. A lodger was fined for allowing overcrowding, and a landlord for not keeping a house in a cleanly and wholesome condition. Rotherhithe—Nine houses were registered during the year. Lambeth—By-laws were confirmed during 1871, and the vestry have selected for registration 93 houses, containing 566 rooms, in which are housed 282 families, consisting of 992 persons, of whom 682 are over 10 years of age. The houses selected are those which cannot be otherwise satisfactorily inspected and supervised, and where there is reason to believe that overcrowding and other insanitary conditions exist to such an extent as to be a nuisance and a danger to health. He writes that the importance of this work cannot be over estimated, especially in the inner districts, and expresses the hope that the vestry will appoint an additional sanitary inspector for the purpose. Wandsworth—(Clapham)—The medical officer of health states that " the one street in which the by-laws have been enforced is not in a much better condition than was formerly the case. The important element is undoubtedly frequent inspection, for landlords who cater for the class of tenants I am referring to will not take the trouble to do the more frequent cleansing work that is necessary without very constant looking up."He says" there are many other nuisances recurring, 'such as defective waterclosets, dilapidated walls and staircases, leaky roofs, &c., that cannot be dealt with under the by-laws but require the service of another set of notices, so that the procedure is much more complicated," and that where a tenant sub-lets, it is he who has to be proceeded against, " manifestly a hopeless business." Dr. Hamer, reporting on the registered houses in this district, writes, " the condition of the registered houses in this district suggests that full advantage is not taken of the powers which by-laws afford even in the case of the single street to which they have been made to apply." (Putney and Roehampton)—The medical officer of health is of opinion that in these parishes the most insanitary houses are not those which would be subject to the by-laws, and that the labour involved in putting in force the by-laws would be very great. (Streatham)—In regretting the falling off of house to house inspection, owing apparently to insufficiency of the staff, the medical officer of health says that this inspection would enable the local committee to determine where, with advantage, the by-laws relating to houses let in lodgings might advisedly be put in force. (Wandsworth)—There are 13 houses on the register, and these will be added to as occasion requires. Camberwell—The medical officer of health writes, " As regards the good effect of the by-laws, I will only ask the members of the vestry to look at some of the houses in Hollington-street, there will be no need for them to enquire which are registered and which are not, for the premises speak for themselves clearly enough." He says that further need has shown itself of raising the rent limit, if those houses, which it is most desirable to register, are not to escape the by-laws, and that 15s. per week is not " too great a limit to place on these houses so far as regards unfurnished rooms." In connection with proceedings before a magistrate, difficulty arose as to the definition of landlord, the defendants, a firm of house agents, having successfully contended that they were not the landlords, the house being let to one man, who himself sub-lets. Greenwich—During the year eight houses were registered. Woolwich—The number of houses registered in this district is 65. Lee (Charlton)—The medical officer of health thinks the registration of houses unnecessary in this district. 68 Plumstead—Proposal to register 12 houses in this district, led in respect of 11 to the house being occupied by one family, and the tenants being turned out. Common Lodging-houses. The year 1897 was the fourth year during which common lodging-houses in the county of London have been subject to regulation by the Council. The number of houses on the register at the end of the year was 581, providing accommodation for 28,718 persons. Ten of these houses were registered for the first time in 1897. In the supervision of these houses, the Council's inspectors made 26,620 inspections, of which number, 26,121 visits were made to registered, and 4-99 visits were made to unregistered houses. In 261 cases preliminary notices were served to compel the keepers to comply with various requirements, and statutory notices were served in 2 cases. Proceedings before the magistrate were instituted in 31 cases, and in 30 cases fines were inflicted amounting in the aggregate to £82 12s., and £9 19s. costs. In the remaining case the summons was withdrawn upon the keeper paying £1 Is. costs. The number of cases of infectious disease reported in these houses was as follows :—Diphtheria, 7 ; enteric fever, 10; erysipelas, 19 ; German measles, 1 ; scarlet fever, 8; small pox, 3 ; or 48 in all. The number of deaths from various causes reported in these houses was 59. The following table shows the number of common-lodging houses, the authorised number of lodgers in such houses at the end of 1897, and the number of houses registered in each sanitary district during the year— Common Lodging-houses. Sanitary district. Number of common lodging-houses. Authorised number of lodgers. Number of houses registered in 1897. Battersea 6 227 — Bermondsey 4 226 — Bethnal-green 13 368 1 Camberwell 10 613 1 Chelsea 18 875 — Clerkenwell 5 249 — Fulham 1 51 — Greenwich 17 775 1 Hackney 10 386 — Hammersmith 8 533 — Hampstead 1 35 — Holborn 11 611 — Islington 47 1,279 3 Kensington 32 950 — Lambeth 12 705 — Lee 1 10 — Lewisham 9 109 — Limehouse 22 823 — Marylebone 22 894 — Mile-end 6 220 — Newington 13 1,537 — Paddington 3 66 — Poplar 12 855 — Rotherhithe 3 116 — St. George-in-the-East 16 455 — St. George, Southwark 31 1,540 — St. Giles 32 1,822 — St. James 1 88 — St. Luke 4 240 — St. Martin 4 170 — St. Olave 1 533 — St. Pancras 26 996 1 St. Saviour's, Southwark 18 889 — Shoreditch 15 772 2 Stoke Newington 1 41 — Strand 11 623 — Wandsworth 13 281 — Westminster 21 1,400 — Whitechapel 64 5,473 — Woolwich 37 882 1 Total 581 28,718 10 With a view to ascertaining the number of persons resident in common-lodging houses at the time of the Queen's Jubilee, I caused inquiry to be made at every lodging-house in the county as to the number of persons sleeping in the house on the nights of the 21st and 23rd June, 1897. The results are shown in the following table. It will be seen that 20,992 and 20,533 slept in those houses on these nights respectively. 69 Sanitary District. No. of Houses. June 21st, 1897. June 23rd, 1897. No. of persons over 16 years of age. No. of persons under 16 years of age. Total. No. of persons over 16 years of age. No. of persons under 16 year* of age. Total. Male. Female. Male. Female. Battersea 6 94 10 9 106 90 12 4 106 Bermondsey 4 190 ... ... 190 174 ... ... 174 Bethnal-green 14 302 ... ... 302 309 ... ... 309 Camberwell 9 325 2 4 331 326 ... 4 330 Chelsea 18 652 53 7 712 608 60 1 669 Clerkenwell 6 190 ... ... 190 204 ... ... 204 Fulham 3 57 ... ... 57 55 ... ... 55 Greenwich 18 599 ... 9 608 543 ... 6 549 Hackney 10 234 ... ... 234 266 ... ... 266 Hammersmith 8 348 12 6 366 338 11 ... 349 Hampstead 1 24 ... ... 24 25 ... ... 25 Holborn 12 350 66 ... 416 367 73 ... 440 Islington 45 890 77 21 988 878 83 19 980 Kensington 32 541 183 7 731 520 148 ... 663 Lambeth 14 393 ... ... 393 400 ... ... 400 Lee 1 10 ... ... 10 10 ... ... 10 Lewisham 10 93 ... ... 93 81 ... ... 81 Limehouse 22 565 ... 3 568 572 ... 10 582 Marylebone 22 748 ... ... 748 774 ... ... 774 Mile-end Old-town 6 186 ... ... 186 185 ... ... 185 Newington 13 832 ... ... 832 721 ... ... 721 Paddington 3 24 20 ... 44 23 17 ... 40 Plumstead ... ... ... ... ... ... ... ... ... Poplar 12 405 ... 2 407 379 ... 4 383 Rotherhithe 3 90 ... ... 90 92 ... ... 92 St. George, Hanover-square ... ... ... ... ... ... ... ... ... St. George-in-the-East 18 297 ... ... 297 296 ... ... 296 St. George, Southwark 32 673 267 8 948 613 233 4 850 St. Giles 32 1,312 214 4 1,530 1,329 208 2 1,539 St. James 1 74 ... ... 74 70 ... ... 70 St. Luke 4 181 25 3 209 187 16 3 206 St. Martin 4 150 ... ... 150 149 ... ... 149 St. Olave 1 271 ... ... 271 287 ... ... 287 St. Pancras 23 661 75 3 739 661 85 1 747 St. Saviour 11 713 ... ... 713 732 ... ... 732 Shoreditch 15 582 ... ... 582 596 ... ... 596 Stoke Newington 1 38 ... ... 38 35 ... ... 35 Strand 11 419 96 1 516 410 96 1 507 Wandsworth 13 151 34 11 196 148 40 11 199 Westminster 21 1,046 96 8 1,150 1,000 95 6 1,101 Whitechapel 64 3,830 424 18 4,272 3,772 416 9 4,197 Woolwich 38 543 116 22 681 510 100 20 630 Total 581 19,083 1,770 139 20,992 18,735 1,693 105 20,533 In 1897 I communicated with medical officers of health in London with a view to learning whether their authorities would give opportunity to the keepers of common lodging-houses to free their bedding from vermin by using the apparatus the authorities have provided for disinfection. In many instances a favourable reply was received. It is satisfactory to observe that there has been a marked improvement in the condition of common lodging-houses in London, especially in respect of cleanliness. During 1897 I personally inspected every common lodging-house in which women are received (see appendix III.) as well as many which are occupied by men. The condition of common lodging-houses in London is in marked contrast with that of much tenemented property. The weekly visits of the Council's inspectors and the steady enforcement of regulations ensures for those inhabiting these houses conditions which are largely wanting in very many houses let in lodgings, but which could be ensured and indeed are ensured whenever sanitary authorities seriously address themselves to this duty. The experience gained during the few years the Council has been responsible for the administration of common lodging-houses points, however, to the need of greater power of control in one respect. Regulations may be complied with, but a keeper may himself fail to exercise sufficient control over his lodgers to ensure their orderly conduct. The frequent practice of leaving the house in charge of a deputy, the keeper himself not being resident on the premises, makes this power the more necessary. It would be provided if such houses were required to be annually licensed and if every keeper knew that his right to keep a common lodging-house in London were dependent on his managing the house and its inmates so that they shall not be a nuisance to the neighbourhood. Such power is given to local authorities in Scotland by the Public Health (Scotland) Act of 1897. The Vestry of St. Margaret and St. John, Westminster, during the year addressed a communication to other sanitary authorities urging the desirability of representations being made to the Home 70 Secretary with a view to obtaining the consolidation and amendment of the law relating to common lodging-houses, the making such houses subject to annual licence by the sanitary authorities, and the transference to these authorities of the administration of the Common Lodging Houses Acts. In only two annual reports is there information as to the action taken by the sanitary authorities, and these reports show that each of these authorities agreed with the Vestry of Westminster. The extreme importance, and indeed necessity, of maintaining an efficient administration in connection with common lodging-houses will not be denied, it might therefore be expected that the desire of sanitary authorities to undertake this duty would stand in some proportion to their willingness to perform a somewhat similar duty in the regulation of houses let in lodgings. It is, however, interesting to observe that concerning one of the authorities mentioned, Dr. Hamer points out that the main difficulty in enforcing the regulations for houses let in lodgings has been the inadequacy of the staff of sanitary inspectors to carry out the duty ; concerning the other authority, Dr. Hamer writes, that no machinery for the purpose of keeping these houses under supervision has as yet been provided, and under these circumstances the benefit which would result from administration of the by-laws is not being secured. costoms and inland revenue acts, 1890 and 1891. The medical officers of health of the following districts state that certificates under these Acts were granted during the year in their districts— Fulham—Certificates for exemption from inhabited house duty were granted in respect of 22, and refused in respect of 63 houses. Hackney—The medical officer of health inspected 316 tenement houses on 15 applications made for certificates. In a large number of cases the dwellings were not in such a condition as to justify the certificate being given unless considerable repairs were done. These in all cases were completed, according to notice, and the certificate furnished to the owner. The medical officer of health, however, considers such certificate should not be made to last for five years, the period of the assessment, but that a certificate should be obtained every year when it relates to tenement property. St. Giles—Certificates were granted to the Peabody-buildings, Incorporated Society for Improving the Condition of the Working Classes, Central London Dwellings Company, and London County Council, in respect of various buildings within the district. Holborn—Alter completion of the sanitary work required certificates were granted in respect of 434 tenements. Shoreditcli—Certificates were applied for with respect to 184 sets of buildings, but only 62 were granted, the others not conforming to the vestry's requirements. Bethnal-green—Applications for certificates were received for 45 houses or 400 tenements; of these 25 were granted and 20 refused. Three blocks of buildings owned by the London County Council did not comply with the requirements of the medical officer of health as to the sufficiency of sinks and water-taps in the scullery. Additions were made in these respects, and in March, 1898, he was able to grant the necessary certificates. Lambeth—In the report on this district the medical officer of health sets out the requirements insisted on, and describes the condition of the building which he thinks should exist before he gives a certificate. He received applications in connection with 2,270 tenements, of which he refused 782, unconditionally granted 268, and conditionally granted 1,220, if certain sanitary improvements and alterations were carried out within a reasonable time—six to twelve months. Battersea— During the year 43 applications were made, certificates were granted in 27 cases, and 16 were refused after inspection. Underground Rooms. In the following districts, underground rooms illegally occupied were dealt with—Chelsea, 3; St. George, Hanover-square, 3; Westminster, 8 ; St. James, Westminster, 11 ; Marylebone, 140 ;St. Pancras, 6 ; St. Giles, 12; Strand, 4 ; Whitechapel, 18; St. George-in-the-East, 33; Limehouse, 4; Mile-end Old-town, 1 ; St. George, Southwark, 5; Battersea; 42 ; Greenwich, 1 ; Deptford, 3. Factories and Workshops. Information as to the proceedings of sanitary authorities in respect to factories and workshops is given in many of the annual reports of medical officers of health. There is much evidence in these reports that progress is being made, and that improvements are being effected in numerous workshops, but as yet only a beginning is being made in many districts. It is also stated in several reports that the work is not meeting with opposition, indeed the willingness of the occupiers of workshops to cooperate with the officers of the sanitary authorities is acknowledged. In several reports, however, mention is made of a difficulty with which sanitary authorities have to contend in dealing with conditions, especially overcrowding, which require remedy. The sanitary authority can only, it is said, proceed under the Public Health (London) Act, and hence the occupier is only liable to penalty for non-compliance with a notice which must in the first instance be served; the result is that although there is compliance with a notice to abate overcrowding, the condition recurs, and the time and efforts of the officers of the authority are less profitably employed than they would be if penalty at once followed the offence. The experience of the last few years shows, moreover, the necessity of the appointment of sanitary inspectors who shall devote the whole of their time to duties in connection with factories and workshops. In districts where this has been done the results compare very favourably with those of other districts in which the workshop inspectors have to devote their attention to other branches of work. It is not stated whether any night inspections have been made. 71 Paddington—Notices of 7 new workshops were received from the district inspectors of factories of the Home Department. " When a workroom is first inspected it is measured, a report on it entered in a register, and a card issued to the proprietor indicating how many persons may be employed in it, the card to be hung in the room." The number of rooms so dealt with during the year was 42. The district inspector of factories forwarded five complaints of insanitary conditions in workrooms, all of which were remedied by the authority. The total number of inspections was 158. The medical officer of health expresses the opinion that the seven new workrooms probably do not represent all the rooms opened in the course of the year, and it is desirable that more inspections should be made by the vestry's officials. It has been found impracticable to do this owing to other demands on the staff. Kensington—The medical officer of health reports that whereas the vestry in 1893 employed two ladies as inspectors of workshops, workplaces, and laundries where women are employed, they now only employ one; he states with respect to workshops where only men are employed "nothing has been done to give effect to legislation in any way comparable with the work carried out by the female inspectors of workplaces where women are employed. These establishments should be taken in hand, but it is impossible with the present limited and reduced staff of sanitary inspectors. We do not so much as know at present the localities of any large proportion of the workshops, no doubt, however, their whereabouts could be ascertained from H.M. Superintending Inspector of Workshops, were it at any time put in my power to take up this branch of sanitary administration." At the beginning of the year 625 workshops, workplaces, and laundries where women are employed, were on the register, during the year 81 were placed on the register and 43 were removed. Information is given as to the improvement effected in the premises under inspection. Hammersmith—During the year 218 notices were served by the vestry's factory inspector, and as many complied with. Chelsea—A table shows that 357 workshops were inspected. St. George, Hanover-square—An inspection was made of all business premises in certain streets and of others in various parts of the district as the result of special complaints. The number inspected was 92, these premises contained 164 workrooms, 22 of which were overcrowded, and 30 in a dirty and unwholesome condition. The sanitary arrangements of 58 premises were found defective, the drains of 29 having to be reconstructed. Cards are exhibited in each room showing the number of persons who may occupy it. Westminster—The workshops have been inspected and most of the arrangements were found to be satisfactory. St. James, Westminster—A table shows that 56 workshops were whitewashed and cleansed, and in two overcrowding was abated. Marylebone—There are 1,095 workshops on the register, in which are contained the address of the employer, the dimensions of the rooms, the manner of warming, lighting, and ventilation, cubic capacity, and the legal limit of occupation. The present entries deal with about 5,976 workpeople, 4,465 being females engaged in either dressmaking or matters closely allied to dressmaking. As many as 256 workshops are lighted by electricity, 91 by petroleum lamps, the remainder by gas. llampstead—Information is given as to the nature of the business carried on in 238 premises. All have been inspected, and orders made where necessary. St. Pancras—The medical officer of health, in discussing the amount of water-closet accommodation necessary in factories and workshops, states that in St. Pancras one water-closet for every 20 persons has been regarded as the standard provision by the vestry's officers. Islington—There were 2,741 inspections, and 3,979 re-inspections of workshops, and details are given of the improvements effected in 2,318 workrooms which were inspected. The vestry employ a male and female inspector of workshops, whose reports are included in that of the medical officer of health, who states that "it is a very significant fact, and one which speaks louder in praise of their work than any comment that can be made on it, that hardly a murmur is now heard from workpeople as to the conditions under which they are compelled to labour, whereas a few years ago complaints were very numerous." Stoke Newington—The factories and workshops have been inspected during the year, and the list of out-workers kept up to date. Hackney—The number of workshops registered during 1897 was 153, being an increase of 50 on the number of the previous year. There were 260 defects found to require remedy. A female inspector was appointed. St. Giles—The number of premises periodically inspected was 118, and the necessary measures were taken for removing unsatisfactory conditions. St. Martin-in-the-Fields—The factories and workshops were duly inspected. Strand—In this district there are about 600 places where persons are employed in some form of mechanical labour. The number of inspections was 478, and of visits, 1,295; in 262 instances the conditions were improved. Holborn—There is a largely increasing number of factories and workshops in the district; as many as 1,015 workrooms were inspected in that part of the district east of the Grays-inn-road. Clerkenwell—In his report to the Council on this district, Dr. Young pointed out the need of a register containing a list of, and setting out the conditions of workshops. The medical officer of health reports that this request has now been complied with, a register has been established, and inspection and measurement of workshops have been effected in a fair number of cases. Cards showing the number of workpeople legally allowed to be employed in each workshop have been provided. St. Luke—A systematic inspection is being carried on and a register compiled. There vere 269 inspections of workshops, and 180 unsatisfactory conditions remedied. City—The Home Office inspector notified 104 premises, 51 about to be occupied as workshops. Improvements were effected in 34 premises. 72 Shoreditch—A large amount of sanitary work in connection with workshops and work places has been carried out. The Home Office inspector brought to the notice of the vestry 43 workshops and factories in which there were insanitary conditions, the necessary steps were taken in each case. Referring to requirements in different districts as to the amount of water-closet accommodation which should be provided, the medical officer of health states that in 18 districts one water-closet is required for 20 male persons employed; in four districts the proportion is 1 to 12; in three districts, 1 to 25; in three other districts 1 to 18, 1 to 16, 1 to 15 respectively; and in four districts there are no fixed proportions. In factories and workshops where females are employed, in 17 districts the proportion is one water-closet to every 20 persons; in six districts it was 1 to 12; in two districts, 1 to 25; in three districts, 1 to 18, 1 to 16, and 1 to 15 respectively; and in four districts there were no proportions. In Shoreditch the standard is one water-closet to 15 males, and 1 to 12 females. Bethnal-green—The vestry received notice from the Home Office inspector of all new workshops opened in the district, "but as we keep no trade register and make no periodical inspections of these places, the notices have not been utilised." The vestry also received from the same source 57 complaints of variou3 insanitary conditions, which with the exception of two were remedied. St. George-in-the-East—It was resolved that a register should be provided for each district of the parish, and that the several inspectors be directed to enter in such register particulars of all workshops. Whitechapel—A tabular statement shows that improvements were effected in 195 workshops. Lirnehovse—A tabular statement shows that there were 194 " factory inspections," and 28 nuisances abated. Mile-end Old-town—The workshops, 424 in number, have been kept under supervision. Information as to sanitary defects was received from the Home Office inspector. The medical officer of health writes, " the frequent inspection of the Home Office inspectors together with our periodical visits, have effected a marked improvement in the conditions and surroundings of the work-people in our district during the last few years." Poplar—A tabular statement shows that sanitary defects were remedied in 44 workshops. St. Saviour, Southwark—In this district improvements were effected in 44 workshops. St. George, Southwarl;—There are 446 workshops now on the register, of which 43 have been added during the past year; 543 visits have been made and 47 notices served in connection therewith. The medical officer of health continues to urge upon the vestry the necessity of appointing a special inspector to carry out the provisions of the Act. St. Olave—A tabular statement shows that improvements were effected in 20 work places. Bermondsey—There are 582 factories, workshops, or work places on the register; 205 of these were inspected during the year, and improvements effected in about half of them. Botherhithe—In this district 14 workshops and workplaces were inspected, and trade nuisances in two cases were abated. Lambeth—The medical officer of health gives a detailed account of the proceedings of the authority, and says that up to the time of writing his report 500 workshops containing 863 workrooms have been inspected, the number of persons employed in these workshops at the time of inspection being 1,331 males and 1,689 females ; in 187 workshops females only were employed. In 11 of the 500 workshops the ventilation was unsatisfactory, in 146 the workrooms were dirty, in 104 the drains were defective, in 19 the workrooms were damp, in 36 out of the 863 work-rooms overcrowding was found to exist, in a few instances it appears that separate accommodation for the two sexes was needed. Since the inspection 20 workshops have been closed. The medical officer of health recommends the appointment of a female sanitary inspector for the purpose of workshop inspection. Battersea—"Sanitary conveniences were provided or improvements effected in factories or workshops in 40 cases." Wandsworth:(Clapham)—The number of workshops on the register was 226 ; they were regularly inspected, and 28 were found to need cleansing and additional sanitary accommodation. (Putney) All the workshops were inspected during the year and with five exceptions were found to be satisfactory ; notices were served in these cases and the necessary work done. ( Wandsworth)—Of the 99 factories and workshops inspected during the year, only three were in an unsatisfactory condition, and in these improvements were effected. Two notices were received during the year from the Home Office inspector, and these were at once attended to and the defects remedied. Greenivich—Workshops, factories, and laundries have during the year received constant supervision, and many improvements have been effected. Steps were taken for the prevention of overcrowding, the enforcement of cleanliness, and the provision of proper sanitary accommodation. Camlerwell—A tabular statement shows that 155 workshops and 133 laundries were inspected. Lewisham—During the year 223 workshops have been regularly inspected. Plumstead—The medical officer of health states that he inspected 17 workshops. " In several cases there was not more than one employe, but in others overcrowding and other insanitary conditions were found, and have since been remedied." The inspection of bakehouses. The reports of the medical officers of health (with the exception of one) show that the bakehouses in the several districts have been inspected during the year. In one report it is stated that a biennial inspection is insufficient for the purpose of maintaining proper conditions of cleanliness. Information as to the number of bakehouses in their districts is afforded by many of the reports. In Paddington there were 148, Kensington 138, Hammersmith 61, Fulham 82, Chelsea 57, St. George, Hanover-square, 46, St. James, Westminster, 27, Marylebone 110, Hampstead 39, St. Pancras 187, St. Giles 23, Strand 27, Holborn 23, St. Luke 35, City 43, Shoreditch 88, Bethnal-green 102, St. 73 George-in-the-East 27, Limehouse 88, Mile-end Old-town 83, St. George, Southwark, 52, Newington 75, St. Olave 7, Bermondsey 81, Lambeth 247, Battersea 104, Clapham 46, Streatham 39, Wandsworth 40, Lewisham 92, Woolwich 41, Plumstead 38. The number of underground bakehouses is stated to be as follows—Hammersmith 40, Fulham 70, Chelsea 47, St. James, Westminster, 25, St. Giles 18, St. George-in-the-East 17, St. George, Southwark, 16, St. Olave 5, Plumstead 18. The medical officer of health of St. Pancras gives the distance of the floor of the bakehouse above or below the ground level; it is thus seen that the floors of 146 are 6 feet or more below the ground level. In Shoreditch there are 57 bakehouses wholly and six partly underground, in Lambeth there are 125 wholly and 22 partly underground. The medical officer of health of Kensington again comments on the fact that, according to magisterial rulings, the disuse of an underground bakehouse subsequent to the 1st January, 1896, by the premises becoming empty, does not prevent the use of them for the purposes of a bakehouse, however unsuitable in character they may be, upon the premises being re-occupied. Unsound Food. Food was condemned as unfit for human consumption in a number of the districts. It usually consisted of fish, fruit, vegetables, eggs and poultry. Reference to condemnation or seizures of food of this kind is found in reports relating to Chelsea, Marylebone, Hampstead, St. Pancras, Islington, Hackney, St. Giles, Strand, Bethnal-green, Whitechapel, St. George-in-the-East, Limehouse, Poplar, St. Saviour, Southwark, St. George, Southwark, Newington, St. Olave, Bermondsey, Lambeth, Battersea, Wandsworth, Greenwich, Westminster, St. Luke, City, Shoreditch and Mile-end Old-town. The medical officer of health of the City states, 175,251 tons of fish were delivered at Billingsgate. and 959 tons, or 0.5 per cent., were condemned by the "meters" at the expense of the Fishmongers' Company. In Mile-end Old-town seizures were made of 1,645 eggs intended for use in the making of biscuits. A prosecution followed and the defendant was sentenced to 21 days' hard labour. A number of tins of meat were also seized in this district. Tinned meat weighing 4¼ cwt. was condemned in St. Olave. The largest amount of meat condemned in any district was in the City. The medical officer of health of that district states that in the Central Meat Markets, Smithfield, 768 tons of putrid meat, 102 tons of diseased meat, 45 tons of meat unsound from accident or causes other than the foregoing, and 3 tons of offal, or 918 tons in all were seized. In Holborn, where the premises of a number of meat salesmen are situated, 1,881 stone 2 lbs. of diseased meat, and 2,331 stone of decomposed meat, or 4,212 stone 2 lbs. in all, offal excluded, were seized. In the remaining districts the amount of meat seized was as follows— in Marylebone, f cwt. were seized ; in Hackney, 1½ cwt.; in St. George, Southwark, about 3 cwt. of pork, beef, and mutton, and 8 ox tails; in Lambeth, 19 pieces of meat; in Greenwich, the carcase of a pig; in Whitechapel, 2 sheep, 1½ tons of bullocks' heads, and 1½ cwt. of sausage-meat; in Shoreditch, 75½ stone of mutton, 3 breasts of mutton, 14 lbs. of mutton cuttings, 8 lbs. of beef, 24 lbs. of mixed cuttings ; in St. Luke, 17 lbs. of beef, 204 lbs. of pork, 7 lbs. of liver, 30 lbs. of tripe ; in Westminster, 2,717 lbs. of mutton, 1,249 lbs. of beef, 154 lbs. of lamb, and 1 barrel of pigs' kidneys ; in Fulham, a box of loins of pork ; in St. Olave, 2 cwt. 2 quarters 20 lbs. of pickled brisket of beef, and 1 cwt. 3 quarters 4 lbs. of pickled tongues ; in Islington, on one occasion meat was seized; in Woolwich, one carcase of beef was seized, to which reference is thus made by the medical officer of the City— Two pieces of beef sent from Woolwich were seized at the Central Market. This place being within the Metropolitan Police area, the usual plan of investigation through the local police could not be adopted, and your officers went to Woolwich to serve the notice of seizure and make inquiries. The owner of the beef kept a butcher's shop in a quiet street, and on the inspectors calling there they saw another badly-diseased carcase of beef hanging in the shop, and at once informed the local sanitary authority, whose officers seized the meat. The owner was summoned at the Justice Room, Guildhall, and sentenced by Alderman Samuel Green to three months' hard labour without the option of a fine. On the next day the defendant was summoned at Woolwich police court, where he could not appear, being in prison; the case was heard in his absence, and he was fined 30s. The smallness of the amount of unsound meat seized in London districts is no doubt due to the absence of proper opportunity for its inspection at the time of killing. In Holborn, the meat seized in 1897 was only about a third of the amount seized in the preceding year; abundant opportunities, however, still exist for the supply of unwholesome meat in London, although the supply of this meat to the Holborn market is decreasing. It is satisfactory to note that magistrates are inflicting considerable penalties when persons are convicted of selling unsound meat. The medical officer of health of Holborn states that one of the meat salesmen by whom large quantities of diseased meat used to be deposited for sale was sent to prison for four months with hard labour and without the option of a fine. In several other cases the defendants were imprisoned. In St. Luke, a defendant was fined £20 ; in Marylebone, £7 7s. In the City, convictions were obtained in 16 instances, in one case the defendant was sentenced to three months imprisonment with hard labour without the option of a fine, in the other 15, fines amounting to £335, exclusive of costs, were inflicted; the defendants, however, in three instances, accepted the alternative of imprisonment, which reduces the amount of fines recovered to £205. An interesting account of meat poisoning is contained in the report of the medical officer of health of Marylebone for the month of March. Four persons had on the 25th March partaken of boiled pork and fowl. The following morning three were attacked with choleraic symptoms, the fourth being attacked in the afternoon. The pork was analysed by Gautier's process, and a crystalline substance, not present in normal pork, was separated. The quantity was very small, and owing to this circumstance it could only be ascertained that this substance was alkaline in reaction, that it gave fine crystals when united with hydrochloric acid, and gave precipitates with the ordinary alkaloidal reagents except the chlorides of gold or platinum. [ 10] 74 Sewage-contaminated oysters and other shell-fish. The subject of sewage-contaminated oysters was under the consideration of the Council in connection with a letter received from the town clerk of Brighton, asking the Council to affix its seal to a memorial to the Local Government Board, praying for legislation for the purpose of minimising the dangers to which the public are exposed through the consumption of sewage-contaminated oysters and other shell-fish. The following report of the Public Health Committee, presented to the Council, was adopted on 27th July, 1897— We have had under consideration a letter from the town clerk of Brighton, asking the Council to affix its seal to a memorial to the Local Government Board, praying for legislation for the purpose of minimising the dangers to which the public are at the present time exposed through the consumption of sewage-contaminated oysters and other shell-fish. The memorial, which has been sealed by the Corporation of Brighton and 16 other corporations, refers to the evidence recently adduced as to the dissemination of cholera and enteric fever by means of oysters contaminated by sewage. It suggests that by legislation local authorities Bhould be empowered to exclude from their districts shell-fish from any pond, river, or place proved to the local authority to be contaminated by sewage, and the consumption of which shell-fish is proved to the satisfaction of the local authority to have been or to be likely to be the cause of serious illness within the district. It also suggests that the Local Government Board should be constituted a court of appeal, and that that Board should, upon the representation of a local authority, be empowered to order the closing of any oyster bed or pond or any shell-fish laying. It concludes by asking that the Board will cause to be introduced into Parliament in the present session a bill dealing with the subject of the culture of oysters and other shell-fish in the manner suggested in the memorial or in some other manner as the Board may deem fit. In view of the fact that medical officers of health in London have stated that they have grounds for suspecting that oysters have been the cause of enteric fever, we think the Council would do well to support the application of the Brighton Corporation, but without suggesting the particular lines which such legislation should follow. The question has been the subject of careful and detailed inquiry by Dr. Bulstrode on behalf of the Local Government Board, who have therefore all the facts connected therewith before them. We recommend— That a letter be addressed to the Local Government Board, stating that the Council concurs in the wish of the Brighton and other corporations that the Local Government Board would introduce a bill for the protection cf the public against the evils described in Dr. Bulstrode's report; and that the town clerk of Brighton be informed of the course taken. The town clerk subsequently wrote to say that the memorial had been adopted by 27 of the 33great towns invited to join in the application, and that the President of the Local Government Board had agreed to receive a deputation representing the memorialists. The deputation was received by Mr. Chaplin on March 30th, 1898. Several members of the deputation having stated their views, Dr. Forman, the chairman of the committee, expressed the willingness of the Council to accept any duties the Local Government Board might desire it to undertake for dealing with this evil. Mr. Chaplin stated that he recognised the importance of the subject, and sympathised generally with the views of the deputation. He said there could be no doubt as to the facts, but he had not been aware, before listening to the deputation, of the magnitude of the evil. He considered that the time had arrived for legislative action, and he had been engaged for some time on the measures necessary and appropriate in the circumstances. As to the dangers which might arise from the sale of contaminated shell-fish other than oysters he had not yet sufficient information, but with regard to oysters he hoped it would be possible for him at no distant time to take action that would be satisfactory. Disinfection. Since writing my last report several sanitary authorities have provided improved apparatus, in which steam will be employed. At present the only district in which dry heat is depended on is St. Saviour, Southwark. In this district the sanitary authority long ago decided to obtain a new apparatus, but no further action appears to have been taken. Several authorities still depend upon the services of a contractor, but in each case steam is used; these districts are: Kensington, Fulham, St. Martin-in-the-Felds, Holborn, Rotherhithe, Battersea, and Wandsworth. In Paddington and Hammersmith new steam disinfecting apparatus was in course of erection and is now completed. The Vestry of Fulham has decided to provide a disinfecting station, and it was expected the work would be shortly commenced. The Vestry of Stoke Newington makes use of the Islington apparatus; the disinfector of the London Hospital is used for the purposes of St. George-in-the-East, and the Plumstead apparatus for the purposes of the Eltham and Kidbrook parishes of the Lee district. The Holborn District Board were arranging with the Clerkenwell Vestry for the use of the Clerkenwell disinfector. The medical officer of health of Kensington reports that in spite of all his efforts the sanitary committee decided " that no variation be made in the arrangements at present in force," and no further action has been taken in the matter, although a letter was received from the Council in 1897, enquiring whether they would be "able to provide a steam disinfector and dispense with the employment of a contractor." Although steam is used in the disinfector in Mile-end Old-town, it is not considered by the medical officer of health to be a satisfactory apparatus, and he reports that he has made many efforts to induce the vestry to provide one suitable to the requirements of the district; his present sanitary committee are also aiding him in this matter, and will shortly again bring the question before the Board. In several reports it is stated that the work done by the disinfectors was entirely satisfactory. In tho majority of the reports, mention is made of the number of rooms and articles disinfected. In some districts experiments have been made with a view to testing the efficiency of various chemical disinfectants. The medical officer of health of Paddington gives a detailed account of the method adopted in that district for the disinfection of rooms, and as a result of careful inquiry concerning the appearance of secondary cases in invaded houses, he comes to the conclusion that in about three per 75 cent, there was reason to think that some failure in the disinfection had taken place. Sulphur di-oxide is generally used in London for the disinfection of rooms, but occasionally formalin has been used tentatively. Provision fok Shelter during Disinfection. The extent of use of shelters is referred to in the reports of some of the medical officers of health of districts in which such shelters have been provided. In Paddington, the family shelter " has been most useful; during 1897 144 individuals were accommodated, comprising 92 adults and 52 children, in 52 families. The stay in each instance has ranged from one night to three days. The house has on more than one occasion been used to receive members of families of patients needing isolation in hospital, but for whom accommodation could not be immediately obtained. The annual expenditure is very trifling, under £50." In Kensington, no shelter has yet been provided, and the medical officer of health shows the need of such provision by pointing out that in 1897, 185 cases of infectious disease occurred in families in occupation of three rooms only, 372 cases in families occupying two rooms, and 98 cases in families occupying single rooms. Inquiry was made for existing premises which could be used for the purpose, but without avail. The medical officer of health states that the only satisfactory plan would be to erect a shelter, and that this could be done most economically in connection with a disinfecting station. In the absence of provision for the purpose, the sanitary inspectors have been authorised to pay for lodgings for people dispossessed of their home during the process of disinfection, an arrangement which, as he points out, is very unsatisfactory. No definite decision as to the provision of a shelter in Fulham has been come to, but the medical officer of health points out that the Town Mead-wharf site, where the disinfecting plant is to be placed, is a suitable site for this purpose. In St. George, Hanover-square, the shelter which has been provided has not been used during the year. In Westminster 25 families were removed to the vestry's reception rooms. The shelter in Marylebone was occupied nine times, 14 adults and 12 children having been temporarily accommodated. The St. Pancras shelter was occupied by 37 persons over 10 years of age and by 27 under that age. In Hackney the vestry allowed 2s. 6d. per night to persons requiring accommodation, the choice of the accommodation being left to the person requiring it. The medical officer of health points out that he has reason to believe that this system led to the infection of a person in a house accommodating a necessitous family. The vestry has now decided to provide a shelter, and the question of site and arrangement of the building are now under consideration. The shelter in the Strand was made use of by eight persons. The shelter at 47, Northampton-road, conjointly used by the Clerkenwell Vestry and the Holborn District Board, was used by 18 families from Clerkenwell and 28 from Holborn. For the purposes of St. Luke, house accommodation with necessary attendance has been provided at 41, Macclesfield-street. The shelter in the City was used by 72 persons at an average cost of £4 6s. 3d. per person, including rent, taxes, repairs, &c. In Shoreditch the shelter was used 5 times, 23 persons being accommodated. The shelter in St. George-in-the-East was not used during the year. In Limehouse the shelter received 16 families, comprising 29 adults and 39 children. In St. George, Southwark, " a refuge house has been established and is in working order." In St. Olave the shelter has been used 20 times during the year by 66 persons, 64 of whom were provided with sleeping accommodation. In Bermondsey no shelter has been provided. During the year 63 families, consisting of 123 adults and 158 children, were turned out of their homes to enable disinfection to be properly carried out. Efforts have been made in past years to secure accommodation, but without success. In Lambeth the shelter was used 3 times, and was occupied by 9 adults and 5 children. "The refuge at the wharf has not been used as much as was expected, owing, no doubt, to its position in the vestry's dust depot, and the parish therefore requires another one in a more suitable situation." The Greenwich shelter has not been used during the year. The Plumstead shelter was completed in, but not used, during the year. Hospital Provision for Infectious Disease. The amount of hospital provision for infectious diseases is shown in the following paragraphs contained in the report for 1897 of the Statistical Committee of the Metropolitan Asylums Board— "Fever and diphtheria.—The Park Hospital, at Hither-green, Lewisham, which was opened by T.R.H. the Prince and Princess of Wales, began to receive patients on 8th November last. This hospital is designed to accommodate 548 patients. During the current year it is hoped that the Grove Hospital at Tooting will be completed, and that the 620 beds which it will provide may be brought into use. There will then only remain, to complete the managers' scheme of hospital accommodation as at present laid down, the erection of the Southern Convalescent Hospital, and certain works of reconstruction and enlargement at the Western and North-Eastern Hospitals. The works at the Western Hospital will probahly be completed this year. When the last of the above-mentioned works are finished the managers will have at their disposal for fever and diphtheria cases (including typhoid fever and isolation cases) upwards of 6,000 beds. In addition, there is the Gore Farm Hospital, which can furnish 740 beds, for convalescent fever cases, but only so long as it is not required for its proper function of a smallpox convalescent hospital. Though, since 1887, the managers have practically doubled their fever accommodation, which has now reached a magnitude of which no one dreamed only five years ago, our present report records, for the fifth year in succession, the entire failure of that accommodation to meet all the demands made upon it during the season of greatest pressure. Smallpox.—For this disease the managers possess 300 beds at the hospital ships, and are about to erect further buildings capable of containing 400 beds on the Joyce-green estate, adjoining the hospital ships. Gore-farm, if at any time the managers are compelled to reclaim it for its original purpose, can, for smallpox convalescents, furnish about 1,192 beds more." The Cleansing of Persons Act. In 1897 "The Cleansing of Persons Act" was passed. This Act, in its relation to London, empowers every sanitary authority, " when in their discretion they see fit, to permit any person who shall apply to the said authority, on the ground that he is infested with vermin, to have the use, free 76 of charge, of the apparatus (if any) which the authority possess for cleansing the person and his clothing from vermin." The use of such apparatus shall not be considered to be parochial relief. The Act also empowers local authorities to expend any reasonable sum on buildings, appliances and attendants that may be required for carrying out the Act. The Act of 1897 will be regarded with satisfaction by all who appreciate the need for opportunity being given for maintenance of cleanliness of the person. It may be hoped that similar opportunity may eventually exist for the poor to cleanse their bedding under similar conditions, and that vermininfested rooms may be definitely regarded as matter for the intervention of the sanitary authorities. This subject has already been referred to in connection with the question whether a by-law can be made under section 94 of the Public Health (London) Act, as proposed by the Kensington Vestry, requiring that furnished rooms let in lodgings shall be kept free from vermin, and I have already stated that many sanitary authorities in London have made favourable reply to my inquiry whether they will give opportunity to the keepers of common lodging-houses to thus cleanse their bedding. With a view to promoting the health of children and educating them in personal cleanliness, some continental countries are providing in their elementary schools bathing rooms in which children can periodically bathe. In schools which I have visited in Christiania, Copenhagen and Berlin, I was informed that this provision is much appreciated both by parents and pupils. This branch of education is not the least valuable which a school authority can undertake, and certainly the habit of personal cleanliness cannot be acquired too early in life. The action taken by sanitary authorities under the Cleansing of Persons Act is shown in several of the reports of the medical officers of health. In Kensington the vestry entered into an arrangement with the guardians whereby the apparatus, &c., at the able-bodied workhouse, Mary-place, Potteries, was made available on payment of a small fee by the vestry. Three persons and their clothing have been cleansed under this arrangement. In Westminster the vestry resolved that the proper officers give effect to the provisions of this Act in the event of any application being made. In Marylebone the vestry, as a tentative measure, has provided a special bath in a building in the front garden of the shelter, which in the case of any application may be used for this purpose. In 25 days 148 persons attended to cleanse themselves and have their clothes disinfected. In St. Giles, one person attended for the cleansing of his person and clothes. The Strand District Board agreed to give effect to the Act as far as the present accommodation would permit. The medical officer of health of Holborn suggests that a bath should be provided for the purpose at the shelter. The medical officer of health of St. Georgein-the-East writes that owing to the nature of the agreement with the authorities of the London Hospital for the use of their disinfector, the parish is unable at present to take advantage of the Act. In St. Olave, the medical officer of health writes that " a bath might easily be provided for this purpose in one of the three cottages forming the Board's shelter and clothes disinfected in the steam apparatus." The Vestry of Bermondsey took no action as the St. Olave Board of Guardians already had the necessary apparatus. Mortuaries. The majority of the annual reports of medical officers of health contain some mention of the extent to which mortuaries are used for the reception of dead bodies pending burial. There are still some districts where further accommodation needs to be provided. In Paddington, a scheme for a new mortuary is before the vestry, and the medical officer of health hopes that a mortuary chapel, distinct from buildings set apart for inquests, may also be erected. In the Kensington mortuary 290 bodies were deposited during the year, 7 at the request of relatives, 37 by undertakers, 212 by order of the coroner, 22 were brought in by the police, and 12 were received on account of death due to infectious disease. The Hammersmith Vestry decided during the year to erect a proper mortuary, and by the middle of 1897 the plans were approved, a tender accepted, and the building was in the course of erection. At the old mortuary were deposited five bodies of persons who had died from infectious diseases, and five bodies of persons for whom no proper accommodation could be found ; there were also 145 bodies brought to the mortuary by order of the coroner or by the police. In Fulham there were 158 bodies removed to the mortuary, two of which were of persons dying from infectious disease. In Chelsea, 16 bodies were removed to the public mortuary " for sanitary reasons." In St. George, Hanover-square, 290 bodies were received into the mortuary, 23 because there was insufficient accommodation for them at home, and 107 were sent from St. George's Hospital, during the re-building of the post-mortem room in that institution. The number of bodies removed to the Westminster mortuary was 140, of which 21 were to await burial. In St. James, Westminster, 29 bodies were received into the mortuary. The Marylebone report gives a tabular statement of the number of bodies removed during each month of the year, making a total of 523, of which 13 were bodies of persons dying from infectious disease. The medical officer of health of Hampstead writes that he regrets more use is not made of the mortuary as a place of deposit for bodies, especially of those who have died from infectious disease, he says, "the mortuary at New-end comprises two chambers, one for infectious and one for non-infectious bodies, both with separate entrances, as well as a well-appointed room for carrying out post-mortem examinations of bodies." The total number of bodies admitted was 72, a larger number than during any previous year. In St. Pancras 499 bodies were deposited in the general mortuary, 26 in that for infectious diseases. In the Islington mortuary 708 bodies were received during the year. In Stoke Newington 33 bodies were deposited in the public mortuary. In Hackney there were 382 bodies deposited in the mortuary, 26 to await burial. In St. Giles 77 bodies were deposited in the mortuary, of these 12 were bodies of non-parishioners ; 4 bodies of persons dying from infectious disease were deposited in the special chamber set apart for this purpose. In the Strand district there are two mortuaries into which 74 bodies were received during the year, only one of which was that of a person who had died from an infectious disease. In Holborn 145 bodies were brought into the mortuary during the year. The Clerkenwell report states that 226 bodies were brought during the year to the mortuary, 56 being received from the Holborn 77 Guardians, and 170 from dwellings of parishioners, including 18 bodies of persons who had died from infectious disease. The medical officer of health of St. Luke writes that on several occasions he has brought to the notice of the Public Health Committee of the vestry the need for increased accommodation at the mortuary, especially for cases of infectious disease, a need mentioned by Dr. Young in his report on the district. The recommendation was rejected by the Committee on the ground of expense. The medical officer of health states that the absence of this accommodation is a real defect calling for remedy. During the year 264 bodies were received into the mortuary. In the City mortuary 131 bodies were received pending interment. The medical officer of health of Shoreditch says " there is an increasing dispositon on the part of the people to make use of the mortuary ; " 421 bodies were received into it in 1807 as compared with 404 during the previous year; by order of the sanitary authority 8 bodies of persons dying from infectious disease were removed there. In Bethnal-green 422 bodies were received in the mortuary. In Whitechapel 171 bodies were deposited in the mortuary, of these 20 were " for purposes of interment." The medical officer of health of St. Georgein-the-East states that he reported to the vestry on the necessity for special regulations relating to the reception at and removal of bodies from the mortuary, and these were accordingly made and approved; during the year 168 bodies were removed to the general mortuary and 1 body to that for infectious cases. In Limehouse 179 bodies were deposited in the mortuary, 9 in that part for infectious cases. In Mile-end Old-town the number of bodies brought to the mortuary was 189, only one of which was deposited in that part set aside for infectious cases. The question of provision of a mortuary for the district of St. Saviour, Southwark, is still under consideration. A site was obtained which the Ecclesiastical Commissioners were willing to sell to the district board, but the conditions imposed by them still required to be approved by the Board. In St. George, Southwark, 179 bodies were removed to the mortuary, this includes bodies brought from the workhouse. During the year 144 bodies were received into the Newington mortuary, of these 6 were bodies of persons dying from infectious disease. The medical officer of health of St. Olave writes that a satisfactory site for a new mortuary has not yet been found; 32 bodies were removed during the year into the old mortuary, which had been thoroughly repaired. In Bermondsey 47 bodies were removed to the mortuary, 10 of persons dying from infectious disease, which were placed in the chamber set apart for that purpose. In Rotherhithe only 3 bodies were removed to the mortuary. The medical officer of health of Lambeth writes that there are now two mortuaries in the district, and that the vestry have decided that one is needed for Norwood, though there is some difficulty in finding a suitable site. The new mortuary near Loughborough-junction was opened during the year. The number of bodies received into the two mortuaries was 400. The medical officer of health of Battersea reports that 289 bodies were received into the mortuary during the year, that the accommodation is becoming somewhat inadequate for the needs of the parish, and that it is proposed to provide a new mortuary with coroner's court. If the plans of the surveyor are carried out, the building will be " far in advance of the majority of metropolitan mortuaries." The difficulty is, however, in deciding as to the most suitable site. From the reports on parishes in the Wandsworth district, it appears that in Streatham 36 bodies were received into the mortuary, and in Tooting 4 bodies were removed to the mortuary. In Camberwell 280 bodies were removed to the mortuary. The report of the parish of Deptford in Greenwich district shows that one body was removed to the mortuary after death from infectious disease. In Woolwich 69 bodies were received into the mortuary. In Plumstead the mortuary was used for 31 bodies, 2 of which were bodies of persons dying from infectious disease. The medical officer of health reports that " the new mortuary is still in abeyance, though much required; the existing one offers very inadequate accommodation, and a better-appointed building would probably be more used and found a great convenience in many cases to persons with inadequate house accommodation." Water Supply. The report of the water examiner appointed under the Metropolis Water Act, 1871, contains the statement that, " the character of the seasons during the year 1897, was on the whole, favourable for the operations of the companies which obtain their supplies from the rivers Thames and Lee. The Thames water was in good condition during 308 days, moderately discoloured and turbid during 35 days, and exceptionally muddy and turbid on 22 days of the year." He further points out "the fact that the impurity of the water in the rivers is so largely increased during periods of flood renders it of great importance that there should be sufficient provision of subsidence and storage reservoirs to enable the necessary daily supplies to be delivered during such periods, while keeping the intakes closed. Such provision is essential for securing uniformly effective filtration. The area of the available filters should also be sufficiently large to enable the necessary supply to be collected when the passage of the water through the material is sufficiently slow to effectively filter the worst water which circumstances may render it necessary to deal with." Referring to the provision of storage reservoirs, Major-General Scott states that " the river deriving companies with one exception are actively engaged in constructing, or in making arrangements for the construction of, additional storage reservoirs. The Chelsea Company, which formerly held a prominent position in this respect, has lost ground to a considerable extent, and unless measures of a similar nature are adopted, this company, within the next few years, will find itself surpassed as regards the provision of storage reservoirs by all the other companies deriving their supplies from the Thames and the Lee. It is, in fact, necessary that, for the purpose of subsidence, the storage reservoirs should be capable of containing a quantity of water equal to twenty days' average supply instead of nine days as at present." 78 The following details are extracted from a table contained in the report— Names of companies. Number of days' supply. Monthly rate of filtration per square foot per hour. Mean monthly average. Gallons. Maximum monthly average. Gallons. Chelsea 9.0 1.75 1.75 East London 29.6 1.33 1.33 Grand Junction 3.3 1.73 1.89 Lambeth 5.4 1.99 2.40 New River 4.7 2.44 2.75 Southwark and Vauxhall 4.1 1.50 1.50 West Middlesex 19.5 1.40 1.75 The results of Sir Edward Frankland's bacteriological examination of the water supplied by the London companies can be learnt from the annual summary of the Registrar General, and the number of times in which he found more than 100 microbes in a cubic centimetre of the filtered water can be thus ascertained. I have previously stated that a monthly examination of the water delivered by any filter is no adequate test of the continued efficiency of the filtration, just as it is impossible to judge of the weather at other times of a month by the condition of the weather during a particular hour of the month. Sir Edward Frankland points out that the filtration plants of some of the companies deliver the filtered water into general receptacles or wells, and hence the behaviour of each separate filter cannot be known. In connection with filtration, Major-General Scott reports—" The Grand Junction Company has completed the entire re-construction of six acres of filter-beds at Hampton, previously used for preliminary filtration, which have now been converted into filters of the most recent type. None of the filters recently constructed have been provided with appliances for continuously gauging the rate of filtration. Such adjuncts are necessary aids for the maintenance of the bacterial standard of purity which has been adopted." Proceedings of the Council—During the parliamentary session 1896-97, bills promoted by the Council for the purchase of the water companies' undertakings were introduced into Parliament, and on the 9th February the Parliamentary Committee of the Council reported on the agreements which had been come to with the several authorities in the water area outside the administrative County of London. On the 23rd March the Committee reported that—" The second reading of the Chelsea Water (Purchase) Bill was moved in the House of Commons on the 11th inst. by Mr. Buxton, member for the Poplar division of the borough of Tower Hamlets. The rejection of the bill was moved by Sir F. Dixon-Hartland, supported by the Government and carried on a division by 258 to 123. In the case of the remaining bills the order for the second reading was ordered to be discharged and the bills were withdrawn." On the 24th June the Committee thus reported on the bills promoted by the water companies— New River Company's Bill. 1.—Under this bill the New River Company sought to obtain power to issue new capital free from the obligation to make a contribution out of revenue to the London water sinking fund. This obligation has for some years past been uniformly applied by Parliament in cases of the issue of new capital by the London water companies. At an early stage the agent, by our instructions, intimated to the company that their bill should be unopposed by the Council if they would insert the usual sinking fund clause. But the company declined to accept this, and the Council had therefore to petition against the bill. The bill was referred to a committee presided over by Mr. Rankin, who after hearing arguments and evidence on the part of the company, and counsel on behalf of the Council, decided that the asual sinking fund clause should be inserted. East London Water Bill. 2.—The bill as introduced contained provisions authorising the company to appropriate the whole of the remaining water of the river Lee. The Council petitioned against it, and we were able to arrange by negotiation, without a contest, an amendment of the bill on this point, which appeared (satisfactory. It was also considered necessary to oppose clause 14 of the bill in the form in which it was originally introduced. This was the clause giving power to the company to enter into agreements with other metropolitan water companies. The agent was, however, instructed to intimate to the company that the petition would not be proceeded with if they would assent to such a modification of clause 14 as appeared to be necessary. The company declined this, and the matter had therefore to go before Mr. Rankin's committee, who decided that the clause should be amended iu accordance with suggestions made on behalf of the Council. We think it right to point out that in both this case and that of the New River Company the contention of the Council has been substantially justified and that all expense might have been avoided had the companies concerned accepted in the first instance at the suggestion of the Council, the modifications of their bills which were ultimately decided by Parliament to be reasonable. Southward and Vauxhall Water Bill. 3.—This case is still under the consideration of Parliament. The bill, as introduced by the company, contained extraordinary powers. The excuse for the bill was that the Thames Conservancy had obtained an injunction against the company to prevent their continuing that illegal appropriation of water from the river Thames which was pointed out to the Council in Mr. Cripps' report on the position of the water companies in 1892. The company sought power by their bill to appropriate and control the distribution of water from the Thames to an extent of about double that which they are now authorised to appropriate. Their statutory concession is limited to 20 millions of gallons per day of 24 hours, or if a certain agreement between the Thames Conservancy and the company be ultimately held valid, 24,500,000 gallons per day of 24 hours. It was pointed out in the petition of the Council against the bill that as regards the greater part of this district the consumers are only prevented by the action of this company from obtaining better water at lower prices. If this company ceased to supply in Deptford, Bermondsey, Rotherhithe and 79 part of Camberwell the consumers would be able to get the better water provided by the Kent Company at about the same charges; and if the company ceased to supply Battersea, Putney and Wandsworth, the consumers would be able to get water supplied by the West Middlesex Company drawn from the same portion of the Thames as if it were taken by the Southwark and Vauxhall Company, at 25 per cent. less charge, and in some cases at a more considerable reduction. The effect of the bill would therefore be permanently to exclude the consumers in those portions of London from the chance which they now have under the existing law of obtaining better water at lower prices; while in the event of a purchase by a local authority the Southwark Company might probably claim double the present value of their undertaking, because they would get under this bill a statutory concession of taking a supply from the Thames of upwards of 40 million gallons per day instead of, as at present, 20 millions or 24,500,000 gallons as the case may be. At the opening of the proceedings before the Committee the company proposed some considerable modifications in their original scheme. The Committee seem to have been impressed with the evidence of Sir Frederick Dixon Hartland that the Thames Conservancy would take steps to enforce their injunction unless an Act were passed. The Committee passed the bill on the day on which the House rose, without hearing the case for the opponents. Mr. Cripps intimated to the company that if they were prepared to accept a temporary measure under which, notwithstanding the injunction, they might temporarily draw what water they required from the Thames subject and without prejudice to any existing legal rights on either side, he would feel justified in not further opposing their bill before the Committee, although, the Council being in recess, no formal authority could at the moment be obtained. This was declined by the company's advisers, who intimated their intention to press for their bill. But it appears from the result of the discussion in the House of Commons this afternoon that the Committee to whom the bill was referred accepted it on the statement of the company that it would do no more than have the effect above indicated. We are satisfied, however, that the effect of the bill would not be so limited. We think the Council will agree that if Parliament permits the appropriation of further water from the Thames for distribution in London by the commercial companies, it should be taken and supplied by those companies whose supply is most efficient, and whose rates of charge are lowest, rather than by a company whose water is often delivered in an unsatisfactory condition, and whose rates of charge are higher; or, at least that this company ought not to have a new concession of taking and supplying water from the Thames, unless its rates of charge are reduced to the lower level at which any other company is already authorised to supply within the same parishes. We propose, however, to repeat our offer to this company to the effect above indicated, namely— that if the bill be limited to a temporary measure, and if it be made quite clear that the passing of the bill does not affect existing legal rights on either side, it will not be further opposed. The bill as framed would imply that—which is contended on the part of the company, but which the Council is advised is without foundation—that the company are under statutory obligations to supply water in any part of this district. Other companies have long ago been authorised by Parliament to supply throughout the whole area of this company in London. With regard to the last-named bill in the Committee's report, it may be stated that the opposition of the Council eventually resulted in a bill being passed legalising for a period of one year the appropriation of water which the company had been making from the Thames. Royal Commission on London Water Supply—At the time of the rejection of the Council's Water Purchase Bills on the 11th of March, it was intimated that it was the intention of the Government to appoint a Royal Commission to consider certain specified points in connection with the water supply. On the 14th May, 1897, the water committee reported the following to be the terms of reference to the Commission— "(1.) To inquire and report whether, having regard to financial considerations and to present and prospective requirements as regards water supply in the districts within the limits of supply of the metropolitan water companies, it is desirable, in the interests of the ratepayers and water consumers of those districts, that the undertakings of the water companies should be acquired and managed either (a) by one authority, or (b) by several authorities, and, if so, what should be such authority or authorities ; to what extent physical severance of the works and other property and sources of supply of the several companies, and the division thereof between different local authorities within the limits of supply, are practicable and desirable, and what are the legal powers necessary to give effect to any such arrangements. "(2.) If the undertakings are not so acquired, whether additional powers of control should be exercised by local or other authorities, and, if so, what those powers should be. "(3) Whether it is practicable to connect any two or more of the different systems of supply now administered by the eight metropolitan companies, and, if so, by whom and in what proportions should the cost of connecting them be borne, and what are the legal powers necessary to give effect to any such arrangement." The Council subsequently decided that the following opinions should be expressed to the Royal Commission— (a) That in the opinion of the Council the water supply of the metropolis should not continue in the hands of private companies. (b) That in the opinion of the Council the undertakings of the metropolitan water companies should forthwith be purchased at the fair and reasonable value of the same, regard being had to the rights, special circumstances, and obligations of the companies. (c) That the management of the water supply should be effected either (1) by the London County Council supplying its own area directly and outside authorities in bulk at a fixed price; or (2) by the London County Council supplying its own area only, and the outside authorities supplying their areas. (d) That, in any case, as the County of London contains 87 per cent, of the rateable value and over 79 per cent. of the population of the whole area supplied by the metropolitan water companies, and will thus be liable for more than four-fifths of the purchase money, it is desirable that the London County Council should, in the first instance, be the purchasing authority on behalf of the population of the whole area concerned. (e) That if the undertakings of the water companies are not acquired, it is essential that effective powers of control should be given to the County Council, aud further that the position of the companies should be reconsidered and the law amended, particularly as regards their power to make and recover rates and charges and divide profits, and their obligations respecting the supply of water. Welsh scheme of water supply—On the 16th of March the Council resolved that the engineer be instructed to proceed with the plans and sections of the Wye portion of the Welsh scheme of water supply. 80 Legislation—The Metropolis Water Act, 1897. The most important provisions of this Act are included in the following sections— 1.—(1.) Any water consumer or any local authority may complain to the Railway and Canal Commission that any of the metroDolitan water companies has failed to perform some statutory duty of the company, and the Commission may hear and determine that complaint, and if satisfied of such failure order the company within the time limited by the order to fulfil the duty, and may, if they think fit, by any such order, impose any penalty for such failure which can be imposed under any Act, and enforce any such order in like manner as any other order of the Commision. (2.) If at any time complaint as to the quantity or quality of the water supplied by any of the metropolitan water companies for domestic use is made to the Railway and Canal Commission, by any water consumer or local authority, the Commission may hear and determine such complaint, and if satisfied that the complaint is well founded, may order the company, within such reasonable time as is specified in the order, to remove the ground of such complaint, and may enforce such order in like manner as any other order of the Commission, and may award damages to the complainant. (3.) All enactments relating to the Railway and Canal Commission (except section two of the Railway and Canal Traffic Act, 1894, which restricts the power to award costs) shall, with the necessary modifications, apply to the Railway and Canal Commission for the purpose of their jurisdiction under this Act. (4.) This Act shall be in addition to and not in substitution for any existing proceedings or remedy. 2.—A local authority m;jy aid any water consumer in obtaining the determination of any question which appears to the local authority to be of interest to water consumers within the district of such local authority with respect to the rights, duties, and liabilities of any of the metropolitan water companies in reference to the quantity or quality of water supplied or the charges made by them. A local authority aiding any legal proceedings under this section may, if the court think fit, be made a party to the proceedings, and shall be liable for costs accordingly. Insufficiency of water supply—The medical officer of health of Mile-end Old-town states that— "Although this year there was no drought during the summer months, there are many tenement dwellings in the east-end of London where cisterns above forty feet from the ground level were not supplied with water, and this caused great inconvenience. There was a break down in the Thames main in August, which may have affected the suppl7." The medical officer of health of Whitechapel also says there was shortness of supply in some parts of the district in the summer; "an accident to one of the mains appeared to be the cause, and when this was rectified no more than the customary occasional inconveniences were met with." Constant supply—The annual report of the chief officer of the Council's Public Control department shows that the constant water supply was extended during the year ending the 31st March, 1898, so that at that date 96'5 per cent of the houses in London were thus receiving their water. Flooding from the Lea. The medical officer of health of Hackney reports that early in the year, after rather excessive rain, the river Lea overflowed its banks between the East London Waterworks Company's offices at Lea-bridge and Spring-field, and flooded the cottages on the western side of the river and the Millfields. He gives a list of sixty houses thus flooded, on inspection of which he found the water had risen about eighteen inches above the ground floor. It appeared, he says, that the houses were flooded in a similar manner a few years before, but the more recent flood appeared to be out of all proportion to the amount of rainfall preceding. "The importance of this flood depends on the fact whether it was an accidental event, due to an extraordinary fall of water in the Lea valley, or whether any change had taken place in the banks of the river by which flood waters are more confined to the course of the stream, or that their exit by the natural channel is restricted." The medical officer of health communicated with the chief engineer to the East London Water Company, who in reply stated that " the Hackney marshes have been embanked and no water can spread over them or reach the various branches of the river at lower levels. All the marshes on the Essex side were under water. Should these be banked eventually, the backing up of the river to even higher extent than on the 6th and 7th February must ensue in time of great floods." On this the medical officer of health comments as follows— While this is no doubt a reasonable explanation, I do not think it goes far enough. I understand that the Hackney-marshes are not the only lands which have been embanked to prevent flooding from the river. The immense reservoir recently completed was constructed on a site contiguous to the river, and which I have every reason to believe used to receive storm waters on the same occasions as the Hackney-marshes. Moreover, certain works have been carried out under the Lea Valley Drainage Act, 1892, for the prevention of flooding of lands adjacent to the river. The net result of these works has been to allow storm waters to get into the lower parts of the river without causing any floods, but it is obvious that unless the outlet for storm waters from the lower part of the river is increased in the same proportion, the river must get overcharged and overflow its banks. Considering the whole of these circumstances, it is probable that the embanking of the Hackneymarshes by the London County Council was instrumental, to some extent, in bringing about the flooding of the houses on the west bank of the river referred to above, but I am of opinion that the other works referred to, and carried out by the East London Water Company and the Lea Valley Drainage Commissioners were also to a similar extent responsible. It is obvious that the waters of a river which during heavy rains is accustomed to overflow its banks and flood low-lying lands will, if the banks are raised, rise considerably during such times and probably overflow other parts if the water cannot get away fast enough by the natural channel of the river. Endeavours are being made to reclaim from the river sueh of the low-lying lands as are capable of being utilised. This is especially the case in our district. We may then confidently anticipate that the flooding of the houses named above, which hitherto has been a rare event, will become more frequent; and the object of recording this event is to consider what, if any, remedy can be applied to prevent the recurrence of floods to the detriment of inhabited houses in this district. It is clear that the reclaiming of low-lying land near the river, and its utilisation, cannot be stopped, so the problem to be solved is how to allow storm waters to pass rapidly enough away to prevent the flooding of inhabited houses on the river banks. The first suggestion is to raise that part of the river bank adjacent to the dwellings, or, if this is not practicable, to construct some channel of relief to be used during the times of flood; but the remedy 81 is really an engineering work, and properly should be proposed by such an expert. As to who should undertake this work, I would suggest that the Lea Drainage Commissioners, who have already done similar work in other parts of the Lea, and apparently with good results, should be re-appointed, under a new Act of Parliament, if necessary, to carry out the work of preventing floods from the Lea in this district. Infant Life Protection Act, 1897. In 1897 an Act was passed amending the Infant Life Protection Act. The Secretary of State for the Home Department forwarded to the Council the following abstract of the Act of 1897. He also stated that he would request the police authorities to give the Council their hearty co-operation in giving effect to the provisions of the Act— (1.) Every person* receiving more than one infant under the age of five years for maintenance apart from their parents for hire or reward for a longer period than 48 hours, shall give notice thereof within 48 hours to the County Council. This notice shall truly state the names, ages and sex of the infants, and the names and abode of the persons receiving, and the persons from whom the infants were received. (2.) If any such infant is transferred from the care of a person who has so received it, notice must forthwith be given of the name and address of the person to whom it has been transferred. (3.) Any person receiving an infant under two years for a lump sum, not exceeding £20, without any agreement for further payment, shall give notice within 48 hours. In default, any sum received is liable to be forfeited. (4.) All such notices shall be in writing, and shall either be delivered at or be sent by registered letter to at (5.) In case of the death of any such infant, notice must be given to the coroner of the district within 24 hours by the person having care of the infant. (6.) All persons receiving such infants must admit without obstruction the inspector or other person appointed by the County Council to inspect the infants and the premises in which they are retained. (7.) They must also obey the directions of the County Council with regard to the number of infants who may be received in any premises, and with regard to the removal of any child from their care to a workhouse or a place of safety. (8.) All persons whatsoever must admit to their premises and refrain from obstructing an inspector or other person acting on the authority of a search warrant issued under this Act. (9.) No infant shall be received for hire by any person who has been deprived of the care of any child under this Act, or has been convicted of any offence under the Protection of Children Acts, unless the County Council consent in writing. (10.) Every person who disobeys the foregoing provisions of the law is liable to be fined £5, or sent to prison for six months. 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. 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 to be 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, which census was taken on that date as provided. In other years an estimate of population on the 6th 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. * This doea not include hospitals and charitable institutions, nor the parents, grandparents, uncles, aunts or guardians of an infant. [11] 82 The following table shows the estimate of population on the 6th April, 1897, and the amount of excess of contribution over grant, or of grant over contribution, in respect of each district for each of the half-years ended 30th September, 1897, and 3lst March, 1898, respectively— Sanitary District. Estimated population, 6th April, 1897. Equalisation charge, being excess of contribution over grant. Net grant being excess, of grant over contribution. £ s. d. £ s. d. Paddington 124,482 4,070 16 2 - - _ Kensington 169,956 9,038 8 11 - - - Hammersmith 104,759 _ _ _ 3,194 1 9 Fulham 115,335 _ _ _ 4,267 8 10 Chelsea 97,676 _ _ _ 13 7 2 St. George, Hanover-square 79,446 16,754 5 10 _ _ _ Westminster 52,666 5,631 14 1 _ _ _ St. James 23,050 7,692 11 8 _ _ _ Marylebone 140,802 5,856 11 7 _ _ _ Hampstead 77,691 2,224 5 11 _ _ _ Pancras 240,854 - _ _ 3,748 5 8 Islington 338,331 - - - 11,797 15 3 Stoke Newington 34,476 - - - 791 13 5 Hackney 226,024 - - - 9,554 6 7 St. Giles 38,453 1,576 _ 10 _ _ _ St. Martin-in-the-Fields 12,774 5,863 5 8 _ _ _ Strand 24,136 5,492 2 11 _ _ _ Holborn 31,262 2,070 17 4 _ _ _ Clerkenwell 66,349 - - - 1,657 13 6 St. Luke 41,555 223 10 6 _ _ _ London, City of 31,423 52,383 4 1 - _ _ Shoreditch 122,260 - - - 3,665 6 _ Bethnal-green 127,141 - - - 7,160 9 7 Whitechapel 77,872 - - - 2,415 9 5 St. George-in-the-East 47,266 - - - 2,307 9 5 Limehouse 58,106 - - - 2,050 _ 1 Mile-end Old-town 110,648 - - _ 6,144 5 _ Poplar 169,161 - - _ 7,792 8 6 St. Saviour, Southwark 24,544 1,924 8 9 _ _ _ St. George, Southwark 63,564 _ _ _ 2,836 _ 8 Newington 121,079 _ _ _ 6,023 7 1 St. Olave 11,615 1,466 10 5 - - _ Bermondsey 85,355 - - - 3,355 6 5 Rotherhithe 40,379 - - - 1,366 9 5 Lambeth 296,102 - - - 8,815 3 6 Battersea 167,366 - - - 5,841 - 8 Wandsworth 194,690 - - - 3,756 2 8 ■Camberwell 254,843 - - - 11,240 1 9 Greenwich 176,805 - - - 6,492 2 9 Lewisham 108,322 - - - 2,206 - 11 Woolwich 41,366 - - - 783 18 9 Lee 40,058 _ - - 505 5 7 Plumstead 60,671 - - - 3,590 13 11 The Charterhouse 139 141 13 _ _ - _ Grav'8-inn 243 178 13 10 _ _ _ The Close of the Collegiate Church of St. Peter 342 15 1 7 _ _ _ Inner Temple 148 278 12 1 _ _ _ Middle Temple 105 171 19 1 _ _ _ Lincoln's-inn 19 233 17 5 _ _ _ Staple-inn 9 30 5 4 _ _ _ Furnival-inn 41 52 17 3 _ _ — Sanitary Administration of Districts. Clerkenwell.—In February, 1897, I presented to the Public Health Committee a report by Dr. Young on the sanitary condition of Clerkenwell (see Appendix IV). The following is a brief summary of the matters to which l)r. Young considered the attention of the vestry should be given— 1. The existence in houses of defective conditions. For the most part these are of such a character as to be readily capable of remedy under the powers given by the provisions of the Public Health (London) Act. 2. The existence of courts and alleys which are narrow and badly arranged, and of houses which are old and worn out. Concerning these the vestry should see the necessity of applying for closing orders or taking other proceedings under the Housing of the Working Classes Act. 3. The existence of a considerable number of houses in the district occupied by members of more than one family. Many of these are not of such a character as to need frequent periodic inspections. Others again are not so well circumstanced as regards the conditions in which they are kept, and these need registration and regulation under the provisions of section 94 of the Public Health (London) Act. 83 (4.) The absence of a register containing a complete list of the workshops in the district and setting out the conditions of these premises. The preparation of such a register should be proceeded with forthwith. (5.) The failure of the present system of house refuse collection to ensure its removal every week from all premises. A reorganisation of the system should at once be undertaken so as to ensure this object. (6.) The desirability of requiring in the by-laws as to houses let in lodgings a minimum cubic space per head of 400 feet in rooms occupied by day and by night, instead of 350 feet which is stated to be the amount specified in the draft by-laws. In October the Committee reported to the Council that they were informed by the vestry that the defects pointed out by Dr. Young were then receiving the vestry's attention, that houses let in lodgings were being put upon the register, that a register of workshops was being prepared, that improvements were being carried out in the system of dust collection, and that upon the representations of the vestry the Local Government Board had confirmed the by-law with the lower air space required for each person in houses let in lodgings. In March, 1898, however, the Committee were able to inform the Council that the vestry had decided to alter their by-law so as to increase the requirement of 350 to 400 cubic feet of air space, and thus to make it in this respect uniform with that of other London sanitary authorities. St. Luke—In November, 1897, I also presented to the Committee a report by Dr. Young on the sanitary condition of St. Luke, (see Appendix V.) and the Committee thus reported on November 30th to the Council— After some correspondence with the Vestry of St. Luke, Middlesex, on the question of the adequacy of their sanitary staff, we thought it desirable that an inquiry should be made by one of the Council's assistant medical officers of health into the sanitary condition and administration of the parish. An inquiry was accordingly made by Dr. Young, and his report states that the existing 6taff of sanitary inspectors is insufficient for the requirements of the parish. Dr. Young, moreover, found that the bylaws of the vestry as to houses let in lodgings were so drawn as to exempt from their application tenements which should be subject to them, and it is desirable that his recommendation that the bylaws be revised in this particular should be seriously considered by the vestry. Other recommendations made by Dr. Young relate to the desirableness of dealing with certain premises under the Housing of the Working Classes Act, of improving the method of collection of house refuse, and of adding a separate chamber to the mortuary for the bodies of persons who have died of infectious complaints. Dr. Young also points out that the shelter which is being provided for the use of persons during the disinfection of their rooms is open to objection in certain respects. We have had the report printed, and have sent copies to the vestry, with a request for their observations upon it. We propose to report again to the Council after a reply has been received. In the meantime we have given instructions for copies of the report to be sent to the members of the Council, and placed on sale. Holborn—In my last report I stated that the Council had represented to the Local Government Board that the District Board of Holborn had failed to appoint a sufficient number of sanitary inspectors for the district. A letter has since been received from the district board stating that at the desire of the Local Government Board they have decided to appoint an additional sanitary inspector. 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 1897, 43 medical officers of health and 204 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— Battersea Lee (Eltham) St. James, Westminster Bethnal-green Limehouse St. Luke Camberwell Mile-end Old-town St. Martin-in-the-fields Chelsea Newington St. Olave City Paddington St. Pancras Clerkenwell Plumstead St. Saviour, Southwark Fulham Poplar (Bow) Shoreditch Hackney Poplar (Bromley and Poplar) Stoke Newington Hammersmith Rotherhithe Strand Holborn St. George-in-the-East Wandsworth ( Wandsworth) Islington St. George, Southwark Westminster Kensington St. Giles Woolwich Lambeth Sanitary districts mentioned in Schedule c of the Local Metropolis Management Act, 1855. St. Peter, Westminster (close of the Collegiate Church) Lincoln's-inn Staple-inn and Liberty of the Charterhouse Inner Temple Middle Temple Gray s-inn Furnival's-inn During the year 1897, in addition to duties more immediately connected with the Public Health and Housing Committees of the Council, the Public Health Department was concerned in enquires arising out of a number of references from other committees of the Council, among which may be mentioned the Reformatory and Industrial Schools, Asylums, Building Act, Appeal, Parliamentary, Local Government, Parks and Open Spaces, and Water Committees. 84 The following table shows the month in which the annual reports of the medical officers of health of London districts were received by the Council— January, 1898 1 July, 1898 7 March „ 5 August „ 4 April 3 September „ 3 May 11 October „ 2 June „ 13 Shirley F. Mukphy, Medical Officer of Health. 6th December, 1898. APPENDIX I. London Countg Council Public Health Department, Spring Gardens, S.W., July, 1898. DIPHTHERIA AND ELEMENTARY SCHOOLS. In March, 1894, I presented to the Public Health Committee a memorandum on the increase of diphtheria in London, and I gave reason for thinking that the aggregation of children in schools, which had continuously increased since the Education Act of 1870, had contributed in important degree to the prevalence of the disease. There has, in fact, with increase of school attendance, been increased incidence of diphtheria mortality on children at school age, and an examination of the statistics contained in the reports of the Registrar-General led me to think that this increase of incidence was not wholly explained by changes in nomenclature or classification. Since this memorandum was presented to the Committee I have shown, in annual reports, that when the schools of the London School Board are closed for the summer holiday there is notable decrease in the prevalence of the disease at all ages, and that the prevalence increases when the schools re-open at the conclusion of the holiday, and further, that this decrease and subsequent increase is especially marked among persons at the school age. Further statistics have become available for the study of the subject since the above-mentioned memorandum was written, and the question has, moreover, been discussed in a report presented to the London School Board by the medical officer of that Board, who has stated in his report the conclusion "that school influence, as such, plays but an unimportant part in the enormous increase of the disease during recent years in London." I propose in this report to restate the evidence which bears upon the subject, and to include the statistics which have become available since March, 1894. In obedience to the instruction of the Committee, I propose also to discuss the reasons given by the medical officer of the London School Board for the conclusion at which he has arrived, and to state how far these reasons must be accepted as militating against the view I have already expressed. In the first instance it is necessary that I should state very clearly that I am not attempting to urge that if children had not been more largely aggregated in schools than before 1870 there would not have been a serious prevalence of diphtheria during the last few years. Experience of other communicable maladies teaches that after intervals of many years, during which the extent of their prevalence has been comparatively limited, they again attain epidemic proportions, and there is no reason for thinking that diphtheria is not subject to the same natural laws as other epidemic diseases. So far as any existing knowledge of this matter may guide us, it shows that these epidemic prevalences will occur irrespective of social changes in the population, that they are probably largely due to some altered condition of the virus which gives to it a greater power of diffusion and a greater power of destroying life. Social changes may, however, give opportunity for this altered condition to manifest itself in greater degree than it would otherwise have done. This is what I believe has occurred in respect to diphtheria, that the disease has in recent years attained epidemic prevalence irrespective of increased attendance at school, but that this prevalence has been considerably greater than it would have been owing to this increased school attendance; firstly, through the larger proportion of children who have contracted their disease at school; and secondly, through the infection of persons not attending school by those who have themselves been infected at school. The questions, therefore, which have to be determined are (a) whether the increase of school attendance has caused increase of diphtheria mortality beyond that which would have been experienced without such increase of school attendance, and (b) whether this increase of diphtheria mortality is of such magnitude as to demand that health and school officers should especially devote themselves to preventing diphtheria caused in this way; or whether, as the medical officer of the London School Board concludes, " school influence, as such, plays but an unimportant part in the enormous increase of the disease during recent years in London." There is no mention of diphtheria in the statistics of the General Register Office until the year 1855. Before that year deaths certified to be due to diphtheria were classified with the deaths certified to be due to scarlet fever. In London the deaths from these diseases were not separated in the returns of the General Register Office until the year 1859. In the following tables relating to England and Wales the first period therefore considered is 1855-60, and in the tables relating to London, and to England and Wales, excluding London, the first period is 1859-60. The tables have been arranged to show the facts concerning diphtheria and croup combined. The figures relating to diphtheria and croup are, I believe, much more reliable than those relating to diphtheria alone, deaths which would in earlier years have been attributed to croup having in later years been attributed to diphtheria. There has, in fact, been transference from croup to diphtheria, and the two, for the purposes of this report, should be considered together. T6388 2 In the following tables the actual rates have been given in successive periods for each ageperiod to 15-20 years of age, a further rate being given for an age-period comprising 20 years and upwards. TABLE I. England and Wales. (A) Diphtheria and Group—Deaths. Period. All ages 0— 1— 2— 3— 4- 5— 10— 15— 20 and upwards. 1855-60 51,501 5,764 9,301 8,774 7,695 5,761 9,737 2,336 779 1,354 1861-70 91,999 10,942 18,234 15,724 13,454 9,770 16,184 3,376 1,232 3,083 1871-80 70,333 7,121 12,268 11,312 10,825 8,537 14,662 2,552 780 2,276 1881-90 84,188 6,156 13,052 12,829 13,178 11,281 20,943 3,273 992 2,484 1891-6 58,658 3,915 8,657 8,407 9,261 8,089 15,371 2,505 712 1,741 (B) Death-rates per 1,000,000 living. 1855-60 443 1,677 2,958 2,827 2,574 1,944 717 192 70 21 1861-70 430 1,709 3,207 2,734 2,418 1,790 641 147 60 26 1871-80 289 989 1,919 1,716 1,681 1,347 501 98 33 17 1881-90 306 817 1,897 1,818 1,885 1,634 640 109 36 17 1891-6 327 839 2,024 1,922 2,120 1,885 732 126 39 18 (C) Death rates per 1,000,000 living, death rate at "all ages," being taken as 100. 1855-60 100 379 668 638 581 439 162 43 16 5 1861-70 100 397 746 636 562 416 149 35 14 6 1871-80 100 342 664 594 582 466 173 34 11 6 1881-90 100 267 620 594 616 534 209 36 12 6 1891-6 100 257 619 588 648 576 224 39 12 6 (D) Increase or decrease per cent, of death rates at each age period in 1861-70, 1871-80, 1881-90 and 1891-6, compared with the death rates in the decade immediately preceding. 1861-70 with 1855-60 — 2.9 + 1.9 + 84 — 3.3 — 6.1 — 7.9 —10.6 —23.4 —14.3 + 23.8 1871-80 „ 1861-70 —32.8 -421 —40.2 —37.2 —30.5 —24.7 —21.8 —34.2 —45.0 —34.6 1881-90 „ 1871-80 + 5.9 —17.4 — 6.4 + 5.9 + 12.1 + 21.3 + 27.7 + 11.2 + 9.1 0.0 1891-6 „ 1881-90 + 6.9 + 27 + 6.7 + 5.7 + 12.5 + 15.4 + 14.4 + 15.6 + 8.3 + 5.9 (E) Increase or decrease per cent, of death rates at each age-period in 1855-60, 1871-80, 1881-90 and 1891-6, compared with the death rates at each age-period in 1861-70. 1855-60 + 3.0 — 1.9 — 7.8 + 3.4 + 6.5 + 8.6 + 11.9 + 30.6 + 16.7 —19.2 1871-80 —32.8 —42.1 —40.2 —37.2 —30.5 —24.7 —21.8 —34.2 —45.0 —34.6 1881-90 —28.8 —52.2 —40.8 —33.5 —22.0 — 8.7 — 0.2 —26.8 —40.0 —34.6 1891-6 —23.9 —50.9 —36.9 —29.7 —12.3 + 5.3 + 14.2 —14.3 —35.0 —30.8 TABLE II. London. (A) Diphtheria and Croup—Deaths. 1859-60 2,169 274 450 372 342 215 319 73 28 96 1861-70 13,031 1,921 3,015 2,532 1,918 1,249 1,638 204 100 454 1871-80 10,576 1,140 2,169 1,885 1,647 1,280 1,829 201 81 344 1881-90 16,829 1,295 3,061 2,971 2,783 2,253 3,483 393 125 460 1891-6 15,578 1,024 2,631 2,531 2,524 2,176 3,707 481 126 378 3 (B) Death rates per 1,000,000 living. Period. All ages. 0— 1— 2 3— 4— 5— 10— 15— 20 and upwards 1859-60 395 1,655 3,221 2,647 2,539 1,660 542 141 55 30 1861-70 430 2,109 3,911 3,281 2,558 1,731 504 71 35 26 1871-80 299 1,089 2,373 2,081 1,873 1,500 475 59 24 17 1881-90 419 1,175 3,108 2,975 2,875 2,398 798 100 32 20 1891-6 601 1,528 4,404 4,060 4,140 3,705 1,326 188 49 25 (C) Death rates per 1,000,000 living, death rate at " all ages " being taken as 100. 1859-60 100 419 815 670 643 420 137 36 14 8 1861-70 100 490 910 763 595 403 117 17 8 6 1871-80 100 365 794 696 626 502 159 20 8 6 1881-90 100 280 742 710 686 572 190 24 8 5 1891-6 100 254 733 676 689 616 221 31 8 4 (D) Increase or decrease per cent, of death rates at each age-period in 1861-70, 1871-80, 1881-90 and 1891-6, compared with the death rates in the decade immediately preceding— 1861-70 with 1859-60 + 89 + 27.4 + 21.4 + 24.0 + 0.7 + 4.3 — 7.0 —49.6 —36.4 —13.3 1871-80 with 1861-70 —30.5 —48.4 —39.3 —36.6 —26.8 —13.3 — 5.8 —16.9 —31.4 —34.6 1881-90 with 1871-80 + 40.1 + 7.9 + 31.0 + 43.0 + 53.5 + 59.9 + 68.0 + 69.5 + 33.3 + 17.6 1891-96 with 1881-90 + 43.4 +30.0 + 41.7 + 36.5 + 44.0 + 54.5 + 66.2 + 88.0 + 53.1 + 25.0 (E) Increase or decrease per cent, of death rates at each age-period in 1859-60, 1871-80, 1881-90 and 1891-6, compared with the death rates at each age-period in 1861-70— 1859-60 — 8.1 —21.5 —17.6 —19.3 — 0.7 — 4.1 + 7.5 + 98.6 + 57.1 + 15.4 1871-80 —30.5 —48.4 —39.3 —36.6 —26.8 — 13.3 — 5.8 — 16.9 —31.4 —34.6 1881-90 — 2.6 —44.3 —20.5 — 9.3 + 12.4 + 38.5 + 58.3 + 40.8 — 8.6 —23.1 1891-6 + 39.8 —27.5 + 12.6 + 23.7 + 61.8 + 114.0 + 163.1 + 164.8 + 40.0 — 3.8 TABLE III. England and Wales, excluding London. (A) Diphtheria and Croup—Deaths. 1859-60 22,646 2,312 3,509 3,338 3,064 2,460 4,965 1,566 570 862 1861-70 78,968 9,021 15,219 13,192 11,536 8,521 14,546 3,172 1,132 2,629 1871-80 59,757 5,981 10,099 9,427 9,178 7,257 12,833 2,351 699 1,932 1881-90 67,359 4,861 9,991 9,858 10,395 9,028 17,455 2,880 867 2,024 1891-6 43,080 2,891 6,026 5,876 6,737 5,913 11,664 2,024 586 1,363 (B) Death rates per 1,000,000 living. 1859-60 664 2,299 3,766 3,640 3,466 2,795 1,230 431 172 47 1861-70 430 1,642 3,097 2,649 2,397 1,799 663 160 64 27 1871-80 287 972 1,844 1,658 1,650 1,324 505 103 35 17 1881-90 287 755 1,695 1,528 1,726 1,513 616 110 37 16 1891-6 281 723 1,638 1,567 1,793 1,596 641 117 37 16 (C) Death rates per 1,000,000 living, death rate at " All ages " being taken as 100. 1859-60 100 346 567 548 522 421 185 65 26 7 1861-70 100 382 720 616 557 418 154 37 15 6 1871-80 100 339 642 578 575 461 176 36 12 6 1881-90 100 263 591 532 601 527 215 38 13 6 1891-6 100 257 583 558 638 568 228 42 13 6 4 (D) Increase or decrease per cent, of death rates at each age-period in 1861-70, 1871-80, 1881-90, and 1891-96, compared with the death rates of the decade immediately preceding. Period. All ages. 0— 1— 2— 3— 4r— 5— 10— 15— 20 and upwards 1861-70 with 1859-60 — 35.2 — 28.6 — 17.8 — 27.2 — 30.8 — 36.0 — 46.1 — 62.9 — 62.8 — 42.6 1871-80 „ 1861-70 — 33.3 — 40.8 — 40.0 — 37.4 — 31.2 — 26.4 — 23.8 — 35.6 — 45.3 — 37.0 1881-90 „ 1871-80 + 0.0 — 22.3 — 8.1 — 7.8 + 4.6 + 14.3 + 22.0 + 6.8 + 5.7 — 5.9 1891-6 „ 1881-90 — 2.1 — 4.2 — 3.4 + 2.6 + 3.9 + 5.5 + 4.1 + 6.4 0.0 0.0 (E) Increase or decrease per cent, of death rates at each age-period in 1859-60, 1871- 80, 1881-90, and 1891-96, compared with the death rates at each age-period in 1861-70. 1859-60 + 544 + 40.0 + 21.6 + 37.4 + 44.6 + 55.4 + 85.5 + 169.4 + 168.7 + 74.1 1871-80 — 333 — 40.8 — 40.5 — 37.4 — 31.2 — 26.4 — 23.8 — 35.6 — 45.3 — 37.0 1881-90 — 333 — 54.0 — 45.3 — 42.3 — 28.0 — 15.9 — 7.1 — 31.3 — 42.2 — 40.7 1891-6 — 347 — 56.0 — 47.1 — 40.8 — 25.2 — 11.3 — 3.3 — 26.9 — 42.2 — 40.7 Table I. (C) relating to England and Wales shows that subsequent to the period 1861-70 there has been a continued relative increase of incidence of diphtheria mortality upon the ages 3— 4— 5— and with trifling exception upon 10—. In the period 1861-70 compared with 1855-60 (D) the greatest relative increases were at the ages 1— and 20—, but in all subsequent periods compared with 1861-70 (E) the greatest relative increase has been at the age 5—; also when each period subsequent to 1861-70 is compared with the period immediately preceding, (D) this age has always had the greatest relative increase except that in the period 1891-6 compared with 1881-90 the increases at ages 4—5— and 10— have been nearly equal. Table II. (C) relating to London shows also that subsequent to the period 1861-70 there has been a similar relative increase of incidence of diphtheria mortality upon the ages 3— 4— 5— and 10—. In the period 1861-70 compared with 1859-60 (D) the greatest relative increase has been at the age 0—, but in all subsequent periods compared with 1861-70 (E) the greatest relative increase has been on age 5—, except that in 1891-6, the increases on ages 5— and 10— have been practically identical; also when each period subsequent to 1861-70 is compared with the period immediately preceding (D) these ages have, with trifling exception, always had the greatest relative increase. Table III., (C) relating to England and Wales, excluding London, shows that subsequent to the period 1861-70, there has been, with trifling exception, a continued relative increase at the ages of 3—4—5— and 10—. In the period 1861-70, as compared with 1859-60, (D) the greatest relative increase was at the age 1—, but in all subsequent periods compared with 1861-70, (E) the greatest relative increase has been at the age of 5—; also, when each period subsequent to 1861-70 is compared with the period immediately preceding, (D) this age has always had the greatest relative increase, except that in the period 1891-6, compared with 1881-90, the greatest relative increases have been at 4— and 10—. There is, therefore, marked agreement in the behaviour of the figures supplied by England and Wales, London, and England and Wales less London ; there has in fact been in each population, since 1861-70, a notable increase of relative incidence of diphtheria mortality on the ages of 3—4—5— and 10—; and, so far as the figures antecedent to the period 1861-70 may be trusted, there is observable difference in the behaviour of the figures in the period before and after that period. Another and important behaviour of the figures deserves attention. It will be seen that the variations in incidence are, speaking generally, such as to form a regular curve which rises from age 0—to a maximum at ages 5— or 10—, and then gradually declines until age 20— is reached. In considering the circumstances which may have brought about the changes in the age incidence of diphtheria mortality, three important points have to be considered— 1. Changes due to difference in nomenclature. 2. Changes due to natural behaviour of disease. 3. Changes due to some varying social condition of the community. 1. Changes in nomenclature.—The disease mostly affected by changed nomenclature is undoubtedly croup, deaths, which in earlier years would have been certified to be due to croup, being now attributed to diphtheria. The addition, therefore, of the deaths attributed to croup and diphtheria is the only safe course to adopt in considering variations in prevalence of diphtheria, or in the age distribution of diphtheria mortality, and this course has been adopted in this report. There may, however, have been, with improved medical knowledge, more exact diagnosis between scarlet fever and diphtheria. If we assume that the transference has been proportionate at each age, it is interesting to observe that owing to the different age-distribution of mortality from the two diseases, transference from one to the other necessarily alters the age incidence of the disease to which the transference is made. In connection with the altered age incidence of diphtheria, transference of scarlet fever to diphtheria alone needs consideration, as the transference of diphtheria to scarlet fever if proportionate at each age would not affect the age incidence of diphtheria mortality. Whether this transference has taken place in any considerable degree is difficult to determine, but the regular character of the curves based on the percentage variations in diphtheria age-incidence (see diagram facing page 8), and which I have already referred to, suggests that some transference has taken place. 5 The question is whether it is the sole explanation of the relatively increased incidence upon ages 3—, 4—, 5—, and the only way in which this can be tested is by adding scarlet fever deaths to diphtheria deaths, and considering the changes in the age incidence of the two diseases combined. The disadvantage attending the adoption of this course is, however, to obscure and minimise any changes in the age incidence of diphtheria, for it cannot be urged that the whole of the scarlet fever mortality of earlier times would now be attributed to diphtheria. Notwithstanding this obscuration, the percentage decrease at the ages 3—, 4— and 5— has been, with trifling exception, less than the decrease at the other age periods in each of the periods 1871-80, 1881-90 and 1891-6 compared with 1861-70 in England and Wales, and especially in London. This will be seen by reference to the following tables (IV. and V. (C).)— TABLE IV. England and Wales. (A) Scarlet fever, diphtheria and croup—Death rates per 1,000,000 living. Period. All ages. 0— 2— 3— 4— 5— 10— 15— 20 and upwards. 1861-70 1,402 3,735 8,379 8,642 8,106 6,457 2,823 650 213 68 1871-80 1,005 2,403 5,884 6.251 5,966 4,817 2.016 422 137 47 1881-90 640 1,488 3,783 3,930 3,934 3.340 1,402 262 77 30 1891-6 509 1,235 3,058 3.114 3.290 2,845 1,123 217 76 30 (B) Death rate per 1,000,000 living, death rate at " all ages " being taken as 100. 1861-70 100 266 598 617 578 460 201 46 15 5 1871-80 100 239 585 622 594 479 201 42 14 5 1881-90 100 233 591 614 615 522 219 41 12 5 1891 -6 100 243 601 612 646 559 221 42 15 6 (C) Increase or decrease per cent, of death rates at each age-period in 1871-80, 1881-90, and 1891-6, compared with the death rates at each age-period in 1861-70. 1871-80 —28.3 —35.7 —29.8 —27.7 —26.4 —25.4 —28.6 —35.1 —35.7 —30.9 1881-90 —54.4 —60.2 —54.9 —54.5 —51.5 —48.3 —50.3 —59.7 —63.8 —55.9 1891-6 —63.7 —66.9 —63.5 —64.0 —59.4 —55.9 —60.2 —66.6 —64.3 —55.9 TABLE V. London. (A) Scarlet fever, diphtheria and croup—Death rates per 1,000,000 living. Period. All ages. 0— 1— 2 3— 4— 5— 10— 15— 20 and upwards. 1861-70 1,565 4,417 10,355 11,218 9,732 7,609 3,141 607 212 82 1871-80 900 2,238 5,642 6,138 5,789 4,788 1,878 313 105 47 1881-90 747 1,827 5,045 5,252 5,168 4,278 1,529 235 82 36 1891-6 814 2,001 5,674 5,637 5,700 4,888 1,783 290 89 36 (B) Death rate per 1,000,000 living, death rate at " all ages " being taken as 100. 1861-70 100 282 661 717 622 486 201 39 14 5 1871-80 100 249 627 682 643 532 209 35 12 5 1881-90 100 245 675 703 692 573 205 31 11 5 1891-6 100 247 700 695 703 603 220 36 11 4 (C) Increase or decrease per cent, of death rates at each age-period in 1871-80, 1881-90, and 1891-8, compared with the death rates at each age-period in 1861-70. 1871-80 —42.5 —49.3 —45.5 —45.3 —40.5 —37.1 —40.2 —48.4 —50.5 —42.7 1881-90 —52.3 —58.6 —51.3 —53.2 —46.9 —43.8 —51.3 —61.3 —61.3 - 56.1 1891-6 —48.0 —54.7 —45.2 —49.8 —41.4 —35.8 —43.2 —52.2 —58.0 —56.1 6 The fact therefore remains that there has been in recent years relative increase of incidence of diphtheria mortality upon the ages 3—, 4— and 5— which is not explicable on the hypothesis of transference from scarlet fever. 2. Changes due to natural behaviour of the disease.—I have already shown in my annual report for the year 1896 that there is reason for thinking that there are seasonal variations in the age distribution of scarlet fever and diphtheria. The following tables (VI. and VII.), showing the results obtained from the notification statistics of the years 1892—(5 I now reproduce. TABLE VI. Diphtheria, 1892-6. Month. " All ages " taken as 1,000. All ages. 0— 1— 2— 3— 4— Under 5. 5— 10— 15— 20 and upwards. January 1,000 27 72 90 106 95 390 289 106 61 154 February 1,000 29 72 91 103 101 396 292 103 53 156 March 1,000 27 76 85 106 110 404 292 107 51 146 April 1,000 31 71 85 106 108 401 287 100 59 153 May 1,000 25 71 84 102 96 378 283 116 66 157 June 1,000 18 64 81 97 101 361 287 115 67 170 July 1,000 24 56 70 94 96 340 287 127 73 173 August 1,000 26 60 83 98 84 351 238 121 85 205 September 1,000 20 53 67 91 94 325 295 123 80 177 October 1,000 24 58 73 85 94 334 294 122 67 183 November 1,000 23 63 79 100 97 362 294 107 66 171 December 1,000 24 65 87 109 95 380 300 111 56 153 TABLE VII. Scarlet Fever—Notifications, 1892-6. Month. " All ages " taken as 1,000. All ages. 0— 1— 2— 3— 4— Under 5. 5— 10— 15— 20 and upwards. January 1,000 17 41 69 90 95 312 391 170 57 70 February 1,000 14 41 64 82 104 305 388 171 60 76 March 1,000 15 41 70 91 94 311 376 176 65 72 April 1,000 17 41 65 85 95 303 378 178 63 78 May 1,000 15 40 70 87 91 303 376 184 63 74 June 1,000 16 38 65 88 92 299 400 171 63 67 July 1,000 15 35 63 85 94 292 392 187 62 67 August 1,000 17 45 75 89 92 318 364 178 70 70 September 1,000 16 34 59 87 91 287 419 184 55 55 October 1,000 16 35 65 85 89 290 410 182 57 61 November 1,000 19 37 63 86 92 297 394 181 63 65 December 1,000 17 39 65 92 97 310 386 174 56 74 Examination of these tables, especially of the column "under 5," shows that, both in the case of diphtheria and scarlet fever, children at the younger ages are attacked in relatively larger proportions at the earlier and later parts of the year, and in less proportions in the summer months. There is, indeed, in both diseases, indication of a curve of seasonal age variation. I have also shown that the London cases of and deaths from scarlet fever and diphtheria indicate seasonal variations of fatality, and in view of these circumstances it is impossible to affirm that the natural age incidence of diphtheria mortality is always constant over a series of years. It is, however, obvious from the age distribution of notified cases in August as compared with other months that there is another and important factor concerned in determining the age incidence of diphtheria mortality. Changes due to some social differences in the community.—This may be best considered by study of other diseases of the same class as diphtheria. For this purpose the following tables* VIII., IX. and X. have been prepared. * The death rate at "all ages " is considerably influenced by variations in the age constitution of the population. This is especially marked in the case of those diseases, such as whooping cough and measles, which have a limited age incidence. Thus the "all ages" death rate from whooping cough in a community must very largely depend, apart from all questions of prevalence, upon the proportion of children aged 0—5 in the population, seeing that the disease is practically confined to children of that age. Thus, if the number of children aged 0—5 increases or decreases in greater proportion than the population at " all ages," the death rate from whooping cough at "all ages" will, ctteris paribus, also increase or decrease The following instance will show this more clearly— Suppose that a certain community in 1871 numbered 100,000 distributed in the following age groups, and that the deaths and corresponding death rates from whooping cough were as under— All ages 0—5. 5—20. 20—40. 40 and upward*. 1871 Population 100,000 10,000 40,000 30,000 20,000 Whooping cough deaths 245 200 40 3 2 Whooping cough death-rate per 1,000 2.45 20 1 0.1 0.1 Death-rate at "All ages" taken as 100 100 816 41 4 4 7 TABLE VIII. London. (A) Measles—Death rates per 1,000,000 living. Period. All ages. 0— 1— 2— 3— 4— 5— 10— 15— 20 and upwards. 1851-60 533 2,921 7,803 4,654 2,558 1,439 318 30 9 4 1861-70 572 3,481 8,691 4,847 2,469 1,281 245 23 8 4 1871-80 508 3,646 7,712 3,643 1,988 1,044 256 18 6 4 1881-90 634 4,543 9,909 4,759 2,733 1,618 366 18 5 3 1891-6 637 5,171 11,251 4,549 2,723 1,555 300 12 2 3 (B) Death rates at " all ages " taken as 100. 1851-60 100 548 1,464 873 480 270 60 6 2 1 1861-70 100 609 1,519 847 432 224 43 4 1 1 1871-80 100 718 1,518 717 391 206 50 4 1 1 1881-90 100 717 1,563 751 431 255 58 3 1 1891-6 100 812 1,766 714 427 244 47 2 ... Now assume that the population in 1881 had increased to 120,000, distributed as under, while the death rate from whooping cough at each age period remained the same as in 1871, then the following results will be obtained— 1881 All ages. 0—5. 5—20. 20—40. 40 and upwards. Population 120,000 15,000 45,000 35,000 25,000 Whooping cough deaths 351 300 45 3.5 2.5 Whooping cough death-rate per 1,000 Death-rate at " All ages' 2.92 20 1 0.1 0.1 taken as 100 100 685 34 3 3 It will thus be seen that the death rate from whooping cough has increased from 2-45 in 1871 to 2 92 in 1881, this increase being entirely due to the altered age constitution of the population. It follows, therefore, that the two rows of figures obtained by taking the "all ages" death rate as 100 are not altogether trustworthy for purposes of comparison in the case of 6uch diseases as whooping cough and measles. Throughout this report, however, the tables showing the increase or decrease per cent, at each age period have been mainly used for purposes of comparison. It ie, however, interesting to observe the effect of the changes in the age constitution of the population upon the comparative death rates, and for this purpose the following table has been prepared, in which the "all ages " death rates used for each period have been approximately corrected for changes in the age constitution of the population by the following method— The recorded death rates at each age group for the periods 1851-60, 1861-70, 1871-80 and 1891-6 have been applied to the mean populations of the period 1881-90, and a death rate at " all ages " has been calculated for each period from the numbers of deaths thus obtained. The corrected death rate at "all ages," therefore, for the period 1851-60, for example, represents the death rate at "all ages" which would have obtained in 1851-60 hal the mean population of that perio I been similar as regards age constitution to the mean population in 1881-90. London.—Comparative death rates at certain age periods.—Corrected death rate at "all ages" taken as 100. Cause of death. Period. Corrected death rate per million " all ages." 0— 1— 2— 3— 4— 5— 10— 15— 20 and upwards. Measles 1851-60 524 557 1,489 888 488 275 61 6 2 1 1861-70 551 632 1,577 880 448 232 44 4 1 1 1871-80 485 752 1,590 751 410 215 53 4 1 1 1881-90 634 717 1,563 751 431 255 58 3 1 1891-96 669 773 1,682 680 407 232 45 2 — — Scarlet Fever 1851-60 944 212 576 678 657 522 241 50 14 5 1861-70 1,118 206 576 710 642 526 236 48 16 5 1871-80 586 196 558 692 668 559 239 43 14 5 1881-90 328 199 591 694 699 573 223 41 15 5 1891-96 219 216 580 720 712 540 209 47 18 5 Whooping Cough 1851-60 846 1,120 1,335 700 398 206 40 2 1861-70 834 1,216 1,347 686 353 182 32 1 1871-80 771 1,354 1,326 599 312 173 33 1 1881-90 690 1,377 1,306 573 330 181 32 1 1891-96 578 1,449 1,349 530 282 158 30 1 — — Diphtheria and Croup 1859-60 386 429 834 686 658 430 140 37 14 8 1861-70 418 505 936 785 612 414 121 17 8 6 1871-80 290 376 818 718 646 517 164 20 8 6 1881-90 419 280 742 710 686 572 190 24 8 5 1891-96 619 247 712 656 669 599 214 30 8 4 Scarlet Fever, Diphtheria, and Croup 1861-70 1,536 287 674 730 634 495 204 40 14 5 1871-80 876 255 644 701 661 547 214 36 12 5 1881-90 747 245 675 703 692 573 205 31 11 5 1891-96 838 239 677 673 680 583 213 34 11 4 8 (C) Increase or decrease per cent, of death rates at each age-period in 1851-60, 1871-80, 1881-90, and 1891-6, compared with the death rates at each age-period in 1861-70. Period. All ages. 0— 1— 2— 3— 4— 5— 10— 15— 20 and upwards 1851-60 — 6.8 —16.1 —10.2 — 4.0 + 3.6 + 12.3 + 29.8 + 30.4 + 12.5 ... 1871-80 —11.2 + 4.7 —11.3 —24.8 —19.5 —18.5 + 4.5 —21.7 —25.0 ... 1881-90 + 10.8 + 30.5 + 14.0 — 1.8 + 10.7 + 26.3 + 49.4 —21.7 —37.5 —25.0 1891-6 + 11.4 + 48.5 + 29.5 — 6.1 + 10.3 + 21.4 + 22.4 —47.8 —75.0 —25.0 TABLE IX. London. (A) Scarlet fever—Death rates per 1,000,000 living. 1851-60 940 1,999 5,436 6,398 6,201 4,931 2,279 469 135 43 1861-70 1,135 2,308 6,444 7,937 7,174 5,878 2,637 536 177 56 1871-80 601 1,149 3,269 4,057 3,916 3,288 1,402 254 81 30 1881-90 328 652 1,937 2,277 2,293 1,880 731 135 50 16 1891-6 213 473 1,270 1,577 1,560 1,183 457 102 40 11 (B) Death rates at " all ages " taken as 100. 1851-60 100 213 578 681 660 525 242 50 14 5 1861-70 100 203 568 699 632 518 232 47 16 5 1871-80 100 191 544 675 652 547 233 42 13 5 1881-90 100 199 591 694 699 573 223 41 15 5 1891-6 100 222 596 740 732 555 215 48 19 5 (C) Increase or decrease per cent, of death rates at each age period in 1851-60, 1871-80, 1881-90, o,nd 1891-6 compared with the d,eath rates at each age-period in 1861-70. 1851-60 — 17.2 — 13.4 — 15.6 — 19.4 — 13.7 — 16.1 — 13.6 — 12.5 — 23.7 — 23.2 1871-80 — 47.0 — 50.2 — 49.3 — 48.9 — 45.4 — 44.1 — 46.8 — 52.6 — 54.2 — 46.4 1881-90 — 71.1 — 71.8 — 69.9 — 71.3 — 68.0 — 6.8.0 — 72.3 — 74.8 — 71.8 — 71.4 1891-6 — 81.2 — 79.5 — 80.3 — 80.1 — 78.3 — 799 — 82.7 — 81.0 — 77.4 — 80.4 TABLE ..............X. London. (A) Whooping cough—Death rates per 1,000,000 living. 1851-60 871 9,476 11,292 5,921 3,363 1,742 341 15 4 1 1861-70 876 10,145 11,237 5,720 2,941 1,520 268 12 4 1 1871-80 813 10,443 10,221 4,620 2,409 1,330 254 9 1 1 1881-90 690 9,504 9,010 3,951 2,280 1,246 221 6 1 1 1891-6 548 8,377 7,798 3,065 1,629 911 172 4 1 1 (B) Death rates at " all ages ages taken as 100. 1851-60 100 1,088 1,296 680 386 200 39 2 1861-70 100 1,158 1,283 653 336 174 31 1 — — 1871 -80 100 1,285 1,257 568 296 164 31 1 — — 1881-90 100 1,377 1,306 573 330 181 32 1 — — 1891-6 100 1,529 1,423 559 297 166 31 1 — —— (C) Increase or decrease per cent, of death rates at each age period in 1851-60. 1871-80, 1881-90 and 1891-6, compared with the death rates at each age period in 1861-70. 1851-60 — 0.6 — 6.6 — 0.5 + 3.5 + 14.3 + 14.6 + 27.2 +25.0 0.0 0.0 1871-80 — 7.2 + 2.9 — 9.0 —19.2 —18.1 —12.5 — 5.2 —25.0 —75.0 0.0 1881-90 —21.2 — 6.3 —19.8 —30.9 —22.5 —18.0 —17.5 —50.0 —75.0 0.0 1891-6 —37.4 —17.4 —30.6 —46.4 —44.6 —40.1 —35.8 —66.7 —75.0 0.0 The changes which have taken place may be most conveniently stated by adopting as in the case of diphtheria the period 1861-70 as a standard for comparison. It will be seem from the accompanying diagrams which are based on the percentages shown in the tables, (C) (the dotted lines in the diagrams representing the period 1861-70), that there has been a tendency to relative increase of incidence of mortality both in measles and whooping cough on ages 3-, 4and 5- as in the case of diphtheria. The increase at these ages is however not manifest in the case of scarlet fever. There has also been relative increase of incidence of mortality on the first two years of life in measles and whooping cough which again is not manifest in the case of scarlet fever. In seeking for an explanation of the relative increase of incidence of measles and whooping cough mortality upon the first two years of life the probability that it is the result of increased opportunity of infection due to These diagrams are based upon the figures contained in Tables II. (e), and VIII. (c), IX. (c), and X. (c). In the case of each curve the distance of each successive point of the curve above or below the dotted line represents the increase or decrease per cent, in the death rates at successive age groups obtaining in the period to which the curve relates, compared with the corresponding death rates obtaining in the period 1861-70. N.B.—In the diagrams relating to measles, whooping cough, and diphtheria and croup, to ensure greater clearness and to avoid intersection of the curves, a separate dotted line is drawn for each curve, the dotted lines following the same chronological order as the curves, i.e., the first curve shown, for each of these diseases, relating to the period 1871-80, is drawn in relation to the first dotted line; the second curve (1881-90) in relation to the second dotted line, &c. In the case of scarlet fever each of the curves have been drawn in relation to the same dotted line, the use of more than one dotted line being unnecessary owing to the progressive decline of the scarlet fever death rates at each age period. Each square in the diagrams represents 10 per cent. London. 9 increased density of population naturally suggests itself, children of this age being less easily protected from exposure to infection than before. Explanation is however still wanted for the relatively increased incidence on the ages 3-, 4- and 5-. There is undoubtedly suggestion of some common cause operating at these ages to produce parallel results with regard to the three diseases—measles, whooping cough and diphtheria. In the case of diphtheria it will be observed that the increase also affects the age 10-, but that this is not manifest in measles or whooping cough. The number of deaths from those diseases at this age is, however, very small. It is difficult to explain the fact that scarlet fever has not been affected in a similar manner at these ages. Transference from diphtheria to scarlet fever, if proportionate at each age, would have the effect of increasing the incidence of scarlet fever mortality on the earliest years of life, and would in this way tend to obscure the result of increased incidence on ages 3-, 4— and 5- due to other cause, such as that which has produced this increase in the other diseases. Whether it will be subsequently found that the increasing feebleness of the scarlet fever virus, shown by the decrease in mortality, is operating to prevent this cause from being manifested, the experience of future years alone can prove. Apart from some such explanation as the above, it would be necessary to assume that the cause which produced these changes in the other diseases was for some reason inoperative in the case of scarlet fever. The fact, however, remains as already pointed out, that irrespective of all questions of change in nomenclature, there is increased incidence of mortality on the ages 3-, 4- and 5-, when the figures relating to diphtheria, croup and scarlet fever are combined. The hypothesis that this increase is caused by the aggregation of children at school is, I believe, the one most likely to be correct, and it does not appear to me that the behaviour of the other diseases referred to militates against this hypothesis. In connection with the hypothesis that increased attendance at school has led to relatively increased incidence of diphtheria mortality on the school ages, the particular period at which this increased incidence is first manifested becomes important. The Compulsory Education Act was passed in 1870, and it will be seen from the following table (XI.) that in London there was marked increase in the early years of the decade 1871-80, and that this increase has been practically continued since. The table shows the diphtheria death rate at all ages, at the age period 3-15 years,* and the comparative death rate of this age period, the death rate at all ages being taken as 100. TABLE XI. London. Diphtheria and Croup. Year. Death rates per million. Death rate at ages 3-15 (all ages death rate taken as 100). All ages. Ages 3-15. 1861 552 805 146 1862 590 952 161 1863 590 1,029 174 1864 516 784 152 1865 396 575 145 1866 402 569 142 1867 385 556 144 1868 364 574 158 1869 282 424 150 1870 286 449 157 1871 258 448 174 1872 263 490 186 1873 308 520 169 1874 347 617 178 1875 384 681 177 1876 286 515 180 1877 229 412 180 1878 320 626 196 1879 306 626 205 1880 306 616 201 1881 345 706 205 1882 447 927 207 1883 455 923 203 1884 427 865 203 1885 401 785 196 1886 344 700 204 1887 389 794 204 1888 442 988 224 1889 501 1,100 220 1890 456 974 214 1891 420 939 224 1892 510 1,126 221 1893 809 1,834 227 1894 661 1,506 228 1895 567 1,264 223 1896 633 1,459 230 * The populations for the age period 3-15 have been calculated on the assumption that the rates of increase in intercensal years have been constant. More precise figures would have been obtained by interpolating the populations by the method of finite differences. This has been done for the years 1868-69-70 and 1872-3-4, also for the years 1880 and 1882, these being the years in which the differences in the results obtained by the two methods of calculation would be greatest. The rates for these years, calculated on either series of populations, are, however, practically identical. [2] 10 Experience gained from the notification of diphtheria. The experience gained from the notification of infectious diseases is especially valuable in connection with the subject under consideration. The statistics of notification of infectious disease only extend back to the year 1890, and it was not until 1892 that the age of the patient was required to be stated on the certificate. I have already published in annual reports diagrams for the years 1893-4-5-6, showing the number of cases notified in each week in relation to the mean of the year at the ages 0-3 years, 3-13 years, and 13 years and upwards. These diagrams I now reproduce, and to them have added a similar diagram for the year 1892.† In studying the prevalence of diphtheria in successive weeks the following facts should be borne in mind— 1892. The schools of the London School Board closed generally for the summer holiday on Thursday, the 21st July, in the 29th week, and re-opened on Monday, 22nd August, i.e., the beginning of the 34th week. Comparison between the number of cases at the several ages in three periods of four weeks (1) the 27th-30th week, (2) the 31st-34th week,* and (3) the 35th-38th week, gives the following results— Under 3 years. 3-13 years. 13 years and above. Increase or decrease per cent, of number of cases in 2nd period in relation to number in 1st period +20 —3 —10 Increase or decrease per cent, of number of cases in 3rd period in relation to number in 2nd period —7 +29 +34 1893. The schools of the London School Board closed generally for the summer holiday on Thursday, 27th July, in the 30th week, and re-opened on Monday, 28th August, i.e., at the beginning of the 35th week. Comparison of the number of cases at the several ages in three periods of four weeks (1) 28th-31st week, (2) 32nd-35th week,* and (3) 36th-39th week, gives the following results— Under 3 years. 3-13 years. 13 years and above. Increase or decrease per cent, of number of cases in 2nd period in relation to number in 1st period +8 —27 +1 Increase per cent, of number of cases in 3rd period in relation to number in 2nd period +6 +81 +33 1894. The schools of the London School Board closed generally for the summer holiday on Thursday, 26th July, i.e., in the 28th week, and re-opened on Monday, 27th August, the beginning of the 35th week. Comparison of the number of cases at the several ages in the three periods (1) 28th-31st week, (2) 32nd-35th week,* (3) 36th-39th week gives the following results— Under 3 years. 3-13 years. 13 years and above. Decrease per cent, of number of cases in 2nd period in relation to numbers in 1st period +11.0 —23.9 +4.1 Increase or decrease per cent, of numbers of cases in 3rd period in relation to number in 2nd period —10.6 +44.5 +10.8 1895. The schools of the London School Board closed for the summer holiday on Thursday, 25th July, i.e., in the 30th week, and re-opened on Monday, 26th August, i.e., the beginning of the 35th week. Comparison between the number of cases at the several ages in three periods of four weeks (1) the 28th-31st week, (2) 32nd-35th week* and (3) 36th-39th week gives the following results— Uuder 3 years. 3-13 years. 13 years and above. Decrease in number of cases in 2nd period in relation to numbers in 1st period —21.5 —36 —16.4 Increase in number of cases in 3rd period in relation to number in 2nd period +6.5 +49 +15.8 1896. The schools of the London School Board closed generally for the summer holiday on Thursday, the 23rd July, in the 30th week, and reopened on Monday, the 24th August, that is, the beginning of the 35th week. Comparison between the number of cases at the several ages in three periods of four weeks, (1) the 28th-31st week, (2) the 32nd-35th week,* and (3) the 36th-39th week, give the following results— Under 3 years. 3-13 years. 10 years and above. Increase or decrease per cent, of number cases in 2nd period in relation to number in 1st period —9.4 —14.9 +4.5 Increase or decrease per cent, of number of cases in 3rd period in relation to number in 2nd period +18.8 +34.0 —7.3 * In these and other tables in the report where similar comparisons are made, the middle period of four weeks, i.e.t the period of "holiday influence" commences and terminates one week later than the actual holiday period, in order to allow as far as possible for " incubation period " and delay in notification. † Since this report was in type, it has been possible to supply the diagram for the year 1897. The particulars relating to the school holidays in 1897 are as follows— 1897.—The schools of the London School Board closed generally for the summer holiday on Thursday, the 22nd July, in the 29th week, and re-opened on Monday, the 23rd August, that is, the beginning of the 34th week. Comparison between the number of cases at the several ages in three periods of four weeks (1) the 27th-30th week, (2) the 31st-S4th week, and (3) the 35th-38th week give the following results— Under 3 years. 3-13 years 13 years and upwards. Increase or decrease per cent. of number of cases in 2nd period in relation to number in 1st period —8.9 —28.7 —12.0 Increase or decrease per cent. of number of cases in 3rd period in relation to number in 2nd period —0.7 +30.4 +6.4 Notified Cases. Diphtheria,1892. Notified Cases. Diphtheria, 1893. Notified Cases Diphtheria, 1894. Notified Cases. Diphtheria, 1895. Diagram XII. NOTIFIED CASES. Diphtheria, 1896. Notified Cases Diphtheria. 1897. DIPHTHERIA AND CROUP DIAGRAM showing mean death-rates from Diphtheria and Croup in 1871-5 and successive quin-quennia in comparison with the mean death-rate of 1861-70 taken as 100. N.B.—The shaded portion of the diagram represents the effect on the "All Ages" death-rate of the increased incidence of these diseases on ages 3-10 since 1861-70. 11 The diagrams enable the decrease in the month of August to be appreciated, and the close correspondence in point of time between this decrease and the closing of the schools when due allowance is made for period of incubation, and a little delay in notification is noteworthy. The further fact that the decrease in the age 0—3 curves generally occur somewhat later than in the age 3—13 curves, suggests a lessening of the infection of the younger by the older children. With a view to enabling the effect of the increased incidence of diphtheria mortality upon particular ages to be easily appreciated, the following table (XII.) and the accompanying diagram have been prepared. The diagram shows the effect on the "all-ages" death rate of the increased incidence of diphtheria on the age period 3—10 years. The diagram had been prepared before this report was written, and hence the age period 3—15 years was not adopted. The effect of the addition of the age period 10—15 years to that of 3—10 years makes, however, no difference deserving of comment. TABLE XII. London. Diphtheria and croup. Period. "Ages 3-10." "All ages." Estimated deaths assuming same proportion of deaths at ages 3-10 in 1871-5 and successive periods as obtained in 1861-70. Registered deaths. Excess. Estimated deaths assuming same proportion of deaths at ages 3-10 in 1871-5 and successive periods as obtained in 1861-70. Registered deaths. Death rate per million calculated on estimated deaths shown in column 4. Death rate per million calculated on registered deaths shown in column 5. Death rate in 1861-70 taken at 100. On estimated death rate in column 6. On death rate in column 7. 1 2 3 4 5 6 7 8 9 1861-70 4,805 4,805 - 13,031 13,031 431.7 431.7 100 100 1871-5 1,776 2,273 497 4,783 5,280 284 313 66 73 1876-80 1,678 2,483 805 4,491 5,296 246 290 57 67 1881-5 2,426 4,019 1,593 6,503 8,096 333 415 77 96 1886-90 2,468 4,505 2,037 6,696 8,733 327 426 76 99 1891-5 3,412 6,870 3,458 9,320 12,778 433 594 100 139 It is desirable to use the experience of notification with a view to learning as far as possible the actual amount of increase of the disease which is due to infection at school. For this purpose tables VI. and VII. may be referred to. The decrease of diphtheria in the holiday month of August among children at school age is conspicuous. But for the holiday the number of cases notified in August would probably stand somewhere between the numbers in July and September. In the following table (XIII.), the estimated mean weekly number of cases in August has been obtained by interpolation, using for this purpose the figures supplied by June, July, September and October. It will be seen that at all ages the estimated figures exceed the actual notification by 24-1 per cent., i.e., the holiday in August has reduced the total number of cases by one-fifth, the most conspicuous reduction being at age 5—, at which age the holiday reduced the number of cases by onethird. TABLE XIII. London, 1892-96. Age—period. Estimated mean weekly number of notifications in August on the assumption of a continuous curve of prevalence extending over the months of June. July, August, September and October, 1892-6. Mean weekly number of cases notified in August, 1896. Increase or decrease per cent. of estimated notifications over actual number of cases notified. 0— 5.6 5.5 + 1.8 1— 13.6 12.6 + 7.9 2— 17.1 17.5 — 2.3 3— 24.3 20.7 + 17.4 4— 24.6 17.6 + 39.8 Under 5. 85.3 73.9 + 15.4 5— 76.2 50.2 + 51.8 10— 33.2 25.5 + 30.2 15— 20.9 17.9 + 16.8 20 and upwards 45.6 43.0 + 6.0 All ages. 261.2 210.5 + 24.1 12 In any effort to form from the foregoing an estimate of the increase in diphtheria which may properly be attributed to school-attendance, the following should be borne in mind— 1. There is suggestion of some transference of scarlet fever to diphtheria which would tend to exaggerate the increased incidence of diphtheria mortality on the school age. 2. Any increase of mortality at other ages than school age, due to infection of persons by those who have contracted disease in school, would tend to obscure the effect of schoolattendance on the school age. 3. It must not be assumed that a holiday in all other times of the year would produce results identical with those of August, seeing that at that time the seasonal curve is rising to the autumnal maximum, and this increase may depend upon the disease possessing a greater personal infectivity at that time than at others. Report of the medical officer of the London School Board. I propose now to refer to the report of Dr. W. R. Smith, the medical officer of the London School Board, published in April, 1896, in which he expresses the opinion "that school influence, as such, plays but an unimportant part in the enormous increase of the disease during recent years in London." The earlier pages are in the main introductory and need no comment. Part I., which follows these introductory pages, gives account of the geographical distribution of diphtheria, scarlet fever and measles, and the conclusions of the writer are stated in the last two paragraphs of this part, which are as follows— **** although the spread of every infectious disease must necessarily bo favoured by bringing together large numbers of those most liable to it, yet the conditions most favourable to the diffusion of measles and scarlet fever are not those most favourable to the diifusion of diphtheria. In other words, if we wish to explain why Sussex is comparatively free from measles and scarlet fever, but suffers from excessive diphtheria mortality, while Staffordshire is comparatively free from diphtheria but suffers excessively from measles and scarlet fever, we must look for some conditions which are not common to the two counties. It may be suggested that such a condition is found in the fact that Sussex is much nearer to London than is Staffordshire; but this suggestion fails entirely to meet the case, since the special liability of Sussex to diphtheria began several years before that of London. If school infection is the chief cause of the mortality from diphtheria in Sussex, why should Staffordshire escape? And if school infection is the chief factor in the spread of measles and scarlet fever in Staffordshire, why should Sussex eseape? It is evident that several agencies must be at work in spreading zymotic diseases among children, and it may be taken as highly probable that school infection is one of those agencies. But the comparison of the geographical distributions of three of these diseases strongly suggests that some local causes other than school attendance have a more potent influence in selecting the disease and promoting its diffusion. I see no reason to take exception to these statements, but would add that, apart from local conditions to which Dr. Smith refers, variation in the quality of the virus is probably the largest factor governing prevalence of diphtheria. In Part II. Dr. Smith publishes a table showing in successive years the proportions in London of the population at school ages attending elementary schools, and he then states his conclusions— It will be seen that while the percentage of children attending elementary schools has largely increased, viz., from 24.8 per cent. in 1871, to 59.8 per cent. in 1893, the comparative death rate at ages 3-10 has remained throughout these years fairly constant, the lowest proportion having been 312 in 1875, the highest 369 in 1881, and the average for the 24 years, 347. There is an obvious fallacy in the method of presenting these facts. It would only be free from objection if the whole of the diphtheria mortality had been due to school attendance. If the school attendance has increased since 1871 nearly three times, it could not be expected that the diphtheria mortality due to other conditions which remain constant, would increase in the same proportion, but only that there should be some conspicuous increase in that amount of the total diphtheria at school age which is due to schools. Apart from this, the statement that "the comparative death rate at ages 3-10 has remained throughout these years fairly constant," is inaccurate, whether judged by the figures supplied by diphtheria or by diphtheria and croup, thus— Period. Death-rate, ages 3—10. All ages taken as 100. Diphtheria. Diphtheria and croup. 1871-5 323 274 1876-80 345 296 1881-5 352 314 1886-90 357 332 1891-5 358 349 It may also be pointed out that the extent of the increase is obscured by taking "all ages" as a basis of comparison seeing that the deaths at ages 3-10 form so large a proportion of the deaths at 13 all ages. The increase is better shown by taking as a basis of comparison the death rate at all ages exclusive of ages 3-10, the following figures are thus obtained— Period. Death-rate ages 3—10. All ages exclusive of 3—10 taken as 100. Diphtheria. Diphtheria and croup. 1871-5 549 407 1876-80 646 469 1881-5 665 526 1886-90 673 580 1891-5 675 638 The next few pages of Dr. Smith's report are occupied by tables showing that some districts in London have suffered from diphtheria in greater degree than others, but no inference appears to have been drawn from this fact. Following these tables is a statement of the number of children at each year of life attending the London School Board schools, and objection is taken to my inclusion of children between three and four years of age among those of school age. The small number of children at this age attending these schools leads Dr. Smith to state that "it is more correct to speak of four years instead of three years as the age at which school attendance commences. We should therefore expect that any tendency to school infection would show itself in a marked manner at age four." By comparing diphtheria in 1881-90 with diphtheria in 1871-80 he shows that the greatest increase in London is in the second year and in England in the third year of life, which is obviously earlier than school age. I think there is no doubt that this increase is, in the main, due to transference of croup to diphtheria; reference to Tables I. and II. relating to diphtheria and croup shows that when these two diseases are considered together the increase at this age is less than at ages 3—, 4—, 5—, and 10—. The question whether children of the age 3— can properly be included among children of school age is not of importance. I included this age because as the result of inquiry I made, I satisfied myself that in schools other than board schools there are a sufficient number of children at this age to make the course I have adopted desirable. Such inclusion, of course, leads to understatement of the increase of incidence on the school age, as will be apparent by reference to Tables I., II. and III. The next two pages of Dr. Smith's report are devoted to showing that girls from 5-10 are more liable to die from diphtheria than boys of this age. It is urged that "no difference in the school conditions of the two sexes can be imagined which would yield even a plausible explanation." The question does not need consideration here; it has before been explained by Dr. Downes on the ground of the greater domesticity of girls. Pages 17, 18, 19 and 20 of Dr. Smiths' report are devoted to discussing the age incidence of attacks of diphtheria. He publishes diagrams showing that the ages which are most affected by diphtheria are not the ages at which there is the largest school attendance, and he states from the teaching of these diagrams that "it is impossible to resist the conclusion that no special increase of liability to diphtheria can be traced to the beginning of school attendance." It is obvious that no lesson is to be learnt from these diagrams beyond the well-recognised fact that there is a natural inequality of age incidence of diphtheria. Whether, and to what extent, this natural age incidence has been modified by school attendance can only be shown by comparing the age incidence of attack in two populations, the one attending school, the other not attending school, or of one population during periods of attendance at school, and periods when school is not attended, or when school attendance is less. On page 21 of Dr. Smith's report is a discussion of diagrams representing the number of notified cases of diphtheria in each week in relation to the mean of the year, and similar to those I have published in my annual reports, except that Dr. Smith's diagrams only exhibit the effect of the August holiday on all ages. Perhaps for this reason the relation between decrease in prevalence in August, so marked among children of school age, is less obvious to him than to myself. He publishes, however, a table representing the number of notified cases at each age during three successive periods of four weeks in 1895, and comments on the fact that the decrease in the second period, when the influence of the holiday would be manifested, is almost as marked among children below school ages as at school ages. Neither his figures nor mine support this contention. He omits, also, to point out that diphtheria among the younger children declines, and subsequently rises, a week later than among the older children, suggesting, as I have before said, that a number of the younger children receive their infection from the older children. On pages 22 and 23 of his report he shows the number of cases of diphtheria notified in each London district in each week of July, August, and September of 1895, and he states that— The various sanitary areas show a marked divergence in the incidence of the disease, before, during, and after the school holidays. School influences should be the same in all of them; but we find that in the crowded eastern and southern districts, with the exception of Greenwich, the school holidays practically did not affect the prevalence of diphtheria. Only in the west and northern districts is the marked fall followed by the equally marked rise noticeable. So far as these remarks are based on the figures of particular districts it must be recollected that the figures are small and therefore less reliable, and the important fact has to be borne in mind that diphtheria may at one time be spreading in a school or schools in a district and not at another. It is only by taking the figures of a large population or groups of districts that the general effect of schools can in this manner be studied. The following table shows the figures relating to groups 14 of London districts for the year he discusses. It will be seen that the effect of the holiday is well marked in each group in that year. Notified Cases—Diphtheria, 1895. Weeks. Notified cases. Increase or decrease per cent. All ages. 0-3 3-4 4-13 13 and up. No age stated. All ages. 0-3 3-4 4-13 13 and up. West Districts. 28-31 206 30 29 107 39 1 - - - - - 32-35 105 18 9 58 20 - — 49.0 — 40.0 — 69.0 — 45.8 — 48.7 36-39 143 17 16 76 34 - + 36.2 — 5.6 + 77.8 + 31.1 + 70.0 North Districts. 28-31 160 26 18 68 48 - - - - - - 32-35 112 19 13 39 40 1 — 30.0 — 26.9 — 27.8 — 42.6 — 16.7 36-39 232 34 26 117 55 - + 107.0 + 78.9 + 100.0 + 200.0 + 37.5 Central Districts. 28-31 43 8 1 15 18 1 - - - - - 32-35 32 8 2 12 8 2 — 25.6 + 0.0 + 100.0 — 20.0 — 55.6 36-39 43 10 4 19 8 2 + 34.4 + 25.0 + 100.0 + 58.3 + 0.0 East Districts. 28-31 293 48 29 138 77 1 - - - - - 32-35 246 48 24 95 79 - — 16.0 + 0.0 — 17.2 — 31.2 + 2.6 36-39 273 33 29 115 95 1 + 11.0 — 31.2 + 20.8 + 21.1 + 20.2 South Districts. 28-31 417 66 34 218 98 1 - - - - - 32-35 306 46 36 132 87 5 — 26.6 — 30.3 + 5.9 — 39.4 — 11.2 36-39 361 51 34 192 79 5 + 18.0 + 10.9 - 5.6 + 45.4 — 9.2 On page 24 of his report he writes— "Is it not probable that the decreased number of notifications during the school holiday is in a "great measure due to the fact that many children are then taken into the country, leaving fewer "susceptible people in London? This explanation would account for the persistence of the notifications "in the poorer districts concurrently with their decrease in other parts of London." I have already discussed this question in 1894,* and expressed the opinion that this hypothesis did not suffice to explain the August decrease. It may, of course, be a small factor, but certainly the assumption that the migration of children from London was explanative of the decrease, would necessitate further assumptions that children 0-3 years of age go out of town for their holiday later than the older children, and that, inasmuch as the extent of the August decrease varies greatly in different years, that the number of people leaving London for an August holiday must vary in like degree. On the face of it this is improbable; the explanation of this difference is probably to be found in the extent to which diphtheria is in one, as compared with another year, spreading in the schools. With regard to the fact that the August holiday effected in 1895 less reduction in diphtheria in the eastern and southern districts as compared with the western, this may likely enough be due to the greater tendency of children in poorer districts to maintain relationship with their schoolfellows in the streets during holidays. On pages 24 and 25 he discusses the experience of other towns, and publishes a table showing the number of notifications in seven English towns in each of the weeks from the 22nd to the 40th in each year of 1891-95. The towns referred to are Manchester, Salford, Oldham. Liverpool, Sheffield, Newcastle-on-Tyne and Birmingham, and he writes "these figures taken as a whole show scarcely any perceptible fluctuations of the incidence of disease which could fairly be attributed to school influence." The number of cases of diphtheria notified in these towns is, however, very small, and require more detailed examination before any sure opinion can be expressed on the subject. I have in the following table shown the results obtained by grouping the cases in respect to age and also in three equal periods—(1) before holiday influence; (2) period of holiday influence; and (3) period subsequent to holiday influence. As far as was practicable I have shown these results in the towns mentioned above, and have added those of certain other towns for which I was able to obtain the necessary figures. The table certainly shows marked decrease in the number of notifications in the period of holiday influence. * Presidential address to the Epidemiological Society, November, 1894. 15 Diphtheria Notifications, 1891-5. Ages under 3. Ages 3-13. Ages 13 and upwards. Weeks preceding holiday influence. Weeks of holiday influence. Weeks following holiday influence. Weeks preceding holiday influence. Weeks of holiday influence. Weeks following holiday influence. Weeks preceding holiday influence. Weeks of holiday influence. Weeks following holiday influence. Bradford. 1891 ... 1 ... ... 1 1 1 1 ... 1892 ... ... ... 1 ... 1 ... ... ... 1893 1 ... ... 2 2 1 4 1 3 1894 1 1 ... 2 ... ... ... 1 ... 1895 ... 1 ... 3 3 ... ... 1 ... Total 2 3 ... 8 6 3 5 4 3 Birmingham. 1891 ... ... 1 3 5 2 3 5 2 1892 4 2 5 12 9 4 17 27 21 1893 2 1 1 12 3 4 21 15 17 1894 3 1 ... 6 3 5 11 5 17 1895 6 3 4 18 17 27 25 18 26 Total 15 7 11 51 37 42 77 70 83 Nottingham. 1891 ... 1 ... ... 1 3 ... ... 6 1892 1 ... ... 8 2 ... 3 2 3 1893 ... 1 ... 1 2 2 2 6 ... 1894 ... ... ... 1 5 ... 1 ... ... 1895 1 ... ... 4 2 2 1 3 2 Total 2 2 ... 14 12 7 7 11 11 West Ham. 1891 ... ... ... 4 5 9 1 1 9 1892 3 ... 2 19 12 13 5 9 10 1893 3 5 5 12 9 12 7 8 13 1894 8 4 5 14 11 28 8 13 9 1895 13 8 8 48 38 60 24 18 31 Total 27 17 20 97 75 122 45 49 72 Salford. 1891 2 3 2 5 6 3 2 8 4 1892 3 ... 5 1 4 17 2 5 6 1893 3 2 3 6 2 8 1 6 6 1894 2 5 4 7 1 6 7 ... 6 1895 3 2 3 4 3 3 4 1 2 Total 13 12 17 23 16 37 16 20 24 Sheffield. 1891 1 ... 1 10 7 2 7 3 1 1892 2 1 2 2 5 6 1 7 4 1893 ... 1 1 3 3 2 2 1 3 1894 2 3 4 2 5 10 1 2 ... 1895 ... 4 ... 4 3 3 2 2 1 Total 5 9 8 21 23 23 13 15 9 16  Ages under 3. Ages 3-13. Ages 13 and upwards. Weeks preceding holiday influence. Weeks of holidayinfluence. Weeks following holiday influence. Weeks preceding holiday influence. Weeks of holiday influence. Weeks following holiday influence. Weeks preceding holiday influence. Weeks of holiday influence. Weeks following holiday influence. Bristol. 1891 ... ... ... 2 1 ... 2 ... ... 1892 ... 1 1 3 3 1 3 4 1 1893 4 ... 2 4 3 2 ... 1 2 1894 2 2 2 2 ... 8 1 1 2 1895 3 ... 2 8 6 6 3 3 5 Total 9 3 7 19 13 17 9 9 10 Manchester. 1891 3 3 2 15 12 12 11 10 9 1892 3 1 4 11 8 11 11 4 15 1893 4 2 2 19 7 11 23 15 11 1894 2 1 2 10 14 8 20 10 11 1895 1 3 ... 3 1 6 6 11 2 Total 13 10 10 58 42 48 71 50 48 Total 8 towns. 1891-5. 86 63 73 291 224 299 243 228 260 Dr. Smith further publishes the weekly deaths in Berlin, and says that there is no diminution of the deaths during the holidays. I can draw no conclusion from these mortality figures, the question should be tested by cases in groups of ages. Without attaching any great importance to "all ages" figures in small communities, it is interesting to observe that the "all ages" notifications in the large population of Berlin distinctly suggest that there is decrease of diphtheria in Berlin in the holidays. The following table is based upon figures kindly sent me by Dr. Pistor— Weekly cases of diphtheria notified in Berlin, from the 24th to the 37th weeks, 1893-5. Weeks. 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Berlin, 1893 66 68 97 80 81 80 64 60 54 72 80 102 112 105 1894 81 71 74 51 52 45 66 59 54 68 81 74 101 111 1895 131 127 99 122 132 113 115 116 88 93 101 111 121 137 Adding together the figures for three periods of four weeks, i.e., before, during (figures shown in clarendon type) and after the period of holiday influence the following results are obtained— 1893. 1894. 1895. Weeks. Cases. Weeks. Cases. Weeks. Cases. Four weeks preceding weeks of holiday influence 26-29 338 25-28 248 25-28 480 Four weeks of holiday influence 30-33 250 29-32 224 29-32 432 Four weeks following weeks of holiday influence 34-37 399 33-36 324 33-36 426 The experience of Berlin in this respect appears to be the same as that of London. Dr. Smith then uses the Berlin deaths for the construction of a diagram representing the proportion of deaths at each age in 1,000 deaths at "all ages." Similar diagrams are exhibited relating to England and London. He thus writes concerning them— The close similarity between the diagrams for Berlin and London is at once apparent. Whereas, however, in London the compulsory school age commences at five years, that in Berlin does not commence until six. Had, therefore, the mere fact of attendance at elementary schools any great influence on the age incidence of diphtheria, one would naturally have expected to find a considerable divergence in the above diagrams. I cannot emphasize too greatly the importance of these facts, and the bearings which they have on the questions upon which I am engaged. 17 Examination of these diagrams leads me to the conclusion that they are very much what might be expected. The figures supplied by Beilin lend support to the view that the age distribution of diphtheria mortality is affected by the age at which compulsory attendance at school begins, thus the following figures show a greater relative incidence of diphtheria mortality upon the ages 3-5 years in London than in Berlin. The death-rates are shown for diphtheria and for diphtheria and croup. In the case of Berlin additional columns are given showing deaths and death-rates from diphtheria and croup plus "scharlach-diphtherie," a disease for which there is 110 equivalent term in the system of nomenclature adopted in the reports of the Registrar General. Diphtheria, 1887-96. Berlin, 1887-96. Age period. Population, 1890. Deaths, 1887-96. Death rates per million. Death rates per million—Death rates at 0-3 being taken as 1,000. Diphtheria. Diphtheria and croup. Diphtheria and croup plus "Scharlach diphtherie.'' Diphtheria. Diphtheria and croup. Diphtheria and croup plus "Scharlach diphtherie." Diphtheria. Diphtheria and croup. Diphtheria and croup plus "Scharlach diphtherie." 0-3 103,409 4,552 5,072 5,327 4,402 4,905 5,151 1,000 1,000 1,000 3-5 60,961 3,244 3,395 3,613 5,321 5,569 5,927 1,209 1,135 1,151 5-10 136,446 3,164 3,235 3,378 2,319 2,371 2,476 527 483 481 10 and upwards 1,277,978 777 797 831 61 62 65 14 13 13 All ages 1,578,794 11,737 12,499 13,149 743 792 833 - - - London, 1887-96. Age period. Population, 1891. Deaths, 1887-96. Death rates per million. Death rates per million —Death rates at 0-3 being taken as 1,000. Diphtheria. Diphtheria and croup. Diphtheria. Diphtheria and croup. Diphtheria. Diphtheria and croup. 0-3 307,182 7,391 9,258 2,406 3,014 1,000 1,000 3-5 194,440 5,916 6,882 3,043 3,539 1,265 1,174 5-10 454,160 4,920 5,345 1,083 1,177 450 391 10 and upwards 3,255,961 1,423 1,445 44 44 18 15 All ages 4,211,743 19,650 22,930 467 544 — — Hitherto Dr. Smith's report has related only to the examination of figures relating to notification and death, but on pages 27-30 he gives the result of a special enquiry he made into 2,168 consecutive cases of diphtheria at "all ages" removed to the hospitals of the Metropolitan Asylums Board. He divides his cases into three groups—cases aged 0-3, 3-13, and 13 and upwards; cases aged 3-13 he sub-divides into three groups— (a) Cases which attended school within seven days of the occurrence of the first symptoms of disease 839 (b) Cases which did not attend school within seven days of the occurrence of the first symptoms of disease 545 (c) Cases about which full information as to school attendance could not be obtained 47 Total 1,431 He then proceeds to point out that the 839 children, constituting "58.6 per cent. of the cases "of diphtheria at school ages, occurred amongst children attending elementary schools"; that of the London population "60 percent. of the children living at school ages attend elementary schools; "and from this it would therefore appear that the disease is equally incident on children attending "schools and upon those not attending." In other words, Dr. Smith draws the inference that diphtheria is equally incident on children of school age attending elementary schools and upon those not attending, from the following data— (а) Of 1,431 cases of diphtheria at ages 3-13 admitted to the hospitals of the Metropolitan Asylums Board, 58.6 per cent. had attended school within seven days of attack. (b) Of the London population 60 per cent. of the children living at school ages are in average attendance at elementary schools. It is obvious that no reliable inference can be drawn from these figures. The figures relating to average attendance at elementary schools are not comparable with the figures relating to the proportion of children of school age in the hospitals who had attended school within seven days of attack. [3] 18 The proportion of children in the hospitals who have attended schools within seven days of attack must vary very much. The fact that the six months selected include the Easter holiday and especially the summer holiday, when the disease has a natural tendency to be prevalent, would lead to increase in the proportion of children in the hospitals who have not attended school within seven days of attack. If the figures of the first and second three months had been given separately, the results in the two periods would probably have been very different. The proportion of children aged 3-4 attending school is, as I have already said, 110 doubt small, but the natural incidence of the disease at this age is great. It would be interesting to learn how many of 261 cases at this age, shown by Dr. Smith in his Table XXXI. to have been removed to hospital, are included among the 545 cases which did not attend school within seven days of attack. He next summarises the results of his inquiry as follows— Cases concerning which full information could not be obtained 47 Cases in which no source of infection could be discovered 1,618 Cases in which infection was traceable directly or indirectly to school 124 Cases in which infection was traced to a school-attending child, and casting, therefore, some suspicion on the school 55 Cases in which infection was traceable to other sources than school 324 2,168 He states that "in only 124 cases can the disease be fairly attributed to school influence, or only "in 5.7 per cent. of the whole." It may be pointed out that of the total number of cases in which the cause of infection could be traced—viz., 503—124 were distinctly traceable to school, or 24.6 per cent. With regard to the 1,618 concerning which no source of infection was discoverable, it would have been fair to have assumed that some proportion, perhaps the same proportion, was also due to schools; but Dr. Smith subsequently appended a note to his report that "no enquiry was made into "the 2,168 cases referred to on page 31, with the view of ascertaining the cause of infection, beyond "the point of determining whether school influence had in any way existed. In 324 cases, however, "a source of infection other than school influence was obvious." The reader is therefore obliged to assume that the 1,618 cases in which "no source of infection "was discoverable" are to be interpreted as being cases in which no source of school infection was discoverable, and if this be the case it is difficult to understand why any distinction is made between these 1,618 cases and the 324 cases which were "traceable to other sources than school." It is especially difficult to understand the amount of importance to be attached by the reader to these 324 cases if, as may be understood by Dr. Smith's later note, this number might be considerably augmented at the expense of the 1,618 cases, had more detailed enquiry been made into the source of infection; for Dr. Smith uses these figures for the calculation of a percentage which, considered in the light of his later note, must be regarded as valueless for comparative purposes. Thus, he writes— "On the other hand 324 cases are traceable to other sources, to which number should probably be added the 55 cases traceable to school-attending children, as the most careful enquiry failed in each of these cases to throw any suspicion upon the school itself; nearly 15 per cent. of the cases are traceable to other sources, and if we include the above 55 cases, the percentage becomes nearly 18." In an endeavour to understand what is meant by the words "traceable to school" the reader of Dr. Smith's report will observe that his enquiry of school teachers includes the question whether any children in the same class-room as a child who had been attacked by diphtheria had suffered from any throat affection during the fortnight before the affected child's illness. His report gives no information as to what, if any, course was adopted for discovering throat illness other than recognised and certified diphtheria in other classes of such school. The question assumes larger importance when Dr. Smith's report on an outbreak of diphtheria in Lewisham in 1896, which had been investigated by Dr. Hamer, is considered. Dr. Smith's method of dealing with this subject led me on that occasion, in commenting on his report, to make the following observations— "By excluding, save in a trifling number of instances, any consideration of the effect which may be produced on a child suffering from diphtheria on his schoolmates, who do not actually happen to share the same class-room with such child, he reduces the number of cases which may be reasonably thought of as school-infected. "In this manner he excludes from the number of children who may be reasonably thought of as school-infected, every child who is the first recognised sufferer from disease in its class-room. Thus inasmuch as 14 or 15 class-rooms in the schools above referred to were infected, this number of cases of diphtheria is included among his 'cases in which the evidence excludes the school as a source of infection.'" In conclusion, I desire to add that in my examination of the report of the medical officer of the London School Board, I am unable to find a single point which militates against the views I have expressed, or which would in my opinion justify the conclusion that the part played by schools in connection with the increase of diphtheria is " unimportant." Summary. The influence of schools in disseminating infectious disease has been long recognised, and in respect of diphtheria was shown, as early as 1876, by Mr. W. H. Power. There is therefore no improbability in the suggestion that with increasing school attendance and corresponding increase of opportunity of infection at school, that the result should be manifested in increased incidence of diphtheria mortality upon children at the school age. The figures contained in this report show that this increased incidence has actually occurred, and, although some part of it is probably attributable to change in nomenclature, there is, I submit, a substantial balance due to this greater opportunity of infection at school. This change in the age incidence of mortality had its beginning about the time 19 that compulsory attendance at school had its beginning, has affected the country as a whole, and has not only been maintained ever since, but has steadily grown in proportion until the present time. Examination of the figures supplied by the notification of diphtheria, points in the same direction. The very striking difference in the age incidence of notified cases when schools are in operation and when school attendance is suspended for the summer holidays, is in agreement with the hypothesis that the age incidence of diphtheria mortality has been affected by the increased attendance at school. Again, this behaviour of the figures supplied by notification is not limited to those of London, but is shared by the figures of other large towns. I am satisfied that the full recognition of the effect of compulsory school attendance in this connection is absolutely necessary if efficient measures are to be adopted for the prevention of diphtheria caused in this way. Referring to the steps which may be taken with this object, it is, I think, necessary to emphasize the fact that the system of notification supplies but a very incomplete record of the total number of persons actually suffering from the disease; that its principal use is to give indications as to where inquiry should be made; and that the circumstance that schools contribute largely to the prevalence of this disease not only justifies but necessitates the medical officer of health having free access to schools, where school children can be most readily examined, for the prosecution of his enquiries. I am led to make these observations because the medical officer of health of a London district reports that the London School Board has addressed to his authority a letter "severely censuring" him for examining in school certain children during scarlet fever prevalence among the pupils of the school, where, in fact, he found children he had grounds for regarding as possibly infective. The Board stated that they would not allow him " or any other medical officer of health to examine children in their schools."* This subject urgently needs the attention of the Local Government Board and the Education Department. Shirley F. Murphy, Medical Officer of Health. * Report of the medical officer of health of Plumstead for the year 1897. Appendix ii. London County Council. HOUSES LET IN LODGINGS. Further report by the Medical Officer of Health as to the operation of By-Laws dealing with Houses let in Lodgings in the several sanitary districts of the County of London. (Printed by order of the Public Health Committee, 9th July, 1897.) Public Health Department, Spring Gardens, September, 1897. The Council resolved on December 1st last "That the medical officer be instructed to make a further inquiry at Midsummer, 1897, as to the extent to which by-laws or regulations dealing with houses let in lodgings are enforced in the several sanitary districts of London, with a view to the Council making a representation to the Local Government Board under section 101 of the Public Health (London) Act, 1891, in the case of any sanitary authority which is not by that time carrying out the provisions of section 94 of the Act." The Council further resolved to communicate a copy of the Committee's report and the Council's resolution thereon to each of the London sanitary authorities. With a view to obtaining further information on the subject, I have forwarded to medical officers of health a proof of the statement made concerning their districts in my report of December, 1895, on By-laws under the Public Health (London) Act, 1891, and obtained from them such corrections as were necessary to bring this statement up to date. These corrected returns show that in the following thirty-one districts, the number of houses on the register ranges between 6 in Plumstead and 1,500 in Kensington. No. of houses on register, No. of houses on register. Kensington 1,500 Whitechapel • • • 64 Hammersmith 201 St. George-in-the-East • • • 17 Fulham 24 Limehouse • • • 69 St. George, Hanover-square 95 Mile-end Old-town • • • 180 Westminster 1,190 St. Olave • • • 11 St. James 18 St. George, Southwark • • • 336 Marylebone 931 Bermondsey • • • 307 Hampstead 840 Rotherhithe • • • 18 St. Pancras 166 Wandsworth ... 36 Islington 400 Wandsworth parish 8 Hackney 48 Clapham parish 28 St. Giles 610 Camberwell ... 154 St. Martin-in-the Fields 168 Greenwich • • • 9 Strand 75 Greenwich parish 9 Holborn 35 Lewisham • • • 27 St. Luke 16 Woolwich • • • 61 Shoreditch 96 Plumstead ... 6 Inquiry has also been made by Dr. Hamer who visited the several districts for this purpose, and I now present to the Committee his report, which shows the extent of progress made by each sanitary authority in London exclusive of the City, in fulfilment of the statutory obligation of making and enforcing by-laws for houses let in lodgings. From this report it will be seen that in every district by-laws or regulations now exist. In the majority of districts the requirements as to cubic space per person are the same, but in a few districts, having regulations made years ago under the Sanitary Act of 1866, the requirement is somewhat smaller. In all cases but one in which by-laws have been made and confirmed under the Public Health Act, 1891, 400 cubic feet per adult person is required in rooms occupied by day and by night, but in Clerkenwell, the exception referred to, the amount is 350. This is to be regretted. By-laws or regulations are not enforced in every district; in Bethnal Green, Lambeth, Lee, Newington, Paddington, Poplar, St. Saviour Southwark, Stoke Newington, Battersea and Chelsea, no houses are now regulated. In Lambeth the by-laws have only been recently confirmed. In Paddington an inspector has recently been appointed to deal with the subject. In some of the parishes of Lee houses are mostly occupied by one family. In Battersea a large number of houses have been entered in a register but no action has been taken to make them subject to the by-laws. In the other districts mentioned there is no evidence that the sanitary authorities will comply with the requirement of the Public Health Act. There are other districts where but a trifling number No. 352. —Price 4d. Sold by Edward Stanford, 26 and 27, Cockspur-street, Charing-cross, S. W. [2106 2 of houses have been registered, thus in Clerkenwell there are six such houses, but the by-laws have only recently come into operation, in Fulham twenty-four, in Plumstead three, in Rotherhithe eighteen, in St. George-in-the-East seventeen, in St. James, Westminster eighteen, in St. Luke sixteen, in St. Olave eleven, and in Greenwich nine, these being in the parish of Greenwich while in the two parishes of Deptford, no houses have been registered. In some other districts better but still insufficient progress has been made, in some cases the inadequacy of the sanitary staff appears to be an explanation of this laxity. In a few districts, the rent of tenements, which excludes the houses from being subject to the by-laws, is so low as to militate against the usefulness of the by-laws. Camberwell, Hammersmith, Poplar, Rotherhithe, St. George-inthe-East, St. Luke, Stoke Newington, and Whitechapel, may be mentioned in this respect. Indeed, in one or two of these districts, if the rental had been actually considered with this object, it would have been unnecessary to have adopted other than that incorporated in the by-laws. In this connection may be mentioned St. Luke, Poplar and Stoke Newington. Recent inquiry by Dr. Young into the sanitary condition and administration of St. Luke, has led him to the conclusion that the majority of tenements needing regulation are exempted by the limits of rental specified in the by-laws, an opinion which is evidently shared by the medical officer of health of the district. In Poplar and Stoke Newington, for the same reason, comparatively few houses could be regulated. St. Giles, Hampstead, and St. Martin-in-the-Fields may be cited as districts having experience of the use of by-laws extending over a number of years, and encouraged by this experience to persevere in their efforts. St. Margaret and St. John, Westminster, is illustrative of a district which has seriously addressed itself to the work within recent years. The results in Westminster are particularly striking, and should serve to encourage other authorities. Dr. Hamer's report shows that in several other districts the work is progressing. Kensington, on the other hand, is now less efficiently using its powers than formerly. Dr. Hamer has especially made inquiry as to experience gained in dealing with over-crowding, and has found that only exceptionally has inspection of registered houses been made at unusual hours. When, however, such inspection has been made it has resulted in discovery of overcrowding which was not previously known. It is obviously desirable to keep within limits domiciliary visits to dwelling-rooms at night-time, but it is evident that visits at unusual hours are in some cases necessary. The legal hours of inspection under the general provisions of the Public Health Act are from 6 a.m. to 9 p.m. It is deserving of observation that inspections at the beginning and end of this period have led to the detection of overcrowding not discoverable at other times. In illustration of the grouping of overcrowded rooms Dr. Hamer has especially cited the experience of Camberwell in a particular area. If overcrowding be permitted in a single tenement, the conditions which are introduced into the house with it soon render the house unacceptable to other than persons of the same class as in the overcrowded tenement, and thus houses come to be devoted, and intentionally devoted, to the accommodation of a class of tenants who appear to be indifferent to conditions of dirt and overcrowding. The absence of control by the landlord renders control by the sanitary authority more necessary, and just as the Council controls the conditions in common lodging houses to prevent the standard sinking too low, so similar control of the conditions in tenemented houses by the sanitary authority is needed. Shirley F. Murphy, Medical Officer of Health. Dr. Hamer's Report. Battersea.—No regulations or by-laws dealing with houses let in lodgings existed in this district prior to 1893, in which year by-laws under the Act of 1891 were confirmed by the Local Government Board. Up to the present time no use has apparently been made of these by-laws. Particulars have been obtained with regard to 8,046 houses in the parish occupied by members of more than one family, and these particulars, which include measurements of the cubic capacity of rooms, have been entered in a register. The steps necessary to make premises subject to the by-laws have not, however, been taken with regard to any single house. I inspected a few houses in several streets in this parish, and found a number of instances of houses which could be dealt with under the by-laws, and in the case of which the need of supervision and regulation was apparent. In one of these streets I found in the houses which I visited extreme instances of neglect to remedy evils which can be dealt with by by-law. The rooms were exceedingly dirty, the plaster of the walls often deficient, and honeycombed to an altogether exceptional extent by vermin. One particularly dirty room had not been " done up," I was informed, for eight years. I found, moreover, several instances of overcrowding. Other streets presented like defects, but in less marked degree. There can be no doubt that there are many houses in Battersea to which the by-laws should be applied. Bermondsey.—Regulations under the Sanitary Act, 1866, were adopted in 1885, and 289 houses were under regulation in 1889. New by-laws were made in 1895, and at the present time 307 houses are on the register. I visited several of these houses and found them in a satisfactory condition. I did not find evidence of overcrowding, and the by-laws appear to be specially useful in checking the tendency to the development of this condition in the poorer parts of Bermondsey. Careful inquiry is made as to the extent of occupation of rooms in the parish, and if the limits specified in the by-laws are exceeded a notice is served, and such notices are, I am informed, invariably complied with. In several instances it has been necessary to take proceedings for overcrowding under the Public Health Act in respect of houses not on the register, but in the case of registered houses the like necessity has not, at all events recently, arisen. It should be noted, however, that inspections of registered houses at unusual hours have not been made ; such inspections might of course reveal the existence of over- HOUSES LET IN LODGINGS. Diagram illustrating extent of overcrowding in a particular area in Camberwell . In connection with each house is exhibited the number of rooms it contains, and the position of the room is indicated by the lettering at the hop of the diagram, thus T.B. - top f/oor back room, T.F. = top floor front room, F.B. = first floor back room, F.F. = first floor front room, G.B. = ground f/oor back room. G.F. = ground floor front room {N.B. The shaded squares represent rooms found to be overcrowded beyond the limits permitted for "houses let in lodgings" } 3 crowding in some of the rooms in which, according to the statements made by the tenants, the limits indicated in the by-laws are not exceeded. Bethnal-green.— Regulations were adopted under the Sanitary Act of 1866, but little use was made of them. By-laws under the Public Health (London) Act were confirmed in 1895. No houses have been registered under these by-laws. The medical officer of health, Dr. Bate, in his last annual report writes, "So far not a single house has been placed upon the register, and therefore we have not had a chance to ascertain whether these by-laws are workable or not; personally, I think they are, but the sanitary committee thinks otherwise." Camberwell.— In 1866 regulations under the Sanitary Act of that year were adopted by the vestry, and some use was made of them. The question of amending the regulations was under consideration in 1883, and draft regulations were submitted to the Local Government Board. The late medical officer of health of Camberwell, however, in reporting on the subject of houses let in lodgings to the vestry some years later, stated that he had "not yet found the opportunity for beginning the register again," and that the main reason of the non-enforcement of regulations had been "that the duties of the inspectors have from year to year grown so enormous and absorbing." By-laws under the Public Health (London), Act, 1891, were confirmed in 1895, and up to the present time 154 houses have been placed upon the register. The parish of Camberwell is divided into 12 inspectors' districts, and hitherto the by-laws have only been made use of in one of these districts. The advantage derived from their employment in this district is already sufficiently apparent, and it is clear that there is need for the extension of their use to houses outside the district to which their operation has, up to the present, been limited. It is, moreover, clear that the limits of rental specified in the exemption clause of the Camberwell by-laws have been fixed too low, inasmuch as in the course of my inquiry I visited several houses which could not apparently be brought within the operations of the by-laws, but in which the need of registration and control was obvious. The district in which the by-laws have already been applied contains several streets almost every house in which can be dealt with, and a large amount of improvement had been effected in these streets. The work of cleansing the rooms had been completed in some of the houses, and was in progress in others. Some of the rooms in which it had not been commenced presented extreme conditions of filth and neglect. At the time of my visit to these streets considerable alterations as regards the amount of accommodation provided for the tenants were being effected. A house to house inspection of the houses in three of the streets had shown that out of a total of 466 families (1,928 persons) occupying upwards of 900 rooms, 172 families, occupying 259 rooms, were living under conditions of overcrowding. At the time of my inspection, the overcrowding had been abated in the case of rather more than one-third of these families. It was noticed that in a large number of instances the persons previously living under conditions of overcrowding were still being accommodated in the immediate neighbourhood; in some cases the difficulty had been met by the removal of one family from a house, and the dividing up of the rooms, formerly occupied by that family, among the other families remaining in the house. The requirements of the by-laws were being carried into effect with singularly little disturbance of the people living in the houses, having regard to the magnitude and importance of the change in progress. One of the most remarkable features in connection with overcrowdiug is the extent to which it affects particular neighbourhoods and particular houses. This grouping of overcrowded tenements was strikingly seen in the case of the streets in Camberwell, now being referred to. A plan of the situation of the overcrowded rooms in these streets has been prepared by Mr. Kerslake, one of the vestry's inspectors, and it will be seen from this plan, which is appended to this report, how marked is the tendency for the overcrowding when it affects a house at all to affect several rooms in that house. Thus in no fewer than seven instances, as shown on the plan, every room in a house was found overcrowded. This peculiarity fortunately renders the abatement of the condition an easier matter than would otherwise be the case, for many houses are not affected at all, and in those which are specially affected, the removal of a single family, and the readjustment of the rooms occupied by that family among the remaining families, may affect all that is necessary. In some instances, the extent of overcrowding which had been detected in these Camberwell houses was exceptional. For instance, a night inspection had been made in the course of last year, which revealed the fact that a ground floor room, 880 cubic feet in capacity, was occupied by fourteen persons and a baby. Two married couples and the baby occupied the bed in this room, four children were accommodated upon one mattrass, five children upon a second mattrass laid upon the floor of the room, and a young girl slept in an orange box at the foot of the bed. It may be added that eight cases of smallpox were removed during the summer of last year from the house in which this overcrowding was found, the members of the families occupying the overcrowded room being those attacked. The overcrowding described was found on an inspection made at midnight under a magistrate's warrant; there is reason to suppose, however, from information subsequently received, that the abatement of the overcrowding of this particular room was effected by the removal of one of the families occupying it to another occupied room upstairs which thus for a time accommodated two families. The number of persons sleeping in the upstairs room after the arrival of the family from downstairs is said to have been fourteen. The overcrowding was therefore only transferred from one room to another. The hopelessness of attempting to deal with overcrowding of this kind by mere inspection at ordinary hours is apparent, and the Camberwell experience clearly shows how necessary it is that occasional visits at unusual hours should be made with a view to checking the tendency to overcrowd which affects certain localities. Chelsea.—Regulations under the Sanitary Act of 1866 came into force in 1868 and large use was made of them during succeeding years. Evidence was given by the late vestry clerk before the Royal Commission on the Housing of the Working Classes in 1884 as to the valuable results obtained by the 4 use of the regulations. Some of the houses formerly registered have been demolished, and in recent years the regulations have unfortunately been allowed to fall entirely into disuse. The question of framing new by-laws has been considered from time to time by the vestry, but no action has been taken, and at the present time no use is being made by the vestry of its power to regulate houses let in lodgings. ClerkenweU.—Regulations came into force in 1887, and a large number of houses (971) was placed upon the register. In reply to a letter from the Council in 1889 the vestry state that "a register has been carefully prepared of every house let in tenements in the parish, and in the opinion of the vestry the regulations relating to these houses are working advantageously to the parish." The use of these regulations was, however, subsequently given up. The question as to the framing of by-laws under the Public Health (London) Act, 1891, was then for some time considered by the vestry, but it was not until a few months ago that these by-laws actually came into force. In the by-laws in question the requirements as to cubic space are less adequate than those which obtain in other districts in London, for which by-laws have within recent years been confirmed by the Local Government Board. The first six notices to supply the information with a view to registering bouses were recently issued in ClerkenweU. Fulham.—By-laws under tho Public Health (London) Act were confirmed in 1895. Up to the present time only 24 houses have been registered. There is obviously need for a large extension of the use of the by-laws. Greenwich.—Regulations were adopted in 1884, and a few houses were registered in the parish of Greenwich, but none were registered in the two parishes of Deptford. New by-laws were adopted by the Greenwich District Board of Works in 1896. At the present time there are nine houses on the register in Greenwich parish. No houses are registered in the two parishes of Deptford. Hackney.—Regulations under the Sanitary Act were adopted in 1866 in Hackney. Particulars concerning a large number of houses were ascertained, and for the first few years after the regulations came into force many notices were served and considerable use was made of them. The detailed results of inquiries concerning upwards of 5,000 houses were entered from time to time in the registers. It was soon found, however, impossible to inspect the registered houses at frequent intervals, as the staff of sanitary inspectors was quite unable to cope with the large amount of additional work entailed. During recent years the regulations were not made use of at all, and the registers were not kept up to date. At the end of 1895 new by-laws, made by the Hackney Vestry under the Act of 1891, were confirmed by the Local Government Board. Up to June, 1897, however, only 48 houses had been made subject to these by-laws. I visited several of these registered houses and found some of them in a fair sanitary condition. Other houses which had been more recently placed on the register were exceedingly dirty and presented many sanitary defects; overcrowding in the rooms of these houses was of common occurrence. Adequate enforcement of the by-laws in the case of these houses would be productive of much good. As yet, however, it is clear that the merest commencement only of what will no doubt prove a very formidable task has been made in Hackney. The district contains a great many houses which require to be regulated, and a large amount of additional work will have to be undertaken in order to satisfactorily deal with these houses. Hammersmith.—Regulations under the Act of 1866 were adopted in 1887; they were not however enforced. In 1896, new by-laws under the Act of 1891 were confirmed by the Local Government Board. For some years a house to house inspection has been in progress in the parish, a special inspector being engaged in carrying out the duty ; this inspector has for some months past reported cases in which the houses visited by him are found to come within the scope of the vestry's new by-laws, and such houses have been registered. The total number on the register in June, 1897, was 201. Inasmuch, however, as the practice of registering houses has only been adopted for a short time, the number of houses on the register only represents a comparatively small proportion of the houses let in lodgings in the parish to which the by-laws are applicable. A certain number of houses which it might be desirable to register cannot be so dealt with, inasmuch as the rents exceed those specified in the exemption clause, viz.: in the case of unfurnished lodgings 5s. per week and upwards. In a large number of houses in Hammersmith, however, the tenements are let at rentals which bring them within the scope of the by-laws. In several instances, legal proceedings have been ordered by the vestry for non-compliance with the requirement to supply information necessary for registration, but no summons has been taken out, owing to the notices having subsequently been complied with. The measurements of rooms have not been entered in the vestry's register. A good beginning has been made by the registration of the 201 houses, and by the carrying out of a certain amount of work in them. No machinery for the purpose of keeping these houses under supervision has as yet been provided, and under these circumstances the benefit which would result from administration of the by-laws is not being secured. I visited a number of registered houses in Hammersmith, and found evidence that considerable improvement had been effected in the majority of them. There was, however, urgent need for systematic periodical inspection of these houses, and the prevention of overcrowding in particular is a question which requires a great deal of attention. Hampstead.—In this district regulations have been enforced since 1885, and extensive use has been made of them. They were replaced by by-laws under the Act of 1891 in 1894. There are at the present time 840 houses on the register. The annual cleansing of rooms is very thoroughly enforced and the by-laws are found particularly useful, Dr. Gwynn informs me, in maintaining premises in a cleanly condition. In company with Dr. Gwynn I visited four localities in Hampstead in which there is a considerable number of registered houses. The beneficial operation of the by-laws was strikingly apparent in the very fair condition of cleanliness and maintenance of the houses inspected. As regards over crowding, no inspections at unusual hours have been made, and inasmuch as the power to proceed directly for penalty has not been exercised, it is not surprising to find that the requirements of the by-laws as to provision of cubic space appear to be less thoroughly enforced than are those relating to cleanliness. 5 Holborn.— Regulations came into force in this district in 1885, and a few houses were placed on the register. These regulations are still in force, as they have not been replaced by by-laws made under the Public Health (London) Act, 1891. At the present time there are only 35 houses on the register. Dr. Young, in his report on the sanitary condition of Holborn, states that "a large proportion of the inhabited houses in this district are occupied by members of more than one family, the tenements consisting for the most part of one or two rooms, and there is little doubt that a much greater number than at present should be placed on the register." The medical officer of health of Holborn, in dealing with the recommendation that the Board "should proceed more largely to reg date houses let in lodgings," comments upon the facts that "very few of the houses let in lodgings are at present registered," and that the existing regulations in several respects " are below the standard of the by-laws now generally adopted." Islington.— Regulations under the Act of 1866, came into force in 1885, and by-laws under the Act of 1891 were confirmed in 1894. A special inspector was appointed to carry out the duty of dealing with registered houses. In so far as experience has been gained it is wholly favourable to the use of by-laws. At the present time about 400 houses are on the register, but there can be no doubt that there are many more houses in this large parish to which the use of the by-laws might with advantage be extended. Dr. Harris, the medical officer of health of Islington, has kindly given me a table of particulars concerning a street in his parish which has been recently dealt with under the by-laws. The improvement effected in this street has been considerable. The houses contain from six to ten rooms each. Before registration the 62 houses were occupied by 850 persons, the number of occupants has since been reduced to 767. The greatest number of persons in a house under the old conditions was 28, under the new conditions the greatest number is 22. Under the old conditions 10 houses contained more than 20 inhabitants, under the new conditions, only two contain more than 20 inhabitants. In all the houses, rooms and staircases have been cleansed and whitened, and sanitary defects which were noted have been remedied. In cases in which more than 12 persons live in a house let in lodgings the provision of an additional water-closet, as required by the by-law 26 made by the Council under section 39 (1) of the Public Health (London) Act, is insisted upon. I inspected a number of registered houses in Islington and found them well supervised. An inspection of a group of tenements in which there was reason to suppose overcrowding existed had been recently made by two of the vestry's inspectors. The time of inspection chosen was the early morning between 6 and 7 a.m. In three instances the rooms were found to be occupied by other persons, in addition to the ordinary occupants for whom the cubic space was sufficient. In one instance a small room, which should have been limited to the use of a man and his three children, was found to also contain a woman and her two grown-up daughters. The occasional use of the power to inspect after 6 a.m., would probably almost entirely obviate the need for making night inspections, at any rate the experience gained in Islington seems to suggest this. Kensington.—In this parish regulations were made under section 35 of the Sanitary Act of 1866, and were confirmed in 1886. In the annual report of the medical officer of health of Kensington for 1889, Dr. Dudfield writes—"Under these regulations, about 1,800 houses have been placed upon the register, and the process of registration is still in progress." Dr. Dudfield's opinion concerning the value of regulations is given in his annual report for 1895, in which he writes—"I have only to add that registration, whilst facilitating the work of my department, has given rise to none of the evils feared by the owners and occupiers proposed to be registered ; that the existing by-laws made in 1886 have worked with smoothness, and practically without objection by any of the parties affected by them ; and that the extension of the operation of the by-laws to all tenemented and other houses occupied in lodgings by the poorer classes would be an unmixed benefit from the public health point of view, by enabling the sanitary authority to maintain the conditions necessary to secure healthy houses for those who, in regard to such matters, have little power to help themselves." The progress which had been made with the registration of houses in Kensington in the first five years following the confirmation of the regulations was not, however, maintained. In the annual report of the medical officer of health for 1892, the number on the register is still given as 1,800, that is the same number as that given in 1889; it is moreover stated that "many others wait attention." In the annual report for 1895 it is stated that " nothing has been done towards the registration of houses in fresh streets since the Public Health (London) Act, 1891, came into operation, it appearing to the Sanitary Committee desirable that new registrations should be carried out subject to by-laws made to conform with the provisions of that Act, as recommended by the Local Government Board in 1892." The framing of new by-laws has been under the consideration of the vestry, and draft by-laws have been submitted to the Local Government Board. The number of houses on the register at the present time is 1,500, i.e., practically the same number as in 1889, allowing for certain houses which have been demolished or taken off the register. Thus, in spite of the experience gained as to the value of regulations in this parish no extension of their use to the many other houses waiting attention has been made during the past seven years. The main difficulty in connection with enforcing the regulations in Kensington has been the inadequacy of the staff of sanitary inspectors to carry out the duty. After the passing of the Public Health (London) Act, 1891, it was of course necessary to increase the staff, and in 1893 the inspecting staff comprised seven inspectors and two assistant inspectors, as well as two female inspectors of workshops. During 1893 considerable public attention was directed to certain streets iu Notting-dale, constituting an area which has since been much under discussion. These streets consist mainly of registered houses, and include also a certain number of common lodginghouses. In his annual report for 1892, Dr. Dudfield writes concerning this area—"With few exceptions the houses in the several streets named have been registered under your vestry's 6 'Regulations for houses let in lodgings or which are occupied by members of more than one family.' Could these regulations be carried out effectively they would probably be found adequate for enforcing cleanliness and for preventing overcrowding." He comments on the fact that the sanitary inspector cannot give sufficient attention to these houses, however, "seeing how many and various are the duties of his office, how extensive the area in which he works, and how many the cases calling for his attention." A committee of the vestry made inquiry concerning this area in 1893, and reported "what appears to be most needed in these districts is frequent house to house inspection, and with a view to secure this your Committee recommend the appointment of a temporary sanitary inspector, and that it be referred to them to make the appointment." A temporary inspector was accordingly appointed, and for a time one inspector had sole charge of the special area. After readjusting the inspectors' districts it was arranged that an area, including that referred to and containing a population of 16,000 persons comprised in about 3,700 families, should be in the charge of one inspector. Dr. Dudfield pointed out in his monthly report, dated March, 1896, that it is impossible for one man to carry out in this area the "frequent house to house inspection" recommended by the Sanitary Committee in 1893. He says—"It is impossible to make a single thorough inspection of each of these tenements in the course of a year much less "frequent house to house inspection.'' Yet in the latter part of 1895 it was decided to add an additional area to this inspector's district. The report of a special committee of the vestry upon the area in 1896 contains, among many others, the recommendation "that it be referred to the Works and Sanitary Committee to arrange for the suggested increase of sanitary inspection in the district in question with a view to the more strict enforcement of the existing by-laws of the vestry relating to houses let in lodgings." In September, 1896, a committee of the vestry recommended that "the district formerly known as north-west (division B) shall be reconstituted and allotted to one inspector." Thus at the present time a single inspector still has charge of the district, concerning which the medical officer of health wrote in March, 1896, "it is impossible for one man to carry out in this area the frequent house to house inspection recommended by the Sanitary Committee in 1893." Dr. Dudfield has drawn attention to the differing extent to which common lodging-houses as compared with other houses in this district are subject to supervision. The Council's inspector visits the common lodging-houses four times a month, while with regard to the rest of the houses it is found "impossible to make a single thorough inspection of each of these tenements in the course of a year."* The report of a special committee of the vestry, dated June, 1896, contains the statement: "It is but right to say that the condition of these houses which are already registered as ' common lodging-houses ' is superior to those which are not so, or cannot be so registered." I visited a number of houses registered as houses let in lodgings in this locality, and found on every hand evidence of the need of an increased amount of supervision. A large amount of improvement had obviously been effected in these houses within recent years. Yards had been paved, the drainage of houses reconstructed, additional water-closets had been provided where the number of occupants rendered this necessary, and in some instances cleanliness had been enforced, and the attempt to abate overcrowding had been made. But to adequately control in this district the recurring conditions which only frequent visits of inspection can deal with, was manifestly altogether beyond the power of a single inspector. The requirement that rooms should be cleansed annually was not being enforced; in many cases, more particularly in rooms let furnished, the walls and ceilings bore evidence of being infested with vermin; again, overcrowding was not infrequently admitted by the tenants to exist, and stopped water-closets and other sanitary defects were of common occurrence. I further visited a number of registered houses in North Kensington, and here too similar evidence was forthcoming. A district with a population of upwards of 30,000 inhabitants, and containing a large proportion of houses requiring frequent inspection, was in charge of a single inspector. Here, too, dirty conditions and overcrowding are of common occurrence, and the need of an increased amount of supervision is apparent. Dr. Dudfield, in his annual report for 1892, points out that there are in Kensington some 20,000 tenements of less than five rooms each, and he says "a very large proportion of these tenement dwellings require attention, and an amount of attention which it is at present impossible to give to them." Changes have been made in the staff since this opinion was expressed by the medical officer of health, but at the present time the position as regards tenement houses appears to remain substantially unaltered, inasmuch as the parish is now, as then, divided into six districts, each in charge of a single inspector. There is now, in addition to this, a special inspector of workshops, but the need for an increased amount of attention being given to tenement houses remains. Lambeth.— Regulations were made in 1873, only a few houses however were placed upon the register. New by-laws were recently made under the Public Health Loudon, Act, 1891, these were confirmed on the 11th May, 1897, by the Local Government Board. Lee.— No use was made of regulations under the Sanitary Act of 1866. In 1895 by-laws made under section 94 of the Public Health (London) Act, 1891, came into force in this district, but up to the present time no houses have been registered in any one of the parishes (Lee and Kidbrooke, Charlton and Eltham) which together make up the area under the jurisdiction of the Lee Board of Works. It may be noted that a considerable part of this area is not yet built upon, and it is more rural in character than other parts of London. Dr. Burton writes, "with regard to houses let in lodgings there are no *In his annual report for 1896 Dr. Dudfield gives the following details with regard to the amount of inspectious made during the year in the special area— "Of the 275 houses 23 are common-lodging houses under the administration of the County Council, each such house being inspected at least once a week; of the remaining 252 houses 159 were inspected once, 46 twice, 18 thrice, 14 four times, one house five times, and one house six times." 7 such houses in the parishes of Lee and Kidbrooke," and Dr. Young found, in the course of an inquiry made last year, that the cottages in Eltham were " mostly occupied by single families." Lewisham.— Regulations were adopted in 1884, and in 1890 the District Board was favourably impressed by the experience gained in the use of these regulations. New by-laws came into force in 1895 and at the present time there are registered 15 houses in Penge, and 12 houses in Lewisham (excluding Penge). Proceedings for the enforcement of the by-laws were instituted in 16 cases in 1896 and in five cases during the present year. These proceedings related in every instance to houses situated in Arpley-road, Penge. The present condition of these Arpley-road houses bears striking testimony to the value of by-laws. Limehotise.— Regulations under the Sanitary Act were adopted in 1867, and some 2,000 houses were placed upon the register. In recent years comparatively little use has been made of the regulations. By-laws under the Act of 1891 superseded the old regulations in 1893, but few houses have, as yet, been dealt with under them, and at the present time only 69 houses are on the register. Proceedings have been instituted and a penalty obtained in two or three cases. It was found, however, in some instances, that the persons convicted were too poor to pay a fine. This circumstance appears to have led to the requirements of the by-laws with regard to annual cleansing not being adequately enforced, as some of the registered houses which I visited were in need of being cleansed and put into proper repair. On the whole the condition of cleanliness in the regulated houses was fairly satisfactory; there was admittedly, however, overcrowding of several of the rooms. The use of the by-laws might with great advantage be considerably extended in this district and they should be more thoroughly enforced. The overcrowding which appears to be of common occurrence in some parts of Limehouse could be readily dealt with by the registration and efficient inspection of houses let in lodgings in which there is reason to suspect that overcrowding exists. A few visits at unusual hours, with application for penalty in cases in which the law was not complied with, would effect a great improvement in the conditions under which some of the inhabitants of this district live. Marylebone.— In this parish regulations were adopted in 1884, and it was found that they facilitated the work of the sanitary department, but that they were too limited in scope. Fresh regulations were made in 1890, and large use has been made of them. At the present time 931 houses are on the register, and from 3,000 to 4,000 inspections of such houses are made in the course of a year. I inspected several of the houses in streets in the neighbourhood of Lisson-grove, in company with the Inspector who has charge of the district in which these streets are situated. A few of the houses were in good condition, others were dirty, and there was need for the execution of works of repair. Considerable as is the amount of inspection of registered houses carried out in this locality, it would appear that more supervision is necessary to secure a satisfactory standard of cleanliness and repair in such houses. There is, moreover, evidence of overcrowding, and until recently a large number of basement rooms have been separately occupied as dwellings in these streets. This matter is now being dealt with by the vestry and some diminution in the amount of crowding will no doubt result, inasmuch as some of the basement rooms are being let in conjunction with rooms above ground, and the number of separate lettings in the houses is thus necessarily reduced. An attempt is made to deal with overcrowding when it is admitted to exist, but inspections are not made at unusual hours, nor have any legal proceedings for the enforcement of the regulation dealing with this matter been recently instituted. Mile End Old Town.—Some use has been made of regulations under the Sanitary Act of 1866, which came into force in 1885, and at the present time 180 houses are on the register. Newington.—Regulations were made in 1890, but were never enforced in this district; by-laws under the Act of 1891 were confirmed last year. Up to the present time no attempt has been made by the vestry to enforce these by-laws. Paddington.—The power to regulate houses let in lodgings has not hitherto been made use of in this parish. By-laws under the Public Health (London) Act, were confirmed by the Local Government Board in 1894, and an attempt was made during 1895 to place some of the houses in North Paddington on the register, but " the work was pushed aside by pressure of other matters." An assistant inspector has quite recently been appointed to carry out the work of registration, and though no houses have at the present date (June, 1897) been actually registered, the medical officer of health hopes that the work will now be carried through in a systematic manner. Plumstead.—By-laws under the Public Health (London) Act, 1891, were confirmed in 1894. At first very few houses were dealt with, then later, particulars concerning several houses were obtained, and it was proposed to register some of them. Some of the houses were actually placed on the register, and had then to be removed from it in consequence of altered conditions as to tenancy which were established. At the present time there are only three houses in the parish under regulation, and the by-laws are practically inoperative. Poplar.—Regulations under the Sanitary Act of 1866 were adopted in 1886, but no use was made of them. By-laws under the Public Health (London) Act were confirmed in 1895. Under the second clause of these by-laws, all houses are exempted from their operation where the rent or charge payable by each lodger is (in the case of unfurnished lodgings) 3s. per week or upwards, and (in the case of furnished lodgings) 4s. per week or upwards. These limits of rental are so low that it may be anticipated they will exclude from the operation of the by-laws, most of the houses which might with advantage be registered. No houses have been dealt with under the by-laws up to the present time. Rotherhithe.—Regulations were made under the Act of 1866, but do not appear to have been put in operation in this parish. By-laws under the Public Health (London) Act, 1891, did not come into force until January, 1896. Only 18 houses have been placed upon the register. The exemption clause in the Rotherhithe by-laws excludes from the operation of these by-laws lodging houses " where the landlord resides upon the premises and not more than one lodger is received in the house." It also excludes houses " where the rent or charge payable by each lodger " is at a 8 rate of 5s. per week or upwards in the case of unfurnished, and 7s. per week or upwards in the case of furnished lodgings. These limits of rental are fixed so low that tenements are excluded from the operation of the by-laws which might with advantage be made subject to them. There can be no doubt whatever that there are many houses in the parish which could be and need to be registered and regulated, and much good would result if the by-laws were applied to them. St. George, Hanover-square.—In this parish regulations were adopted in 1885 and new by-laws were confirmed in 1894. A few houses have been placed upon the register, but the cubic contents of rooms and particulars as to the persons occupying the houses have not been entered in accordance with the practice which has generally obtained in other districts. The houses on the register are houses to the sanitary condition of which attention has at one time or another been directed, but more systematic inspection of these houses appears to be required, and the powers of regulating them which by-laws afford have not been taken full advantage of. I visited a few registered houses in the "out-ward" at the southern end of the parish, and found them, almost without exception, more or less in need of cleansing and repair; moreover, in some instances underground rooms were separately occupied in them in contravention of section 96 of the Public Health (London) Act. This "out-ward," which is practically allotted to one inspector who has upwards of 30,000 inhabitants in his district, appears to consist mainly of houses occupied by members of more than one family. The vestry has hitherto, however, only registered houses in which the person who receives the rents is non-resident, and only 95 houses in all have been registered up to the present time. St. George-in-the-East.— Regulations were made under the Sanitary Act in 1889, but little use was made of them. In 1895 new by-laws under the Public Health (London) Act were made. Concerning them the medical officer of health writes in his annual report for 1895, " In several particulars they are a dis-improvement upon our old by-laws made under the Sanitary Act, 1866, sec. 35, now repealed, more especially in the question of rent, as by the new by-laws a lodginghouse is exempted from registration when the rent payable by each lodger, and exclusive of any charge for the use by such lodger of any furniture, is at the rate of 5s. per week or upwards. This will consequently have the effect of removing from the register several of the houses already registered under the Sanitary Act which should continue to be registered." Prom the annual report of the medical officer of health for 1896 it appears that of 28 houses which were registered under the old Act only 17 "would allow of re-registration by reason of the rents." Only 17 houses are on the register therefore at the present time, and no proceedings under the by-laws have been instituted. There is reason, from the census report, for supposing that a considerable amount of overcrowding exists in this district, and for the exercise of adequate control with regard to this matter it is specially necessary that the by-laws should be enforced. The adequate discharge of the duty would probably necessitate an increase being made in the number of sanitary inspectors. St. George-the-Martyr, Southwark.—Regulations under the Act of 1866 were adopted in 1867, no large use was however made of them. By-laws under the Act of 1891 were confirmed in 1894 and were found valuable, but it was seen that no considerable amount of attention could be given to the enforcement of the new by-laws without increased inspectorial assistance. The vestry decided therefore to appoint an inspector whose time should be entirely devoted to this work, and it was thought desirable that this duty should devolve upon a woman. The regulation of houses let in lodgings has thus been seriously taken in hand and a great deal of improvement has been effected since the new inspector was appointed. At the present time there are 336 houses on the register, and a large amount of cleansing and of work of repair has been executed in them. As an instance of the utility of by-laws it was interesting to note the following circumstance in respect to a particular group of houses which had been recently, at the instance of the vestry, placed in a habitable condition. Some of the houses were registered, others were occupied by members of one family only, and therefore could not be registered. All the houses were under inspection by the sanitary authority, but the work of cleansing rooms and staircases had only been effected in the registered houses. The amount of overcrowding in this district must be very large. In a considerable proportion of the tenements which I visited the limits imposed by the by-laws were admittedly exceeded. During the past eight months 48 notices for the abatement of overcrowding have been served, and in two instances proceedings for overcrowding have been instituted, and penalties amounting in one of these cases to £1 2s. and in the other to £5 9s. 6d. were inflicted by the magistrate. The present condition as regards overcrowding of the registered houses urgently calls for continued effort in the direction of securing compliance with the minimum requirements as to cubic space which the by-laws prescribe. St. Giles.—Regulations were confirmed in 1867 ; no large use was, however, made of them. In 1885 fresh regulations were made and these remain in force, and have been and continue to be extensively employed. At the present time there are 610 houses on the register. Dr. Lovett is greatly impressed with the value of these regulations. I visited a number of registered houses in this district, and in each house visited the general state of maintenance was good, and the condition as to cleanliness was under careful supervision. There was a notable absence of sanitary defects. In a few instances, however, overcrowding was either admitted to exist or there was reason to suspect its existence, and large as the use of the powers conferred by the regulations has been in St. Giles, it appears that there is still need for the enforcement of the requirements as to provision of cubic space. As an instance of the operation of the regulations in St. Giles it may be mentioned that two registered owners were summoned on July 7th, 1897, for failure to abate breach of regulations. Both owners were convicted and fined 40s. and 2s. costs, and £1 per day for every day the breach of regulations existed from the date of the notice served by the authority to the date of final abatement. The tines and costs amounted to £63 2s. and £56 2s. respectively. St. James, Westminster.—Regulations under the Act of 1866 were adopted in 1885, but no large use was made of them. In 1895 new by-laws came into force, and an inspection was made of 9 the houses entered in the old register with a view to deciding as to their re-registration. A few houses formerly subject to regulations had, however, been demolished, and only 18 houses are entered in the new register at the present time (July, 1897). It is obvious that the use of the new by-laws requires to be considerably extended. St. Luke.— Regulations came into force in 1885, but little or no use appears to have been made of them. By-laws under the Public Health (London) Act were confirmed in 1895. The limit of rental fixed in the exemption clause of these by-laws in the case of unfurnished lodgings is 3s., and there can be no doubt that this limit is too low. Sixteen houses only have been placed on the register at the date of this inquiry. In his annual report for 1896, Dr. Yarrow, the medical officer of health of St. Luke, writes, concerning these houses, that they "are the only houses at present on the vestry's register, although a very large number exist in the parish which the by-laws were intended to include, and which in my opinion should be registered. The amount of rent paid, however (3s. per week) excludes them from the operation of the by-laws." St. Mcvrtin-in-the-Fields.—In this parish regulations have been in force since 1884. They have been largely used. I visited a number of registered houses in company with the inspector who has the duty of seeing that the regulations are enforced. The registered houses are clean, well maintained, and free from the ordinary sanitary defects. Their condition is the more remarkable from the close and confined situation of many of these houses, and from the fact that they are for the most part of considerable age. The houses are inspected once a month and biennial cleansing is carried out. I did not find any evidence of overcrowding. These houses are a striking instance of the beneficial result produced by the persevering use of the power to regulate by by-law houses let in lodgings. St. Olave.—Regulations were adopted in 1866 under the Act of that year, but they were not enforced. In 1893 by-laws under the Act of 1891 were confirmed. Up to the present time however only 11 houses have been actually placed upon the register. These houses include only premises in the case of which (with one or two exceptions) the landlord is non-resident. Measurements have been made and particulars ascertained in the case of other houses, and the question as to the desirability of registering these houses will be shortly under consideration. I visited most of the houses already registered and found them to be occupied in a manner suggesting the need of their being regulated by by-law and subjected to periodical inspection. There must be a number of other houses in this district to which the by-laws might with advantage be applied. St. Pancras.—By-laws were confirmed in 1893, and a few houses have been placed on the register. The number registered at the present time is, however, only 166. There must be a large number of houses in this district to which by-laws might with great advantage be applied. I found, in the course of three days' inspection, numerous instances of houses urgently requiring to be kept under proper supervision, and the experience gained rendered it quite clear that adequate supervision cannot be exercised over tenement houses in this parish unless the existing staff is strengthened for the purpose. I have noted numerous instances of dirty and dilapidated conditions of rooms, of overcrowding, and of other conditions requiring remedy. In some of the streets I visited I found many cases of overcrowding; in some houses the overcrowding was not limited to one room, but many of the rooms were admittedly accommodating a number of persons in excess of the limits laid down in the by-laws. Many of the houses I visited were in an exceedingly dirty and vermin-infested condition. There is obviously much need for an increased amount of inspection in this parish, and some of the conditions commonly met with and which call for remedy with special urgency, are precisely those which could be satisfactorily dealt with by the enforcement of the existing by-laws relating to houses let in lodgings. St. Saviour, Southwark.—No use was made of the power of regulating houses let in lodgings conferred under the Sanitary Act. By-laws were made under the Act of 1891 and confirmed in 1894. No use has been made of these by-laws. Shoreditch.—Regulations were adopted in 1866; no large use was made of them. By-laws under the Public Health (London) Act were confirmed in 1894. Up to the present time 96 houses have been placed upon the register. It is clear that there is need for further extending the operation of the by-laws in this district. Stoke Newington.—By-laws were confirmed by the Local Government Board in 1895. The "exemption clause" in these by-laws fixes the limits of rental at 2s. 6d. in the case of unfurnished and 4s. in the case of furnished lodgings. These limits are lower than those fixed in the case of any other district, and it appears likely that they will be found to exclude from the operation of the by-laws almost all the houses in the parish. No houses are registered at the present time in Stoke Newington. Strand.— Regulations under the Sanitary Act were not made use of in this district. By-laws under the Public Health (London) Act came into force in 1894. In April, 1896, 86 tenements had been dealt with, and a special inspector was engaged in the inspection of registered houses. During 1896 police court proceedings were instituted in two instances. The number of houses on the register in June, 1897, was 75, so that no extension of the use of by-laws has recently been made; moreover, the inspector's time has been largely occupied with other duties. The condition of the majority of the registered houses which I visited bore testimony to the value of by-laws, and much good would result if they were more largely employed in the Strand district. The question of overcrowding in particular would appear to require attention in this district. Wandsworth.— The district board did not make regulations under the Act of 1866. By-laws under the Act of 1891 were confirmed in 1893. A few houses have been registered in two of the five parishes which are included in the Wandsworth district. Thus in Clapham some 28 houses in one street have been entered on the register, but no systematic attempt to make use of by-laws on a considerable scale has been made. The condition of the registered houses suggests that full advantage is not taken of the powers which by-laws afford, even in the case of the single street to which they have been made to apply. 10 In Wandsworth parish eight houses have been registered recently and it is proposed to continue to add to the number. I visited some houses in this district which afforded striking instances of the need of regulation by by-law. In Putney, Streatham and Tooting no use has as yet been made of the by-laws. Westminster, St. Margaret and St. John.— In the united parishes of St. Margaret and St. John, Westminster, large use has been made of by-laws regulating houses let in lodgings during the last three years. The power to make regulations under the Act of 1866 was never exercised in Westminster, indeed it was not until 1893 that by-laws came into operation. A special inspector was, however, given the duty of carrying out the by-laws, and for a time an assistant inspector was also engaged in connection with the work. Dr. Norton, the medical officer of health, in his annual report for 1895, was able to state that considerable progress had been made, as during the year 575 houses were registered. The procedure adopted before registration was accomplished entailed a large amount of labour, full particulars as to the houses and their occupants and as to the cubic contents of each room being obtained and entered in the register. The services of the assistant inspector were retained until June, 1896, and the work of registration was proceeded with. At the present time the number of houses on the register is 1,190, and it is estimated that this number includes the large majority of the houses in the united parishes which come within the definition of houses let in lodgings and the rental of the tenements of which does not exceed the limits specified in the exemption clause, viz.—8s. per week in the case of unfurnished lodgings and 11s. per week in the case of furnished lodgings. An almost complete survey has thus been made of the streets in Westminster containing houses of this class and a great improvement in the condition of these houses has been effected. I visited several registered houses and found them clean and remarkably free from defects such as can be remedied by the action of the sanitary authority; on the other hand I found premises the condition of which stood in marked contrast to that obtaining in the registered houses, and I was told that these premises could not be placed on the register because they did not come within the definition of houses let in lodgings or occupied by members of more than one family. Dr. Norton believes that the great advantage as regards legal procedure afforded by the by-laws as compared with the general powers of the Public Health Act is that a breach of the bylaws is a fineable offence with a further daily penalty after written notice, and is not a nuisance subject to an order for abatement within a certain time. It would appear that the by-laws have from the first been enforced with but little difficulty. During 1896, and during the present year, it has only been necessary to take proceedings in 11 instances. With reference to the question of overcrowding, it may be noted that Dr. Norton gives an account in his annual report for 1896 of an inspection made during unusual hours. He says: "Under the by-laws a midnight inspection was made on 5th October, 1896, of 40 tenements in Lewisham-street to ascertain the amount of overcrowding that actually existed therein; most of the rooms were found to be slightly overcrowded, and the nuisances arising therefrom were abated without much trouble. In four cases, however, it was found necessary to take legal proceedings against the landlord for allowing excessive overcrowding, the result of which was that a fine of one guinea was inflicted upon him and he had to pay eight shillings costs." There can be no doubt that a few prosecutions of the kind instituted by the Westminster sanitary authority will do more to put a stop to overcrowding than the mere issuing of notices can ever effect. It is noteworthy, nevertheless, that in Westminster, where so much has been done in the direction of making known the requirements of the law as to overcrowding, this night inspection of the registered houses in Lewisham-street brought to light the fact that " most of the rooms were found to be slightly overcrowded." Whitechapel.—Regulations under the Act of 1866 were at one time in force in this district. No use, however, has been made of them during recent years. In 1893 new by-laws under the Act of 1891 were confirmed. Their use has hitherto been limited to houses let out in "furnished rooms." Sixtyfour houses are at the present time on the register. I visited several of these houses and found evidence that great improvement had been effected in their condition. The use of the by-laws might, however, in my opinion, with great advantage be largely extended in Whitechapel. It is much to be regretted that the limits of rental specified in the exemption clause of the Whitechapel by-laws are so low. The exclusion of unfurnished rooms letting at a rent exceeding 5s. per week has the effect of placing outside the scope of the by-laws many tenements which should be subject to their provisions. Woolwich.—Regulations under the Sanitary Act of 1866 were adopted in 1869, but they were not systematically enforced. By-laws under the Public Health (London) Act, 1891, came into operation in 1895. Up to June, 1897, only 61 houses had been placed upon the register. These houses are periodically inspected ; they cannot be regarded, however, as including all the houses in Woolwich to which by-laws might, with advantage, be applied. W. H. Hamer, Assistant Medical Officer of Health. APPENDIX III. London County Council. ACCOMMODATION OF WOMEN AND CHILDREN IN COMMON LODGING-HOUSES AND SHELTERS IN LONDON. Report by the medical officer on the subject of the accommodation of women and children in common lodging-houses and shelters in London, giving statistics as to the numbers for which there is now accommodation, the character of the accommodation, and the localities in which the same exists. (Ordered by the Public Health Committee to be printed, 22nd July, 1897.) Public Health Department, Spring Gardens, S.W., October, 1897. This report is based upon an inspection I made in the months of June, July and September of all the common lodging-houses and shelters in London (excluding those in the city) receiving women as lodgers. The intention of the report is to show the class of persons accommodated, the character of the accommodation provided, and where men are also received into the common lodging-house how far separate accommodation is provided for the two sexes. It is necessary at the beginning to say, by way of explanation, that in dealing with this subject I have described as one house, two or more houses in the same occupation having yard space, kitchen, washhouse, or water-closet accommodation common to the several houses. Considered in this manner London may be said to have 73 common lodginghouses receiving women, these houses providing accommodation for 1,505 single women or women occupying beds for one person only, and 732 women occupying "doubles" or beds provided for married couples, the houses thus accommodating 2,237 women.* Of these 73 houses very few receive single women only. There are, in fact, only 18 such houses providing for 801 women, the remaining 55 houses receiving either single men or married couples or both. In 22 houses receiving 352 single women, single men are also received, and in some of them doubles are also accommodated. Considering next the accommodation for married couples, it is again found that very few houses provide for this class only. There are but three such houses, these together receiving 87 married couples, whereas the total number of houses receiving married couples is 52, accommodating 732 married couples. Speaking generally, the accommodation provided for women is distinctly inferior to that provided for men. In much less proportion have the houses they occupy been especially constructed for use as common lodging-houses, but nearly all were originally designed to accommodate a single family, and in many the only alteration made is the construction of a washhouse in the yard and of additional water-closets. But while the accommodation is inferior the charges are usually higher. Not infrequently when men and women are received into the same house, the women have to pay one penny per night above the amount paid by the men. Women, I was told by more than one keeper, are less desirable lodgers than men, and the expenses incidental to the working of a women's lodging-house are greater than in the case of a men's lodging-house. Hence it is argued a higher charge is necessary on account of the greater cost of maintenance. The charges for single women's beds range from 4d. to 6d. per night, and the privilege of allowing a regular lodger to have a bed on Sunday night free is rarely extended to women. The usual charge for a double is 8d., but in some houses where but few married couples are received, 10d., or even 1s. and 1s. 6d. is charged. There is often only one kitchen for use in houses occupied by both sexes. In houses accommodating singles of both sexes and doubles, and in which two kitchens are provided for separate use, the married men may use the women's kitchen, but the married women do not always use the single men's. In a number of houses separate water-closet accommodation is provided for the two sexes, but it is difficult to say to what extent this separate use is maintained in practice. In several instances, at the instigation of the Council's inspectors, the yard in which the water-closets are Situated has been sub-divided by wooden partitions, so as to make this separation more complete. But while separate water-closets are generally regarded as being desirable, the need for separate washhouses is less recognised; thus, in houses occupied by men and women, both sexes often either share a common washhouse in the basement or the washhouse which is used by both consists of basins situated beneath a roof in the yard and is open on three sides. Occasionally a foot bath is provided but no fixed bath. The need for better common lodging-house accommodation for women is evident. As a rule the houses are well maintained, the water-closets clean, and provided with water supply, and the yards well paved; the condition of cleanliness of the houses varies, but as a whole is * In a very few houses among the cubicles provided for married couples is occasionally a cubicle containing a single bed which may be used to accommodate either sex, but generally used by women. These are not included in the above figures. [3074 2 satisfactory. In the poorer houses the greatest difficulty which the Council's inspectors have experienced relates to the cleanliness of bedding. Effort is continually made by them to secure the removal of dirty and worn-out bedding and its replacement by clean and new, and as a result considerable improvement has been made in this respect. Old wooden bedsteads which tend to harbour vermin are being replaced by iron bedsteads, and indeed, but few of the former now remain. The extent to which common lodging-houses are occupied in the different seasons of the year depends upon the occupation of the lodgers, and further somewhat upon the situation of the houses. Broadly, the lodging-houses in London are less fully occupied in summer than in winter. The opportunity for obtaining work in the fruit and hop fields in summer reduces the number of lodgers by some 25 or 30 per cent., but in some houses near Covent-garden and the Borough people of this class find employment in pea-shelling and similar work in summer, and this enables older persons to earn their own livelihood and live in common lodging-houses, who in winter have to depend upon the workhouse. Others again who depend upon prostitution are not affected by seasons, and houses containing a large proportion of this class maintain their full complement of lodgers with less variation throughout the year. In particular houses it was said that these women are not received, but how far they are in practice excluded is doubtful. The keeper of a common lodging-house does not as a rule profess to know the occupation of his lodgers; so long as they pay for their bed and conduct themselves in an orderly manner in his house his requirements are satisfied. The enforcement by the keeper of a rule that no lodger should be admitted after 11 p.m. would probably be found impracticable for financial reasons. I have also visited a number of shelters and refuges. These do not profess to be commercial enterprises intended to be a source of profit to the keeper. Among those I have visited I have not found any that provide a comfortable home, in which women live in common, and that are distinctly self-supporting or remunerative. The conclusion at which I have arrived is that any lodging-house for women, to be remunerative, would have to admit all comers without antecedent inquiries as to their habits, or without any rule such as I have mentioned, which would exclude undesirable lodgers. It does not appear that such a rule could be enforced without putting restrictions upon others to whom there would be no objection, and so far as the information 1 have obtained extends, it teaches that women will not in any large number resort to a house where they have not full liberty of action. I have endeavoured during my inquiry to ascertain how far a parent with children is received into common lodging-houses, and the information I have received is to the effect that they are only exceptionally admitted. The reasons given for this are various, but usually relate to the fear of disturbance of other lodgers ar.d the risk that the parents may desert the children in the common lodging-houses. In some districts furnished lodgings are let by the keepers of common lodginghouses, and especially in Whitechapel and Kensington ; these are used by families requiring lodging for a short time. The Committee may like to have before them a few notes as to a family house somewhat recently provided by the Glasgow municipality for a single parent who with his or her children requires accommodation, perhaps while temporarily occupied on a particular piece of work. I visited Glasgow last year with the object of seeing this institution. It is capable of accommodating 160 adults with their children. During the day the children are under the charge of resident nurses, who see that the older ones are cleaned and sent to school, while the younger ones are cared for in the home. Adults are supplied with meals at fixed prices, and a kitchen is provided in which, if they wish it, they can cook their own food. Children are boarded at fixed weekly prices. The building is of considerable size, constructed for the purpose at a cost of £15,000, a sum of £6,000 having been spent on the site. The cost of furnishing was £2,094. In addition to the family rooms, a large dining room, nursery, lavatory, bath-room, and water-closets are provided. I was told that the amount received for children's board and meals had so far more than covered the cost of all food sold. More detailed information lias been kindly supplied me by Mr. Menzies, the manager of the Glasgow Improvement Trust property. Further time is required to show how far the institution will be self-supporting. I have inspected the following common lodging-houses and shelters for the purpose of this report— Common Lodging-houses. Whitechapel.—Ten common lodging-houses in Whitechapel receive women. In only one are single women exclusively received; six houses receiving single women also accommodate married couples or " doubles," and three receive each of the three classes, viz., single women, single men, and married couples. The inmates were generally described as street hawkers, vendors of flowers, matches, &c., others were said to be employed as laundrywomen, charwomen, needlewomen, &c. In the majority of the houses I was told that the houses were most fully occupied in winter, the nature of the occupation of the lodgers determining their choice of the country or the town. At the time of my inspection in June some of the houses had about 20 per cent. of their beds unoccupied. Children with parents are only occasionally received, and I was invariably told that children without parents were never admitted. Several of the keepers of common lodging-houses also provide furnished lodgings in neighbouring houses. Thus one keeper had one hundred and six such rooms which let at weekly rentals of three, four, and five shillings; another had thirty furnished rooms let at weekly rentals of six shillings, or one shilling per night. Very few of the houses were specially constructed for the purpose for which they were used, but frequently adjoining houses were extensively altered so as to make communication between them and to enlarge the rooms by removing the partitions. 3 The manner in which the houses are occupied and the amount of charge is shown in the following table— Common lodging-house. Single women. Single men. Doubles. 1 5 6d. • • • • • • 37 8d. 2 44 4d. ... • • • 29 8d. 3 36 4d. 32 4d. 39 8d. 4 37 4d. 10 4d. 26 8d. 5 4 5d. 44 4d. 29 9d. 6 ... ... • • • • • • 51 8d. 7 65 5d. 8 4 5d. • • • ... 55 8d. 9 • • • • • • 45 4d 35 8d. 10 • • • • • • • • • ... 23 8d. The first house consists of a house fronting on the street, and having in its rear a building originally occupied by a glass silverer. The second was built some twenty years ago especially for use as a common lodging-house. The third was in great part built for the same purpose, at the same time as the preceding. The fourth is a group of five old houses three storeys in height. The fifth is a group of three old houses three and four storeys in height, converted into one. The sixth is a fourstorey house. The seventh is a group of three old houses converted into one. The eighth is a fourstorey house with basement, about ten years old, and built especially for a common lodging-house. The ninth is a four-storey house. The tenth consists of two houses four storeys high, and having two buildings at the rear. In the first common lodging-house the front house is used for doubles and single women, and the rear building for doubles only. In the second the two top floors are reserved for doubles, and the rest of the house is used for single women. In the third common lodging-house one house accommodates doubles and single men, another, doubles and single women, a third, doubles, and a fourth single women. The fourth common lodging-house has the rooms for single women and doubles opening off the same staircase, while the rooms for single men are separately approached from the yard. The fifth has the rooms for single men and doubles approached by a different staircase, the rooms for the single women being on the staircase leading to the doubles, with which are two single women's beds. The sixth is wholly devoted to doubles, the seventh wholly to single women, the rooms of the different houses being thrown together. The eighth is practically a " double " house, having only four single women's beds ; these are situated in cubicles among those for the doubles. The ninth, accommodating single men and doubles, has the single men in a large dormitory on the ground and first floors, on the latter floor being two small rooms used for doubles, the rest of the doubles being accommodated on the two floors above. Where more than one double bed is in the same room the beds are separated by wooden partitions. The tenth contain doubles only, which are situated in cubicles on each floor. There are iron bedsteads in each house, but wooden bedsteads still exist in the second, third, fourth and ninth houses. The bedding consists of flock beds and mattresses stuffed with shavings or straw, but in the tenth common lodging-house twenty beds are furnished with wire-wove mattresses. Kitchens.— Separate kitchens for the two sexes are not provided in any of these houses. The first house has the kitchen on the ground floor ; the second has two kitchens one on the ground floor and one in the basement, both dark; the third common lodging-house has two kitchens on the ground floor ; the fourth has two kitchens, one on the ground floor the other in the basement; the fifth, one on the ground floor; the sixth, two on the ground floor; the seventh, two on the ground floor; the eighth has a dark kitchen in the basement; the ninth has its kitchen on the ground floor; the tenth has one kitchen on the ground floor of a building in the rear. Water-closets.— The water-closets in each house are situated in the yard, and where there are lodgers of both sexes separate water-closets are provided for each sex. Washhouses.— In the first house six fixed basins with cold water laid on and one washing-trough are provided beneath a roof in the yard and used by both sexes. In the second house the washhouse is similar to the preceding and two washing-tubs are provided. In the third a room in the basement supplies the washhouse and is used by both sexes; it contains six fixed basins and five washingtroughs. In the fourth five basins with cold water laid on are situated beneath a roof in the yard and used by both sexes. In the fifth a dark basement room is used as a washhouse, it has five fixed basins with cold water laid on, and hot water can be drawn from a tap on Sunday; two washing-tubs are provided. In the sixth the yard is subdivided to provide separate washhouses and water-closets for the two sexes, five fixed basins with cold water being laid on to the former; hot water can also be drawn from a tap; two washing-troughs are provided. In the seventh, five basins are situated beneath a roof in the yard with cold water laid on, five washing-tubs are also provided. In the eighth the yard is subdivided, and separate provision of washhouses and water-closets is made for the two sexes; the men are provided with four fixed basins with hot and cold water, the women with three fixed basins with cold water and two washing-troughs. In the ninth, two basement rooms opening into each other and practically making one room constitute the washhouse for the two sexes. In this washhouse are situated six fixed basins with cold water and two washing-troughs. In the tenth, three fixed basins with cold water and a washing-trough are provided beneath a roof in the yard for the two sexes. Strand.— Two houses in the Strand are occupied by women. Men are not received. The rents charged are as follows— Common lodging-house. Single women. 1 34 5d. 2 81 6d. 4 In the former the front basement room is used as a kitchen, and the back basement room as a washhouse, having three fixed basins with cold water laid on and two washing-tubs, the rest of the house being used as dormitories furnished with iron bedsteads, shaving or straw mattresses and flock palliasses. In the latter the basements of both houses are used as kitchens, and are dark and unsuitable, the cellars in the back area are used as washhouses having six fixed basins with cold water laid on and four washing-tubs, and the upper part of the houses as dormitories furnished with iron bedsteads, shaving or straw mattresses and flock palliasses. In both these houses the greater proportion of the inmates are "regulars," some are engaged in selling matches and flowers, some in tailoring, some are employed in Covent-garden market. The former house was, I was told, always full, some dozen women being turned away every night for want of accommodation. In the latter in winter many beds are often empty owing to the inability of persons of the class frequenting it in summer to pay for their beds, and thus being driven into the workhouse. Exceptionally, but only exceptionally, a woman with a child is received into these houses. Adjoining the former house is a house of which the lodging house-keeper is owner, and where she lets four furnished rooms at 3s. 6d. each weekly. This keeper told me that for want of room she turns away "loads of women with children." These are often accompanied by their husbands, but she makes it a rule never to receive men. On the opposite side of the court to the latter house is another house owned by the keeper, who occupies the lower part of it herself and lets the five upper rooms as furnished lodgings, charging 1s. per night for the front room and l0d. for the back room. I inspected both these houses, and the latter contained especially dingy rooms. Paddington.—There is only one common lodging-house in this district occupied by women; men are not received. The house is an agency for domestic servants, and only women of this class are received into it. It is registered for 34 lodgers. The charges are 3s. per week in dormitories containing several beds where two persons occupy the same bed, and 3s. 6d. when each occupies a separate bed, 5s. per week is charged for a separate room. The kitchen is a somewhat dark basement room. The waterclosets are situated on the stairs, no special lavatory is provided, but washhand-stands are provided in the dormitories. Chelsea (detached).— There is one house in this part of Chelsea occupied by women, and doubles are also received. The charges are as follows— Single women. Doubles. 15 4d. 15 8d. This is an ordinary nine-roomed house, some of the rooms being divided by wooden partitions into cubicles for the doubles, the other rooms being devoted to singles and doubles. The bedsteads are iron, with flock beds and straw mattresses. The kitchen is situated in the back garden, and is used by both sexes. A separate water-closet is provided in the garden for the men and for the women. For washing purposes a shed in the garden contains four fixed basins with cold water laid on and two washing-tubs ; this is used by both sexes. The people who resort to this house are mostly labourers, laundry women, and hawkers. Children are received when accompanied by parents, but not otherwise. The house is often full in winter, but in summer is more than half empty. Kensington.— There are ten common lodging-houses in Kensington into which women are received, and only one of these is devoted exclusively to women. The number of persons for which these houses are registered and the prices charged is shown in the following table— Common lodging-house. Single women. Single men. Doubles. 1 • • • • • • 30 4d, 11 8d. 2 18 4d. 5 8d. 3 31 4d. 30 4d. 10 8d. 4 7 4d. 44 4d. 12 8d. 5 20 4d 28 4d. 9 8d. 6 23 4d. 17 4d. 12 8d. 7 25 4d. • • • 8 • • • • ... 41 4d. 9 8d. 9 14 4d. 30 4d. 8 8d. 10 16 4d. 8 8d. These houses are all of the kind constructed originally for the accommodation of a single family. The standard of cleanliness maintained generally is not a high one. The inmates consist for the most part of lodgers who are called "regulars" and comprise laundry women, hawkers, and flower and match sellers; in two houses men employed in the construction of a neighbouring railway were also resident. In one house it was said effort was made to exclude women of the unfortunate class, and in one I was told that girls under 18 years of age were not received. Children without parents generally were excluded. The houses are as a rule less occupied in the summer than winter, especially during the hopping season. At the time of inspection of some of the houses in June some 25 to 30 per cent. of the beds had not been occupied the previous night. At the time of a later inspection in September the houses visited were much fuller. One keeper has neighbouring houses which he lets in furnished lodgings, charging for each of twenty rooms 3s. 6d., 4s. or 4s. 6d. per week, according to its size. Another keeper has also two houses which he lets in a similar manner. A third has, at the rear of his lodging-house, an outbuilding 5 in which are ten rooms let furnished at 4s. 6d. per week. The last have been in much demand by married men and their wives since the construction of a neighbouring railway has commenced. A fourth keeper has ten houses let as furnished rooms at 8d. or 9d. per night, no charge being made for Sundays when occupied for a week. The first common lodging-house, which consists of three old houses with a common back-yard, contains doubles and single men in each house. The second is an ordinary three-storey house with basement containing doubles in the back additions and one front room, and single women in the rest of the house. The third, consists of three similar houses with a common back-yard, two of these houses are devoted to doubles and single women, and the third to single men. The fourth, which consists of one house, provides for married couples and single women on the first floor and single men on the top floor. The fifth, which consists of two houses, accommodates single men in the upper part of one house, one room of which is devoted to a single woman and a double, and accommodates single women in the upper part of the other, the enlarged addition of the latter being used for doubles. The sixth, which also consists of two houses with a building in the rear, has single women and doubles in each, and the upper part of the building in the rear is devoted to single men. The seventh contains single women only. The eighth consists of two houses having a common back-yard. One house accommodates doubles and single men, and the other single men only. The ninth, consisting of two houses with a common back-yard, has single men in one house and single women and doubles on each floor of the other. The tenth, which consists of one house, has single women on the ground floor and back-rooms and doubles in the rest of the house above the basement. All the dormitories are furnished with iron bedsteads and the usual shaving mattresses and flock palliasses. Kitchens.—The kitchens of the first common lodging-house are two in number, and are situated in an out-building, the one is used by married couples and single women, the other by single men. In the second, a single house, the basement room, which is on a level with the yard, is used as a kitchen for singles and doubles. The third, consisting of three houses, has the kitchen in the basement of each. Two of these kitchens accommodate doubles and single women, the other single men. In the fourth, which accommodates married couples, single women, and single men, there are two large kitchens in the basement, the one used by the married couples and single women, the other by the single men. In the fifth the back addition has been replaced by a large building providing a kitchen, which is used by married couples, single men, and single women. The sixth has as its kitchen the ground floor room of a building at the rear of the yard, which was formerly a workshop, and which is used by married couples, single men, and single women. The seventh has its kitchen in the basement, on a level with the back yard. The eighth, consisting of two houses, has the basement of one devoted to a kitchen, which is level with the back yard; this kitchen is used by doubles and single men. The ninth, which also consists of two houses, has a similar kitchen in each, the one used by doubles and single women, the other by single men. The tenth, a single house, has for its kitchen an outhouse in the back yard, lighted by the door when open, and by sky-lights, and used by the single women and doubles. Water-closets.— The Water-closets of each house are situated in the yard. In the first, one was said to be usually used by women. In the second they appeared to be used in common. In the third, separate water-closets for the sexes were provided. In the fourth, one of three water-closets was marked " Females only." In the fifth they appeared to be used in common. In the sixth there are separate water-closets for men and women, two in the back yard for the former, and two in the back area for the latter. In the eighth, one water-closet was marked " Women only," a man occupied it at the time of my inspection. In the ninth and tenth one water-closet was said to be more generally used by men. Washhouses.—The washhouse in the first house is situated in the back addition, where there is a sink with cold water laid on, and loose bowls; this is used in common by both sexes. In the second, the washhouse is also in the back addition, and has two fixed basins and bowls used by both sexes. The third has a washhouse in each of the three houses, one for single men, the others used by the doubles and single women in common, each having two basins and a sink with cold water laid on. In the fourth there is an enclosed and roofed outhouse in the yard; it has fixed basins and cold water laid on, and is used in common by both sexes. In the fifth, six fixed basins with cold water laid on are situated beneath a roof in the yard, and are used in common by both sexes. In the sixth house the washhouse leads out of the kitchen in the rear building, and has fixed and loose basins with cold water laid on, and a copper. The washhouse is used in common by both sexes. In the seventh three fixed basins with cold water laid on have been provided beneath a roof in the yard. In the eighth the washhouse is in the back addition. It has five fixed basins with cold water laid on, used by both sexes. In the ninth there is a washhouse in the back addition with three fixed basins and cold water laid on, used by married couples and single women. Similar provision is made in the single men's house for their use. In the tenth a similar washhouse is provided and used in common by both sexes. Hammersmith.—One common lodging-house receives women in this district. It consists of a row of five adjoining cottages having four rooms in each cottage. The number of persons accommodated and the charges are— Single women. Single men. Doubles. 3 4d. 25 4d. 8 8d. The inmates are mostly hawkers, charwomen and laundrywomen, of whom about two-thirds are "regulars." The house is less occupied in summer than in winter, and was somewhat more than half full at the time of my inspection. Each of four cottages receives married couples and single men, and one cottage also provides accommodation for single women. The ground floor of the fifth cottage is used as a kitchen common to both sexes, and the keeper and his family live above. Separate water-closets are provided in the yard for the two sexes. 6 For washing purposes there is a shed in the yard with two fixed basins used by both sexes in common. The cottages are old, but were kept clean and in good order. They are furnished with iron bedsteads with straw mattresses and flock beds. The keeper has two additional cottages providing eight rooms, which he lets as furnished lodgings, charging 4s. per week for each room. He does not let them for less than a week. He tells me he will not receive young girls or boys. Chelsea.— There is one common lodging-house in this district into which women are received. It is used solely by the one sex and provides 34 beds at a charge of 6d. It consists of a large kitchen on the ground floor and two large dormitories above. Waterclosets and a washhouse with three fixed basins are situated in the yard. I was told that a few of the inmates were engaged in laundrywork as ironers. Westminster.— 1 here are tour common lodging-houses receiving women in this district, providing accommodation as follows— Common lodging-house. Single women. Doubles. 1 8 6d 9 .. Is. for first night. 9d. „ each subsequent night, if occupied by " regulars." 2 11 6d 6 1s. „ first night. 9d. „ each subsequent night, if occupied by " regulars." 3 23 6d 2 1s. and 1s. 6d. for first night. 4 52 6d. and 4d. 16 9d. for first night. 2 family rooms 10d. The first two belong to the same owner, and each of them consists of two adjoining houses, old but clean, three storeys in height. The third common lodging-house is a larger house of three storeys, old but clean, and the fourth is a house fronting in the street having immediately at its rear a building forming part of the lodging-house but which was formerly a factory. Some of the women resorting to these houses sell flowers, &c., in the street, go out washing, or are engaged in tailoring. The first lodging-house, as already stated, consists of two adjoining houses, and one of these is occupied by doubles, the other by doubles and single women. The second, which also consists of two adjoining houses, contains doubles and singles in each house. In the third, which provides accommodation for 23 single women and two doubles, the doubles are situated away from the rooms occupied by the single women and are immediately above the kitchen in a building at the rear of the yard. In the fourth, which consists of a house fronting on the street with a building (formerly a factory) at its rear, the doubles are situated on the first floor over the latter. The difference between the 4d. and 6d. beds for singles are that the former are situated in the attic. The family rooms are extra large cubicles having in each a double and single bed. Kitchens.— The kitchen in the first lodging-house is one of the ground floor rooms. In the second both ground floor rooms are used as kitchens, one kitchen being used by the singles in one of the two houses of which it consists and by the doubles of the other, leaving to the singles in the latter the kitchen on the ground floor of that house. By this arrangement the keeper separates women of the unfortunate class from the rest of the lodgers. Thus, in these two lodging-houses two kitchens are used by married couples and singles and one by single women. In the third common lodging-house the ground floor of the rear building serves as kitchen for the singles and the two doubles. In the fourth the basement of the front house provides a rather dark kitchen for the singles, the doubles having a kitchen on the ground floor of the rear building. The bedsteads in these houses are iron with flock beds and straw mattresses, and were fairly clean. Water-closets.— The water-closets for the first two lodging-houses are situated in the yards, and there is an understanding that men and women do not use the same water-closet. In the third house two water-closets are situated in the yard, and in the fourth six water-closets are provided in the yard. Washhouses.— For washing purposes each of the first two lodging-houses has two or three fixed basins with cold water laid on under a roof in the yard, and a copper for washing clothes is provided in the yard. The men are intended to use these lavatories, the women washing in basins in the kitchen. In the third house three fixed basins with cold water laid on are situated under a roof in the yard. In the fourth house there are two lavatories each with six fixed basins and cold water laid on, used separately by singles and doubles; hot water is available. A dormitory for single women opens out of the lavatory used by the married couples. The first two and the last of these houses were, I was told, more fully occupied in winter than in summer; the third was about equally occupied throughout the year. Children are only admitted exceptionally and not without parents. I was told that girls under 18 years of age are not received into the fourth house. Tho keeper of the first two houses told me that she had frequent requests for accommodation by people with families. Holborn.— There is one house in this district receiving women. It provides 94 single beds for this sex at a charge of 4d. per bed. The registered premises include the whole of two adjoining houses and a part of a third, the rest of the last house and one other constituting a common lodging-house for men. The provision made for women and for men is, however, in every way separate. The premises are very old. The women occupying this house include persons employed in Covent-garden-market. tailoresses, laundresses, &c. 7 The kitchen is a large basement room, and on the floor above is another room used as a dayroom for the lodgers. There are four water-closets in the yard, in which are also situated six fixed basins with cold water laid on under a roof. The bedsteads are iron with flock beds and straw mattresses. The summer is the most busy time owing to the greater opportunity of finding employment in Covent-garden-market, where the women shell peas, &c. About three-quarters of the inmates are " regulars." Children are not received into the house with or without parents. Islington.— There are six registered common lodging-houses in the district receiving women The following statement shows the number for which accommodation is provided and the charges— Common lodging-house. Single women. Single men. Doubles. 1 — • • • 13 8d. 2 9 6d. 69 4d. 14 6d. 3 6 6d. — — 4 10 4d. — 15 8d. 5 12 6d. — 2 1s. 6 15 6d. and 8d. — — The first is an ordinary house of three storeys in height. The second consists of three houses three storeys in height and having back additions two storeys in height; one of these three houses is used for single women and doubles, the next for single men, and the third for single men and also for three single women. The third is a house of four storeys, let as furnished rooms at a weekly charge of 5s. per room, and having one room registered for six single women. The fourth consists of four houses, part of two of these houses is occupied by single men, the other two by doubles and single women. The fifth consists of two houses let in great part as furnished lodgings at 5s. per week each, but having three rooms occupied by 12 single women and one room occupied by two doubles. The sixth is an ordinary house of three storeys registered for 15 single women. The inmates were described as hawkers, laundresses, and charwomen, and in one house it was said that women of the unfortunate class were not received. A considerable proportion were said to be regulars. Children without parents are not received. The houses generally are fullest in winter. The keeper of the first house has four houses in the same street let as furnished lodgings, a weekly charge of 4s. or 5s. being made for each room. The keeper of the second house has five houses in the same street which he lets as furnished lodgings at weekly rentals of 4s. 6d., 5s., and 6s. The keeper of the fourth house has two houses let in a similar manner at weekly rents per room of 4s., 4s. 6d. and 5s. per room. In the first house the rooms are divided into cubicles by wooden partitions, two or three double beds being situated in each room. In the second, which consists of three houses, the first of these is wholly devoted to single women and doubles, the whole of the second house is devoted to single men, and the whole of the third house to single men, except two rooms, one of which on the ground floor is occupied by single women, the other in the first floor of the back addition by one double. The fourth, consisting of four houses, has two used only for single men, but the backyards are thrown into those of the next two houses used for single women and doubles. The fifth, consisting of two houses, is mostly let as furnished lodgings, but one of these houses also contains single women and doubles, and the other single women. Kitchens.—In the first the kitchen, which is on the ground floor, is used by the doubles. In the second a kitchen has been built at the back of the yard for the doubles and single women, a kitchen for the single men having been built over the backyard of the middle of the three houses. The third is, as already stated, let mostly as furnished lodgings, the six single women, received into the room which is registered, having the right to use the kitchen. The fourth, which contains (a) single men (b) single women and doubles, has separate kitchens for the two, but the two kitchens communicate with each other. The fifth, which consists of two houses mostly let out as furnished lodgings, has a kitchen in one of these houses for the doubles and single women. The sixth house has a kitchen on the ground floor for the inmates. Water-closets.—The water-closets in all these houses are situated in the backyards. Separate provision is made for the women and for the men in the second and fourth houses. The washhouse provision is as follows—In the first house the back addition is fitted with three fixed basins with cold water laid on for the two sexes. In the second two washhouses have been provided. Each consists of a roof beneath which are three fixed basins with hot and cold water laid on, and has a copper. In the fourth a washhouse opening out of the kitchen having four fixed basins with cold water laid on, provides for the women, and similar provision is made in a back addition for the men ; each washhouse has wash-tubs. The washhouse in the fifth is on the ground floor of the back addition. It has three fixed basins with cold water laid on, and a copper, and is used by both sexes. In the sixth wash-hand basins are situated in the dormitory and a copper in the back addition. In these houses the bedsteads are of iron, the beds flock, and the mattresses shavings or straw, except in the sixth house, where better bedding and wire-wove mattresses are supplied for the higher charge. St. Luke.—There is one common lodging-house in this district receiving women. It is an old house four storeys in height, having kitchens on the ground floor, the upper rooms being used for 15 single women at a charge of 6d. per night, and 12 doubles at a charge of 1s. per night. Some of the women in the doubles were said to work in the markets, and do odd jobs. The house is fuller in winter than in summer. Children are occasionally received. In the yard are two water-closets and an enclosed and roofed washhouse containing four fixed basins with cold water laid on, and a wash-tub. The bedsteads are iron, with shaving or straw mattresses and flock beds. 8 St. Pancras.— Five common lodging-houses in this district receive women, and in only one house are men also received. The charges are as follows— Common lodging-house. Single women. Doubles. 1 46 6d 15 2s. 2 30 6d. 3 26 6d. and 8d. 4 7 3s. per week. 5 10 3s. per week. The first house is an ordinary house three storeys in height, with basement. The second and third are large houses of the kind usually found in the better streets of Bloomsbury, with large and lofty rooms. The fourth and fifth are smaller houses, only partially used for lodgers, the fifth having a " general shop " on the ground floor. In the first house the women appeared to be largely of one class, in the second, some were said to be dressers in the theatre, in the third two or three were said to work at laundries, in the fourth and fifth, the women were distinctly servants out of employment. These houses are used chiefly by the keepers for their own purposes, but who have furnished in their respective houses one and four rooms for lodgers. In the third it was stated that the house was fullest in summer. In the first three houses the basement rooms are used as kitchens, that in the first house being dark, in the others well lighted; in the other two houses the lodgers take their meals in basement kitchens occupied by the keepers. It was stated that the men and women in the doubles of the first house were not permitted to use the kitchens. The water-closets in all are situated in the yards or areas. In the first house the washhouse, which has four fixed basins with cold water laid on and two wash-tubs, is a lean-to in the back area ; in the second, four similar basins and two wash-tubs are provided in the basement, which was formerly part of the kitchen; in the third the back kitchen is used as a washhouse, but in the rooms with the higher-priced beds washhand-stands are provided in the dormitories ; in the fourth and fifth the lodgers wash in their bedrooms. The bedsteads are iron, and in the last four houses the cleanliness of the beds was distinctly above the average. St. Giles.— There are only three lodging-houses receiving women in this district, and only single women are provided for in each. The numbers accommodated and the charges are as follows— Common lodging-house. Single women. Charge. 1 108 5d. 2 56 6d. 3 51 6d. The first is a double row of old cottages in a court, the whole of the court being thus occupied. The partition walls of some of the cottages have been removed, and the rooms thrown together. The second common lodging-house consists of two adjoining houses three stories in height with basement. The third consists of two houses three stories in height with basement, the whole of one house and the rooms above the ground floor of the next being used as common lodging-houses, the ground floor of the latter is used as a general shop. These last houses adjoin houses occupied by the same keeper and used for men. The inmates were said to include women employed in the market, hawkers, tailoresses, dressmakers, &c., and were described for the most part as regulars. It was stated that the first and third houses are most full in summer and the second in winter. Children are not received. The dormitories of the first common lodging-house are situated on the upper floors with the exception of one which is on the ground floor. They are low pitched, and those on each side of the court communicate with each other. In the second the ground and upper floors are used as dormitories together with a large room on the ground floor of a building in the back of the yard. In the third the dormitories are arranged in a similar manner, but the first floor of one of the two houses is occupied by single men who enter it from the corresponding rooms in the adjoining house and have no communication with the rest of the house occupied by women. The bedsteads are iron, and furnished with the usual shaving or straw mattresses, with flock beds. Kitchens.—The kitchen in the first is on the ground floor ; in the second there are two kitchens, one in the basement of the original house, the other in the basement of the building at the back of the yard. In the third house the one basement, which is included in the common lodging-house, is used as kitchen. Water-closets.—The water-closets of the first house are situated in a yard which was previously the site of one of the cottages demolished for this purpose. In the second and third the water-closets are situated in the back yard or area. Washhouse.—The washhouse of the first house is situated in a part of the ground floor of one of the buildings, and has five fixed basins with cold water laid on and three wash-tubs. The back basement room of the second house is used as a washhouse, and has fixed basins with cold water laid on, together with two wash-tubs, and further provision is made in the back-yard or area. In the third the back part of the basement kitchen is provided with a sink and loose basins, and used as a washhouse. Woolwich.—There are eleven common lodging-houses in Woolwich which receive women, each of these houses also containing accommodation for doubles or single men, or both. 9 The extent of accommodation and the charges are shown below. Common lodging-house. Single women. Single men. Doubles. 1 16 4d. 3½ 8d. 2 . 36 4d. 124½ 8d. 3 16 6d. 8 4d. 9 8d. 4 9 4d. and 6d. 40 4d. 6½ 5 7 4d. and 6d. 32 4d. 104 8d. 6 6 6d. 8 8d. 7 38 4d. 74½ 8d. 8 18 4d. 74½ 8d. 9 12 4d. 11 4d. * i 10 20 4d. 8½ 11 3 4d. 4 4d. 10½ 8d. None of these houses have been constructed for the purpose of a common lodging-houses, but all are ordinary dwelling houses, certain alterations having been made in a few. The registered houses generally in this district are old. The first, which was originally two cottages, is an especially old house, said to be the oldest in Woolwich. The second was originally a public-house. The third consists of two adjoining houses, with a back yard common to both. The fourth and fifth each consist of a single house with a cottage in the back yard. The sixth is a single house which shares the backyard of the two next houses, the latter being used as a common lodging-house for men. In all other respects the premises are separate. The seventh consists of two houses having a back yard common to both. The eighth consists of two houses, but having one entrance and a common back yard. The ninth has two numbers in the street, but is practically one house, and a part extends over a third house which is a public-house. The tenth consists of two houses having a common back yard. The eleventh consists of two houses having but one entrance and a common back j'ard. The female inmates were said to include hawkers, laundresses, and the men in the doubles were said to be hawkers, or to work in the docks, or be employed as tailors or shoemakers. The houses generally, though not always, are fullest in winter, the lodgers finding occupation in the country in summer. Children when accompanied by parents are not infrequently received, but it did not appear there was much demand for accommodation by people having children. In one house a single bed in the same room with two doubles was specially recognised as intended for children. One keeper, who let seven furnished rooms at a charge of 4s. 6d. and 5s. per week, told me they were always occupied. Another, who let furnished rooms at 4s. per week, told me that people with children rarely applied for them. In the first house all the rooms are occupied by single men, except one, which contains two doubles and an odd bed for children. In the second the doubles are on the first floor and the single men are on both the ground and first floors. In the third, consisting of two houses, one house has single women only, and the other contains doubles and single men and single women. In the fourth the back rooms of the front house are used for single women, and the front rooms for single men or doubles, the cottage in the rear being used for single men and doubles. In the fifth, the front house is used for single women and doubles, and the cottage in the rear for single men. In the sixth, the first and second floors are occupied by doubles, and the attic by single women. In the seventh there are single men and doubles in each of the two houses. In the eighth, one of the two houses is occupied by single men, the other by doubles. In the ninth there is no special arrangement of the rooms used by single men and single women. In the tenth, one house is used by doubles and the other by single men. In the eleventh, one house is occupied by doubles and the other by doubles, single women and single men. The bedsteads are in almost all cases iron, with the usual shaving mattresses and flock beds. Kitchens.—In the first and second houses there is a kitchen on the ground floor, used in common by both sexes. In the third house there are two kitchens on the ground floor but not used separately by the two sexes. In the fourth house there is one kitchen below the street level, but on the level of the back-yard, used in common by both sexes. In the fifth there is one kitchen in the front basement. In the sixth, the kitchen is below the level of the street in front but in a level with the back yard, and is used in common by both sexes. In the seventh there are two kitchens similar to the preceding, and each used by doubles and single men. In the eighth there are two kitchens on the ground floor, one used by doubles, the other by single men. A notice is exhibited in the single men's kitchen to the effect that no women are allowed in it. In the ninth there is one kitchen on the ground floor used by doubles and single women. In the tenth there are two kitchens on the ground floor, the one for doubles, the other for single men ; the usual entrance to the house occupied by married couples is through the single men's kitchen. In the eleventh the kitchen is a separate building in the back yard, and is used by the doubles, single men and single women. Water-closets.—In each house the water-closets are situated in the back yard. In the eighth house, which has a double back yard, one water-closet for single men is situated in one yard and two for married couples in another. In the tenth house one of the two water-closets is intended for use by men. In the other houses there appeared to be no special use of the water-closets. Washliouses.—In the first house there is a small back room with a sink, but the inmates usually wash in the back yard. The second house has a large room on the ground floor with three fixed basins and cold water laid on, used in common by both sexes. In the third house there are two washhouses, each with three fixed basins and cold water laid on, under roofs in the back yard : each is used in common by both sexes. In the fourth house there is one similar washhouse with four fixed basins used in the same manner. In the fifth there are two washhouses, the one with three loose basins and cold water laid on under a roof in the yard for the single men, the other, in the back [2] 10 addition, has similar provision for the doubles and single women. In the sixth there are two washhouses, each with two basins under a roof in the yard, intended for, but not used by the]sexes separately. In the seventh there is one washhouse beneath a roof in the yard, with four fixed basins and cold water laid on, used by the single men and doubles. In the eighth, a washhouse in the backyard is provided for the single men, and the back addition has three fixed basins with cold water laid on for the marrie:! couples. In the ninth, three fixed basins with cold water laid on are situated beneath a roof in the yard, and used by both sexes. In the tenth, a washhouse is provided in the yard for the men, with fixed basins and cold water laid on, and the women wash in the scullery of an adjoining house let in lodgings. In the eleventh there is an enclosed and roofed structure in the yard, having three loose basins with water laid on. and used in common by both sexes. All the houses are well supplied with wash-tubs, and most of the houses have coppers, which are used principally on Sundays. Wandsworth.—There are five common lodging-houses in this district receiving women. Three receive doubles and single men, one doubles and single women, and another while receiving mostly single men and doubles occasionallv receives a sino-le woman The extent of and charges for accommodation are shown below— Common lodging-house. Single women. Single men. Doubles. 1 15 4d. 8 8d. 2 52 4d. and 5d. 10 8d. 3 12 4d. 4 Is. 4 8 4d. 10 8d. 5 1 4d. 21 4d. 4 8d. 1 he first consists of three adjoining terrace houses, each two storeys in height with back additions, having a common back yard for two houses, which communicates with the back yard of the third. The second is a house three storeys in height, having a large building attached to it at the rear, erected purposely for use as part of the common lodging-house. The third consists of two houses three storeys in height, with back additions and a common back yard. Adjoining is a house for single men which, however, is entirely separate from the others. The fourth consists of two houses two storeys in height, having a common back yard. The fifth also consists of two houses two storeys in height, the back-yards of which communicate. The women are mostly casuals, and were said to be in very large proportion hawkers, the houses being much more largely occupied in winter than in summer. I was told there was no special demand by families for accommodation. The keeper of one common lodging-house has two adjoining houses which she lets as furnished rooms, charging one shilling per night. The accommodation was poor. In the first common lodging-house, consisting of three houses, two of the houses (having a common back yard) are used for doubles, the third house, having a back yard communicating with that of the others, being used exclusively by single men. In the second the doubles are accommodated on the top floor of the front house, the single men on the floor below, and in the back building. In the third and fourth there is no constant arrangement of the use of the rooms. In the fifth, consisting of two houses, the ground floor of one house, which is approached from the back yard, accommodates doubles and occasionally a single woman ; the upper floor is approached from the same floor of the next house; this floor of the two houses accommodating doubles and single men, the ground floor of the second house accommodating single men. The bedsteads throughout are iron, with the usual shaving or straw mattresses and flock palliasses. Kitchens.—In the first common lodging-house there are two kitchens, the ground floor of one house providing one kitchen and the back addition the other. In the second the ground floor of the front house provides a kitchen for the doubles and the ground floor of the back buildings for the single men. In the third the back room on the ground floor of each of the two houses provides the kitchen. In the fourth house the arrangement was the same. The kitchens were intended for separate use by the sexes, but this evidently was not adhered to. In the fifth house there is a kitchen on the ground floor of one house for the inmates of both. Waterclosets.—The waterclosets of each house are situated in the back yards, and only in the first house could be regarded as separate for the two sexes. Waslihouses.—In the first house the back addition of one house is furnished with three fixed basins and cold water for the doubles and single men. In the second a washhouse is provided on the ground floor of the back building, and has seven fixed basins and cold water for the doubles and single men. There is also a small washhouse for clothes, used by the keeper, and where lodgers may wash clothes; hot water is available. In the third house, a scullery in the back addition of each house serves as the washhouse. In the fourth a sink under a roof in the back yard serves as a washhouse. In the fifth a scullery is used as a washhouse for both sexes. Coppers are provided in all the houses but the second, wooden tubs are generally provided. Battersea.—There is only one common lodging-house in this district receiving women. The inmates are said to be mostly hawkers, laundrywomen, &c.. and the house is most occupied in winter. I was told by the keeper that she often had requests from families for accommodation, but she had no furnished lodgings. It consists of three houses, accommodates single women, single men and married couples, also a family room containing a double bed and a single bed. Thus 30 doubles, 1-5 single women, 10 single men and one family can be received, the charges being 4d. for single beds, 8d. for doubles, and Is. for the family. Each house contains doubles, two are also occupied by single women, the other by single men. The rooms in the basement of two of the houses are thrown together and provide a large and somewhat dark kitchen for both sexes. The back additions of one of the houses is fitted up as a washhouse, with fixed basins and cold water laid on, for the three houses. The water-closets for women are situated in a back-yard which is common to two houses. The water-closets for men in a separate back-yard. 11 St. George-tbe-Martyr, Southwark.—There are ten common lodging-houses in this district into which women are received, two honses containing single women only. Only one of the houses was originally constructed to be used as a common lodging-house, hut extensive alterations and additions have been made in a few to fit them for this purpose. One was originally a warehouse. The inmates were described for the most part as hawkers or as working in summer in the Borough market. As a result the majority of the houses are most fully occupied in the summer when such work as pea-shelling is carried on. One house was equally full winter and summer, and one or two fuller in the former season. Children even when accompanied by parents are usually refused admission. Generally it was said that the majority of the inmates were " regulars." The keepers as a rule do not let furnished lodgings. One who told me he previously had forty rooms so let has now only four, his reason for their discontinuance was that they caused more trouble than he cared to experience. His charges are 5s. per week. Two other keepers have four furnished rooms, the charges of one being 9d. and lOd. per night, depending on the position of the room. These are let to people who occupy them for loner periods. The extent of accommodation and the charges made are as follows— Common lodging-house. Single women. Single men. Doubles. 1 83 6d. 2 29 4d. 53 4d. 8 8d. 3 23 4d. 8 4d. 4 33 4d. . . . 8 8d. 5 40 5d. 78 4d. 6 8 5d. 74 4d. 1 .. 1s. 7 42. 4d. 8 22 5d. 24 lOd. 9 5 4d. io 4d. 4 9d. 10 80 4d. 6 Is. The first common lodging-house is a row of four, two and three storey houses, having in the back yard, which is common to all, a large building at the rear specially constructed for use as a common lodging-house. The second consists of three similar houses with a large building especially constructed in the back yard at the rear of one of them. This back yard opens into another back yard common to the other two houses. The third common lodging-house is an old house of three storeys with a basement. The fourth consists of two old houses, three storeys in height, and used together. The fifth is a large building specially constructed for the purpose. The sixth consists of three houses, three storeys in height and without basements, with extension in the rear. The seventh is a large house three storeys in height and without basement. This house was originally built for the purposes of a public-house. The eighth was originally a warehouse, and is a large building four storeys in height. The ninth is a row of five houses, four of which are used for single men, the other for furnished lodgings, and having at the rear a building in which single women and doubles are accommodated. The tenth consists of two houses, three storeys in height with basement, and practically used for single men, but having sleeping accommodation for six married couples. In the first common lodging-house, the single women sleep in the front houses and on the first and second floors of the back building. In the second common lodging-house, one house is used for single women, the second for married couples, the third is in direct connection with the building at the rear, and the first floor of this front house, and a room on the ground floor of the back building is reserved for single women, the upper part of the back building being occupied by single men. In the third common lodging-house, the front room on the ground floor is used for single men, and the rest of the house for single women. The fourth common lodging-house, consisting of two houses, has the back addition of each house and the second floor of one house devoted to doubles, and the rest of the houses to single women. In the fifth the first floor is devoted to single women, and the two floors above to single men. The sixth, consisting of three houses, has the two rooms on the ground floor of one house opening into each and used for women, the back room opens into washhouse in the back addition used for men ; the rest of the house is used for single men, except the back addition over the washhouse, which accommodates one double bed. In the seventh, one ground floor and the upper part of the house is used as sleeping rooms for single women. In the eighth, which was originally a warehouse, the first and top floors are divided by corrugated iron partitions into cubicles for doubles, and the second floor is used for single women. In the ninth house, the single women and doubles are accommodated in a building at the rear of the front houses, the singles on the ground floor, the doubles above, the front houses are used for men. In the tenth, which is almost entirely a single man's house, the ground floor is divided by corrugated iron partitions into cubicles for the doubles. The bedsteads are generally iron with the usual shaving mattresses or sacking and flock palliasses, but in the first house nearly all are provided with wire-wove mattresses. In the third, fourth and ninth the bedsteads are wood. Kitchens.—In the first common lodging-house the ground floor of the back building provides a large kitchen for the inmates, all of whom are single women. In the second there are two kitchens, the ground floor of one of the front houses provides a kitchen for the single women and the women of the doubles, the ground floor of the back building contains a kitchen for single men. The men of the doubles use either kitchen. In the third the front basement room provides a dark kitchen for the single women and single men. In the fourth the ground floor of one of the two houses provides a kitchen used by the single women and married couples. In the fifth a large and somewhat dark room in the basement serves as a kitchen for both sexes. In the sixth the kitchen is built at the rear of one of the houses and is used by both sexes. It communicates with the ground floor of the house used lor 12 the sleeping of single men. In the seventh a good room on the ground floor provides a kitchen for the one sex the house receives. In the eighth a large ground floor room serves as a kitchen for the single women and doubles. In the ninth the women have a kitchen in a lean-to in the rear of one of the other houses. In the tenth no kitchen is provided for the women of the doubles in this house, and they are not allowed in the men's kitchen. I was told that if they wanted any food in the dormitory their husbands took it to them in their cubicles. Water-closets.—In each instance the water-closets are situated in the yards at the rear of the houses. Separate provision is made for the two sexes in the second house, the water-closets for women being situated in a back yard common to two houses, occupied by single women and married couples, while the water-closets for men are in another yard. In the third house there is one water-closet used in common by both sexes. In the fourth house there are two yards with two water-closets in one, and one in the other, but apparently not used separately. In the fifth separate accommodation in the back yard is provided for the two sexes. In the sixth, four water-closets in the back yard are used by both 6exes. In the seventh, two water-closets are provided in the yard. In the eighth, four water-closets are situated in a yard and a further two, which it was stated were used by women, in the rear of another yard connected with a house in which the deputy lived and also let in furnished lodgings. In the ninth, two water-closets were provided for women in the yard in which their kitchen is situated. In the tenth the women in the doubles used the water-closets provided for the men and themselves. Washhouses.—In the first house an enclosed and roofed building in the yard contains seven fixed basins, with cold water laid on, and washing troughs. Here a mangle is provided in the yard. In the second at the rear of two of the houses, a good washhouse with four fixed basins and water laid on and with washtubs is provided separately for the women. In the third, two basins are provided under a roof in the yard for both sexes. In the fourth there are two washhouses, the one in the back addition having two loose basins with water laid on, the other consisting of three basins under a roof in the yard. In the fifth the front area is covered in and contains six fixed basins, with water laid on, for men. At the rear of the yard is a back building containing five similar basins for women. In the sixth the back addition which communicates with the women's dormitory contains a washhouse for men, the women using wash-hand stands in their dormitory. In the seventh beneath a roof in the yard there are four fixed basins with water laid on for the lodgers. In the eighth at the rear of the building is a washhouse containing five fixed basins with water laid on, and further there is a scullery in the neighbouring house let in furnished lodgings which was said to be for women. In the ninth a washhouse containing five basins with water laid on is provided for women in the yard of the adjoining house. In the tenth basins are provided in the cubicles. Shelters and Homes for Women. With a view to enabling some estimate to be formed of the extent of accommodation in London provided for women, and which resembles that afforded by common lodging-houses, I have visited the following houses— Salvation Army shelter, 194, Hanbury-street.—This shelter was formerly a swimming bath, and consists of large rooms accommodating 260 persons. One large room is devoted to floor bunks, and another to "jubilee" bunks. The building is provided with good trough closets, one bath and a washhouse. The charge for a night's lodging is 2d. A pint of tea can be purchased for ^d., and a large piece of bread and butter or jam for a similar amount. The shelter closes at 11 p.m., but applicants are occasionally received after that hour. The lodgers may enter at 3 p.m. and may remain till 8 a.m. I was told it was quite full the night before my visit in June, that it was full every night, and that in winter the number of applications would fill a building twice the size. I have also visited this shelter at night and found it full. Metropole, Hanbury-street.—This is a house, two rooms of which are used as dormitories, there are seven beds in each room, the bedsteads are of iron, and are furnished with wire-wove mattresses and wool palliasses. The water-closets in the adjoining shelter are used by the inmates. The charges are 6d. per night or 2s. 6d. per week, and meals can be obtained at a charge of 4d. per meal. The accommodation is good, but I was told the house was not always full. Dr. Bamardo's home for young girls, 12, Dock-street.—This was originally a public-house, now converted to use as a home. The upper rooms are used as dormitories, and contain 58 bunks. The beds are stuffed with seaweed, and are provided with one blanket. There is a good kitchen in the basement with washhouse adjoining with five fixed basins with cold water laid on, towels are not supplied. There are four closets in the back yard. This is a free shelter, and until recently a supper of cocoa and bread was given, but owing apparently to decrease in the funds, this is now discontinued. Women over 25 years of age are not admitted. The shelter is nearly always full, and was so the night before my visit in June. Dr. Bamardo's shelter, 81, Commercial-street.—This building was originally a warehouse, and afterwards used as the Metropolitan Free Hospital. The dormitories are three large and lofty rooms, furnished with iron bedsteads, with straw mattresses and seaweed palliasses. In the basement is a good kitchen which is used by the lodgers. Three trough water-closets are provided in the front area. Adjoining the kitchen is a good washhouse with four basins with hot and cold water laid on. Lodgers are expected to wash at night, and may wash in the morning; soap is supplied, but not towels. Accommodation is provided for 110 to 120 persons, women under 25 years of age, and mothers with children being admitted. The night before my visit, 57 inmates were received, and the two preceding nights 72 and 78 respectively. These numbers are much less than formerly, and the reduction is probably attributable to efforts made by charitable societies to place the children in homes. No charge is made ; until recently a mug of tea or a pint of cocoa could be purchased for £d., and two slices of bread and butter for a similar sum, but lately this has been discontinued for the reason stated above. 13 Providence-row Refuge.—This institution, among other branches of work, provides a fre« shelter, containing accommodation for men and women, the object being to provide the inmates with a home while work is being found. The dormitories are fitted with bunks. In the basement are trough water-closets and a wash-house fitted with basins. Provision is made for 112 women. Sir George's Residence, High-street, Whitechapel.—This is a resident home for young women under 25 years of age, and provides accommodation for 60. It is a good house fitted up with cubicles, and having all necessary provision. A charge of 3s. 6d. per week is made for a cubicle and for breakfast and supper, dinner can be had on payment of 4d. ; meals on Sunday are free. At present there are only 42 women in the house, and this number, I was told, was rather above the average. The women are mostly employed in the neighbourhood as cigar makers, michinists, tailoresses, and in tea-shops; they are not admitted without a reference. Field-lane Refuge, Holborn.—This is a refuge for destitute men and women, 20 women being accommodated. The dormitory for women is one good large room in which meals are also taken. Below is a washhouse and water-closets, in the former are slate washing troughs, and also two baths and three washing basins. Women are taken in here without charge, and are allowed 14 nights' lodging while they find work, breakfast and tea being provided. Church Army Homes, Paddington.—There are a series of homes belonging to the Church Army; the first in Shouldham-street contains eight beds, which are all free. The inmates stay only two or three days as a rule, and are then drafted to the other homes, being classified for this purpose. At 27, Nutford-place is a labour home, dormitory accommodation being provided for 17. The ground floor is used as a laundry, in which the inmates are employed; any sum they earn in the laundry over 6s. per week is placed to their credit. At No. 29 in the same street accommodation for 10 women is provided. This is a rescue home, and the women are employed in needlework. At No. 32, also in the same street, is a boarding house. It contains 22 beds, placed in cubicles, and charges are made of 7s. and 8s. per week for board and lodging. A few lodge in the house without receiving food, and pay 4s. 6d. a week. The house was full at the time of my visit, and is generally full. It is not found that it pays its working expenses. Shaftesbury Institute, Union-street, Edgware-road.—In this house sleeping accommodation is provided for 60 lodgers who pay 2d. a night, the beds being leather-covered mattresses which are laid on the floor with a leather coverlet lined with felt. There are also 10 beds in other rooms let at 6d. per night, these are iron bedsteads with good seaweed mattresses and sheets and blankets. Supper and breakfast can be obtained at a charge of Id. each meal. The 2d. beds are practically always filled, but this is not the case with the others. The house is less occupied in winter than in summer, owing probably to free shelters being open in the former and not in the latter season. No one is admitted after 11 p.m., and disorderly persons are refused. A good lavatory, a bath and two water-closets are provided in the basement. Effort is made to find employment for people who are received into the house, and a labour home is connected with the shelter. The institution does not appear to be actually self-supporting. St. John s-place, Kensington.—This is a free shelter, containing accommodation for 46 women and children. There is a large dormitory on the first floor with 24 bunks, and on the floor above, ten bunks in one room and four in each of three other rooms. In the basement is a kitchen, and a washhouse with five fixed basins, with hot and cold water laid on, and two baths. The ground floor is used for religious services. Women under 25 years of age or over that age with children are received into the house. The house was not full at the time of my visit, but I was informed it was generally full. The inmates are permitted to stay three nights, and are then not re-admitted until after an interval of another seven nights. Food was until recently supplied; this has been recently discontinued owing to want of funds. Newport Market Refuge, Westminster.—This refuge is only used in winter, and provides free accommodation for 30 men and 26 women. One large room is fitted up with 26 hammocks for the women ; each hammock is supplied with four blankets, and here are also two cubicles for casual reduced ladies. A good washhouse is provided, having washtubs and five fixed basins with cold water laid on. Breakfast and supper, consisting of bread and dripping, cocoa and tea are provided free in the large room referred to. The refuge is intended for genuine working men and women who are seeking work. Children are not actually refused, and sometimes the husband is in the male ward and the wife and child in the female. The inmates are not permitted to stay mere than seven nights. Unfortunates are not received, and hence, I am told, there is only a demand for accommodation for six or seven persons per night in winter. Shirley F. Murphy, Medical Officer of Health appendix iv. London County Council. THE SANITARY CONDITION OF CLERKENWELL. Hepokt by the Medical Officer, submitting report by Dr. Young on the Sanitary Condition and Administration of the Parish of Clerkenwell. (Ordered by the Public Health Committee to be printed on 4th February, 1897.) Public Health Department, Spring Gardens, S.W., 4th February, 1897. In presenting Dr. Young's report on the sanitary condition and administration of Clerkenwell, I would desire to point to his conclusion that the staff as it existed at the time of his inquiry was inadequate for the proper performance of the duties devolving on the sanitary authority. He is, however, not prepared to assert that the appointment of a clerk to the sanitary department which was contemplated would not be found sufficient for immediate purposes, and it is right, therefore, that further experience should be gained before the appointment of an additional sanitary inspector is recommended by the Council. The attention of the sanitary authority will no doubt be directed to the localities he has especially indicated, and to his recommendations of a house to house inspection of the district and of the preparation of a complete register of workshops. It will be. observed that the vestrv has provided a shelter, but the absence of a bath somewhat detracts from its usefulness. I would desire to express the hope that the vestry, moreover, in their by-laws relating to houses let in lodgings, will not require less cubic space per head than 400 cubic feet in bedrooms not used exclusively as sleeping apartments. The necessity of an improved system of collection of house-refuse is already under the consideration of the Council's Public Health Committee. Shirley F. Murphy, Medial Officer of Health. Dr. Young's Report. Clerkenwell is one of the central districts of the metropolis, and admins the following other districts, namely, on the west St. Pancras and Islington, on the north Islington, on the east Islington and St. Luke, and on the south Holborn and the Liberty of the Charterhouse. The district under the jurisdiction of the Vestry of Clerkenwell also includes a small detached area of 6 H acres in extent, situated without the metropolitan limits in the district of Hornsey. The soil throughout the greater part of the district is clay, but a small part at the eastern end is composed of gravel. The total area, including the detached portion of the district, is 380 acres. In 1896, when the last census was taken, the average number of persons per acre was 174. The rateable value of the district in 1896 was £398,910. Under the Equalisation of Rates Act, 1894, Clerkenwell received from the Equalisation Fund a grant in excess of its contribution to the fund by £1,766 13s. Id. for the six months from April 1st to September 30th, 1896; this is equivalent to a rate of rather more than twopence in the £ per annum on the rateable value. For statistical purposes Clerkenwell forms part of the registration district of Holborn, the following sub-districts of which constitute the area under the jurisdiction of the Clerkenwell Yestry— namely, St. James, Amwell, Pentonville (which includes the detached portion), and Goswell-road. The population at the census taken in March, 1896, consisted of 66,202 inhabitants. This number is practically the same as that obtained at the previous census in 1891, the population then being 66,216. Comparing these figures with the population in 1881, it is found that the number of inhabitants has since then undergone a slight decrease of about 4 per cent., but compared with 1861 and 1871 the population is now somewhat larger than it was at those dates, owing to an increase between 1871 and 1881 of 5'6 per cent. If the figures relating to each sub-district during the interval since 1861 be considered, it is found that the sub-district of St. James, which is situated nearest to the business portion of the metropolis, has undergone a steady decrease in the number of its inhabitants, this being no doubt due to the extension and substitution of commercial for residential premises and to the formation of Clerkenwell-road, which passes through this part of Clerkenwell and which led to the demolition of dwelling houses; the Pentonville or northern sub-district, on the other hand, which includes the detached portion in Hornsey, has slowly increased. In the Amwell sub-district, or central part of Clerkenwell, but little change in the number of inhabitants has taken place compared with the population in 1861, although here there was a marked increase between 1871 and 1881, but this was followed by an equal diminution between 1881 and 1891. This part of the district contains several streets and houses of a good class, and was apparently within recent times entirely residential in character, and it is possible that the increase in population between 1871 and 1881 was due to the fact that the houses in this part of Clerkenwell, instead of being occupied by separate families as formerly, were being let in tenements. The diminution which occurred between 1881 and 1891 was probably in great measure due to the disuse as a prison of the House of Correction—the site of which is now occupied by premises in connection with the General Post Office—and to the removal of premises during the formation of Rosebery-avenue, which traverses this part of Clerkenwell from south-west to north-east. In the Goswell-street sub-district there was a marked decrease in population between 1881 Nc. 339.—Price 2d. Sold by Edward Stanford, 26 and 27, Gockspur-slreet, Charing-crosi, S. W. [1424 2 and 1891. There appears, therefore, to be a tendency to diminution of the population throughout the district, except in the more outlying part. The following table gives the number of inhabited houses and persons, as well as the acreage of each sub-district and of the entire area of Clerkenwell: — Acres. Inhabited houses. Population. 1861. 1871. 1881. 1891. 1896. 1861. 1871. 1881. 1891. 1896. St. James 73 1,928 1,784 1,930 1,281 1,218 19,152 18,917 17,516 16,803 15,777 Am well 83 1,697 1,580 1,631 1,652 1,466 17,250 16,884 19,281 16,883 16,640 Pentonville 68½ 1,574 1,573 1,614 1,504 3,486 13,079 13,293 14,746 16,837 17,361 which includes a detached part 64½ ( 8 5 54 61 44 27 318 355 Goswell-street 91 1,889 1,889 1,924 1,825 1,679 16,200 16,242 17,506 15,375 16,069 380 7,088 6,834 7,104 6,316 5,910 65,681 65,380 69,076 66,216 66,202 The average number of persons to each inhabited house has increased from 9 2 in 1861 to 10"4 in 1891 and to 112 in 1896. In London in 1891 the corresponding number was 7'7. A considerable proportion of the inhabited houses in Clerkenwell in 1891 were let in tenements, 62 per cent, of which consisted of one and two rooms, 17.6 per cent, of the population living in single rooms, and 321 per cent, in two rooms. The population largely consists of persons of the working class and shopkeepers, together with a small proportion of persons fairly well off living in the squares and better class streets in their neighbourhood. At one time the working class in this district was largely engaged in the watch and jewellery trades, and this still appears to be the case, for although in the greater number of workshops which were visited during the inspection other trades were being carried on, yet the watch and jewellery trades were more frequently met with than any other. Of the total population in 1891, 32,751 or 49.5 per cent, were males and 33,465 or 50.5 per cent, were females, as compared with 47.3 per cent, males and 52.7 per cent, females in London generally. In 1896 the male population in Clerkenwell exceeded the female, there being 33,223, or 50.2 per cent, males, and 32,979, or 49.8 per cent, females. The age constitution of the population in 1891 was as follows—- Age period. 0- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Clerkenwell— Males per oent. of population 6.21 5.72 5.13 5.02 4.89 8.30 6.24 4.37 2.36 1.01 0.21 Females per cent, of population 6.40 5.53 5.12 4.95 4.85 8.12 6.37 4.73 2.76 1.31 0.40 London— Males per cent, of population 5.92 5.36 4.90 4.69 4.61 7.92 5.85 4.11 2.35 1.20 0.37 Females per cent, of population 599 5.42 4.99 5.21 5.56 9.11 6.49 4.64 2.92 1.72 069 According to these figures, in Clerkenwell, as compared with London, there was a greater proportion of both sexes up to 15 years of age, a greater proportion of the male sex between 15—65 vears. and a smaller proportion of the female sex between these ages. In the following table rates of births and deaths per 1,000 are given of both Clerkenwell and London since 1891. The general death rates have been corrected for age and sex distribution. Year. Clerkenwell. London. Births. Deaths all causes. Zymotic deaths. Infantile mortality per 1,000 births. Births. Deaths all causes. Zymotic deaths. Infantile mortality per 1,000 births. 1891 33.3 27.8 4.35 170 31.8 22.4 2.27 153 1892 32.9 27.2 2.86 172 30.9 21.6 2.80 154 1893 31.9 29.2 4.83 202 31.0 22.4 3.04 163 1894 33.0 20.8 2.63 145 30.1 18.6 2.65 143 1895 31.5 25.0 3.80 192 30.6 20.8 2.62 165 All the death rates in Clerkenwell are markedly greater than in London generally. 3 At the present time Clerkenwell consists largely of fairly wide streets, which are well paved, and which have for the most part houses three storeys in height on either side. There are also in the district several squares in which the better-class houses are situated. The houses are, generally speaking, well provided with open space in the rear. The existence of the above-mentioned squares, together with the occupation of land in the parish by the New River Water Company for the purposes of iilters and a reservoir, is of advantage in contributing to the air space provided by open spaces available for the public use in the district. The construction of Rosebery-avenue, which traverses the district from south-west to north-east, has also been useful in respect of open space by providing a broad thoroughfare in place of narrow streets. There are still, however, in the district some narrow streets, and some courts and alleys which are open only at one end, and which in many cases are approached by an archway from the main street. These mostly contain houses two storeys high, some of which are old and worn out or show signs of dampness of walls, or are unprovided with back yards or have no means of through ventilation. Many of these houses contain but two rooms, the one above the other, the outer door opening directly into the ground floor room, in which the staircase leading to the upper floor is placed. These conditions chiefly exist in the older part of Clerkenwell, that is in the neighbourhood of Clerkenwell-green, and in that part of the district adjoining Islington ; examples of such conditions are to be found in the following— White Lion-buildings.—This is a narrow alley closed at one end, containing two rows of two-storey cottages, about a dozen in all. They are old and worn out and some are damp, but are maintained in good repair. The houses have two rooms, the one above the other, and few have ventilatiou of space under the ground floor. They have small back yards but no windows at the rear. There is a common dustbin. Seabrooke-place.—A narrow street, about 15 feet wide with two-storey cottages on either side. Some of the houses show signs of dampness of walls, but in most cases the ground floor room walls are matchlined, and some have no ventilation of the space under the ground floor. There are some 15 cottages. It is anticipated that upon the expiration of leases of houses in the above courts demolition and reconstruction will take place. Chapel-place.—A fairly wide street, closed at the end by cowshed premises, and containing two-storey houses, old and some showing signs of dampness of walls. Russell-place.—Contains ten two-storey cottages, arranged in two rows about 15 feet apart and one cottage at end. They have small unpaved forecourts, and the adjoining wall is in some cases damp. Each house has also a small back yard. There is no washhouse, but each house has a copper in the back yard. Mount Sion and Union-square.—These contain a badly arranged cluster of old two-storey cottages lying between Chapel-street and Sermon-lane. Mount Sion is, however, cut o£E from Union-square by a wall, a house and some outbuildings. Mount Sion is a narrow street containing houses and a badly-kept stable yard on one side and a row of houses on the other; altogether there are about a dozen houses. Unionsquare is approached from Chapel-street by a narrow way; there are fifteen houses, each two storeys high, and each has a fair sized front space but no back yard. In each front space is situated a washhouse building, in one corner of which is a water-closet, which is not separated from the washhouse, but this is now being altered. The cottages have two rooms each; they have no through ventilation and several show signs of damp walls. There is a common dustbin in centre of the square, and the surface of the latter is badly paved. Eagle-court.—This has archway approaches from Red Lion-street and from St. John's-lane. About three houses on the portion of the court running north and south have no back yards and no proper through ventilation. They appear to be partly back to back with houses in Pump-court, which is situated in the area of the Holborn District Board of Works. Jerusalem-court.—This is a narrow winding court approached by a covered way from St. John'ssquare and communicating with St. John's-street. It contains some block dwellings and a few threestorey houses. These are confined and are inadequately provided with open space, light and ventilation. Aylesbury-place.—This consists of a collection of old two-storey cottages in a small court situated in the angle at rear of houses in Aylesbury-street and St. John's-street. Each house has a small backyard and contains two rooms, one on each floor. The external door leads direct into lower room, the staircase leads from this room to upper room. There is a common dustbin in the centre of the court, and there are two common water taps. The water-closets are situated in back yards. There are twenty-nine cottages, some show signs of dampness, and pointing of the brickwork is defective. Bishop's-court.—A narrow court about 15 feet wide in its widest part. It has three-storey houses on either side, and a small cottage which blocks the end; twelve houses in all, all let in tenements. Berkeley-court and Francis-court.—These are two short streets next to and parallel to each other, leading off Berkeley-street. They are both closed at end by wall of gardens of houses in Albion-house. Each court is about 15 feet wide. The houses are old, most of them have small back yards, and are in a fair state of repair. All let in tenements. Corporation-row.—Numbers 1 to 33 are old two-storey cottages, arranged partly fronting on the main thoroughfare and partly in two lateral alleys which are about 10 feet wide and closed at the end. Some of the houses show signs of dampness, the ground floor rooms are dark, and there is no ventilation of the space under the ground floor. They have small back yards. Union-place.—This is approached by an archway from Clerkenwell-close. It is a narrow court closed at end, and containing seven two-storey houses. The houses are old, in a confined situation, and have no proper through ventilation. The ground floor rooms' walls are matchlined. There are three common water-closets at the entrance of the court, a common dustbin, and a common water tap for the use of the inhabitants. Application for closing orders was made about two years ago, but was refused by the magistrate. Caroline-place.—This is a small closed court approached through an archway from Bakers-row, and containing four houses, two on either side. These houses are two storeys high, without back yards, and have no through ventilation. There are two water-closets and a common dustbin in the court. Providence-place.—This consists of two rows of five two-storey cottages with small front yards and a central footway between, underneath which the water-closets are situated. The houses have no through ventilation and the four end houses are built against adjoining premises. Each house has two rooms. There is a common dustbin and a common water cistern. Ann's-place.—This is a court approached by an archway from Margaret-street. The court is about 18 feet wide and contains nine two-storey cottages, old but well maintained. Some show signs of dampness, and with one exception none have any ventilation of space beneath ground floor. Each house has a small back yard. New Buildings.—Approached by a long narrow archway from Margaret-street. The alley contains ten two-storey cottages. Each house has two rooms, small back yard and a separate water-closet. They 4 are well maintained, but in some the walls are damp and in others they are matchlined. There is one common dustbin. Margaret-place.—This is a narrow court approached from Margaret-street by an archway and containing two rows of two-storey cottages, ten in all, which are old and worn out and not well maintained. Some of them are damp. There are no streets in the district with houses built back to back. Considerable provision has been made for the housing of residents in model dwellings, blocks covering an extensive area existing near Goswell-road, in Peartree-court, in Rosoman-street, and elsewhere. Some of the blocks visited during the inquiry are well arranged for the purpose of habitation, but objection must be made to some of the conditions in Jerusalem-buildings and St. Paul's-buildings. Inspection was made of separate dwellings in 443 instances, and in a fair proportion of these no noteworthy defective condition was found, the premises being well maintained, and affording evidence of supervision by the officials of the sanitary authority; in a large number of instances, however, one or more conditions of sufficient import to justify the attention of the sanitary authority were found to exist. Thus defective paving or insufficient paving of yards was noted in 79 instances, defective or dirty condition of water-closets in 50 instances, rooms required cleansing or the interior of houses was in need of repair owing to defective flooring or ordinary dilapidations in 99 instances ; signs of defective condition of the roof were seen in 24 premises. Defective stack pipes or gutters existed in 28 houses, and dampness of walls in 69 houses. Drain inlets were in nearly all cases well trapped, and where sinks exist inside houses the waste pipe was found to be properly disconnected and to discharge over a trapped gulley situated outside the house. The drains of premises which have been reconstructed in recent years are disconnected from the sewer by an intercepting trap and are provided with means of ventilation, but in many houses where the drains are of older construction no ventilation exists. From information gathered during the inquiry it appears that a considerable number of houses in the district have drains in common. At 55 houses insufficiently covered or dilapidated dustbins were seen. A large number of ttese receptacles in the district are fixed brick structures, difficult to cleanse properly, and often much too large for the storage of the refuse of one week. This, owing to the system at present in vogue in the district for the collection of refuse (referred to later in this report), tends to cause accumulations of refuse for periods longer than that allowed by the Council's by-law made under section 16'(2) of the Public Health (London) Act, 1891. It has been stated earlier in the report that many of the houses in the district are occupied by more than one family. In a large number of cases these premises are let to one person who resides on the premises and sublets rooms not required for the accommodation of his own family, and in these cases, for the most part, the houses were found well kept and maintained; in others, however, the landlord is not resident, and a dirty condition of passage walls and ceilings and of rooms pointed to the need for periodic inspection. The majority of houses let in tenements have at one time been occupied by single families, the rooms are generally of a large size, and overcrowding of tenements—as judged by the low standard adopted by the vestry in their draft by-laws as to houses let in lodgings— was but seldom met, only 14 instances having been noted. The sanitary authority does not possess a list of houses let in lodgings in the district, and no houses are registered under the regulations of the vestry in regard to such premises which were confirmed in 1887. At the present time, however, new by-laws have been framed in substitution of these regulations, but they had not up to date of enquiry been confirmed by Local Government Board. There are in Clerkenwell 5 registered common lodging-houses, 2 of them forming one set of premises. These at the time of inspection were well maintained and cleanly, with one exception, where the sheets were dirty. At one house the common kitchen and the lavatory are badly lighted and ventilated, and not well suited for the purpose. In another the lavatory is unenclosed and unsuitable. During the inspection of houses in the district I met with and visited 47 workshops; 18 of these were in need of cleansing, and in 7 instances the water-closets were foul or defective. In one the water-closet accommodation was inadequate, and one workroom was overcrowded. Generally speaking, the means of light and of ventilation are well provided. Many of the workshops in this district are small buildings which have been erected on part of the space at the rear of houses, originally probably for the use of the tenant of the house; now, however, these houses are occupied by more than one family, and the worker may or may not live in the house. In nearly all cases there are now but one or two men working in these workshops, and there is ample air-space per head. The workshops which I visited were mostly those which I came across in making inspection of ordinary dwelling-houses, for although the sanitary authority have a book in which are entered workshops to which their attention has been directed by complaint, or which have been met with by the sanitary inspectors in the course of their routine duties, no systematic inspection of such premises throughout the district has been undertaken, and no complete register has yet been prepared. No systematic attempt, moreover, has been made to carry out the provisions relating to outworkers. Of the bakehouses in the district 22 were visited; 16 are situated underground, and of these 8 are badly lighted, and 2 are inadequately ventilated. In 4 cases the floor paving was in need of repair. No drain inlet was found inside any bakehouse, and in all there was evidence that the walls are periodically limewashed and that the floors and troughs are cleansed. The cowsheds, milkshops and slaughterhouses were at the time of inspection in compliance with the by-laws and regulations applying to these trades. As regards the slaughterhouses, two are not well adapted for the purpose, and one cowshed is objectionable owing to the fact that it abuts upon the living house, and the door of the kitchen opens into the cowshed. The water supply is furnished by the New River Company, and a constant supply is provided throughout the district. 5 The collection of house refuse in the district and the cleansing of the streets is carried out by the sanitary authority. For the purpose of collecting the house refuse from all premises once in each week the district has been divided into five divisions, each of these has been again divided into three sub-divisions, and each of the latter is visited by the dustman twice in each week; but it is not the custom to call at each house, dependence being placed upon the householder giving some indication that the dust requires removal, and for this purpose the vestry annually distribute to all householders a card bearing the letter D and giving information as to days when the street is visited. During the inspection I obtained evidence which leaves no doubt that the system fails to ensure a weekly removal of house refuse. In 37 instances I noted accumulation of refuse of more than one week's duration. In some cases the householders were satisfied that the removal was effected frequently enough when they had it collected after two or three weeks, but in other cases complaint was made of difficulty which had been experienced in obtaining the removal; and at one house where there was an undue accumulation it was stated that the dustmen had refused to collect it, owing to the oart being full, and had informed the householder that they would call for it on the next usual day when they were in the street. The dust carts, when loaded, convey the refuse to the vestry's wharf, where it is sorted and sifted by hand labour (men and women being employed for this purpose), and then removed by barges. The wharf is situated on the southern bank of the river Thames, in the parish of Lambeth, and/is a considerable distance from the district of Clerkenwell. For the disinfection of articles of clothing and bedding, the vestry have at the present time a dry heat apparatus, but they have recently had under consideration the desirability of providing a steam disinfector, and have now resolved to provide one forthwith. Rooms are disinfected by means of burning sulphur, this duty being carried out by an officer of the authority. A shelter for the use of persons during the time that their dwellings are undergoing this process has been provided. This is situated in Northampton-street, and in it two rooms have been fitted up as bedrooms for the use of families, a third as a sleeping and day room, and a fourth as a sitting room. There is no bath-room. The house is in charge of a caretaker, who lives in the next house and who does the cooking required by persons during the time they are in the shelter. The shelter is also used by the inhabitants of the district of Holborn. It is stated that the shelter has been but little utilized by residents in Clerkenwell. A mortuary, having separate rooms for bodies of persons dying from infectious and noninfectious complaints, as well as a post-mortem room, has been provided in conjunction with the coroners' court. For the sanitary administration of the parish the vestry have appointed a medical officer of health who devotes his whole time to the duties of the office, and three sanitary inspectors, to each of whom a district has been allotted, in which each inspector carries out all duties connected with the administration of the Public Health Act, and also collects samples under the Food and Drugs Act. In addition there is an assistant who carries out the disinfection of articles of clothing and of rooms, and also assists in distributing intimation notices. The vestry also employ an inspector to supervise the cleansing of the streets and the collection of house refuse, this officer however is not one of the sanitary staff, but is under the control of the surveyor. The sanitary inspectors are under the supervision of the medical officer of health. They attend daily at the offices of the vestry in Rosebery-avenue in order to interview builders and others, and to do the clerical work connected with the execution of their inspectorial duties, no clerical assistance for the sanitary department having been provided by the vestry at the time of the inquiry. The books kept at the office include a complaint book in which are entered all complaints received with particulars relating to them, intimation and statutory notice books, and also a book showing the result of legal proceedings in cases where it ha3 been necessary to obtain summonses in order to enforce compliance with the requirements of notices. Further, there is a register relating to cases of infectious disease occurring in the district, and a book containing a list of those workshops which have up to the present time been visited. There is no register of tenement houses. The vestry have made by-laws under the Public Health (London) Act, 1891, for the prevention of nuisances, the paving of yards, the cleansing of cisterns, and the provision of waterclosets with adequate water supply. By-laws under section 94 of the above Act as to houses let in lodgings havs also been drafted, but have not yet been confirmed by the Local Government Board. These draft by-laws differ from the model by-laws of the Local Government Board in that it is proposed that the minimum amount of cubic space to be required in rooms used both as day and sleeping rooms shall be 350 feet and not 400 feet, and in extending the age limit of children from 10 to 12 years of age. In concluding this report on the sanitary condition of Clerkenwell it is to be observed that there is evidence that a considerable amount of work has been and is being done for the removal of insanitary conditions and for maintaining premises in a proper state of repair. I am satisfied, however, that there is need for a systematic house to house inspection throughout the district. By such means the sanitary authority can obtain a complete knowledge of the tenement houses needing periodical inspection and regulation, and of the workshops which should come under their supervision. Since the appointment of a third inspector twelve months ago, effort has been made to carry out a house to house inspection. As the result, however, of the claims made upon the inspectors' time by duties arising from the complaints which are received and in connection with the notification of cases of infectious disease, it does not appear that the inspection I refer to has made any material progress. The inability of the inspectors to undertake this duty undoubtedly raises question as to the sufficiency of their number. 6 I am informed, however, by the medical officer of health of the district that, as the result of a report presented by him to the vestry, it has been decided to re-organise the work of the sanitary department and to appoint a clerk to the department. The effect of these alterations will be to economise the time of the inspectors and to relieve them of clerical work, which at present entails their spending much time in the office, and will thus enable them to devote more time to inspectorial duties in their respective divisions. It may be that these changes will be sufficient for the purpose. If, however, it be found that complete information as to the various premises in the district and as to the conditions existing throughout it is not obtained within a reasonably short period the vestry should increase the number of inspectors. I may thus briefly summarize the matters to which I think the attention of the vestry should be directed— 1. The existence in houses of defective conditions. For the most part these are of such a character as to be readily capable of remedy under the powers given by the provisions of the Public (Health) London Act. 2. The existence of courts and alleys which are narrow and badly arranged, and of houses which are old and worn out. Concerning these the vestry should see the necessity . of applying for closing orders or taking other proceedings under the Housing of the Working Classes Act. 3. The existence of a considerable number of houses in the district occupied by members of more than one family. Many of these are not of such a character as to need frequent periodic inspections. Others again are not so well circumstanced as regards the conditions in which they are kept, and these need registration and regulation under the provisions of section 94 of the Public Health (London) Act. 4. The absence of a register containing a complete list of the workshops in the district, and setting out the condition of these premises. The preparation of such a register should be proceeded with forthwith. 5. The failure of the present system of house refuse collection to ensure its removal every week from all premises. A reorganisation of the system should at once be undertaken so as to ensure this object. 6. The desirability of requiring in the by-laws as to houses let in lodgings a minimum cubic space per head of 400 feet in rooms occupied by day and by night, instead of 350 feet which I am told is the amount specified in the draft by-laws. C. W. F. Young, Assistant Medical Officer of Health. appendix v. London County Council. SANITARY CONDITION AND ADMINISTRATION OF THE PARISH OF ST. LUKE. Public Health Department, Spring Gardens, S.W., November, 1897. Report by the Medical Officer, submitting report by Dr. Young on the Sanitary Condition and Administration of the Parish of St. Luke. (Ordered by the Public Health Committee to be printed on Hud July, 1897.) In presenting Dr. Young's report to the Committee, I would desire to refer to his conclusion ;hat the existing staff of sanitary inspectors is insufficient for the present requirements of the district. Phis view I beg to endorse. It will be observed, moreover, that Dr. Young has found that the bylaws of the vestry as to houses let in lodgings are so drawn as to exempt from their application tenements which should be subject to them. His recommendation that the by-laws be revised in this particular should be seriously considered by the vestry. It is undoubtedly important that these bylaws should be enforced. Dr. Young's recommendations as to other matters are well deserving adoption by the vestry. Shirley F. Murphy, Medical Officer of Health. Dr. Young's Report. The district under the jurisdiction of the Yestry of St. Luke is one of the smallest in area in the county of London. It is situated in the central part of the metropolis and adjoins the City of London, which forms its southern boundary. On the east and north it is bounded by Shoreditch and Islington respectively, and on the west by Clerkenwell and the Charterhouse, while, for a short extent of boundary at the south-western corner, it is in juxtaposition with the district under the jurisdiction of the Holborn Board of Works. Tho sanitary district of St. Luke corresponds with the civil parish of the same name. The soil throughout the district is composed of gravel and sand overlying the London clay. The area of the district is 237 acres including about three acres of water, which consists of that portion of the City-road basin of the Regent's-canal situated in the northern part of St. Luke. The rateable value of the parish in April, 1896, was £347,192. During the year April 1st, 1896, to March 31st, 1897, the contribution of St. Luke to the equalisation of rates fund exceeded the grant made from the fund by £286 3s. 4d. For statistical purposes St. Luke forms part of the registration district of Holborn, which also includes the whole of the sanitary district under the Vestry of Clerkenwell and the greater part of that under the jurisdiction of the Holborn Board of Works. St. Luke is now divided into three sub-districts, known as City-road, Whitecross-street and Finsbury, the first being the northern, the second the south-western, and the third the sonth-eastern nart of tVin narish. The following table shows the acreage, number of inhabited houses, and population of each subdistrict, and of the whole parish at the date of each census since 1871— Acres. Inhabited houses. Population. 1871. 1881. 1891. 1871. 1881. 1891. 1896. City-road 127 3-5 acres of which arc water. 3,199 3,154 2,917 30,462 30,169 29,177 29,897 W hitecross-street 32 1,430 830 558 13,792 9,217 8,278 7,595 Finsbury 78 1,227 817 475 10,741 7,463 4,985 4,035 Whole district 237 5,856 4,801 3,950 54,995 46,849 42,440 41,527 These figures show that during the interval since 1871 a marked decrease has been taking place both in the population and in number of inhabited houses in the district, although the results of the last census in 1896 point to a lessened rate of decrease, and in the City-road sub-district there No. 251—Price 2d. Sold by E. Stanford, 26 and 27, Gockapur-street, Charing-crest, S.W. [2927—4185 2 was a small increase in the number of residents. The decrease has at each census been most marked in the two sub-districts adjoining the City of London, and is doubtless largely accounted for by the substitution of business premises for inhabited houses. The clearances made in connection with the widening of Golden-lane in and after 1877 must have displaced a number of residents from this part of the district, but decrease in the population from this cause has probably been counterbalanced by the erection of the large number of blocks of artizans' dwellings now existing in the streets at either side of Whitecross-street. The average number of residents to each acre in 1871, 1881, 1891 and 1896 was 232, 198, 179 and 175 respectively, in London the corresponding number in 1896 was 59. The average number to each inhabited house in St. Luke in 1871, 1881 and 1891 was 9'3, 9'7 and 10-7 respectively, and in the county of London 7*7 persons. The resident population is almost entirely made up of the labouring class, artizans and small shopkeepers. There is a small proportion of people better off in the neighbourhood of Finsburysquare and King's-square, while towards the western end of the district south of King's-square are to be found some of the very poor classes. In 1891 the population was made up of 20,746, or 48*9 per cent, males, and 21,694 or 51*1 per cent, females, the relative proportion of the sexes having remained practically the same since 1871. In London generally the proportion was 47'3 per cent, males and 52-7 per cent, females, follows— The age constitution of the population at the date or the loyi census was a! follows— Age period. 0— 6— 10— 15— 20— i5— 35— 45— 55— 65— 76— St. Luke— Males, per cent, of population 6.33 5.71 5.20 5.09 4.54 7.96 6.24 4.19 2.37 1.02 .24 Females „ „ 6.70 5.88 5.30 5.21 4.85 7.77 6.37 4.19 2.88 1.48 .48 London— Males, per cent, of population 5.92 5.36 4.90 4.69 4.61 7.92 5.85 4.11 2.35 1.20 .37 Females „ „ 5.99 5.42 4.99 5.21 5.56 9.11 6.49 4.64 2.92 1.72 .69 Compared with London there is in St. Luke a greater proportion of persons under 20 years ot age, the excess being most marked at the younger ages ; above 20 years the proportion is less than in London generally. In the following table the rates of births and deaths per 1,000 persons in St. Luke are given for recent years. For the purpose of comparison, the corresponding rates in the adjoining districts of Clerkenwell and Holborn, as well as in London generally, are also given. Birth rate. Death rate. London. St. Luke. Holborn. Clerkenwell. London. St. Luke. Holborn. enwell.[/] 1891 31.8 45.5 27.7 33.6 22.4 32.8 33.6 27.8 1892 30.9 45.2 27.1 32.9 2.6 27.9 29.9 27.2 1893 31.0 42.2 26.8 31.9 22.4 33.0 29.9 29.2 1894 30.1 45.0 26.2 33.0 18.6 24.9 22.6 20.8 1895 30.6 45.8 26.2 31.5 20.8 31.8 28.1 25.0 1896 30.2 46.7 28.1 33.7 19.3 27.1 25.7 23.2 The rates have been corrected by exclusion of non-residents dying in the district, and inclusion of deaths of residents dying in outlying institutions, as well as for age and sex distribution. Dr. Yarrow, the medical officer of health, in his annual reports to the vestry, points out that a number of mothers of children born in the City-road Lying-in Hospital are not permanent residents in the parish; if allowance be made for these the birth rates are considerably lowered, but still remain higher than those Drevailiner in London generally. The deaths from the principal zymotic diseases, and of children under one year of age, give the following rates— * Zymotic death rate per 1,000 living. Deaths under one year old per 1,000 births. London. St. Luke. Holborn. Clerkenwell. London. St. Luke. Holborn. Clerkenwell. 1891 2.27 2.82 4.36 4.35 153 159 228 170 1892 2.80 3.09 3.00 2.86 154 142 211 172 1893 3.04 5.53 3.38 4.83 163 174 214 202 1894 2.65 2.08 2.55 2.63 143 123 180 145 1895 2.62 5.39 2.87 3.80 165 184 212 192 1896 3.14 3.82 3.21 3.78 160 154 194 184 * Smallpox, measles, icarlet fever, diphtheria, whooping cough, fever, diarrhoea. 3 The inhabitants of St. Luke are housed in premises consisting chiefly of two and three storeys, situated in fairly wide streets which form the main thoroughfares of the district, and in narrower sid*> streets off these. The district is entirely built over, there being no open space except in the centre of King's-square and in the neighbourhood of Finsbury-square, where there is a small amount of land unbuilt on in connection with militia barracks, and a disused burial ground. The two-storey houses are to be found in the side streets and alleys; they are mostly old cottages showing signs of decay, though at the time of inspection they were on the whole in a fair state of repair, owing to the fact that they are constantly receiving attention from the officers of the authority. Each house generally contains two rooms, one on the ground floor and the other on the top floor, the staircase affording communication between the two being situated in the ground floor room, into which also the door from the street directly opens. They mostly have small back yards, and some have in addition a small room at the rear of the ground floor room which is used as a kitchen or washhouse. These premises are mostly occupied by single families, but, in some cases by two, though from their arrangement they are not adapted for this purpose. The houses three storeys in height are situated chiefly in the larger thoroughfares; they generally contain an entrance passage and have two rooms, one behind the other on each floor, but in some cases there are but three rooms in the house, one on each floor. These premises are in nearly all instances occupied by members of more than one family, this being so even in many cases where the ground floor is used as a shop. In the better class streets the whole house is rented by one tenant, who sublets unfurnished one or more of the rooms, while in the poorer class of street it is usually found that the rooms are let separately to each tenant, there being no one person resident who has any control over the house generally, unless the landlord arranges with one of the tenants to act as caretaker and to see that those parts of the house used in common are kept in a proper and cleanly condition. In addition to the above-mentioned housing accommodation considerable provision has been made for the inhabitants of the district by the erection of blocks of model dwellings, especially in the neighbourhood of Whitecross-street. These dwellings, it is stated by Dr. Yarrow, the medical officer of health of St. Luke, in his annual report for 1896, are inhabited by as much as one-fifth of the total resident population. Many of these blocks of dwellings were visited during the inquiry, and were found to be well arranged in respect to the means of light and ventilation of the living rooms, and the provision made for washhouses and water-closets, and they were clean and in good repair. In all instances the blocks are in charge of a resident superintendent. There are no houses in the district built back to back with the exception of a small block known as Baltic-place and Baltic-court. There are a few narrow courts and alleys, some of which are approached by an archway from the adjoining street, and in some of which the houses having no back yards are provided with waterclosets and washhouses for common use in the space in front of the houses. For the most part, however, the houses in such cases being but two storeys high, and having but one room on each floor, the evils arising from absence of open space at the rear of the premises is somewhat diminished. The majority of premises have small yards. Some of these houses appear to be of considerable age, and show signs of decay. During the inquiry I visited 432 houses and in these defective conditions of sufficient import to require the attention of the officers of the authority were noted as follows—Defective or insufficient paving of yards in 63 instances; defective or dirty condition of waterclosets in 83 instances; dilapidated dustbins or absence of proper covers in 66 instances, and undue accumulations of house refuse in 13 instances. Domestic cisterns were found to be insufficiently covered or in a dirty state in 34 cases, and animals kept so as to be a nuisance were met with on 9 occasions. Dampness of walls was noticed in 23 cases, but in a large number of the older houses matchboarding of walls exists, and it is possible that in some of these after wet weather dampness would also be present. Inlets to drains, which in the large majority of cases are placed outside the dwellings, were found to be in good repair, in only 13 instances were they found defective or choked; defective stack pipes and gutters were noticed in 10 cases. But the conditions requiring remedy and most frequently met with relate to the interior of dwellings; thus in 146 tenements the rooms and staircases and passages were in need of cleansing, while walls, ceilings and floors were dilapidated or defective in 71 cases, notwithstanding the fact stated by the sanitary inspector, that the rooms in many cases had been cleansed after inspection made within the previous eighteen months. These conditions were most marked in the poorer class of tenement houses referred to above as houses in which rooms are let out separately. Inadequate water-closet accommodation for the number of residents in houses was noticed on two occasions, and illegal occupation of basement rooms in three instances. Overcrowding of rooms, judged by the standard adopted in the by-laws of the authority as to houses let in lodgings, was noted in as many as 49 cases. There are in the district 19 houses let in lodgings which have been registered, they are situated in the following streets : Lever-street four houses, Bastwick-street five houses, Featherstone-street two, and Honduras-street eight houses. Some of these were visited, and found for the most part in compliance with the by-laws. There are four registered common lodging-houses in St. Luke, three for the accommodation of male lodgers, and one for both males and females. One of the lodging-houses consists partly of a building formerly used as a mission room, and is not well adapted for its present purpose, and, although improvements were effected upon the occasion of its transfer to the present keeper, the day room accommodation is still unsuitable. Two of the houses are old premises, and frequently in need of repair. The fourth house has lately been transferred, and is at the present time undergoing mprovement. 4 The sanitary authority have not a complete list of the workshops in the district. During the inquiry 91 of these premises were visited, and for the most part they were satisfactory, but defective conditions, or the need for cleansing were noted as regards 43, while the water-closet accommodation for the number of workers was insufficient in two instances. No effectual attempt has been made to carry out the section of the Factory and Workshop Act relating to outworkers. Of the 35 bakehouses in St. Luke 30 were inspected and found to be maintained in a satisfactory condition, except in the case of 3, which were in need of some slight repairs. The means of light and ventilation are unsatisfactory in the case of 8, and 16 of the bakehouses visited are situated underground. The cowsheds, milkshops and slaughterhouses were found at the date of inspection in compliance with the regulations. One slaughterhouse, although satisfactory in other respects, is open to objection, owing to the situation of a water-closet in relation to it, and at one cowshed the dung and grain pits communicate with the shed when the doors of the pits are open. There are two registered tripe-boiling premises in St. Luke, one of these (as to which complaint was made to me during the inspection) is not at present in use. The second is undergoing alterations with a view to improvement. The water supply of the district is furnished by the New River Company, and a constant supply is provided throughout. A few houses obtain their water from the rising main, but in the majority of cases storage cisterns exist. These cisterns are in nearly all houses situated in the back yard, and in many instances they are not provided with adequate covers, and from inquiries which I made of householders it does not appear that the by-law as to periodical cleansing is carried out. The scavenging of the streets and the collection and removal of house refuse is carried out by the sanitary authority. As regards the collection of house refuse, the dustmen call at all houses once in each week in order to remove the contents of the ashpit, but inquiries made of householders during the inspection appear to show that collection depends to some extent upon whether the householder considers there is or is not sufficient accumulation for removal at the time that the dustmen call, the result being that in some cases the refuse, only small in amount and probably filling only part of the receptacle, is allowed to remain on the premises till the next week. At the time of my visit to two houses in one street, I found that the dustmen had just made their weekly call, but had been told there was no refuse for collection; but upon examining the dust-bins it was found that each contained refuse which had collected since removal a week previously. In the main thoroughfares the collection of refuse is made daily. The refuse at the present time is taken to a wharf on the City-road basin of the Regent's-canal and thence removed by barge, but this method of disposal will shortly cease on the completion of the dust-destructor which is being erected for the use of the district. For the disinfection of articles of clothing and bedding after the occurrence of cases of infectious disease in the families of residents in the district, the vestry has recently provided a steam disinfecting oven. This is situated at the mortuary buildings, and is in charge of and worked by the caretaker of the mortuary and coroner's court. Rooms in which cases of infectious disease have occurred are fumigated with sulphur by an assistant. The shelter for the use of persons during the time that their room or rooms are undergoing disinfection is not yet ready for use. It is proposed to utilize for this purpose six rooms on the top floor of the building which is being erected in connection with the vestry's new wharf and dust destructor buildings. These rooms are over, and approached by the same staircase as, the rooms to be occupied by the wharf superintendent. It is not proposed to fit up a bath-room in connection with the shelter. A mortuary has been provided in connection with the coroner's court near Whitecross-street. It contains one mortuary chamber and a post-mortem room. There is no separate mortuary chamber for the bodies of persons dying of infectious complaints. The sanitary authority for the district is the Vestry of St. Luke. For the purpose of carrying out the duties relating to the sanitary condition of the district the vestry has appointed the followiug officers—a medical officer of health, two sanitary inspectors, and a clerk for the sanitary department. The medical officer of health is not allowed to engage in the practice of his profession. He controls and supervises the work of the public health department and attends daily during certain hours in the morning and afternoon at the offices of the vestry in the City-road. Each inspector has a part of the district allotted to him, and in this part he carries out all duties arising under the Public Health (London) Act, 1891, and under the Food and Drugs Act. As regards, however, the sections of the former Act relating to the seizure of food unfit for human consumption, the existence of a public street market in Whitecross-street throws additional duties in this respect on the sanitary authority, and in order that inspection of the market may be made twice in each day the duty is equally borne by the two inspectors. In addition to these Acts the vestry is an inspecting authority under the Canal Boats Act, and one of the inspectors has been appointed under the Act for the purpose of visiting boats in the City-road basin, and is expected to visit a certain number during each month, though up to the present time it has not been possible to inspect this number of boats in the period owing to the inspector's time being engaged in other duties. The register of these inspections is kept by the sanitary inspector. Office accommodation for the inspectors is provided at the Vestry Hall, and they attend there daily in the morning in order to keep appointments and to give information to builders, complainants, and others, and in the latter part of the afternoon to consult the medical officer and to fill up their diaries, in which are recorded the result of inspections made during the day time. These diaries are supervised by the medical officer of health, and are presented at each meeting of the committee. The clerk is occupied entirely with duties arising out of the work of the departmeut. He keeps the complaint and report book and prepares the intimation and statutory notices from notes supplied by the inspectors. He also fills up the certificates forwarded to the School Board and to the Metropolitan Asylums Board relating to cases of infectious diseases notified to the medical officer of health, and carries out any other clerical duties of the department. 5 In addition to the above mentioned officers there is a general assistant who is engaged to assist the sanitary inspectors in drain-testing and in the collection of samples, to fumigate rooms after the occurrence of cases of infectious disease, to convey articles of clothing and bedding requiring disinfection to and from the disinfecting oven, and to serve notices. The mortuary keeper is also under the control of the medical officer of health, and he in addition to duties arising out of the use of mortuary and coroner's court, disinfects articles of clothing in the disinfecting oven. The vestry, as sanitary authority for the district, have made by-laws under the Public Health (London) Act, 1891, for securing the periodical cleansing of drinking-water cisterns and the proper flushing of waterclosets ; for the prevention of nuisances arising from various causes, including the keeping of animals; for securing the paving of open spaces in connection with dwelling-houses; and for the registration of houses occupied by members of more than one family. These by-laws have been confirmed by the Local Government Board, and are similar to those made by other metropolitan authorities. As regards the last-mentioned by-laws, the amount of cubic space required in registered rooms is 3U0 cubic feet for each adult in the case of sleeping rooms, and 400 cubic feet in rooms used both as living and sleeping rooms, for persons under 10 years of age only half these amounts are required. Provision is also made for the exemption of houses as follows— (i.) Where the landlord resides upon the premises, and the letting by such landlord is to not more than one lodger. (ii.) Where the rent or charge payable by each lodger, and exclusive of any charge for the use by such lodger of any furniture, is at a rate of three shillings per week or upwards. (iii.) Where the rent or charge payable by each lodger, and inclusive of any charge for the use by such lodger of any furniture, is at the rate of five shillings and sixpence per week or upwards. This inquiry into the sanitary administration of St. Luke, and the inspection of the conditions existing in the district at the present time, the results of which are set out in the foregoing part of this report, show that the population is almost entirely composed of the labouring and the poorer class, and that the houses in the district are in most instances occupied by more than one family, the majority occupying one and two rooms. The notes as to the condition of premises made during the inspection show that it is most markedly in respect to conditions of a recurring nature, such as a dirty and dilapidated state of rooms and overcrowding of tenements, that attention should be directed. It is for remedying and preventing the recurrence of conditions such as these that by-laws as to tenement houses are specially useful, and it is necessary therefore that the authority should enforce in a thorough manner the powers which they possess under their by-laws as to houses let in lodgings. The by-laws of the authority were confirmed by the Local Government Board in 1895, and I understand that since that date an attempt has been made to enforce them, and notices were served upon the owners of 48 houses, but upon the return of these notices with particulars as to occupation and rent of tenements, it was found that owing to the low limit of exemption, namely, three shillings a week, only 16 houses came within the scope of the by-laws, although other houses in the same and other streets are substantially the same as regards their occupation as those which have been registered. Inquiries made of tenants as to rent during my inspection confirm this experience, that the present limit of exemption renders the by-laws inoperative in this district; thus out of a total of 177 tenements, which appear to be of the class for which these by-laws are intended, 145 were let at three shillings or more per week, and would therefore escape registration. There is little doubt that much benefit would be derived from the periodical inspection and cleansing of the majority of houses let in lodgings in the district, some needing both inspection and cleansing more frequently than others. In view of the experience already gained as to the practicability of using the by-laws, the authority should take steps to amend the exemption clauses. It has been customary to have house to house inspections made by the inspectors of those parts of the district which are known to require most attention, and, as the result of this, many of these premises were found in respect to conditions other than those referred to above in a satisfactory state. These inspections, together with inspection on complaint, re-inspection after completion of works, and duties relating to food, and the collection of samples is sufficient to take up the time of the present staff; and it has not been possible to undertake a systematic house to house inspection throughout the whole district, with a view to obtaining a record of the conditions of, and the mode of use of all premises in the district, although the vestry have passed a resolution that each inspector shall devote two days in each week to this purpose. The result is that many insanitary defects exist in houses, and the sanitary authority has not yet a complete knowledge as to all the workshops and workplaces in the parish and the requirements of such premises, although a number have been visited and particulars relating to them entered in the vestry's register of factories and workshops. In order to carry out this house-to-house inspection, and to visit periodically as often as may be considered necessary houses let in lodgings when registered, it will be necessary to make an increase in the number of inspectors at present engaged by the authority. The increase necessary in the staff will depend to some extent upon the number of houses which it is found should be registered, when the by-laws are so amended as to make them practically useful in the district. In arriving at this conclusion of need of increase in the sanitary staff, the following facts, to which my attention was directed by the chairman of the vestry's public health committee when I commenced the inquiry, have been kept in mind, namely— 1. That since the reorganisation of the work of the department some twelve months ago, and the appointment of two new inspectors, an increased amount of work has been effected in the district. 2. That at least one-fifth of the total population reside in blocks of artisans' dwellings which, having resident superintendents and being let to tenants subject to certain regulations, require less supervision on the part of the sanitary authority than other premises. 6 3. That much small property in the district is being replaced by commercial premises, and that the consequent decrease in population will lead to a less amount of work being necessary under the Food and Drugs Act. These points, however, do not affect the fact that the staff is at present inadequate to deal with conditions now existing in the district and requiring action by the vestry. Further, the substitution of commercial premises for houses and a possible decrease in the resident population does not necessarily mean a lessened amount of inspectorial-duties if these premises comprise a large number of work-places. The conditions- enumerated in the earlier part of the report are mostly such as can be readily dealt with under the Public Health Act, but it may be desirable to resort to the powers which the vestry possess under the Housing of the Working' Classes Act, in the case of some of the older houses in the parish, as well as in such cases as Baltic-place and court, and Beckford-square, where there is an absence of rear space. The method of collection of house refuse in the parish requires to be further improved, so as to secure the cleansing of ashpits at all premises once in each week. The shelter which is being provided for the use of persons during the disinfection of their rooms is, as at present proposed, open to objection in being approached by the entrance and staircase which also leads to apartments reserved for the vestry's wharf superintendent, and it is desirable that one room should be set apart for use as a bathroom. The addition of a separate chamber to the mortuary for the bodies of persons dying of infectious complaints is also desirable. C. W. F. Young, Assistant Medical Officer of Health.