43/3 towhich is added:- Dr Clows 4th Report on Sewage Report on Euteric in London\ „ lemeteries Burial Grounds Experiments on Disinfection LCC 9 London Countg Council NINTH ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH of the ADMINISTRATIVE COUNTY OF LONDON. 1900. (Ordered by the Council to be printed.) JAS. TRUSCOTT & SON, PRINTERS, SUFFOLK LANE, CANNON STREET, E.G. [174 TABLE OF CONTENTS. Part 1.— page Population 1 Marriages 3 Births 3 Deaths 5 London mortality in the ten years 1891-1900, compared with the decennium 1881-90 7 Infant mortality 9 Deaths from several classes of disease 11 Principal zymotic diseases 12 Smallpox and vaccination 13 London vaccination returns 17 Measles 18 Scarlet fever 22 Proportion of cases and deaths in hospitals 24 Return cases 24 Age and sex distribution 24 Diphtheria 25 Diphtheria and elementary schools 28 Proportion of cases and deaths in hospitals 32 Return cases 32 Age and sex distribution 32 Whooping cough 33 Typhus 34 Enteric fever 35 Age and sex distribution 37 Diarrhoea 38 Cholera 39 Erysipelas 39 Puerperal fever 40 Influenza, bronchitis and pneumonia 41 Phthisis 41 Cancer 43 Plague 44 Notifiable diseases in the metropolitan boroughs during the ten years 1891-1900 46 Meteorology 47 Part II.— Dairies, cowsheds and milkshops 48 Septic sore throat due to milk 49 Offensive businesses 49 Complaints to the London County Council 49 Nuisances 49 Smoke nuisances 49 Removal of offensive matter and stable manure 50 Removal of house refuse 51 Nuisance from sewers 53 Nuisance from the Regent's-canal 53 Nuisance from the river Lea 55 Housing of the working classes 55 Amendment of the Housing of the Working Classes Act 55 Administration of the Housing of the Working Classes Act 57 (1) Schemes undertaken by the Council under Part I. of the Act 57 (2) Schemes undertaken by the Council under Part II. of the Act, to the cost of which the district authorities contributed 58 (3) Schemes undertaken by district authorities under Part II. of the Act to the cost of which the Council contributed 58 (4) Proceedings under Part III. of the Act 58 Displacement of the working classes by private action 59 Proceedings in respect of houses represented as unfit for human habitation 61 Houses let in lodgings 62 Common lodging-houses 63 Customs and Inland Revenue Acts, 1890 and 1891 64 Underground rooms 65 Workmen's trains 65 Inspection of workshops 65 Bakehouses 65 Unwholesome food 65 Poisoning by arsenic 67 The regulation of milk and cream 67 Disinfection 68 Provision of shelter during disinfection 68 Infectious disease—Bacteriological examination 69 The Cleansing of Persons Act 69 Mortuaries 69 page Water supply 70 Water fittings 70 The London Equalization of Rates Act, 1894 70 Sanitary Officers (London) Order, 1891 72 Medical officers of health of London sanitary districts in 1900 73 Appendices— I.—Report on certain localised prevalences of enteric fever in London, 1900. II.—The signs and symptoms of plague. LIST OF DIAGRAMS. FACING PAGE. Diagram I.—Marriages, 1851-1900 3 „ II.—Births, 1851-1900 3 ,, III.—Deaths, 1841-1900 5 „ .—Smallpox, 1841-1900 14 „ V.—Average weekly deaths from smallpox, measles, scarlet fever, diphtheria, whooping cough and enteric fever 15 „ VI.—Age-incidence of smallpox, measles and whooping cough in successive decennia 17 „ VII.—Measles, 1841-1900 18 „ VIII.—Scarlet fever, 1859-1900 22 „ IX.—Scarlet fever; admissions to and deaths in hospitals of the Metropolitan Asylums Board, per cent.of the total cases and deaths in London 22 „ X.—Scarlet fever; monthly notifications and case mortality, 1891-1900 23 „ XI.—Scarlet fever; weekly notifications at certain age periods, 1900 24 „ XII.—Diphtheria and croup, 1859-1900 25 „ XIII.—Diphtheria; admissions to and deaths in hospitals of the Metropolitan Asylums Board, per cent. of total cases and deaths in London 25 ,, XIV.—Diphtheria; monthly notifications and case mortality, 1891-1900 25 „ XV.—Diphtheria; weekly notifications at certain age periods, 1900 31 „ XVI.—Whooping cough, 1841-1900 33 XVII.—Typhus, 1869-1900 34 „ XVI11.—Enteric fever, 1869-1900 35 „ XIX.—Diarrhoea in relation to mean temperature (summer quarter), 1841-1900 35 ,, XX.—Enteric fever ; monthly notifications and case mortality, 1891-1900 35 „ XXI.—Enteric fever ; weekly notifications, 1900, and mean weekly notifications, 1890-1900 35 Chart A.—Showing London sanitary districts with increase and decrease of population in 1891-1901 2 Administrative County of London. REPORT OF THE MEDICAL OFFICER OF HEALTH. 1900. PART I. Population. The population of the administrative County of London estimated to the middle of the year 1900 was 4,526,700. The estimates of the population of London quoted in my previous reports for the years 1896-1899 were based on the assumption that the increase between the two census years 1891 and 1896 had been since maintained. The enumeration of the London population at the recent census of 1901 enables a more accurate estimate of the population for the middle of each of the years 1896 to 1900 to be made. The following results are thus obtained, the figures based on the enumerations of 1891 and 1896 are shown for the purpose of comparison— Estimated population—Administrative County of London. Year. Estimate based on enumerations of 1896 and 1901. Estimate based on enumerations of 1891 and 1896. 1896 4,438,474 4,443,311 1897 4,460,368 4,484,717 1898 4,482,370 4,526,508 1899 4,504,481 4,568,689 1900 4,526,700 4,611,264 It will thus be seen that owing to the diminished rate of increase in the population between 1896 and 1901, the estimates based on the enumerations of 1891 and 1896 are in excess of those based upon the enumerations of 1896 and 1901. The enumerated population of the administrative county in each census year and the intercensal rate of increase are shown in the following table— Year. Enumerated population. Intercensal rate of increase per cent. 1801 958,788 - 1811 1,138,746 18.8 1821 1,379,081 21.1 1831 1,655,099 20.0 1841 1,948,563 17.7 1851 2,363,274 21.3 1861 2,808,862 18.9 1871 3,266,987 16.3 1881 3,834,194 17.4 1891 4,232,118 10.4 1901 4,543,436 7.4 It will thus be seen that the rate of increase in the population has declined from 21.3 per cent. in 1841-51 to 7.3 per cent. in 1891-1901. The natural increase in the London population in the period 1891-1900 (i.e., the excess of births over deaths) was 490,518, while the actual increase in the population as shown by the census of 1901 was only 311,318. The loss of population by the excess of emigration over immigration was, therefore, 179,200. The following table shows the proportion of the London population at the several ages in each census year since 1851— London—Proportion of population at different ages in 1861, 1871, 1881 and 1891. (All ages taken as 10,000.) Males. Age period. 0- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85 and upwards. 1861 1,383 1,142 1,000 917 937 1,640 1,303 874 500 228 68 8 1871 1,385 1,136 1,005 940 945 1,661 1,230 883 505 239 64 7 1881 1,383 1,158 999 955 980 1,653 1,237 822 506 234 66 7 1891 1,252 1,135 1,035 992 975 1,676 1,237 870 496 253 71 8 1901 1,157 1,028 969 976 1,015 1,735 1,310 911 554 257 80 8 2 Females. 1861 1,212 1,009 893 930 1,035 1,754 1,310 887 562 295 99 14 1871 1,222 1,021 904 947 1,027 1,727 1,257 903 563 311 103 15 1881 1,230 1,048 925 976 1,035 1,705 1,232 856 569 305 105 14 1891 1,136 1,028 946 988 1,055 1,728 1,231 880 553 326 113 16 1901 1,034 929 885 973 1,088 1,828 1,296 912 589 325 124 17 Persons. 1861 1,292 1,071 943 924 989 1,700 1,307 881 533 264 85 11 1871 1,299 1,075 952 944 988 1,696 1,244 894 535 277 85 11 1881 1,302 1,100 959 967 1,009 1,680 1,234 840 540 272 86 11 1891 1,191 1,078 989 990 1,017 1,704 1,234 875 526 291 93 12 1901 1,092 976 925 974 1,053 1,784 1,303 912 572 293 103 13 The following table shows the increase or decrease of population in the inter-censal period 1891-1901, compared with the excess of births over deaths in each sanitary district of the administrative county during the ten years 1891-1900. This table relates to the London sanitary districts as constituted prior to the London Government Act of 1899. No such comparisons can be made for the new metropolitan boroughs, as the births and deaths relating to these areas cannot be obtained for the ten years 1891-1900— Increase or decrease of population 1891-1901, compared with excess of births over deaths in each sanitary district of the administrative county during the ten years 1891-1900. Sanitary district. Population. In the ten years 1891-1900 Excess of registered births over deaths, 1891-1900. Increase or decrease of population between 1891 and 1901. 1891. 1901. Births. Deaths. Increase. Decrease. Paddington 117,846 127,328 29,597 20,231 9,366 9,482 - Kensington 166,308 173,073 36,731 28,582 8,149 6,765 - Hammersmith 97,239 111,970 29,827 18,811 11,016 14,731 - Fulham 91,639 137,249 39,955 20,976 18,979 45,610 - Chelsea 96,253 93,549 26,038 18,430 7,608 - 2,704 St. George, Hanover-square 78,364 77,031 14,426 11,659 2,767 - 1,333 Westminster1 55,774 52,030 12,472 11,403 1,069 - 3,744 St. James 24,995 21,588 4,822 4,148 674 - 3,407 Marylebone 142,404 132,295 42,521 28,395 14,126 - 10,109 Hampstead 68,416 82,329 15,057 8,988 6,069 13,913 - Pancras 234,379 234,912 69,426 47,701 21,725 533 - Islington 319,143 335,238 96,604 58,817 37,787 16,095 - Stoke Newington 30,936 34,293 70,551 40,708 29,843 23,749 - Hackney 198,606 218,998 St. Giles 39,782 34,534 10,778 8,160 2,618 — 5,248 St. Martin-in-the-Fields 14,616 11,596 2,008 2,498 — 490 — 3,020 Strand 25,122 20,220 5,512 5,808 — 296 — 4,902 Holborn2 34,043 29,794 8,243 7,969 274 — 4,249 Clerkenwell 66,216 64,037 21,165 14,955 6,210 — 2,179 St. Luke 42,440 37,443 18,693 11,261 7,432 — 4,997 London, City of3 37,678 26,816 5,343 7,024 — 1,681 — 10,862 Shoreditch 124,009 117,706 43,317 27,835 15,482 — 6,303 Bethnal Green 129,132 129,727 47,879 29,227 18,652 595 — Whitechapel4 74,420 78,634 30,939 17,286 13,653 4,214 — St. George-in-the-East 45,795 49,068 20,099 12,660 7,439 3,273 — Limehouse 57,376 58,106 19,525 14,708 4,817 730 — Mile-end Old-town 107,592 112,565 41,876 23,208 18,668 4,973 — Poplar 166,748 168,886 59,364 36,344 23,020 2,138 — St. Saviour, Southwark 27,177 23,209 7,775 6,360 1,415 — 3,968 St. George, Southwark 59,712 60,755 21,428 15,395 6,033 1,043 — Newington 115,804 122,172 42,106 27,084 15,022 6,368 — St. Olave 12,723 10,573 4,109 2,844 1,265 - 2,150 Bermondsey 84,682 82,124 31,244 19,035 12,209 — 2,558 Rotherhithe 39,255 38,424 13,172 8,314 4,858 — 831 Lambeth 275,203 298,962 92,950 54,646 38,304 23,759 - Battersea 150,558 168,905 51,861 28,421 23,410 18,347 - Wandsworth 156,942 234,202 48,790 27,260 21,530 77,260 - Camberwell 235,344 259,414 74,425 44,415 30,010 24,070 — Greenwich 165,413 184,563 55,206 32,861 22,345 19,150 - Lewisham 92,647 131,607 26,569 15,179 11,390 38,960 - Woolwich 40,848 41,625 12,768 8,405 4,363 777 - Lee 36,103 47,559 28,046 14,688 13,358 27,347 — Plumstead 52,436 68,327 London 4,232,118 4,543,436 1,333,217 842,699 490,518 311,318 - 1 Including the Close of the Collegiate Church of St. Peter. 3 Including Inner and Middle Temple. 2 Including Charterhouse, Gray's Inn, Lincoln's Inn, Staple's Inn and Furnival's Inn. 4 Including the Tower of London. 3 An examination of the preceding table shows that in seven districts the increase in population exceeded the natural increase, in seventeen districts the increase of population was less than the natural increase, while in seventeen other districts the population has decreased. In my annual report for 1892 I pointed out that a decrease in population had occurred during the inter-censal period 1881-1891 in the following districts— St. George, Hanover-square. Clerkenwell. Westminster. St. Luke. St. James. London—City. Marylebone. Shoreditch. St. Pancras. St. George-in-the-East. St. Giles. Limehouse. St. Martin-in-the-Fields. St. Saviour, Southwark. Strand. Bermondsey. Holborn. It will be seen from the foregoing table that two of these districts—St. Pancras and Limehouse—show slight increase of population in the inter-censal period 1891-1901, while the district of St. George-in-the-East shows the somewhat remarkable increase of 3,273 persons, although it will be seen that this increase is less than half the natural increase, viz., excess of births over deaths. The table also shows a decrease in the population of the districts of Chelsea, St. Olave, and Rotherhithe, although in the inter-censal period 1881-1891 the population of these districts had increased. The accompanying chart (A) shows (a) the districts in which an actual decrease of population has occurred as shown by the recent census; (b) districts in which the increase in population during the ten years 1891-1900 has been less than the natural increase, i.e., excess of births over deaths; and (c) districts in which the increase in population during the decennium has been greater than the natural increase. The population of each of the 43 sanitary districts of London (as constituted prior to the London Government Act of 1899), estimated to the middle of the year 1900, is shown in the following table— Sanitary district. Estimated population, 1900. Sanitary district. Estimated population, 1900. Sanitary district. Estimated population 1900. Paddington 126,952 St. Giles 35,080 St. George, Southwark 60,708 Kensington 172,749 St. Martin-in-the-Fields 11,813 Newington 122,035 Hammersmith 110,813 Strand 20,740 St. Olave, Southwark 10,743 Fulham 133,496 Holborn 30,092 Bermondsey 82,651 Chelsea 94,146 Clerkenwell 64,383 Botherhithe 38,727 St. George, Hanoversquare 77,393 St. Luke 38,044 Lambeth 298,490 City of London 27,422 Battersea 168,399 Westminster 52,282 Shoreditch 118,440 Wandsworth 226,568 St. James, Westminster 21,810 Bethnal-green 129,694 Camberwell 258,557 Marylebone 133,646 Whitechapel 78,666 Greenwich 183,291 Hampstead 81,291 St. George-in-the-East 48,850 Lee 46,110 St. Pancras 235,876 Limehouse 58,160 Lewisham 127,187 Islington 335,602 Mile-end Old-town 112,383 Woolwich 41,595 Stoke Newington 34,185 Poplar 169,011 Plumstead 66,909 Hackney 218,182 St. Saviour, Southwark 23,529 Marriages. The number of marriages in the Registration County of London in 1900 (52 weeks) was 40,499, giving an annual rate of persons married of 18.0 per 1,000 living. The marriage rate in successive periods has been as follows— 1851-60 20.6 1892 17.4 1897 18.6 1861-70 20.3 1893 17.2 1898 18.9 1871-80 19.0 1894 17.0 1899 18.7 1881-90 17.5 1895 17.2 1900 18.0 1891 17.7 1896 18.1 The accompanying diagram (I.) shows the marriage rate in each year since 1850 in relation to the mean marriage rate of the period 1851-1900. Births. The number of births registered in the Administrative County of London in 1900 (52 weeks) was 131,362 giving a birth rate of 291 per 1,000 living per annum; this is the lowest birth rate recorded in London since civil registration began. 4 The birth rate in successive periods has been as follows— 1851-60 83.6 1892 30.9* 1897 30.1* 1861-70 35.4 1893 31.0* 1898 29.7* 1871-80 35.4 1894 30.1* 1899 29.7* 1881-90 33.2 1895 30.6* 1900 29.1* 1891 31.8* 1896 30.2* The corresponding figures for England and Wales are as follows— 1851-60 34.2 1892 30.5 1896 29.7 1861-70 35.2 1893 30.8 1897 297 1871-80 35.5 1894 29.6 1898 29.4 1881-90 32.5 1895 30.4 1899 29.3 1891 31.4 The accompanying diagram (II.) shows the London birth rate in each year since 1850 in relation to the mean birth rate of the period 1851-1900. The following table shows the birth rate in each district in 1900 per 1,000 persons living at all ages 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 2,891 22.8 6.9 Kensington 3,586 20.8 5.9 Hammersmith 2,994 27.1 10.0 Fulham 4,524 34.0 13.0 †Chelsea 2,235 23.8 8.8 St. George, Hanover-square 1,295 16.8 4.8 Westminster 1,058 20.3 7.6 St. James 409 18.8 6.5 †Marylebone 3,991 29.9 9.6 Hampstead 1,621 20.0 5.5 Pancras 6,447 27.4 10.6 Islington 9,253 27.7 10.5 Stoke Newington 775 22.7 7.5 Hackney 6,373 29.3 11.0 †St. Giles 1,017 29.1 10.3 St. Martin-in-the-Fields 155 13.2 4.5 Strand 445 21.5 7.8 Holborn 732 24.4 9.7 Clerkenwell 1,963 30.6 12.6 †St. Luke 1,821 48.0 19.8 London, City of 397 14.5 5.5 Shoreditch 4,004 33.9 14.3 Bethnal-green 4,588 35.5 15.3 Whitechapel 2,902 37.0 15.8 St. George-in-the-East 2,175 44.6 19.6 Limehouse 1,839 31.7 14.2 †Mile-end Old-town 4,261 38.0 16.0 Poplar 5,923 35.1 16.0 St. Saviour. Southwark 700 29.8 13.5 St. George, Southwark 2,093 34.6 14.5 Newington 4,173 34.3 14.5 St, Olave 400 37.3 15.9 Bermondsey 2,826 34.3 15.2 Rotherhithe 1,184 30.7 14.4 †Lambeth 9,167 30.8 11.9 Battersea 5,161 30.7 12.9 Wandsworth 5,774 25.6 8.8 Camberwell 7,211 28.0 11.2 Greenwich 5,562 30.4 12.7 Lewisham 3,278 25.8 8.8 Woolwich 1,175 28.3 14.1 Lee 990 21.5 7.0 Plumstead 1,994 29.9 13.3 London 131,362 29.1 11.0 * 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. 5 Deaths. The number of deaths in the Administrative County of London in 1900 (52 weeks) was 83,987, giving an annual death rate of 18.6 per 1,000 living. The London death rate in successive periods has been as follows— All causes—Death rates per 1,000 living. 1841-50 24.8 1891 21.01 1896 18.21 1851-60 23.7 1892 20.31 1897 17.81 1861-70 24.4 1893 21.01 1898 18.41 1871-80 22.5 1894 17.41 1899 19.61 1881-90 20.5 1895 19.51 1900 18.61 The death rate in each year since 1840 in relation to the mean death rate of the period 18411900 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 those 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 RegistrarGeneral in the annual summary for 1900. Towns. Estimated population middle of 1900. Crude death rate per 1,000 living. Death rate per 1,000 living (corrected for age and sex distribution). 1890-9. 1900. 1890-9. 1900. London 4,503,782 19.82 19.12 21.1 20.4 Manchester 548,768 24.3 24.1 27.5 27.3 Liverpool 634,780 25.7 25.7 28.2 28.2 Birmingham 519,610 20.9 21.5 23.1 23.8 Leeds 431,287 20.3 20.0 22.5 22.2 Sheffield 365,922 21.4 22.6 23.8 25.1 Bristol 324,973 18.4 16.7 19.1 17.3 Nottingham 242,676 18.7 19.1 20.1 20.5 Bradford 291,535 19.1 16.4 21.8 18.7 Hull 238,736 19.7 19.7 20.7 20.7 Salford 220,816 24.2 25.1 27.2 28.2 West Ham 314,472 17.3 15.9 18.7 17.2 London had therefore (comparing the corrected death rates) a lower death rate than any of these towns except Bristol, Bradford and West Ham in the year 1900, and a lower death rate than any except Bristol, Nottingham, Hull and West Ham in the period 1890-9. The following table enables comparison to be made of the death rates of London with the death rates of several foreign cities.3 All causes—Death rates per 1,000 living. Towns. 1890-9. 1900. Towns. 1890-9. 1900. London 19.82 19.12 St. Petersburg 28.8* 24.5 Paris 20.9 20.6 Berlin 19.2 19.0 Brussels 19.2 16.4 Vienna 22.7 20.5 Amsterdam 18.5 16.6 Rome 20.2 19.1 Copenhagen 19.2 17.8 New York 22.2 20.6 Stockholm 18.7 16.8 It will be seen that in the period 1890-9 the London death rate was lower than that of any of these towns except Brussels, Amsterdam, Copenhagen, Stockholm and Berlin, while in 1900 it exceeded the death rates of all except Paris, St. Petersburg, Vienna, Rome and New York. The following table shows the crude death rates, corrected for differences in the age and sex 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's Hospitals within Registration London. 2 All death rates in this report relating to foreign cities are calculated upon figures published by the Registrar-General. *Excluding the years 1891 and 1892. [2] 6 constitution of the populations, obtaining in each of the sanitary districts of London for the year 1900 (52 weeks) and the period 1890-9, Crude and corrected death rates1 per 1,000 pertons living in sanitary districts of London. Sanitary area. Standard death rate. Factor for correction for age and sex distribution. Crude death rate, 1890-9. Corrected death rate, 1890-9. Comparative mortality figure, 1890-9. (London 1,000.) Crude death rate, 1900. Corrected death rate, 1900. Comparative mortality figure, 1900. (London 1,000.) England and Wales 19.15 - - - - - - - London 17.96 1.06626 19.42 20.7 1,000 18.62 19.8 1,000 Battersea 17.80 1.07584 17.7 19.0 918 17.8 19.1 965 Bermondsey 18.10 1.05801 22.6 23.9 1,155 23.6 25.0 1,263 Bethnal-green 18.39 1.04133 22.9 23.8 1,150 21.8 22.7 1,146 Camberwell 18.10 1.05801 18.0 19.0 918 17.0 18.0 909 Chelsea 17.95 1.06685 19.5 20.8 1,005 18.5 19.7 995 Clerkenwell 17.28 1.10822 22.9 25.4 1,227 22.0 24.4 1,232 Fulham 18.27 1.04817 19.0 19.9 961 17.7 18.6 939 Greenwich 18.63 1.02791 19.0 19.5 942 18.1 18.6 939 Hackney 18.30 1.04645 — — — 16.7 17.5 884 Hammersmith 18.05 1.06094 18.4 19.5 942 17.1 18.1 914 Hampstead 16.63 1.15153 12.2 14.0 676 11.4 13.1 662 Holborn 17.62 1.08683 25.5 27.7 1,338 25.7 27.9 1,409 Islington 17.90 1.06983 18.0 19.3 932 17.1 18.3 924 Kensington 17.38 1.10184 17.0 18.7 903 15.8 17.4 879 Lambeth 18.24 1.04989 19.1 20.1 971 18.2 19.1 965 Lee 17.67 1.08376 14.6 15.8 763 13.4 14.5 732 Lewisham 17.92 1.06864 13.8 14.7 710 13.6 14.5 732 Limehouse 17.59 1.08869 25.5 27.8 1,343 26.4 28.7 1,449 London, City of 16.65 1.15015 22.2 25.5 1,232 21.6 24.8 1,253 Mile-end Old-town 18.58 1.03068 21.3 22.0 1,063 20.6 21.2 1,071 Newington 18.32 1.04531 22.8 23.8 1,150 22.4 23.4 1,182 Paddington 17.72 1.08070 16.6 17.9 865 16.3 17.6 889 Plumstead 19.09 1.00314 15.5 15.5 749 16.0 16.1 813 Poplar 18.49 1.03569 21.7 22.5 1,087 22.6 23.4 1,182 Rotherhithe 18.49 1.03569 21.1 21.9 1,058 22.9 23.7 1,197 St. George, Hanover-square 17.34 1.10438 15.0 16.6 802 14.5 16.0 808 St. George-in-the-East 18.43 1.03907 27.8 28.9 1,396 24.4 25.4 1,283 St. George, Southwark 17.35 1.10375 25.6 28.3 1,367 27.3 30.1 1,520 St. Giles 17.27 1.10886 22.3 24.7 1,193 19.2 21.3 1,076 St. James 17.16 1.11597 18.3 20.4 986 15.8 17.6 889 St. Luke 17.72 1.08070 27.8 30.0 1,449 28.6 30.9 1,561 St. Martin-in-the-Fields 15.74 1.21665 19.4 23.6 1,140 17.7 21.5 1,086 St. Marylebone 17.82 1.07464 20.7 22.2 1,072 19.7 21.2 1,071 St. Olave 18.42 1.03963 24.6 25.6 1,237 21.6 22.5 1,136 St. Pancras 17.89 1.07043 20.3 21.7 1,048 19.7 21.1 1,066 St. Saviour 18.29 1.04702 25.4 26.6 1,285 25.6 26.8 1,354 Shoreditch 18.45 1.03794 23.2 24.1 1,164 22.0 22.8 1,152 Stoke Newington 17.85 1.07283 — — — 13.2 14.2 717 Strand 16.24 1.17919 25.4 30.0 1,449 22.4 26.4 1,333 Wandsworth 17.93 1.06804 14.6 15.6 754 14.2 15.2 768 Westminster 16.94 1.13046 21.7 24.5 1,184 20.4 23.1 1,167 Whitechapel 17.74 1.07948 22.9 24.7 1,193 20.2 21.8 1,101 Woolwich 16.99 1.12713 19.9 22.4 1,082 22.1 24.9 1,258 The death rates of Stoke Newington and Hackney cannot be given for the period 1890-9, as during some portion of this period Stoke Newington was combined with Hackney; the death rates of the combined area for this period, however, are shown in the following table— Sanitary area. Standard death rate. Factor for correction for age and sex distribution. Crude death rate, 1890-9. Corrected death rate, 1890-9. Comparative mortality figure, 1890-9. [London 1,000.] Hackney (combined with Stoke Newington) 18.23 1.05047 17.0 17.9 865 It will be seen (comparing the corrected death rates) that all the eastern and central districts had in the year 1900 death rate3 above the average of London. The district of St. Luke had the highest death rate (30.9). and the district of Hampstead the lowest (13.1). 1 All death rates in this report relating to London sanitary districts are fully corrected for institutions (see footnote (1), page 5.) 2 See footnote (1), page 5. 7 The following table shows the number of deaths1 occurring at several ages in each of the sanitary districts of the administrative county during the year 1900 (365 days)— Age-period. 0- 1- 2- 3- 4- Under 5. 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- All ages. Paddington 477 113 46 23 22 681 47 23 25 47 99 162 223 246 260 202 63 2,078 Kensington 649 139 46 27 20 881 47 30 30 56 145 229 261 328 352 299 85 2,743 Hammersmith 486 113 31 33 22 685 44 24 35 38 107 139 190 185 206 195 50 1,898 Fulham 668 195 68 32 44 1,007 67 35 34 46 140 211 221 233 189 140 34 2,357 Chelsea 336 88 34 27 12 497 26 18 32 38 103 172 208 207 241 167 40 1,749 St.George,Hanover-sq. 140 33 16 12 9 210 14 11 17 30 79 112 147 177 160 126 36 1,119 Westminster 201 47 17 15 8 288 14 8 15 22 68 138 128 136 126 99 23 1,065 St. James 64 11 5 4 4 88 3 2 3 10 22 34 42 48 59 28 5 344 Marylebone 496 179 66 37 21 799 48 38 53 51 162 237 300 339 321 218 61 2,627 Hampstead 162 34 18 12 18 244 28 9 21 18 37 66 101 128 127 110 33 922 Pancras 1,022 322 115 70 45 1,574 90 41 70 108 313 411 498 551 561 344 90 4,651 Islington 1,354 356 127 78 55 1,970 123 62 115 113 347 481 610 662 683 483 115 5,764 Stoke Newington 85 17 6 2 7 117 17 4 6 12 24 36 48 53 69 49 18 453 Hackney 1,002 218 91 56 26 1,393 61 46 54 93 198 259 319 372 402 325 102 3,624 St. Giles 119 24 9 9 9 170 14 9 6 12 57 81 98 102 79 46 6 680 St. Martin-in-the-F'lds 24 5 3 1 ... 33 4 2 3 4 17 27 35 29 35 14 6 209 Strand 61 22 7 5 5 100 8 4 9 6 38 55 56 64 67 51 12 470 Holborn 182 39 15 9 6 251 12 7 10 11 49 80 85 101 106 54 12 778 Clerkenwell 329 128 39 27 12 535 27 21 21 25 83 143 160 176 131 87 14 1,423 St. Luke 253 90 25 13 14 395 15 10 13 22 64 102 120 115 144 74 16 1,090 London, City of 73 21 2 6 6 108 12 8 9 13 43 53 60 91 111 76 11 595 Shoreditch 748 233 94 47 37 1,159 65 30 39 63 132 187 273 237 273 143 24 2,625 Bethnal-green 782 243 102 47 36 1,210 77 27 48 60 154 210 252 299 272 191 48 2,848 Whitechapel 389 121 34 28 15 587 31 22 22 43 104 167 204 176 141 76 16 1,589 St. George-in-the-East 356 119 37 13 20 545 20 11 12 32 71 114 105 137 87 50 6 1,190 Limehouse 425 152 39 27 21 664 31 18 29 36 76 149 134 151 158 78 12 1,536 Mile-end Old-town 678 186 64 34 34 996 53 32 27 44 137 197 215 224 223 141 36 2,325 Poplar 1,146 296 114 93 55 1,704 99 56 55 67 187 325 321 378 373 212 50 3,827 St. Saviour, Southwark 137 41 17 5 5 205 15 6 11 9 44 67 63 71 59 43 8 601 St. George, Southwark 439 153 51 23 22 688 40 18 33 32 109 165 190 170 137 67 14 1,663 Newington 723 205 81 38 32 1,079 72 29 42 61 162 231 271 291 257 208 39 2,742 St. Olave 45 18 6 8 3 80 8 ... 1 4 8 22 26 33 35 12 2 231 Bermondsey 536 181 62 48 27 854 50 25 29 46 99 163 210 195 174 104 27 1,976 Rotherhithe 241 78 41 28 12 400 19 18 12 28 53 68 65 77 88 57 11 896 Lambeth 1,336 310 114 68 65 1,893 108 55 88 123 303 459 544 633 634 491 131 5,462 Battersea 820 199 53 51 38 1,161 76 58 44 82 175 234 297 302 303 215 43 2,990 Wandsworth 832 175 83 44 33 1,167 74 34 65 72 176 236 290 340 384 298 83 3,219 Camberwell 1,113 266 118 85 56 1,638 106 46 91 69 230 324 417 473 500 411 93 4,398 Greenwich 895 211 81 65 31 1,283 73 37 58 77 191 265 274 350 359 264 74 3,305 Lewisham 413 95 43 31 19 601 46 25 37 36 97 129 150 200 196 194 49 1,760 Woolwich 204 69 24 18 6 321 26 10 26 30 71 87 87 102 83 61 22 926 Lee 154 22 11 5 2 194 10 7 16 15 39 50 47 63 68 77 28 614 Plumstead 259 89 27 16 15 406 37 17 21 35 74 80 88 104 110 86 12 1,070 London 20,854 5,656 2,082 1,320 949 30,861 1,857 993 1,387 1,839 4,887 7,157 8,433 9,349 9,343 6,666 1,650 84,432 In this table where 110 death occurred is inserted. London mortality in the ten years, 1891-1900, compared with the decennium 1881-90. The following table shows the mean death rates obtaining in London at the several ageperiods and for each sex in the decennia 1881-90 and 1891-1900— Age period. Males. Females. Mean death rate 1881-90. Mean death rate 1891-1909. Differences per cent. Mean death rate 1881-90. Mean death rate 1891-1900. Differences per cent. 0— 73.09 72.21 —1.2 63.26 62.15 —1.8 5— 5.93 5.10 —14.0 5.82 5.27 —9.5 10— 2.92 2.56 —12.3 2.89 2.57 —11.1 15— 4.05 3.67 —9.4 3.58 3.06 —14.5 20— 5.44 4.85 —10.8 4.40 3.54 —19.5 25— 8.65 7.57 —12.5 6.82 5.65 —17.2 35— 14.96 14.22 —4.9 11.42 10.63 —6.9 45— 23.87 23.31 —2.3 17.23 16.91 —1.9 55— 41.33 40.32 —2.4 30.77 30.18 —1.9 65— 77.97 75.82 —2.8 63.28 61.28 —3.2 75— 155.93 148.84 —4.5 134.28 130.22 —3.0 85 and upwards 297.63 277.76 —6.7 264.77 259.81 —1.9 All ages. 22.10 20.91 —5.4 18.83 17.73 —5.8 It will be seen from the above table that the death-rates in the period 1891-1900 are lower at each age, in the case of both males and females, than the corresponding death-rates in the period 1881-90. 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," the method used being similar to that employed by Dr. Tatham in a report on the health of 1 See footnote (1), page 5. 8 greater Manchester for the period 1891-3. It is now possible to compare on these lines the London mortality in the decennium 1891-1900 with that obtaining in the decennium 1881-90, and for this purpose the following table* has been used, showing the mean future lifetime of males and females in certain age-groups, calculated from the Ex and columns of the life table for London 1881-90, published in my annual report for the year 1893. 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. Years. Years. Years. Years. 0— 49.06 52.69 35— 24.19 27.24 5— 48.94 52.68 45— 18.15 20.57 10— 45.05 48.80 55— 12.95 14.56 15— 40.79 44.55 65— 8.89 9.78 20— 36.70 40.39 75— 6.35 6.74 25— 31.04 34.51 85 and upwards 2.75 2.85 In the following table the mean annual number of deaths occurring in the decennium 1891-1900 is compared with the annual number of deaths which would have occurred had the death-rates of the decennium 1881-90 been maintained in 1891-1900, and the annual number of lives gained or lost in the latter period at each age-group is shown. The figures in the last column of the table express this gain or loss in terms of "life capital," these figures being obtained by applying the mean future lifetime figures given in Table I. to the number of lives gained or lost at each age-group. Table II. Age groups. Deaths calculated according to mean rates of 1881-90. Mean deaths occurring in the decennium 1891-1900. Mean annual gain (+) or loss (-) of lives in the decennium 1891-1900 by fluctuations of mortality. Mean annual gain ( + ) or loss (-) of " life capital" in the decennium 1891-1900 by fluctuations of mortality. Males. 0— 18,198 17,979 +219 +10,744 5— 1,325 1,139 +186 +9,103 10— 605 531 +74 +3,334 15— 824 746 +78 +3,182 20— 1,121 999 +122 +4,477 25— 3,054 2,672 +382 +11,857 35— 3,947 3,752 +195 +4,717 45— 4,403 4,299 +104 +1,888 55— 4,501 4,392 +109 +1,412 65— 4,115 4,002 +113 +1,005 75— 2,429 2,318 +111 +705 85 and upwards 485 452 +33 +91 "All ages" 45,007 43,281 +1,726 +52,515 Females. 0— 15,839 15,562 +277 +14,595 5— 1,313 1,190 + 123 + 6,480 10— 611 543 +68 +3,318 15— 811 693 +118 +5,257 20— 1,090 878 +212 +8,563 25— 2,806 2,322 +484 +16,703 35— 3,338 3,108 +230 +6,265 45— 3,570 3,504 +66 +1,358 55— 4,064 3,985 +79 +1,150 65— 4,756 4,605 +151 +1,477 75— 3,692 3,581 +111 +748 85 and upwards 1,022 1,003 +19 +54 "All ages" 42,912 40,974 +1,938 +65,968 Total 87,919 84,255 +3,664 +118,483 * The method employed in the calculation of this table is shown in more detail in my annual report for the year 1894, page 10. 9 It will be seen from the preceding table that during the decennium 1891-1900, compared with the decennium 1881-90, there has been a mean annual saving of 3,604 lives, representing a mean annual saving of 118,483 years of "life capital." In connection with the reduction of the death rate from all causes it is interesting to note that this reduction has not been manifested in the death rate from each of these causes. In the following table is shown the death rate from a number of causes and groups of causes in the two decennia 1881-90 and 1891-1900— Cause of death. Death-rate1 per 1,000 living. Increase ( + ) or decrease (—) in 1899-1900 compared with 1881-90. 18811890. 18911900. All causes 20.38 19.23 — 1.15 Smallpox .12 .00 — .12 Measles .64 .58 — .06 Scarlet fever .33 .17 — .16 Diphtheria .26 .50 + .24 Whooping cough .69 .50 — .19 Typhus .01 .00 — .01 Enteric fever .19 .14 — .05 Simple continued fever .02 .00 — .02 Diarrhoea and Dysentery .75 .76 + .01 Cholera .02 .02 — Cancer .68 .86 + .18 Tabes Mesenterica .35 .25 — .10 Phthisis 2.08 1.79 — .29 Other Tubercular diseases and .54 .50 — .04 Scrofula Nervous system, Diseases of the 2.33 1.79 — .54 Circulatory system do. 1.50 1.56 + .06 Respiratory system do. 4.30 3.93 — .37 Digestive system do. 1.12 1.20 + .08 Urinary system do. .51 .54 + .03 Generative system do. .08 .06 — .02 Influenza .02 .34 + .32 Other causes 3.84 3.74 — .10 ln this table, .00 indicates that the deaths were too few to give a rate of .005. It will be observed that in 1891-1900 there has been marked increase in the death-rate from diphtheria, cancer and influenza, and slight increase in the death-rates from a few other causes. On the other hand there has been marked reduction in the death-rate from phthisis and respiratory diseases and from diseases of the nervous system, as well as less marked decrease in the death-rates from several other causes. Infant mortality. The deaths of children under one year of age in the Administrative County of London during 1900 (52 weeks) numbered 20,773, being in the proportion of 158 per 1,000 births. The proportion in each year since 1890 has been as follows— Year. Deaths under one year per 1,000 births. 1891 1532 1892 1542 1893 1632 1894 1432 1895 1652 1896 1602 1897 1582 1898 1662 1899 1662 1900 1582 The following table enables comparison to be made of the infant mortality in London and other large English towns— 1 These death-rates are based upon deaths registered in the Registration County of London, and are uncorrected for deaths occurring in public institutions. 2 See footnote (1), page 5. 10 Deaths under one year of age per 1,000 births. Towns. 1890-99. 1900. Towns. 1890-99. 1900. London 1601 1601 Bristol 149 133 Manchester 190 189 Nottingham 179 196 Liverpool 192 186 Bradford 174 141 Birmingham 186 199 Hull 176 183 Leeds 178 183 Salford 203 207 Sheffield 184 200 West Ham 164 189 London had therefore in the period 1890-99 a lower infant mortality than any of these towns except Bristol, and in 1900 a lower infant mortality than any except Bristol and Bradford. The following table shows the infant mortality in 1890-99 and in 1900 in each of the London sanitary districts— Sanitary district. Deaths under one year of age. Deaths under one year of age per 1,000 births. 1830-9. 1900. Paddington 477 151 165 Kensington 646 172 180 Hammersmith 485 169 162 Fulham 666 172 147 Chelsea 332 159 149 St. George, Hanover-square 139 134 107 Westminster 200 171 189 St. James 63 154 154 Marylebone 498 137 125 Hampstead 162 120 100 Pancras 1,031 166 160 Islington 1,345 150 145 Stoke Newington 84 142 108 Hackney 1,004 158 St. Giles 120 145 118 St. Martin-in-the-Fields 23 189 148 Strand 60 195 135 Holborn 176 209 240 Clerkenwell 328 181 167 St. Luke 252 152 138 London, City of 70 149 176 Shoreditch 744 181 186 Bethnal-green 771 167 168 Whitechapel 404 155 139 St. George-in-the-East 352 192 162 Limehouse 420 192 228 Mile-end Old-town 675 155 158 Poplar 1,139 170 192 St. Saviour, Southwark 138 190 197 St. George, Southwark 437 192 209 Newington 714 178 171 St. Olave 48 158 120 Bermondsey 526 165 186 Rotherhithe 243 162 205 Lambeth 1,326 147 145 Battersea 821 164 159 Wandsworth 830 139 144 Camberwell 1,109 156 154 Greenwich 893 156 161 Lewisham 407 142 124 Woolwich 203 159 173 Lee 154 127 156 Plumstead 258 129 London 20,773 1592 1582 During the year 1900, the eastern group of districts had the highest infant mortality (175), the northern the lowest (145); the infant mortality of the southern, central and western groups being 158. Of the districts Holborn had the highest (240), and Hampstead the lowest infant mortality (100). 1 See footnote (2), page 5. 2 See footnote (1), page 5. 11 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 1900— Causes of death. Corrected annual average 1890-9. 1900. Zymotic diseases 15,312 13,115 Parasitic „ 65 45 Dietetic „ 664 791 Constitutional diseases 17,483 16,969 Developmental „ 5,854 5,992 Nervous „ 9,210 8,236 Diseases of organs of special sense 181 216 Diseases of the circulatory system 7,373 7,295 Respiratory diseases 18,540 17,495 Diseases of the Digestive system 5,491 5,816 „ „ Lymphatic „ 119 135 „ „ Urinary „ 2,418 2,599 „ „ Generative ,, 562 461 „ „ Locomotive „ 297 207 „ „ Integumentary system 324 346 Violence (accident) 2,997 3,155 Violence (other than accident) 535 516 Other causes 3,000 2,618 All Causes 90,425 86,007 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 1890-9. 1900. Rheumatic fever, rheumatism of heart 411 361 Rheumatism 108 103 Gout 162 124 Rickets 283 262 Cancer 3,800 4,251 Tabes mesenterica 1,201 829 Tubercular meningitis 1,250 1,169 Phthisis 8,532 8,030 Scrofula, tuberculosis 1,034. 1,101 Other constitutional diseases 702 739 Apoplexy 2,285 2,309 Epilepsy 397 374 Convulsions 2,081 1,663 Other diseases of the brain and nervous system 4,447 3,890 Croup 215 51 Bronchitis 10,226 8,699 Pneumonia 6,341 7,189 Pleurisy 316 321 Other diseases of the respiratory system 1,442 1,235 More exact comparison can be made of certain causes of death in London sanitary districts by reference to the following table. These death rates are fully corrected for deaths in institutions (see footnote (1), page 5), but are uncorrected for differences in age and sex distribution. Such correction may perhaps, profitably be made when the death rates from these diseases, fully corrected for institution deaths, can be ascertained for a more extended period than two or three years. 1 See footnote (2), page 5. 12 Death-rates1 per 100,000 from all causes and from various causes in each sanitary area, 1900 (365 days). Measles. Rheumatic fever. Cancer. Tabes mesenterica. Tubercular meningitis. Phthisis. Other tubercular diseases. Pneumonia. Other respiratory diseases. All other causes. All causes. West— Paddington 38 9 108 14 28 118 14 124 188 996 1,637 Kensington 57 9 93 11 20 119 28 111 197 943 1,588 Hammersmith 85 8 86 17 25 168 24 128 194 978 1,713 Fulham 61 6 85 18 22 157 24 160 203 1,030 1,766 Chelsea 35 9 105 16 28 177 19 166 255 1,048 1,858 St. George, Hanover-sq. 8 6 96 9 13 137 21 110 196 850 1,446 Westminster 38 6 86 11 17 245 29 224 293 1,088 2,037 St. James, Westminster 28 — 128 14 9 151 23 133 151 940 1,577 North— Marylebone 36 15 129 19 26 202 25 135 271 1,108 1,966 Hampstead 27 4 98 4 9 85 21 68 107 711 1,134 Pancras 53 8 102 17 32 199 24 186 206 1,145 1,972 Islington 48 7 96 16 23 166 19 134 204 1,005 1,718 Stoke Newington 9 6 108 9 15 105 35 82 123 833 1,325 Hackney 16 9 87 24 23 121 19 131 169 1,062 1,661 Central— St. Giles 31 — 117 20 40 319 11 185 191 1,024 1,938 St. Martin-in-the-Fields - 8 59 — 8 229 8 161 229 1,067 1,769 Strand 24 10 101 14 43 347 24 174 386 1,143 2,266 Holborn 70 7 93 30 40 282 40 216 395 1,412 2,585 Clerken well 61 2 62 19 34 261 22 233 309 1,207 2,210 St. Luke 79 5 97 11 32 347 21 226 513 1,534 2,865 London. City of 15 4 102 4 33 230 15 182 252 1,333 2,170 East— Shoreditch 65 6 68 24 41 193 36 170 320 1,294 2,217 Bethnal- green 51 11 84 21 39 216 27 200 345 1,202 2,196 Whitechapel 41 10 78 18 33 236 38 228 247 1,091 2,020 St. George in the East 41 - 61 20 35 262 70 254 313 1,380 2,436 Limehouse 144 7 74 17 31 249 48 241 246 1,584 2,641 Mile-end Old-town 53 9 73 17 28 178 29 209 229 1,244 2,069 Poplar 46 8 83 27 33 182 23 188 279 1,395 2,264 South— St. Saviour, Southwark 43 13 119 43 34 315 26 247 353 1,361 2,554 St. George, Southwark 58 10 66 41 46 366 36 346 364 1,406 2,739 Newington 57 10 96 31 25 227 21 212 307 1,261 2,247 St. Olave 56 9 93 — 28 270 19 233 270 1,172 2,150 Bermondsey 53 8 86 25 35 202 29 277 271 1,405 2,391 Rotherhithe 106 15 54 39 29 121 26 364 307 1,253 2,314 Lambeth 23 7 100 15 31 174 23 141 237 1,079 1,830 Battersea 46 9 68 12 21 153 26 150 228 1,063 1,776 Wandsworth 36 9 76 11 22 112 19 102 143 891 1,421 Camberwell 16 10 85 15 27 143 15 118 214 1,058 1,701 Greenwich 33 8 93 22 20 149 17 112 220 1,129 1,803 Lewisham 17 6 89 13 17 100 16 101 129 896 1,384 Woolwich 72 12 65 14 34 245 29 185 240 1,330 2,226 Lee 13 4 76 11 13 80 20 106 91 918 1,332 Plumstead 70 13 87 21 13 145 25 114 132 979 1,599 London 43 8 89 18 26 173 24 157 227 1,100 1.865 In this table where — is inserted no death occurred. Principal Zymotic Diseases. The number of deaths in the Administrative County of London from the principal zymotic diseases, viz., smallpox, measles, scarlet fever, diphtheria, typhus, enteric, and ill-defined fevers and diarrhoea during 1900 (52 weeks'* was 10.046. giving an annual death rate of 2.23 per 1,000 living. The death rates in each year since 1890 have been as follows— Year Death rate from principal zymotic diseases. 1891 2.271 1892 2.801 1893 3.041 1894 2.651 1895 2.621 1896 3.ll1 1897 2.581 1898 2.801 1899 2.491 1900 2.231 1 See footnote (1), page 5. 13 It will be seen from the following table that London in the period 1890-9 had a lower death rate from these diseases than any of the undermentioned towns, except Leeds, Bristol, Nottingham and Bradford, and in 1900 a lower death rate than any except Bristol and Bradford. Principal zymotic diseases—Death rates per 1,000 living. Towns. 1890-9. 1900. Towns. 1890-9. 1900. London 2.74 2.251 Bristol 1.95 1.88 Manchester 3.40 3.05 Nottingham 2.46 2.35 Liverpool 3.49 3.18 Bradford 2.27 1.36 Birmingham 2.90 2.72 Hull 2.88 3.10 Leeds 2.61 2.92 Salford 4.30 3.98 Sheffield 3.28 4.33 West Ham 2.99 3.10 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 1890-9 and in 1900 higher than that of any of these towns except St. Petersburg— Six principal zymotic diseases—Death rates per 1,000 living. Towns. 1890-9. 1900. Towns. 1890-9. 1900. London 2.00 1.461 St. Petersburg 3.42 3.08 Paris 1.16 1.04 Berlin 1.37 1.29 Brussels 1.02 0.59 Vienna 1.61 0.89 Amsterdam 0.95 0.81 Rome 1.34 1.31 Copenhagen 1.51 0.62 New York 1.74 1.31 Stockholm 1.98 0.82 The death rates from the principal zymotic diseases in the several sanitary districts of London in 1900 and the period 1890-9 are shewn in the following table— Sanitary district. Deaths in 1900. Death rate per 1,000 living. Sanitary district. Deaths in 1900. Death rate per 1,000 living. 1890-9. 1900. 1890-9. 1900. Paddington 222 2.06 1.75 Shoreditch 364 3.87 3.08 Kensington 286 1.99 1.66 Bethnal-green 355 3.72 2.7 4 Hammersmith 247 2.66 2.23 Whitechapel 142 2.81 1.81 Fulham 387 3.39 2.91 St. George-in-the-East 127 4.27 2.61 Chelsea 170 2.62 1.80 Limehouse 241 4.05 4.15 St. George, Hanoversquare 63 1.41 0.82 Mile-end Old-town 288 3.30 2.57 Poplar 569 3.48 3.37 Westminster 75 2.29 1.44 St. Saviour, Southwark 70 3.28 2.98 St. James 23 1.76 1.06 St. George, Southwark 213 3.89 3.52 Marylebone 259 2.27 1.94 Newington 355 3.33 2.92 Hampstead 96 1.33 1.18 St. Olave 20 3.03 1.87 Pancras 580 2.67 2.47 Bermondsey 277 3.30 3.36 Islington 667 2.52 1.99 Rotherhithe 140 3.08 3.62 Stoke Newington 51 2.55 1.50 Lambeth 519 2.55 1.74 Hackney 476 2.19 Battersea 415 2.97 2.47 St. Giles 61 2.17 1.74 Wandsworth 361 2.07 1.60 St. Martin - in - the Fields 10 1.63 0.85 Camberwell 534 2.65 2.07 Greenwich 418 2.87 2.29 Strand 26 2.33 1.26 Lewisham 212 1.71 1.67 Holborn 69 3.12 2.30 Woolwich 116 2.69 2.80 Clerkenwell 179 3.59 2.79 Lee 57 1.60 1.24 St. Luke 132 3.83 3.48 Plumstead 150 2.49 2.25 London, City of 24 1.45 0.88 London 10,046 2.72 2.232 The eastern group of districts had the highest mortality from the principal zymotic diseases in 1900, viz., 2.92 per 1,000 living, and the western the lowest (1.87). Among the sanitary districts Limehouse had the highest death rate (4.15) and St. George, Hanover-square, the lowest (0.82). Smallpox and Vaccination. The deaths from smallpox in the Administrative County of London numbered 4 in 1900, and 2 deaths were attributed to cowpox and effects of vaccination. lSee footnote (a), page 5. *See footnote (*), page 5. [3 ] 14 The 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 1894 0.0201 1861-70 0.28 1895 0.0121 1871-80 0.46 1896 0.0021 1881-90 0.14 1897 0.0041 1891 1 1898 0.0001 1892 0.0071 1899 0.0011 1893 0.0401 1900 0.0011 In this table where — is inserted no deaths occurred. The smallpox death rate in each year since 1840 in relation to the mean smallpox death rate of the period 1841-1900 is shown in diagram IV. The relation of smallpox mortality to season will be seen on reference to diagram V. (A.), showing the average weekly deaths from this disease in the 60 years 1841-1900. 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 living. 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 1898 33 0.007 1899 29 0.006 1900 86 0.019 If the London smallpox death rate be compared with the death rates of the following large English towns it will be seen that in the period 1890-9 the London death rate was exceeded by the death rates of Birmingham, Bristol, Bradford, Hull and West Ham, while in 1900 in none of these towns, except Liverpool and Hull, were sufficient deaths registered to give an appreciable death rate— Smallpox death rates per 1,000 living. Towns. 1890-9. 1900. Towns. 1890-9. 1900. London 0.01 0.002 Bristol 0.02 — Manchester 0.01 — Nottingham 0.00 — Liverpool 0.01 0.03 Bradford 0.07 — Birmingham 0.05 — Hull 0.07 0.08 Leeds 0.01 0.00 Salford 0.01 0.08 Sheffield 0.00 — West Ham 0.05 — In this table 0.00 indicates that the deaths were too few to give a rate of 0.005 ; where no death occurred — is inserted. If the London small-pox death rate be compared with the death rates of the following large foreign towns it will be seen that in the period 1890-9 the London rate was exceeded by the rates of all these towns, except Amsterdam, Copenhagen, Stockholm, Berlin and Rome, while in 1900 in none of these towns, except Paris and St. Petersburg, were sufficient deaths registered to give an appreciable death rate— Small-pox death rates per 1,000 living. Towns. 1890-9. 1900. Towns. 1890-9. 1900. London 0.01 0.002 St. Petersburg 0.12 0.21 Paris 0.02 0.08 Berlin 0.00 0.01 Brussels 0.09 0.00 Vienna 0.04 — Amsterdam 0.00 — Rome 0.01 0.01 Copenhagen 0.00 — New York 0.02 0.00 Stockholm — 0.00 In this table 0.00 indicates that the deaths were too few to give a rate of 0.005; where — is inserted no deaths occurred. 1 See footnote (') page 5. 2 See footnote (2), page 5. 15 In view of the recrudescence of smallpox in London at the present time the recent behaviour of this disease in foreign cities is of interest, notably the prevalence of smallpox in the Indian cities of Calcutta and Bombay. In Calcutta, in 1895, 1,500 persons died from smallpox, after which the disease declined; but in 1900 the number of deaths was 900. In Bombay there was considerable mortality in 1895 and 1896, and again in 1899 and 1900, the number of deaths in the last year being 3,000. There was also prevalence of the disease in these years in Cairo. In the foreign cities mentioned in the preceding table, during the last five years only in St. Petersburg has there been prevalence in each of these years, but in 1900 there was prevalence in Paris, causing some 200 deaths. While there are no indications of wide-spread prevalence of smallpox in Europe generally at the present time, there are reasons for believing that greater prevalence of smallpox in London than that in recent years may be expected for some time to come. The diagram already referred to (diagram IV.) shows the amount of prevalence of the disease during the last six completed decennia. In the years immediately antecedent to 1841 London, however, had suffered severely from small-pox, as nearly 4,000 persons died from this disease in 1838 in a population of 1¾ millions. It is probable that that year was the crest of a great epidemic wave previous to the wave which culminated in 1871, when the death-rate actually exceeded that of 1838. The interval between 1838 and 1871 is one of thirty-three years, and since 1871 a like period approaches completion. Should, therefore, there be widely-extended prevalence of small-pox in London it should be remembered that in certain important respects the population is more favourably situated in respect of risk of exposure to small-pox infection than in that year. As the result of Mr. W. H. Power's observations on the distribution of small-pox in the neighbourhood of the small-pox hospitals in London this large cause of infection has been removed from the metropolis, since the year 1885, when the hospital ships, " Atlas" and " Endymion," which had replaced the " Dreadnought " at Greenwich, were removed to Long Reach, fifteen miles below London. Subsequent to 1885 the only small-pox hospital capable of exercising in London the influence which Mr. Power had demonstrated was that situated at Highgate, and this hospital has now been removed from London. In 1879 the Metropolitan Asylums Board obtained powers to establish an ambulance service, and in 1889 the notification of cases of infectious disease was made obligatory in London. To what extent these changes will reduce prevalence cannot be estimated, but that they will largely do so there cannot be doubt. While there is much reason for thinking that the natural behaviour of small-pox will largely govern the prevalence of the disease, and that increased prevalence may for some time be expected, there is no ground for anticipating that it will attain such proportions as occurred in 1871. The behaviour of small-pox in 1900 undoubtedly suggests increase of infectivity, and the following resume of the cases in that year supplies evidence of a considerable ability of the disease to spread. During the year 86 persons were certified to be suffering from small-pox. In 13 of these cases, subsequent examination led to the conclusion that there had been an error in diagnosis, and in at least 5 of these 13 cases the disease was thought to be chicken-pox. In one other case the diagnosis of small-pox was regarded as doubtful. The report of the Statistical Committee of the Metropolitan Asylums Board states that 94 patients alleged to be suffering from small-pox were received at the South Wharf, of whom 64 were considered to be actually suffering from that disease. London had been nearly free from small-pox during the last six months of 1899. With the exception of two cases infected abroad, which occurred in November, the only other cases which occurred during the six months were 8 patients in the Eastern Hospital who were attacked in December, and the first of which was a man who had been infected on the way from Jerusalem to London via Paris. The nature of this man's illness had not at first been recognised, and hence he was admitted into the Eastern Hospital instead of being removed out of London to the hospital ships. The occurrences of smallpox in 1900 were as follow— January—A boy, aged 7 years, suffered from a mild attack of small-pox in a house in a street less than two hundred yards from the Eastern Hospital in which the cases of smallpox of the previous month had occurred ; this child, the nature of whose illness was not at first recognised, attended a party on Christmas and Boxing days in a neighbouring street, and among the guests was a child living in Bethnal-green who subsequently suffered from small-pox, which was recognised. The fact was communicated to the medical officer of health of Hackney, who found the boy aged 7, just mentioned, to be " marked with scars and a few crusts of eruption, of undoubted small-pox." He also found the father and mother of this boy and his two brothers to be suffering from small-pox. Three cases occurred in the house in which the party was given, as well as other cases in Hackney and Bethnal-green, making, in connection with this group in January, 14 cases in 6 houses situated in Hackney, Bethnalgreen and Shoreditch. Other cases which occurred during the month were—An engineer in the Port of London, who contracted disease from a fireman who had been infected in Bombay. A man, aged 22, who contracted small-pox on the homeward voyage from Buenos Ayres. A carpenter in Fulham who had been employed in erecting a small-pox hospital in Hull; a lodger in the same house as the preceding case. The wife of a man in St. George, Hanover-square, who had been employed in the erection of the small-pox hospital in Hull, and who had returned with " a few spots on him." A young man who was attacked with small-pox in the Eastern Hospital, to which he had been removed on account of an attack of scarlet fever. February—A case in Fulham, traceable to the case of the carpenter infected in Hull. A case in Poplar, a sister of one of the cases included in the Hackney group. A woman in Woolwich, whose mother had died a week previously from " blood poisoning," and whose illness it is conceivable was small-pox; a sister of the preceding case, who lived in another house in Woolwich. 16 March—A boy, stepson of, and living in Poplar with the patient attacked in February, and associated with the Hackney group; a man in Hackney, who worked with a member of the Hackney group; the wife of the last case. April—A clerk, aged 23 years, in St. Pancras, who had been employed on board s.s. Caledonia, which two days after leaving Bombay had two cases among the crew; the brother and the mother of the clerk, living with him; a charwoman, also living in St. Pancras, who worked for her; a steward, living in block dwellings, in Marylebone, employed on board the same vessel; the wife of the last patient; a woman, living in the block dwellings, Marylebone, who visited the steward's wife. May—A man, who occupied rooms in the block dwellings, in Marylebone, adjoining those of the ship's steward. The wife of a valet in Chelsea, whose husband had died just before from hemorrhagic but unrecognised small-pox;* she was removed to the St. George's infirmary, where an attendant was attacked; a girl in Kensington, where her step-grandmother, the valet's wife, had been staying for two nights after discharge from the infirmary; a boy in Marylebone, who was the son of the man employed by the vestry in the removal of infected bedding; a woman in Mile-end Old-town, who fell ill the day she arrived from Hamburg.† June—A child in Kensington, sister of the child who had been with the valet's wife. Two in-patients, a nurse, a ward maid and a student in St. Mary's hospital, Paddington (a female patient who had resided immediately over the flat in Chelsea in which the valet and his wife had lived had been previously admitted to St. Mary's hospital, where she died of unrecognised hoemorrhagic small-pox). The valet's linen had been sent to a laundry at Chiswick, and during the month of J une six cases of small-pox were notified in Kensington and Fulham, all having origin in infection received directly or indirectly from this source, the persons attacked being either workers or relatives of workers at this laundry. ‡ A boy in St. George-in-the-East, who was thought by his mother to have contracted the disease from an infant in the house, whose illness, however, had not been notified as small-pox; the boy was removed to the infirmary, where he infected three members of the staff and two patients. A man on board a vessel in the Port of London; a boy who sickened in Bethnal-green a day or two after landing from a ship from Russia. July—Two cases in Fulham and two in Hammersmith, belonging to the Chiswick laundry group. A woman living in the house where the boy, who gave rise to the: cases in St. George-in-the-East Infirmary, went to school; between the boy's attack and the woman's, the schoolmaster's son had measles with a few dark spots on the face during convalescence; a man in Wandsworth, source of infection unknown; a woman in Bethnal-green, source of infection not known. August—A boy and girl in Wandsworth. Their brother had come home from sea suffering from what had been called chicken-pox; his father died from " heart disease," but had a rash. September—A woman in Wandsworth, who visited the boy and girl. November—A resident in a house in Chelsea suffered from what was called blood poisoning two days after his return from Paris. His illness was followed by attack by small-pox of two of his servants—the one notified in Chelsea, the other in Fulham. Dr. Collingridge, the medical officer of health of the Port of London, gives account of eight vessels arriving in the port, cases of small-pox having occurred on board. In six instances these vessels had come from Bombay. It is well deserving of note that much of the small-pox in London in 1900 had its origin in infection received abroad. The first case of the group of eighteen cases, occurring mostly in Hackney, was that of a boy living in proximity to the Eastern Hospital, the date of whose attack appears to coincide in point of time with those of patients in the Eastern Hospital who had been infected by a man in the Eastern Hospital who was admitted on the 7th December, and was removed, suffering from small-pox, on the 9th December, 1899. This man had returned from Jerusalem suffering from small-pox. If this explanation of the boy's illness be correct, some twenty-five cases (eighteen in 1900) had their origin in this source. If Dr. Ricketts' view that the illness of the Chelsea valet was due to infection from one of the s.s. Caledonia cases, there are twenty-nine cases (probably thirty-one) again having their origin in infection received from abroad. To these must be added a group of three or four cases probably due to infection from a boy infected abroad; also two servants infected by their master, who had no doubt contracted small-pox in Paris. There were also a few other cases in which infection had been received abroad, but not giving rise to a series of cases. Of the cases admitted into the hospital ships, sixty-seven in all, the report of the Statistical Committee of the Metropolitan Asylums Board shows that in forty-nine cases vaccination cicatrices were present; in thirteen cases they were absent, and in three there was "no evidence." Of these patients three died, one having vaccination cicatrices and two having none. * Dr. Ricketts, medical superintendent of the small-pox hospital ships, in a report to the Metropolitan Asylums Board, states "the origin of his illness was for long obscure, but it appears probable that he caught small-pox at an eating-house in the north of London, from one of the cases originating in the Caledonia. † Dr. Dudfield also states that the funeral of the valet was attended by his son from a Midland town on 12th May, who was taken ill on the 25th with what was thought to be eczema. His child was taken ill on 8th June, and his servant on 9th June. The latter's illness was recognised as small-pox, and this led to correct diagnosis of the earlier cases. The man sickened on the 13th, and died of hemorrhagic small-pox. ‡ Dr. Reginald Dudfield in his annual report mentions two other persons residing in Kensal-town but working at this laundry who suffered from a disease which at the time had been regarded as chicken-pox. Diagram VI LONDON. Diagram shewing for Smallpox, Measles and, Whooping Cough, the number of deaths at ages 0-5, 5-20 and 20 and upwards per cent, of deaths at "All Ages in successive decennia. 17 Since the year 1880 the Registrar-General has classified the deaths from small-pox under three heads, viz., "vaccinated," "unvaccinated," and "no statement." The totals for the twenty years 1881-1900 are as follows— Small-pox deaths, London, 1881-1900. Age-period. All ages. 0-1 1-5 5-20 20-40 40-60 60-80 80 and upwards. 1,286 22 33 229 732 228 39 3 Unvaccinated 2,032 337 486 669 416 105 18 1 No statement 1,909 244 227 455 667 250 63 3 The following table, in which the number of deaths at each age-period is expressed as a percentage of the total deaths from small-pox 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 17.8 57.0 17.7 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 81 21.4 43.8 15.0 3.2 0.2 Unvaccinated 100 16.6 23.9 33.0 20.4 5.2 0.9 o.o In previous reports I have referred to the increasing proportion of children born in London who appear in the vaccination returns as "not finally accounted for." The proportion in successive years has been as follows. The figures for the years subsequent to 1898 are not yet available. 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) percent. of total births. 1872 8.8 1886 7.8 1873 8.7 1887 9.0 1874 8.8 1888 10.3 1875 9.3 1889 11.6 1876 6.5 1890 13.9 1877 7.1 1891 16.4 1878 7.1 1892 18.4 1879 7.8 1893 18.2 1880 7.0 1894 20.6 1881 5.7 1895 24.9 1882 6.6 1896 26.4 1883 6.5 1897 29.1 1884 6.8 1898 33.0 1885 7.0 In diagram VI. is shown the changing age incidence of mortality from small-pox in London in successive periods since 1841. In the period 1842-50 deaths of children under 5 years of age constituted nearly 70 per cent. of the total deaths. In successive decennia this proportion decreased until it reached a minimum in the decennium 1881-90, when it constituted about 25 per cent. of the total deaths. In the last decennium, 1891-1900, it has somewhat increased. The difference between the behaviour of small-pox and that of measles and whooping-cough in this respect is also shown by the diagram. The reduction in successive periods is no doubt due to the increase of infantile vaccination, and the increase in the last decennium is very suggestive when the neglect of infantile vaccination in recent years is borne in mind. The diagram also enables comparison to be made between the age distribution of small-pox deaths registered in 1881-1900 among the "vaccinated" and "unvaccinated." The age distribution of the large "vaccinated" population is probably very much that of the population as a whole, and if this view be correct the small mortality under five years of age is significant. "With respect to the smaller " unvaccinated " population the age distribution is more doubtful, and it cannot be stated to what extent a larger proportion of children under five years of age in this class of the population has contributed to the results shown. Estimate may, however, be made of the proportion of children under ten years of age in the London population who in 1898 were unvaccinated, assuming that the general rate of mortality has been the same among vaccinated and unvaccinated children, and that those who in the vaccination returns are described as "unaccounted for" were 18 not subsequently vaccinated. By applying the figures of the English life table of 1881-90 to the number of children " unaccounted for " in respect of vaccination in each year of the period 18891898 it is found that approximately 25 per cent. of the children born during that period and surviving to 1898 were unvaccinated. If these populations are applied to cases of small-pox properly belonging to them received into the hospitals of the Metropolitan Asylums Board, of which 16 cases had vaccination cicatrices and 428 had no vaccination cicatrices, the attack rates are 21 per million and 1,715 per million respectively. In other words, for every child attacked among those having vaccination cicatrices 82 children were attacked who had no such cicatrices. The number of deaths among the former class was nil, among the latter class 131, giving death-rates of 0 and 525 per million respectively. Measles. The deaths from measles in the administrative County of London in 1900 (52 weeks) numbered 1,930, as compared with 2,141 in 1899. The death rates from this disease per 1,000 living in 1900 and preceding periods have been as follows— Measles—Death rates per 1,000 living. 1851-60 0.53 1894 0.761 1861-70 0.58 1895 0.601 1871-80 0.51 1896 0.821 1881-90 0.64 1897 0.431 1891 0.431 1898 0.691 1892 0.791 1899 0.481 1893 0.381 1900 0.431 The death-rate in each year since 1840 in relation to the mean death-rate of the period 1841-1900 is shown in diagram VII., while the relation of measles mortality to season will be seen on reference to diagram V. (B.), page 15, showing the average weekly deaths from this disease in the 60 years 1841-1900. If the London measles death-rate be compared with the death-rates of the following large English towns it will be seen that in the period 1890-9 the London death-rate exceeded the deathrates of all except Manchester, Liverpool, Salford, and West Ham, while in 1900 the London death-rate was lower than any except Liverpool, Birmingham, Nottingham, and Bradford. Measles—Death rates per 1,000 living. Towns. 1890-9. 1900. Towns. 1890-9. 1900. London 0.622 0 432 Bristol 0.46 0.62 Manchester 0.81 0.47 Nottingham 0.41 0.18 Liverpool 0.63 0.23 Bradford 0.42 0.39 Birmingham 0.49 0.25 Hull 0.45 0.58 Leeds 0.49 0.58 Salford 0.95 0.56 Sheffield 0.58 0.55 West Ham 0.63 0.48 The following table shows that the measles death-rate in London was higher than that of any of the undermentioned foreign towns except St. Petersburg in the period 1890-9, and in 1900 was higher than that of any except St. Petersburg, Vienna and Rome. Measles—Death rates per 1,000 living. Towns. 1890-9. 1900. Towns. 1890-9.  London 0.622 0.432 St. Petersburg 0.62 0.48 Paris 0.37 0.34 Berlin 0.19 0.28 Brussels 0.36 0.12 Vienna 0.56 0.43 Amsterdam 0.24 0.33 Rome 0.36 0.45 Copenhagen 0.27 0.06 New York 0.29 0.24 Stockholm 0.38 0.04 In the distribution of measles mortality in London throughout the year 1900 the eastern group of districts had the highest death-rate (0.58) and the southern the lowest (0.36). Among the sanitary districts, Limehouse had the highest death-rate (1.43), and St. Martin-in-the-Fields the lowest (—). During the first quarter of the year the measles mortality in London was 0.53 per second quarter of the year the measles death-rate in London rose to 0.66 per 1,000 living, the death-rate in the southern group of districts alone being below this average. In the third quarter of the year the London death-rate declined to 0.29 per 1,000 living, the death-rate of the central and eastern groups of districts being above the London average. In the fourth quarter of the year the London death-rate further declined to 0.21 per 1,000 living, the deathrates of the eastern and southern groups being above the London average. 1 See footnote ('), page 5. ' See footnote ('), page 5. 19 The death-rates in each sanitary district of London in the period 1890-99 and in the year 1900 (52 weeks) are shown in the following table— Sanitary district. Deaths in 1900. Death-rate per 1,000 living. Sanitary district. Deaths in 1900. Death-rate per 1,000 living. 1890-9. 1900. 1890-9. 1900. Paddington 50 .39 .39 Whitechapel 31 .72 .40 Kensington 98 .47 .57 St. George - in - the Bast 20 1.10 .41 Hammersmith 90 .55 .81 Fulham 81 .72 .61 Limehouse 83 1.08 1.43 Chelsea 33 .54 .35 Mile-end Old-town 60 .72 .54 St. George, Hanoversquare 6 .32 .08 Poplar 78 .79 .46 St. Saviour, Southwark 10 .96 .43 Westminster 20 .55 .38 St. James 6 .49 .28 St. George, Southwark 36 .96 .59 Marylebone 49 .57 .37 Hampstead 21 .27 .26 Newington 70 .76 .58 Pancras 126 .56 .54 St. Olave 5 .70 .47 Islington 161 .59 .48 Bermondsey 42 .83 .51 Stoke Newington 2 .49 .06 Rotherhithe 40 .68 1.04 Hackney 33 .15 Lambeth 69 .55 .23 St. Giles 11 .61 .31 Battersea 78 .69 .46 St. Martin - in - the Fields ... .40 ... Wandsworth 82 .41 .36 Camberwell 40 .57 .16 Strand 5 .69 .24 Greenwich 58 .60 .32 Holborn 21 .88 .70 Lewisham 22 .26 .17 Clerken well 39 .93 .61 Woolwich 29 .73 .70 St. Luke 30 1.08 .79 Lee 5 .27 .11 London, City of 4 .27 .15 Plumstead 47 .54 .70 Shoreditch 76 .91 .64 London 1,930 .621 .431 Bethnal-green 63 .93 .49 The following table shows the number of deaths1 from measles 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 areas in which the deceased had previously resided— Age period. 0— 1 — 2— 3— 4— under 5 5— 10— 15 and wards. All ages. Paddington 12 17 7 5 2 43 3 1 1 48 Kensington 26 42 10 9 7 94 4 — — 98 Hammersmith 22 38 13 14 3 90 3 — 1 94 Fulham 12 41 13 5 6 77 4 1 — 82 Chelsea 7 10 11 5 — 33 — — — 33 St. George. Hanover-square 1 4 1 — — 6 — — — 6 Westminster 2 11 3 1 1 18 1 — 1 20 St. James 1 2 1 1 — 5 1 — — 6 Marylebone 7 25 10 — 2 44 3 1 — 48 Hampstead 7 3 5 3 2 20 2 — — 22 Pancras 23 50 26 12 5 116 7 — 1 124 Islington 42 63 25 11 9 150 9 — 3 162 Stoke Newington 2 1 — — — 3 — — — 3 Hackney 13 15 3 3 — 34 — — — 34 St. Giles 3 4 2 2 — 11 — — — 11 St. Martin-in-the-Fields — — — — — — — — — — Strand — 3 — 1 — 4 1 — — 5 Holborn 7 5 4 — 2 18 3 — — 21 Clerkenwell 10 16 3 2 3 34 5 — — 39 St. Luke 6 12 7 3 1 29 1 — — 30 London, City of — 2 — — — 2 2 — — 4 Shoreditch 13 44 11 4 2 74 3 — — 77 Bethnal-green 11 34 11 6 1 63 3 — — 66 Whitechapel 12 16 3 1 — 32 — — — 32 St. George-in-the-East 7 11 1 — 1 20 — — — 20 Limehouse 26 36 10 7 3 82 2 — — 84 Mile-end Old-town 14 26 8 5 3 56 3 — — 59 Poplar 14 22 20 11 7 74 2 — 1 77 St. Saviour, South wark 2 3 3 1 9 1 — — 10 St. George, South wark 6 14 7 2 2 31 4 — — 35 Newington 12 33 13 2 5 65 5 — — 70 St. Olave 1 5 — — — 6 — — — 6 Bermondsey 5 22 6 3 8 44 — — — 44 Rotherhithe 8 12 8 8 3 39 2 — — 41 Lambeth 23 21 12 9 3 68 2 — — 70 Battersea 19 31 9 7 6 72 3 — 3 78 Wandsworth 18 33 15 8 4 78 3 — 1 82 Camberwell 5 16 7 6 3 37 3 1 — 41 Greenwich 14 26 7 9 3 59 1 — — 60 Lewisham 7 8 1 — 3 19 2 — 1 22 Woolwich 9 11 5 2 1 28 2 — — 30 Lee 1 1 3 1 — 6 — — — 6 Plumstead 11 19 6 6 2 44 3 — — 47 London 441 808 310 175 103 1.837 93 4 13 1,947 In this table where — is inserted, no deaths occurred. 1 See footnote (*), page 5. 20 The methods adopted for the limitation of dangerous infectious diseases are not as yet in the same degree available for the limitation of measles. There is no obligation on the medical practitioner or the householder to notify measles; hospitals have not been provided for the isolation of persons suffering from measles; nor is it illegal to expose such persons in a public place; and further, the sanitary authority has no power to require the disinfection of a house which has been occupied by a person so suffering. Information as to the occurrence of measles in the homes of children attending the London School Board schools, and which becomes known to the teacher, is required by the Board to be given to the medical officer of health of the district, whose authority when this is done promptly, is able usefully to exercise its powers of exclusion from school of particular scholars, or to temporarily close the school or part of the school. With respect to disinfection, sanitary authorities often give opportunity for the disinfection of a house if the occupier be willing to permit this to be done. The report of the medical officer of health of Paddington states that 1,191 cases of measles were brought to his knowledge in 1900, the number of deaths in the district in that year being 50; the medical officer of health of Islington received notice of 1,619 cases of measles, the number of deaths in that district being 161; in the Strand district 50 cases were reported, the number of deaths being 5. In other districts the number of children excluded from school attendance on account, of measles is given, but the actual number of cases of this disease known to the medical officer of health is not stated. The facts as to the three districts mentioned show that the number of cases kuown to have occurred to each death was as follows— No. of cases District. per death. Paddington 24 Islington10 Strand 10 Average 13 For the purposes of comparison similar proportions may be given for Edinburgh, where the notification of cases of measles was obligatory. I extract the number of cases from a paper by Dr. Harvey Littlejohn on "Ten Years of Compulsory Notification of Infectious Diseases in Edinburgh," using those years for which I can find the number of deaths from measles occurring in Edinburgh stated in the annual summary of the Registrar-General for England. The following figures are thus obtained— No. of cases of Year. measles per death. 1882 46 1883 22 1884 26 1885 50 1886 32 1887 51 1888 38 1889 33 Average 32 It is probable therefore from these figures that the cases of measles occurring in London which became known under existing arrangements were but a small proportion of the total cases. The information obtained from school teachers is, moreover, not continuous, for it is necessarily interrupted during the school holidays. The constitution of new administrative bodies in London under the London Government Act of 1899 led the London County Council to renew with the several borough councils the proposal that measles should for certain provisions of the Public Health (London) Act be declared a dangerous infectious disease. The following letter was accordingly addressed to them— Spring Gardens, S.W., 1st December, 1900. Sir, I am directed to inform you that the Public Health Committee of the Council have under consideration the question whether it is advisable that the Council should include "Measles" in the term " Dangerous and Infectious Disease," for the purposes set out in the following sections of the Public Health (London) Act, 1891— Section 68, which prohibits, under a penalty, the exposure of infected persons and things. Section 60, which gives power to sanitary authorities to require the cleansing and disinfection of infected premises, and the disinfection or destruction of infected articles, and contains other provisions as to compensation and shelter during disinfection. Section 61, under which sanitary authorities can require bedding, clothing, etc., to be delivered up to them for disinfection, and must pay compensation for any unnecessary damage. Section 62, which prohibits, under a penalty, the casting of infectious rubbish into ash-pits without previous disinfection. Section 63, which prohibits, under a penalty, persons from knowingly letting houses in which infected persons have been lodging, until such premises have been disinfected. Section 64, which provides for a penalty on persons letting houses who make false statements as to infectious disease. Section 65, which provides for a penalty on persons ceasing to occupy houses without disinfection or notice to owner, or making false answer. Section 66, which provides for the removal to hospital of infected persons without proper lodging. 21 Section 69, which prohibits infected persona from carrying on any occupation in such a manner as to be likely to spread disease. Section 70, which prohibits the conveyance of infected persons in public conveyances. Section 72, which prohibits, in certain cases, the retention of the body of a person who has died of any dangerous infectious disease. Section 73, as to the body of a person who has died in hospital of any dangerous infectious disease being removed only for burial. Section 74, as to the disinfection of a public conveyance if used for carrying the body of a person who has died of any infectious disease. Jn 1898 a letter was received from the School Board for London on the subject, and in accordance with a resolution of the Committee I addressed a circular letter to the various vestries and district boards asking for their views on the question. The replies received showed a considerable divergence of opinion, and in these circumstances the Committee think it desirable to consult the councils of the metropolitan boroughs with reference to the proposal. I am accordingly to ask that your Council will be so good as to state whether they are in favour of the extension to measles of the provisions contained in any or all of the sections above mentioned. You will observe that these sections do not relate to the question of " notification," which is dealt with in sections 55 and 56. I shall be glad to be favoured with a reply by the end of January, 1901. I am, Sir, Your obedient Servant, G-. L. Gomme, Clerk of the Council. There is no doubt that the risk to child life from measles is insufficiently appreciated, and that often no care is taken in the home to prevent any extension of the disease within it or to other houses, or even to schools. The proposal therefore contained in the letter of the London County Council would if adopted have a useful educational effect in emphasising the need for precautions for this purpose. Among efforts which have been made by medical officers of health to prevent extension of this disease through the association of children in elementary schools has been the closure of schools or parts of schools attended by children who were attacked. The reports which have been received show that the following schools were closed in 1900 on account of prevalence of measles among the scholars— December, 1899, and January, 1900—Plumstead—Burrage-road Board School, classes D, E, F, G, infants' department—251 on roll and 37 absent. A" icarage-road Board School, class G of the infants' department—61 on roll, 8 absent; classes 4 and 5 of the infants' department'—118 on roll, 19 suffering from measles; all closed for four weeks. February—Earl-street Board School, infants' department, class A—63 on roll, 33 absent; closed for three weeks. Lambeth—Stockwell Training College, infants' department, class I.—8 per cent. absent; closed for two weeks; class II.—40 per cent. absent; closed for three weeks. Christ Church, Chapel-street, Brixton-road, infants' department—average attendance 95; 40 per cent. absent; closed for about six weeks. March—Paddington Jewish School, Bayswater, infants' department—85 on roll, 35 per cent, absent; closed for twenty-three days. Westminster—James-street Board School, infants' department—178 on roll, 83 in attendance; closed for sixteen days. Clerkenwell—Winchester-street School—One class. May—Paddington—St. Mary Magdalene School, Cirencestet-street, infants' department—588 on roll, 96 absent, 56 suffering from measles; closed for twenty-five days. St. Paul's School, Waverley-terrace, infants' department—208 on roll, 100 present; closed for tweinty-five days. Plumstead—Central School, infants' department—160 on roll, 38 absent; No. 3 boys' class, 36 on roll, 9 absent; No. 4 girls' class-room, 42 on roll, 14 absent; all closed for four weeks. Mile-end Old Town—Ben Jonson Board School, Harford-street, infants' department—Closed for three weeks. St. Giles—National School, Galen-place, infants' department—Closed for fifteen days. Holborn—St. George-the-Martyr, infants' department—119 absent out of 220, chiefly on account of measles; closed for three weeks. June—St. Olave—Fair-street Board School, babies' classes—215 on roll, 29'8 per cent, absent on account of infectious diseases generally and 22'3 per cent, absent on account of measles; closed for three weeks. Paddington—St. John's School, Tichbornestreet, infants' department—153 on roll; about half absent. St. Stephen's School, Westbourne-park—302 on roll; about half absent; both closed for twenty-five days. Plumstead- Plum-lane School, infants' department—163 on roll, 37 suffering from measles. Bloomfield-road School, infants, G class—70 on roll, 6 absent; H class, 81 on roll, 6 absent; class C, 74 on roll, 8 absent; class I), 74 on roll, 5 absent;closed for four weeks. High-street School, infants, H class—92 on roll, 13 absent; and C class, 169 on roll and 17 absent; closed for four weeks. The medical officer of the London School Board subsequently recommended the closing of the whole infant department. Conway-street School, infants' department—604 on roll, 69 absent on account of measles and 52 on account of other infectious diseases; closed for three weeks. Newington—• Crampton-street Board School, infants' department—Closed for fourteen days on account of measles and chicken-pox. July—Plumstead—Purrett-road School, infants' department—451 on roll, 115 absent on account of measles; closed for three weeks. Shoreditch—Haggerston-road Board School, infants' department—24 per cent, of children absent; one class-room closed for three weeks. October—Plumstead—Eglinton-road, infants' department, class A—57 on roll, 10 suffering from measles; class G, 80 on roll, 9 suffering from measles; both closed for [4] 22 three weeks. Shoreditch-—-St. John's-road Board School, infants' department. One class-room closed for three weeks. December—Shoreditch—Trinity-place Board School, infants' department—One class-room closed for a week before Christmas. Catherine-street Board School, infants' department—One class-room closed for three weeks. Scarlet Fever. The cases of scarlet fever notified in the administrative County of London during 1900 numbered 13,892, compared with 18,224 in 1899. The number of deaths registered from this cause in 1900 was 361. com Dared with 398 in 1899. The London rate's in 1900 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 0.371 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 1898 0.131 3.8 3.4 1899 0.091 4.1 2.2 1900 0.081 3.1 2.6 The death-rate in each year since 1858 in relation to the mean death-rate of the period 1859-1900 will be seen on reference to diagram VIII., and the monthly case-rate and case-mortality in each of the years 1891-1900 in relation to the mean of the whole period is shown in diagram X. The relation of scarlet fever mortality to season will be seen on reference to diagram V.(c.), page 15, showing the average weekly number of deaths from this disease in the 40 years 1861-1900. It will be seen from the following table that in the1 period 1890-9 the London scarlet fever death-rate was lower than that of any of the undermentioned towns except Birmingham, Leeds, Bristol, Nottingham, Hull, and West Ham, and in 1900 was lower than that of any except West Ham. Scarlet fever—Death rates per 1,000 living. Towns. 1890-9. 1900. Towns. 1890-9.  London 0.202 0.082 Bristol 0.13 0.12 Manchester 0.28 0.19 Nottingham 0.20 0.22 Liverpool 0.40 0.17 Bradford 0.25 0.25 Birmingham 0.20 0.19 Hull 0.17 0.16 Leeds 0.18 0.12 Salford 0.37 0.45 Sheffield 0.28 0.17 West Ham 0.18 0.05 The following table shows that the London scarlet fever death-rate was in the period 1890-9 lower than that of any of the undermentioned foreign towns except Paris, Brussels, Amsterdam, and Home, and in 1900 was lower than that of any except Paris, Brussels, Amsterdam, Stockholm, and Rome. Scarlet fever—Death rates per 1,000 living. Towns. 1890-9. 1900. Towns. 1890-9. 1900. London 0.202 0.082 St. Petersburg 0.69 0.59 Paris 0.07 0.07 Berlin 0.24 0.33 Brussels 0.05 0.02 Vienna 0.21 0.10 Amsterdam 0.03 0.02 Rome 0.02 0.00 Copenhagen 0.24 0.15 New York 0.29 0.13 Stockholm 0.50 0.07 In this table 0.00 indicates that the deaths were too few to give a rate of 0.005. In the distribution of scarlet fever mortality in London throughout the year 1900 the central group of districts had the highest death-rate (0.11) and the western and northern groups * The Infectious Disease (Notification) Act came into force in 1889. 1 See footnote (') page 5. 2 See footnote (2) page 6. 23 the lowest (0.07). Of the districts the mortality was highest in Limehouse (0'22) and lowest in the districts of St. Martin-in-the-Fields, St. Saviour and Lee, in each of which districts no death from this disease was recorded throughout the year. During the first quarter of the year the northern group of districts had the highest death-rate (0.10) and the western and southern groups the lowest (0.06); during the second quarter the central group of districts had the highest deathrate (014) and the western group the lowest (0.06); during the third quarter of the year the eastern group of districts had the highest death-rate (0.11) and the northern group the lowest (0.04); and during the fourth quarter of the year the central group of districts had the highest death-rate (0.15) and the northern group again the lowest (0.05). The case-rate of each district in 1891-9 and in 1900 and the death-rate of each district in 1890-9 and in 1900 are shown in the following table— Sanitary district. Cases, 1900. Case-rate per 1,000 living. Deaths, 1900. Death-rate per 1,000 living. 1891-9. 1900. 1890-9. 1900. Paddington 306 3.8 2.4 5 .12 .04 Kensington 366 3.7 2.1 4 .17 .02 Hammersmith 352 4.2 3.2 7 .17 .06 Fulham 552 5.3 4.1 23 .26 .17 Chelsea 233 4.5 2.5 7 .20 .07 St. George, Hanover-square 167 3.6 2.2 6 .12 .08 Westminster 122 3.8 2.3 1 .19 .02 St. James 62 3.2 2.9 1 .15 .05 Marylebone 382 3.9 2.9 12 .19 .09 Hampstead 224 3.8 2.8 4 .11 .05 Pancras 658 5.0 2.8 10 .20 .04 Islington 1,088 5.1 3.3 25 .17 .07 Stoke Newington 126 5.9 3.7 4 .19 .12 Hackney 695 3.2 19 .09 St. Giles 98 3.7 2.8 4 .13 .11 St. Martin-in-the-Fields 24 3.4 2.0 - .13 - Strand 79 3.8 3.8 1 .20 .05 Holborn 99 4.8 3.3 4 .19 .13 Clerkenwell 138 5.8 2.1 10 .27 .16 St. Luke 96 5.1 2.5 2 .32 .05 London, City of 83 4.5 3.0 5 .18 .18 Shoreditch 327 4.9 2.8 16 .24 .14 Bethnal-green 370 6.1 2.9 12 .26 .09 Whitechapel 399 5.5 5.1 11 .24 .14 St. George-in-the-East 138 5.3 2.8 6 .33 .12 Limehouse 172 6.3 3.0 13 .29 .22 Mile-end Old-town 334 6.0 3.0 7 .22 .06 Poplar 498 5.8 3.0 8 .25 .05 St. Saviour, Southwark 82 4.6 3.5 — .26 - St. George, Southwark 251 5.4 4.1 11 .29 .18 Newington 356 5.5 2.9 11 .24 .09 St. Olave 37 5.4 3.5 1 .29 .09 Bermondsey 258 5.4 3.1 7 .28 .08 Rotherhithe 102 5.7 2.6 6 .27 .16 Lambeth 824 4.8 2.8 21 .18 .07 Battersea 545 6.3 3.2 11 .20 .07 Wandsworth 673 4.6 3.0 17 .12 .08 Camberwell 817 4.6 3.2 12 .17 .05 Greenwich 685 5.8 3.7 15 .22 .08 Lewisham 501 3.4 3.9 9 .08 .07 Woolwich 134 5.0 3.2 6 .23 .14 Lee 137 6.4 3.0 — .16 - Plumstead 298 4.5 7 .25 .10 Port of London 4 — — — — - London 13892 50 3.1 361 .201 .081 With decreasing prevalence of scarlet fever in London and diminishing virulence as manifested by lower fatality, but few special outbreaks of the disease are commented on by the medical officers of health of the several districts in the county. The medical officer of health of St. Marylebone gives account of an outbreak in the St. Marylebone Charity Schools, in which fourteen cases occurred between the 18tli and 27th October. The remaining children we're, on his recommendation, removed to another house. Subsequently two of these children developed scarlet; fever, and their prompt isolation brought the outbreak to an end. The medical officer of health of Clerkenwell gives account of cases of scarlet fever occurring in seven families. " In: the first nine cases either the patient or some member of the family attended the same elementary school, and other cases attributed their infection to another school. Neither of these schools came under our supervision." In Paddington nine cases occurred in a "high-class" girls' boarding school. Dr. Reginald Dudfield, as the result of careful enquiry into the causes of infection, concluded that the first child attacked, probably contracted disease when in a crowd witnessing a procession, 1 See footnote page 5. 24 and that the malady then spread within the school. Six cases also occurred in a mixed day and boarding school in that district, the first case occurring in a day scholar. The medical officer of health of the Strand mentions an outbreak in connection with a police section-house, and the medical officer of health of Westminster calls attention to the special incidence of scarlet fever on the populations of Government buildings, chiefly in barracks or married soldiers' quarters. In St. Saviour's district the medical officer of health states—Christchurch Schools were closed for a fortnfight owing to the prevalence of the disease amongst the younger scholars. This closure was effectual in putting a stop to the disease." As in previous reports, I have shown in diagram XI. the number of cases of scarlet fever appearing in each weekly notification list, in relation to the mean of the year, in 'three age groups, 0—3, 3—13, and 13 years and upwards, these age groups representing approximately the pre-school age, school age and post-school age. The summer holiday of the London School Board schools began in 1900 on Thursday, the 20th July, i.e., the latter part of the 30th week, and the schools re-opened on Monday, the 27th August, i.e., at the beginning of the 35th week. If the number of cases notified in the four weeks, which would be most subject to holiday influence, be compared with the number of cases notified in the four preceding and four subsequent weeks, the results shown in the following table are obtained. It will be seen that, the decrease during the period of holiday influence is most marked at ages 0—3 and 3—13, and the increase subsequent to the period of holiday influence is particularly marked at the school age. Scarlet fever—Notified cases, 1900. 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 (28th to 31st) 108 607 202 — — — Four weeks of holiday influence (32nd to 35th) 90 512 182 —16.7 — 15.7 — 9.9 Four weeks following weeks of holiday influence (36th to 39th) 108 865 263 + 20.0 + 68.9 + 44.5 Scarlet fever, 1900—Proportion of eases and deaths in hospitals. It will be seen by reference to diagram IX. that there was in 1900 a slight increase in the proportion of the notified cases admitted to the hospitals of the Metropolitan Asylums Board, and a slight decrease in the proportion of deaths occurring in those institutions compared with the proportions in the preceding year. Return cases. The occurrence of "return cases" of scarlet fever is mentioned in a number of the reports of medical officers of health. In Paddingtou fifteen such cases were noted by the medical officer of health; in Kensington, one case; in Fulham, seven cases; in St. George, Hanover-square, two cases; in Stoke Newington, three cases; in Shoreditch, one case; in Battersea, thirteen cases occurred after the return of a patient who had suffered from scarlet fever, one after a patient had suffered from diphtheria, and two in which cases of diphtheria followed the return of patients who had suffered from scarlet fever. In some of these cases the interval between the return of the first patient and the occurrence of others was prolonged. In Wandsworth. parish three cases occurred, and in Plumstead nine cases. In the above statement where oi\e or more persons appear to have been infected by the patient who had returned, they are included in the total as a single case. It is interesting to note that some of these cases occurred after the retention in the hospital for a considerable period of the patient, who was believed to have returned home in an infective condition; in one instance this period was sixteen weeks. Scarlet fever—Age and sex distribution. The following table shows the case-rates, death-rates, and fatality of scarlet fever during the year 1900. The case-rate was practically the same among males at all ages as that among females, but the death-rate and fatality were higher among males than among females. In the age groups adopted for the purposes of the table the greatest incidence of attack was upon both males and females of four years of age. The greatest incidence of death was upon males of four years of age and upon females of two and three years of age. The fatality was greatest among males under one year, and among females of one year of age. NOTIFIED CASES. Diagram XI Scarlet Fever, 1900. Diagram XIV. Diphtheria. Diagram XII Diphtheria. 25 Scarlet fever,* 1900. 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. 6,548 193 2.9 308 9 7,253 176 2.4 305 7 0— 79 13 16.5 145 24 69 7 10.1 127 13 1— 262 23 8.8 542 48 229 29 12.7 473 60 2— 460 33 7.2 941 68 435 32 7.4 893 66 3— 622 31 5.0 1,306 65 642 32 5.0 1,332 66 4— 629 36 5.7 1,350 77 628 17 2.7 1,354 37 5— 2,300 26 1.1 1,052 12 2,820 43 1.5 1,277 19 10— 1,125 13 1.2 545 6 1,278 5 0.4 608 2 15— 495 6 1.2 239 3 469 3 0.6 203 1 20— 288 6 2.1 133 3 328 3 0.9 127 1 25— 218 5 2.3 59 1 272 4 1.5 63 1 35— 51 1 2.0 18 0 65 — — 21 — 45— 16 — — 8 — 17 1 5.9 8 0 55 and upwards. 3 — — 2 — 1 — — 0 — Diphtheria. The cases of diphtheria notified in the administrative County of London in 1900 numbered 12,023, compared with 13,711 in 1899. The number of deaths registered from this cause in 1900 was 1,540, compared with 1,946 in 1899. The diphtheria case rates and death rates in 1900 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 1898 0.391 2.7 14.8 1899 0.431 3.1 14.2 1900 0.341 2.7 12.8 The death-rate in each year since 1858, in relation to the mean death-rate of the period 1859-1900, is shown for diphtheria and for diphtheria and croup combined in diagram XII., and the monthly case-rate and case mortality in each of the years 1891-1900 in relation to the mean of the whole period is shown in diagram XIV. The relation of diphtheria mortality to season will be seen on reference to diagram V. (D.), page 15, showing the average weekly number of deaths from this disease in the 40 years 1861-1900. If the London diphtheria death-rate be compared with the death-rates of the following large English towns it will be seen that in the period 1890-9 the London rate exceeded the rates of all these towns except West Ham, and in 1900 exceeded the rates of all except Leeds, Sheffield. Salford and West Ham. Diphtheria—Death-rates per 1,000 living. Towns. 1890-9. 1900. Towns. 1890-9. 1900. London 0.492 0.352 Bristol 0.14 0.31 Manchester 0.21 0.18 Nottingham 0.08 0.12 Liverpool 0.20 0.26 Bradford 0.08 0.11 Birmingham 0.24 0.14 Hull 0.12 0.08 Leeds 0.23 0.59 Salford 0.34 0.41 Sheffield 0.29 1.26 West Ham 0.51 0.50 *In the preparation of this table, the question whether the persons, who were attacked and who died, belonged to London is disregarded, the percentage being calculated on the number of cases notified in London, and the number of deaths occurring in London and the institutions belonging to London. Inasmuch as the age of the patient is not in all cases recorded in the notification certificate it has been necessary to distribute such cases among the various ages proportionately. †The Infectious Diseases (Notification) Act only came into force in 1889. 1 See footnote (1), page 5. 2 See footnote (2), page 5. 26 It will be seen from the following table that the London diphtheria death-rate was, in the period 1890-9, lower than the death-rate of any of the undermentioned foreign cities except Paris, Brussels, Amsterdam and Rome, while in 1900 the London rate was only exceeded by the rates of Stockholm, St. Petersburg and New York. The inclusion of deaths from croup, however, in the case of several of these towns, makes comparison of the death-rates of little value†— Diphtheria—Death-rates per 1,000 living. Towns. 1890-9. 1900. Towns. 1890-9. 1900. London 0.491 0.351 St. Petersburg 0.89 0.85 Paris 0.35* 0.12* Berlin 0.59 0.29 Brussels 0.13* 0.09* Vienna 0.65* 0.18* Amsterdam 0.24 0.08 Rome 0.22 0.11 Copenhagen 0.54 0.16 New York 0.74 0.56 Stockholm 0.76* 0.55* In the distribution of diphtheria mortality throughout the year 1900 the eastern group of districts had the highest death-rate (0.45), and the western and central groups the lowest (0.24); of the districts, Bermondsey had the highest death-rate (0.72), and St. George, Hanoversquare, and Strand the lowest (0.14). During the first quarter of the year the southern group of districts had the highest death-rate, and during the remaining three quarters of the year the eastern group of districts had the highest death-rate. The case-rate of each district in 1891-9 and in 1900, and the death-rate in the period 1890-9 and in 1900 are shown in the following table— Sanitary district. Cases, 1900. Case-rate per 1,000 living. Deaths, 1900. Death-rate per 1,000 living. 1891-9. 1900. 1890-9. 1900. Paddington 153 2.1 1.2 27 .43 .21 Kensington 336 1.7 1.9 27 .33 .16 Hammersmith 252 2.2 2.3 28 .46 .25 Fulham 642 2.9 4.8 66 .53 .50 Chelsea 180 2.9 1.9 18 .53 .19 St. George, Hanover-square 91 1.4 1.2 11 .25 .14 Westminster 105 1.9 2.0 8 .37 .15 St. James 39 1.7 1.8 4 .26 .18 Marylebone 216 1.8 1.6 40 .36 .30 Hampstead 160 1.8 2.0 31 .29 .38 Pancras 590 2.2 2.5 72 .50 .31 Islington 637 2.3 1.9 105 .47 .31 Stoke Newington 130 2.9 3.8 14 .50 .41 Hackney 622 2.9 59 .27 St. Giles 60 1.3 1.7 8 .31 .23 St. Martin-in-the-Fields 13 1.3 1.1 2 .36 .17 Strand 39 1.7 1.9 3 .33 .14 Holborn 67 2.7 2.2 5 .47 .17 Clerkenwell 121 3.3 1.9 18 .57 .28 St. Luke 76 2.8 2.0 13 .49 .34 London, City of 66 1.8 2.4 6 .33 .22 Shoreditch 354 2.6 3.0 57 .57 .48 Bethnal-green 407 3.7 3.1 63 .73 .49 Whitechapel 262 3.1 3.3 19 .59 .24 St. George-in-the-East 118 3.6 2.4 14 .70 .29 Limehouse 180 2.9 3.1 17 .63 .29 Mile-end Old-town 297 3.2 2.6 35 .66 .31 Poplar 645 3.9 3.8 115 .61 .68 St. Saviour, Southwark 116 3.3 4.9 15 .52 .64 St. George, Southwark 221 3.1 3.7 23 .56 .38 Newington 447 3.1 3.7 70 .53 .58 St. Olave 14 2.2 1.3 3 .41 .28 Bermondsey 352 2.8 4.3 59 .59 .72 Rotherhithe 113 2.5 2.9 26 .52 .67 Lambeth 849 2.4 2.9 101 .44 .34 Battersea 316 3.3 1.9 34 .57 .20 Wandsworth 453 2.2 2.0 44 .37 .19 Camberwell 901 3.2 3.5 132 .55 .51 Greenwich 522 3.2 2.9 64 .54 .35 Lewisham 340 2.2 2.7 33 .36 .26 Woolwich 99 1.8 2.4 7 .37 .17 Lee 163 22 3.5 19 33 .41 Plumstead 242 3.6 25 .53 .37 Port of London 17 — — — — — London 12,023 2.6 2.7 1,540 .492 .342 *Including deaths from croup. †The death-rate in London from diphtheria, including deaths from croup, was .54 in 1890-9, and .36 in 1900. 1 See footnote (2), page 5. 2 See footnote (1), pace 5. 27 To enable the variations in diphtheria prevalence and mortality in the several sanitary districts of London to be better appreciated the following tables (A) and (B) have been prepared. Table (A) shows (1) the diphtheria case-rates per 10,000 living in the several sanitary districts of London for each of the years 1891-1900 inclusive, and (2) the comparative case-rates of each district in these years, i.e., the case-rates of each district in each year shown in relation to the London case-rate of the same year, the London case-rate being taken as 100 Table (B) shows, similarly, the comparative death-rates of the several sanitary districts for each of the years 1887-1900, inclusive, the London death-rate for each year being taken as 100— (A) Diphtheria—Case-rates per 10,000 living and comparative case-rates (London rate taken as 100) in sanitary districts in each of the years 1891-1900. Sanitary district. Case-rates per 10,000 living. Comparative case-rates (London case-rates taken as 100). 1891. 1892. 1893. 1891. 1895. 1896. 1897. 1898. 1899. 1900. 1891. 1892. 1893. 1894. 1895. 1896. 1897. 1898. 1899. 1900. Padding ton 15 14 24 32 19 19 26 20 16 12 100 70 75 123 73 61 87 77 53 44 Kensington 12 11 22 17 22 21 19 13 15 19 80 55 69 65 85 68 63 50 50 70 Hammersmith 29 32 27 18 20 21 15 15 18 23 193 160 84 69 77 68 50 58 60 85 Fulham 9 11 24 31 36 30 32 38 41 48 60 55 75 119 138 97 107 146 137 178 Chelsea 20 21 24 25 32 50 32 28 25 19 133 105 75 96 123 161 107 108 83 70 St. George, Hanover square 11 16 16 14 12 15 15 14 11 12 73 80 50 54 46 48 50 54 37 44 Westminster 9 26 15 13 20 20 21 24 19 20 60 130 47 50 77 65 70 92 63 74 St. James 9 12 19 18 18 16 23 19 17 18 60 60 59 69 69 52 77 73 57 67 Marylebone 11 16 29 21 16 20 16 17 14 16 73 80 91 81 62 65 53 65 47 59 Hampstead 16 19 23 13 16 26 14 17 14 20 107 95 72 50 62 84 47 65 47 74 Pancras 13 19 34 22 23 20 22 21 24 25 87 95 106 85 88 65 73 81 80 93 Islington 23 23 28 27 18 33 22 16 20 19 153 115 88 104 69 106 73 62 67 70 Stoke Newing- ton Hackney 19 28 40 16 18 23 16 16 9 38 127 140 125 62 69 74 53 62 30 141 28 24 27 36 40 32 29 108 92 87 120 154 107 107 St. Giles 6 16 20 11 16 15 15 11 8 17 40 80 63 42 62 48 50 42 27 63 St. Martin - in the-Fields 4 18 19 12 14 12 11 6 14 11 27 90 59 46 54 39 37 23 47 41 Strand 5 13 32 13 17 15 17 21 16 19 33 65 100 50 65 48 57 81 53 70 Holborn 10 19 30 22 19 23 53 49 21 22 67 95 94 85 73 74 177 188 70 81 Clerkenwell 20 20 46 25 22 37 53 40 30 19 133 100 144 96 85 119 177 154 100 70 St. Luke 15 11 37 16 23 32 45 47 25 20 100 55 116 62 88 103 150 181 83 74 London, City of Shoreditch 9 25 19 12 13 23 21 16 20 24 60 125 59 46 50 74 70 62 67 89 19 17 42 25 21 30 31 21 31 30 127 85 131 96 81 97 103 81 103 111 Bethnal-green Whitechapel 23 45 58 43 37 35 43 26 27 31 153 225 181 165 142 113 143 100 90 115 23 35 28 24 37 44 38 23 25 33 153 175 88 92 142 142 127 88 83 122 St. George - in - the-East Limehouse 20 29 53 46 46 44 40 23 21 24 133 145 166 177 177 142 133 88 70 89 13 16 42 34 33 46 33 23 23 31 87 80 131 131 127 148 110 88 77 115 Mile - end Old - town Poplar 11 24 33 32 44 49 40 26 33 26 73 120 103 123 169 158 133 100 110 96 29 29 68 41 46 41 42 28 25 38 193 145 212 158 177 132 140 108 83 141 St. Savionr, Southwark 14 16 33 34 26 32 42 47 51 49 93 80 103 131 100 103 140 181 170 181 St. George, Southwark 12 13 32 31 17 31 32 41 74 37 80 65 100 119 65 100 107 158 247 137 Newington 9 15 41 28 23 33 27 38 59 37 60 75 128 108 88 106 90 146 197 137 St. Olave 9 13 25 22 19 37 25 14 28 13 60 65 78 85 73 119 83 54 93 48 Bermondsey 11 11 27 32 14 30 33 31 63 43 73 55 84 123 54 97 110 119 210 159 Rotherhithe 9 12 27 37 36 30 21 10 39 29 60 60 84 142 138 97 70 38 130 107 Lambeth 13 19 30 22 23 23 25 27 36 29 87 95 94 85 88 74 83 104 120 107 Battersea 22 24 42 31 25 25 37 47 35 19 147 120 131 119 96 81 123 181 117 70 Wandsworth 11 16 26 20 16 16 29 30 30 20 73 80 81 77 62 52 97 115 100 74 Camberwell 10 13 21 29 36 55 46 27 47 35 67 65 66 112 138 177 153 104 157 130 Greenwich 10 11 29 33 51 47 34 31 38 29 67 55 91 127 196 152 113 119 127 107 Lewisham 7 15 23 17 13 36 23 28 45 27 47 75 72 65 50 116 77 108 150 100 Woolwich 2 4 6 12 16 24 36 26 31 24 13 20 19 46 62 77 120 100 103 89 Lee 7 15 25 12 12 19 28 41 34 35 47 75 78 46 46 61 93 158 113 130 Plumstead 20 25 34 22 18 29 36 77 96 110 73 69 97 133 London 15 20 32 26 26 31 30 26 30 27 100 100 100 100 100 100 100 100 100 100 28 (B.) Diphtheria—Comparative death-rates1 (London death rate taken as 100) in sanitary districts, 1887-1900. Sanitary district. Year 1887. 1888. 1889. 1890. 1891. 1892. 1893. 1894. 1895. 1896. 1897. 1898. 1899. 1900. Paddington 113 213 95 103 63 52 77 125 73 86 102 123 53 62 Kensington 104 177 176 61 53 45 65 75 102 68 94 38 58 47 Hammersmith 222 135 129 155 234 168 71 80 83 83 56 54 53 74 Fulham 113 42 39 76 66 73 84 162 135 112 106 126 105 147 Chelsea 87 48 66 176 53 93 72 89 113 198 112 110 63 56 St. George, Hanover-square 70 181 97 48 81 75 57 39 58 51 42 31 35 41 Westminster 191 210 132 48 63 182 35 79 75 63 86 108 44 44 St. James 48 61 21 36 88 57 77 103 33 15 26 59 33 53 Marylebone 43 52 61 58 56 77 88 84 48 88 66 82 60 80 Hampstead 96 84 34 94 59 89 71 44 37 66 44 62 44 112 Pancras 113 100 68 167 94 102 113 82 106 68 94 103 107 91 Islington 65 52 53 76 156 107 81 110 85 125 76 67 84 91 Stoke Newington 83 113 116 88 106 127 116 25 29 95 112 36 40 121 Hackney 97 75 80 124 141 93 79 St. Giles 239 87 111 73 94 120 75 59 65 31 38 41 30 68 St. Martin-in-the-Fields 139 61 34 21 88 191 77 72 102 39 48 62 19 50 Strand 157 35 79 45 63 73 120 61 104 20 42 44 70 41 Holborn 113 45 129 158 84 118 91 103 42 64 106 187 47 50 Clerkenwell 109 126 95 85 131 95 153 84 98 105 146 141 98 82 St. Luke 117 74 79 112 88 75 147 59 92 105 102 151 58 100 London, City of 52 87 79 85 106 150 41 30 46 58 66 87 58 65 Shoreditch 96 84 147 139 166 82 148 100 90 102 128 92 126 141 Bethnal-green 91 132 208 267 147 207 141 169 150 97 130 123 107 144 Whitechapel 35 106 121 206 228 177 107 98 144 102 86 64 77 71 St. George-in-the-East 143 106 247 197 131 164 179 179 204 105 118 74 58 85 Limehouse 104 139 216 145 88 100 141 144 150 141 100 113 135 85 Mile-end Old-town 91 61 132 121 106 171 97 121 194 146 112 144 135 91 Poplar 78 84 103 127 103 107 133 105 173 103 142 133 105 200 St. Saviour, Southwark 126 152 116 55 128 50 87 126 98 119 96 156 163 188 St. George, Southwark 87 126 89 70 94 100 100 134 54 110 92 154 242 112 Newington 104 52 126 82 119 75 105 84 83 98 106 151 195 171 St. Olave 70 103 21 94 125 55 76 41 65 129 34 69 188 82 Bermondsey 83 52 71 67 59 55 125 128 65 142 146 131 240 212 Rotherhithe 70 68 111 61 31 64 104 128 148 107 104 69 181 197 Lambeth 170 129 153 82 88 107 87 80 73 78 96 97 119 100 Battersea 83 65 61 82 144 80 143 120 110 83 126 179 84 59 Wandsworth 148 79 42 72 91 89 74 48 36 114 113 77 56 Camberwell 130 94 82 67 63 75 72 128 138 171 132 85 142 150 Greenwich 104 71 50 85 88 70 116 126 204 132 78 62 93 103 Lewisham 74 152 18 64 34 61 92 62 33 149 84 74 140 76 Woolwich 35 26 39 36 16 23 27 56 65 125 160 118 119 50 Lee 100 45 37 42 25 36 72 92 56 73 86 90 81 121 Plumstead 109 132 71 82 34 159 157 105 119 154 78 62 58 109 London 100 100 100 100 100 100 100 100 100 100 100 100 100 100 Diphtheria and elementary schools. With the exception of the occurrence of a considerable number of cases of diphtheria in the vicinity of the St. Marylebone Infirmary, North Kensington, mentioned by the medical officer of health for Kensington, the only special prevalences of diphtheria discussed by medical officers of health in their annual reports are those which have been associated with school attendance. The medical officer of health of Fulham in a separate report discusses a special prevalence of the disease in the 13 weeks ending the 24th November occurring particularly in the Munster and Sand's-end wards, and especially the latter, largely due, Dr. Jackson states, to the existence of unrecognised cases. Inquiry into the circumstances of the prevalence led Dr. Jackson to advise the closing for two weeks of class-room H. of the infants' department of the Langford-road Board School and the exclusion from the school of other children attending the school and living in the same houses as the children attending that class-room. This advice was acted upon by the Vestry of Fulham, and the circumstances which led to it deserve to be stated in detail, inasmuch as the London School Board appealed to the Board of Education against the action of the sanitary authority, the School Board being of opinion "that the steps taken are unnecessary, and a doubt exists as to whether in such a case as this children can legally be excluded from obtaining proper educational advantages when not residing in infected houses." As the result of this appeal the Local Government Board called for a report by the medical officer of health upon the circumstances which led him to advise the particular course adopted, and subsequently informed the Board of Education "that the course pursued does not appear to the Board to be unreasonable." The following is extracted from Dr. Jackson's report— Langford-road Board School. (Sand's-end Ward.)—Dealing now with this school, there was, during the first six weeks of the period under consideration, no exceptional incidence of the disease upon the See footnote, (1) page 5. 29 children attending that school, the following being the cases notified subsequent to the reopening of the school on August 27th, after the summer holidays— Child. Department. Date of notification. Last attendance. M. H. Boys'(1st standard) September 21st September 17th. A. F. Infants' (Class A) „ 22nd ,, 21st. F. S. Boys' (3rd standard) ... October 6th October 4th. F. S. ,, ,, „ 15th „ 12th. The last two boys lived in neighbouring houses and played together, and there is reason to believe that there had been a mild unrecognised case in the house of the boy first notified. Nine other members of the families of the two boys were subsequently attacked. On October 15th two children were notified who, I was informed, had attended class room "H,'' infants' department, up to October 12th, but I have since ascertained that I was misinformed respecting C. S., and that he attended class "F," and that it was his brother who was in class "H." On October 19th, a boy in Langford-road, not attending any school, was notified as suffering from diphtheria, and on making enquiries I found that his sister had been attending class "H" up till October 16th, and was said to have had, prior to that date, a "cold and slight sore throat"; and on bacteriological examination, the bacillus diptheriæ was isolated from the nasal secretion, so that it would appear that this child was attending class-room "H" while in an infective condition. On October 20th and 22nd, two children were notified who had been attending class "H" up to October 19th, and, at my request, the headmistress of the infants' department furnished me with the names of twelve other children who were said to be absent from that class on account of illness. These I visited, and three of them I found to be suffering from undoubted diphtheria, two of whom had been attending class "H" up to October 19th while the third had been sent home ill from that class on the day I saw her, viz., October 22nd. I also found two other children who then showed no clinical signs of diphtheria, but had a history of some slight throat trouble, and on bacteriological examination, the bacillus diptheriæ was isolated in each case. Therefore, since October 12th, in a class with an average attendance, since the holidays, of 90, and with 110 on the roll, there had ben six cases of diphtheria of a rather severe type, viz.— F. S., last attendance, October 12th. 1. D„ „ „ 19th. L. B., ,, ,, ,, H. N. ,, ,, ,, J. F., „ „ ,, P.F., ,, ,, ,, Of these, 5 had, so far as I could ascertain, no relations with each other except in school, their homes lay in opposite directions, and there had been no other cases in them; in fact up to that time, in three of the roads, no case of diphtheria had been notified of late, so that there was a very strong presumption that at any rate the four who were simultaneously attacked, were infected bysome child attending the class. Moreover, in addition to these, there were the three other children who had been attending that class, who, though showing no clinical signs of diphtheria at the time of my inspection, had suspicious previous histories, and from whom the diphtheria bacillus was subsequently isolated. Hence, having regard to the prevalence of the disease in the district, its special incidence on the children attending this class, and my knowledge that not only had they been exposed to the infection of mild, or perhaps I should say, bacteriological diphtheria, but also to that of acute diphtheria in the person of P. F., who was sent from school so suffering, I had no hesitation in advising the sanitary authority to require the closure of that class-room, and also the exclusion of the children living in the same houses, as otherwise there was, in my opinion, grave danger of a more general outbreak in the school. There was, I considered, no reason for any further steps to be taken at that time, as the rest of the school was not affected. The only other recent case in the remaining classes of the infants' department, with some 600 children on the roll, was one in class "F," and at that time, as I have stated, I was under the impression that this child was attending class " H." In the boys' department, in addition to the two cases in Standard 3 above-mentioned, a boy in Standard I was notified on October 21st, and on enquiry, I ascertained that on October 14th, a boy sitting next to him had vomited when in school, been absent for a few days ill, and had then returned to school; but on examining him in school, I found him suffering from mild diphtheria, and at his home found his sister, who had been attending the infants' school, and had sickened after him, suffering from the disease in a severe form, neither case having been notified. There have been, however, no other primary cases notified in this department up to the present time. In the girls' department there had been no case up to the time of the closure of class "H," but since then four cases have been notified, viz.— October 25th 2nd Standard. 29th 4th November 4th 5th „ „ 14th 2nd „ but one of these was found, after admission to hospital, not to be suffering from diphtheria. After the closure of class "H" on the 26th October, and the exclusion from school of the other children from the same houses, the head-mistress continued to furnish me with the names of those absent on account of alleged illness from other classes. From class "G," which adjoins class "H," there were several absentees, and one of them I found to be suffering from undoubted diphtheria, although not notified, while two others, though showing no clinical signs of diphtheria, had a history of slight sore throat, and on bacteriological examination, the bacillus diphtherias was found. There were, however, no further cases in the infants' department until November 4th, when a child was notified, who had been excluded from school in consequence of her brother being in class "H," and on enquiry, I was informed that he had been somewhat unwell, prior to the closure of the class, and on bacteriological examination, the diphtheria bacillus was isolated, so that, but for the closure of the class-room, this child would have continued attending in apparently an infective condition. Two days after this, a child in the next house, attending school, who had played with these children was notified. Since then, two cases have been notified in classes "B" and "E," infants' department, on November 16th and on November 20th respectively, and one of these was probably infected by a child in an adjacent house, with whom he played, so that although the disease had continued prevalent in the district, there has, since the closing of class "H," been no exceptional incidence upon the children attending the school. With regard to the question raised by the School Board, "that children cannot be legally excluded from obtaining proper educational advantages when not resident in infectious houses," it [5] 30 is of course beyond my province to express any opinion, but I may remind you that the steps taken in this case have been no new departure on the part of the sanitary authority, as it has always been their custom, when ordering the closure of a particular class, to also require the exclusion of the other residents in the homes of the children of the closed class, and the extracts from my annual reports which will be found in the appendix to this report, furnish several instances of this proceeding. I may point out that if the partial closure, hitherto requested by the sanitary authority, cannot be enforced, the alternative will be, in cases similar to these, to close either the entire department or the whole school, with the result that there would be, in either case, an interference with the education of a much larger number of children. In the present case, by the method adopted, there were excluded from school— Infants' Department, including those in class "H" 210 Girls' „ 69 Boys' „ 67 346 while in the whole school there were— Infants' Department 702 Boys' „ 514 Girls' „ 583 1,799 so that interference with education was minimised in a marked degree. The experience I have had of these class outbreaks leads me to believe that they are usually due to the attendance at school of a child or children suffering from unrecognised diphtheria, and the best course, in my opinion, to check any further spread of the disease, is to promptly close the infected class, and as it is always probable that some other members of the class have been already infected, and as the relatives of the unrecognised case or cases have also been exposed to infection, it is certainly necessary, if partial closure is to be effective, to also exclude the children living in the same houses as the children belonging to the infected class. By this immediate action I believe that the risk of the invasion of the whole school is materially lessened, and the subsequent closure of the whole school possibly obviated. In Chelsea, during March, April, and early May, over 60 per cent. of the cases of diphtheria notified in the home district were children attending or living in the' same house with a child attending a Board school in the central part of the parish, "the same school," Dr. Parlies writes, "as that concerned in the propagation of the epidemic in 1896. The majority of these children were in the infants' department, two were in the girls', and one in the boys' department. No cases occurred in connection with the school after the 13th May." Dr. Parkes also states that four cases occurred among children attending a Church school. "In this instance also the iufection appears to have spread from one child to another during school attendance, although an interval of a week elapsed between the sticcessive cases." In Westminster, Christ Church Schools were closed on two occasions at the request of the medical officer of health, once in January for five days, and for a few days, eight weeks later, on account of two cases of diphtheria occurring in the schoolmaster's family residing on the premises. In Stoke Newington one school was temporarily closed "on account of a school outbreak of diphtheria." In Shoreditch, between the 10th October and the 20th December, 18 cases of diphtheria occurred in the neighbourhood of Scrutton-street Board School among children living for the most part in artisans' dwellings. Dr. Bryett writes: "The principal thing in common amongst those attacked was attendance at the infants' department of the Scrutton-street School, for practically the whole of the sufferers were children attending the department or had been brought into contact with children attending the department. Upon the school closing for the Christmas holidays the cases ceased." Dr. Bryett also gives an interesting account of the occurrence of cases of sore throat associated with cases of diphtheria among children attending another school in Shoreditch. The circumstances of this outbreak deserve to be stated in detail and the following is therefore extracted from Dr. Bryett's annual report— Towards the end of November my attention was attracted by the occurrence of several cases o diphtheria in households from which there were children attending the Mintern-street Middle Class School, and upon enquiry I ascertained that there had been, besides the cases certified as diphtheria, several other cases of "sore throat." The cases amongst the school children were practically confined to those attending the infants' department, which numbered at the time of the outbreak 110. The history of the outbreak showed that during the first fortnight of November a case or two of "sore throat" had occurred amongst the members of a family living in a house in Cavendish-street. On or about November 19th a little boy belonging to this family was taken ill with a "sore throat," and was subsequently aertified to be suffering from diphtheria. At the time he was taken ill he was attending the infants' department of the school mentioned. On November 21st or 22nd, one of the teachers in the infants' department was taken ill with a "sore throat." She taught in the school however until mid-day on November 23rd, when she became too ill to continue. This teacher was subsequently certified to be suffering from diphtheria. Then followed a series of 15 cases of throat illness in houses from which children were attending the infants' department of the school. The majority of the cases were certified to be diphtheria. In one instance, in which a bacteriological examination was made, the specific microorganism of diphtheria was present. The cases were distributed as follows—two, one of diphtheria and one of "sore throat," at houses in St. John's-road; one of diphtheria at a house in Mintern-street; two, one of "sore throat" and one of diphtheria, at a house in Buckland-street; six, all of diphtheria, at a house in New North-road; one case of "sore throat" at a house in Balmes-road, Hackney, and three cases of diphtheria at a house in Bevenden-street. Of the six cases at the house in Now North-road, three were of children attending the infants' department, and the other three were adults who were probably infected through contact with the children. Of the three cases in Bevenden-street, two doubtless resulted through infection from a child, a member of the family, who was attending the infants' department, and had been home from school for several days suffering with what was at first regarded as a " sore throat," but which was afterwards found bactcriologically to be diphtheria . . . The indications were that infection from person to person, direct or indirect, was the chief factor in the NOTIFIED CASES. DiagramXV Diphtheria, 1900. 31 dissemination of the disease, and that the infants' department of the school was the principal medium of transferring the infection from family to family, so, acting under my advice, the school authorities closed the infants' department on December 10th, with the result that the cases at once ceased. In Poplar a number of cases of diphtheria occurred in the neighbourhood of the St. John's National School in the Isle of Dogs. "Upon the 12th November," the medical officer of health states, "the number on the roll was 113, and with diphtheria there were 15 scholars absent (13.2 per cent.). In the babies' department, the number on the roll was 73, and with diphtheria there were 6 absent (8.2 per cent.).'' On the 19th November the proportion absent was greater and the whole school was closed. In Plumstead cases of diphtheria occurred among the scholars of Knee-hill Board School, concerning which the medical officer of health, Dr. Davies, reports as follows— On April 4th I reported to the vestry that 10 cases had occurred in connection with Knee-hill School, "that there has only been one case of diphtheria recently in the Erith side of Abbey-wood. The evidence points plainly to the Knee-hill School being the probable source of the prevalent diphtheria at Abbey-wood, I have written to Professor Smith on the subject. I think this is just a case where all the children attending the school should be examined for latent diphtheria. The drains have been tested by the School Board and found satisfactory." Unfortunately, by the School Board's direct prohibition, I am not allowed to examine children in their schools myself. In consequence of a further report, dated 16th May, on the continued prevalence of diphtheria at Abbey-wood, in which I stated that as I could not examine the children and exclude the suspected ones, the only way would be to close the whole school, the vestry directed a letter to be sent to the School Board asking them to allow me to examine the children. The Board did not grant this request, but apparently as a result of it, one of the Board's medical officers came down on the 23rd and 25th May, and examined the children, and certain ones were excluded. After these steps, delayed unfortunately so long, eight cases occurred, but all were secondary cases with one exception, i.e., only one home was invaded which had not been already affected. I learnt afterwards that two of the children excluded were found to have the diphtheria bacillus in their throat. I visited the home of one of these, and warned the mother as to keeping her children away from school, and as to disinfection of the mouth and throat; but the other child had been moved from the locality before I heard of the exclusion. In Clapham parish a few cases occurred among boys attending the Bonneville-road Board School, the circumstances of these cases are interesting because in this case also the course was adopted of medically examining the children attending the school. Dr. Field's report states— "During November, four cases of diphtheria were notified in boys attending the school. On enquiry it was found that there were other cases among scholars in the same room who lived outside Clapham parish, and as to whom I had, of course, had no notification. It also appeared that all the boys had their seats in the same part of the room. Suspecting that there might be a boy in an infectious condition in this part of the schoolroom, I, with the assistant to the medical officer of the School Board, examined the throats of a considerable number of boys. We found two with throats suggestive of diphtheria, and clearly infectious. These boys were sent home, and not allowed to come back to school till certified as free from infection by their doctors. Excepting one further case, that of a boy who was already ill at this time and was notified two days subsequently, there were no more cases reported in connection with this school. These boys looked ill at the time, and would no doubt have been kept at home by parents belonging to a more educated and careful class. This confirms my opinion that much more could be done in preventing the spread of this disease by the examination of children attending elementary schools by a medical man." The need for medical examination of children attending school at times when the school is suspected of causing the spread of diphtheria has long been evident, and the adoption of such a course may be expected to materially reduce the need of school closure, and thus to prevent the interruption to education which school closure involves. For the purpose of ascertaining whether as in previous years there was decrease of diphtheria prevalence among children of school age during the summer holidays, diagram XV. has been prepared. The summer holiday of the schools of the London School Board began on Thursday, the 26th July, i.e., the latter part of the 30th week, and the schools re-opened on Monday, the 27th August, i.e., the beginning of the 35th week. If the number of cases in the four weeks preceding and four weeks subsequent to the weeks most subject to holiday influence be compared, the following results are obtained for the age periods of 0—3, 3—13, and 13 years and upwards. It will be seen that the decrease in the number of cases notified during the period of holiday influence, and the increase in the subsequent period is most marked at the school age. Diphtheria—Notified cases, 1900. 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 (28th to 31st) 127 616 217 — — — Four weeks of holiday influence (32nd to 35th) 134 417 162 +5.5 —32.3 —25.3 Four weeks following weeks of holiday influence (36th to 39th) 151 606 200 +12.7 +45.3 +235 In my last annual report I published a table showing the percentage of total notified cases of diphtheria occurring at ages 3-13 for, the three years 1897-1899 in each of the London sanitary areas. The following table gives similar information for the five years 1896-1900. 32 Diphtheria—Cases occurring at ages 3—13 per cent. of total notified cases. Sanitary district. 1896. 1897. 1898. 1899. 1900. Sanitary district. 1896. 1897. 1898. 1899. 1900. Paddington 54.5 63.8 57.3 63.2 58.8 Whitechapel 57.4 51.8 52.4 50.0 51.7 Kensington 54.6 61.8 54.5 51.6 61.7 St. George-in-theEast 55.4 66.5 51.3 60.6 48.3 Hammersmith 59.4 52.7 61.6 61.9 73.4 Fulham 64.3 64.9 68.7 70.6 69.6 Limehouse 61.3 59.9 67.2 68.9 65.6 Chelsea 61.3 61.5 65.9 60.4 66.7 Mile-end Old-town 63.0 62.5 58.8 63.3 60.1 St. George, Hanoversquare 56.1 63.2 50.5 48.3 56.0 Poplar 58.1 63.0 64.6 57.7 66.5 St. Saviour, Southwark 61.4 55.8 61.7 72.6 57.8 Westminster 54.1 59.5 61.4 54.5 53.8 St. James 45.9 54.0 50.0 64.9 56.4 St. George, Soathwark 64.9 66.3 56.7 68.8 66.1 Marylebone 54.9 50.7 53.6 57.2 64.2 Hampstead 56.1 55.1 52.6 50.0 61.2 Newington 62.2 58.6 65.6 65.5 62.2 Pancras 60.3 58.7 61.0 60.1 63.8 St. Olave 56.8 57.1 68.7 51.6 50.0 Islington 62.4 63.4 60.4 64.8 60.1 Bermondsey 65.0 61.9 68.4 65.6 63.6 Stoke Newington 63.7 59.3 55.6 66.7 67.7 Rotherhithe 54.1 61.6 47.6 68.4 62.8 Hackney 61.3 63.2 66.2 59.7 61.2 Lambeth 63.6 60.2 67.9 67.5 64.4 St. Giles 55.0 61.8 60.0 45.2 50.0 Battersea 57.8 59.1 67.0 68.3 57.8 St. Martin-in-theFields 62.5 35.7 75.0 41.2 21.4 Wandsworth 51.8 62.9 63.4 65.8 65.9 Camberwell 65.3 63.7 61.0 66.3 66.4 Strand 48.6 58.5 55.1 59.5 39.5 Greenwich 65.6 54.6 56.9 59.9 57.5 Holborn 52.8 61.6 55.2 49.2 58.2 Lewisham (excluding Penge) 63.7 57.8 60.5 63.7 67.2 Clerkenwell 57.0 65.9 63.4 64.3 57.5 St. Luke 56.8 60.2 55.7 50.0 53.9 Woolwich 56.9 68.2 70.6 64.6 54.5 London, City of 50.7 55.6 35.6 38.6 43.1 Lee 57.9 56.4 60.5 51.1 69.5 Shoreditch 60.2 56.7 53.3 56.7 63.0 Plumstead 62.0 61.5 61.3 66.5 67.2 Bethnal-green 48.8 52.7 58.8 57.7 60.0 London 60.3 60.5 61.8 62.9 62.6 It will be observed that while there have been considerable fluctuations in the proportion of cases at ages 3—13 in the several districts the proportion has in London up to the year 1889 steadily increased. The proportions obtaining for the whole of London in each of the years 18921900 inclusive were as follows— Tear. Cases at ages 3—13 per cent. of total cases. 1892 50.9 1893 51.0 1894 57.8 1895 57.8 1896 60.3 1897 60.5 1898 61.8 1899 62.9 1900 62.6 Diphtheria—Proportion of cases and deaths in hospitals. Diagram XIII. (page 25), shows the proportion of London cases of diphtheria admitted into the hospitals of the Metropolitan Asylums Board during each of the years 1890-1900 inclusive, and the proportion of deaths from this disease which occurred in these institutions during each of the years 1888-1900. It will be seen that these proportions were greater in 1900 than in any previous year. Return cases. In Paddington the return of a child from hospital after attack with diphtheria was followed at the end of a week by attack of his brothers. The first child suffered from slight discharge from the nose. "Swabs were taken from the nose and throat. In that from the throat a very few bacilli were found which might be B. diphtherice." In Kensington "return" cases occurred in two instances, the interval between the coming back from the hospital of the first case and the attack of the next child being four days, and between the return of the first case and the notification of the second being eleven days. In both instances diphtheria bacilli were discovered in the throat of the child who had returned. In Shoreditch one "return" case was observed. In Battersea the return home of two children who had been removed to hospital on account of attack of scarlet fever was followed in each instance by the attack of another child with diphtheria. Diphtheria—Age and sex distribution. The following table shows the cases, deaths, case-rates, death-rates and fatality of diphtheria at the several ages and for each sex in London during 1900. As in preceding years, the incidence of attack at "all ages" was greater on females than on males, but the death rate and fatality were higher among males than among females. In the age groups adopted for the purposes of this table the greatest incidence of attack was upon males and females of four years of age, and the greatest incidence of death was upon males of one year and females of two years of age. The fatality was greatest among males of one year of age and females under one year of age. Diagram XVI. Whooping Cough. 33 Diphtheria*, 1900. 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. 5,569 784 14.1 262 37 6,416 811 12.6 270 34 0— 150 53 35.3 274 97 100 46 46.0 184 85 1— 408 151 37.0 844 312 330 108 32.7 682 223 2— 547 128 23.4 1,119 262 508 130 25.6 1,043 267 3— 648 130 20.1 1,361 273 663 120 18.1 1,376 249 4— 664 94 14.2 1,425 202 694 120 17.3 1,497 259 5— 1,799 173 9.6 823 79 2,098 236 11.2 950 107 10— 604 33 5.5 293 16 764 29 3.8 363 14 15— 291 11 3.8 140 5 358 8 2.2 155 3 20- 192 5 2.6 89 2 315 2 0.6 122 1 25— 180 1 0.6 49 0 395 4 1.0 91 1 35— 55 3 5.5 20 1 130 1 0.8 42 0 45— 25 1 4.0 13 1 48 3 6.2 22 1 55 and upwards. 6 1 16.7 3 1 13 4 30.8 5 2 Whooping cough. The deaths from whooping cough in the Administrative County of London in 1900 numbered 1,948, compared with 1,728 in 1899. The death-rates from this disease in 1900 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 1894 0.491 1861-70 0.88 1895 0.341 1871-80 0.81 1896 0.65' 1881-90 0.69 1897 0.421 1891 0.681 1898 0.481 1892 0.581 1899 0.38' 1893 0.541 1900 0.431 The death-rate in each year in relation to the mean death-rate of the period 1841-1900 is shown in diagram XVI. The relation of whooping cough mortality to season will be seen on reference to diagram V. (E.), page 15, showing the average weekly number of deaths from this disease in the 60 years 1841-1900. It will be seen from the following table that the London whooping cough death-rate exceeded the death-rates of all the undermentioned towns except Manchester, Liverpool and Salford in the period 1890-9, and in 1900 was lower than that of any except Leeds, Bristol, Nottingham, Bradford and Hull. Whooping cough—Death-rales per 1,000 living. Towns. 1890-9. 1900. Towns. 1890-9. 1900. London 0.532 0.43- Bristol 0.46 0.17 Manchester 0.56 0.68 Nottingham 0.37 0.42 Liverpool 0.59 0.84 Bradford 0.38 0.09 Birmingham 0.51 0.58 Hull 0.38 0.31 Leeds 0.40 0.38 Salford 0.71 0.84 Sheffield 0.0 0.55 West Ham 0.51 0.59 *See footnote (*), page 25. 1 See footnote (1) page 5. 2 See footnote (2), page 5. 34 The following table shows that the London whooping cough death-rate exceeded the death-rates of all the undermentioned foreign towns both in the period 1890-9 and in the year 1900— Whooping-cough—Death rates per 1,000 living. Towns. 1890-9. 1900. Towns. 1890-9. 1900. London 0.531 0.431 St. Petersburg 0.24 0.19 Paris 0.15 0.08 Berlin 0.29 0.32 Brussels 0.17 0.13 Vienna 0.09 0.10 Amsterdam 0.33 0.26 Rome 0.07 0.02 Copenhagen 0.37 0.13 New York 0.21 0.17 Stockholm 0.23 0.15 In the distribution of the disease during the year 1900 the death-rate was highest, in the eastern group of districts (0.58), and lowest in the western group (0.23). Of the several sanitary districts Limehouse had the highest death-rate (0.97) and St. Martin-in-the-Fields the lowest (0.08). During the first quarter of the year the central group of districts had the highest death-rate (0.94) and the western group the lowest (0.19); during the second quarter of the year the eastern group of districts had the highest death-rate (0.79) and the western the lowest (0.25); during the third quarter of the year the southern group of districts had the highest deathrate (0.64) and the western group again the lowest (0.23); during the fourth quarter of the year the death-rate was highest in the northern and southern groups of districts (0.29) and lowest in the central group (0.17). The death-rate in each sanitary district during 1900 and the preceding ten years is shown in the following table— Sanitary district. Deaths in 1900. Death-rate per 1,000 living. Sanitary district. Deaths in 1900. Death-rate per 1,000 living. 1890-9. 1900. 1890-9. 1900. Paddington 35 .39 .28 Shoreditch 48 .81 .41 Kensington 33 .37 .19 Bethnal-green 94 .71 .73 Hammersmith 10 .49 .09 Whitechapel 23 .43 .29 Fulham 54 .58 .41 St. George-in-the-East 27 .61 .55 Chelsea 18 .52 .19 Limehouse 56 .91 .97 St. George, Hanoversquare 11 .27 .14 Mile-end Old-town 58 .64 .52 Poplar 104 .70 .62 Westminster 15 .42 .29 St. Saviour, Southwark 12 .66 .51 St. James 2 .32 .09 St. George, Southwark 43 .79 .71 Marylebone 55 .39 .41 Newington 65 .71 .53 Hampstead 9 .27 .11 St. Olave 8 .61 .75 Pancras 105 .53 .45 Bermondsey 64 .65 .78 Islington 147 .55 .44 Rotherhithe 22 .60 .57 Stoke Newington 11 .49 .32 Lambeth 98 .53 .33 Hackney 112 .51 Battersea 108 .58 .64 St. Giles 14 .41 .40 Wandsworth 44 .43 .19 St. Martin-in-theFields 1 .29 .08 Camberwell 122 .52 .47 Greenwich 111 .54 .61 Strand 5 .39 .24 Lewisham 52 .35 .41 Holbom 11 .65 .37 Woolwich 15 .45 .36 Clerkenwell 52 .68 .81 Lee 9 .32 .20 St. Luke 35 .67 .92 Plumstead 27 .44 .40 London, City of 3 .23 .11 London 1.948 532 .432 Typhus. The deaths from typhus in the Administrative County of London during the year 1900 numbered two. The death-rates from this disease in 1900 and previous periods were as follows— Typhus—death-rates per 1,000 living. Period. Death-rate per 1,000 living. Period. Death-rate per 1,000 living. 1871-80 .055 1895 .0012 1881-90 .008 1896 .0012 1891 .0022 1897 .0002 1892 .0032 1898 .0012 1893 .0012 1899 .0002 1894 .0012 1900 .ooo2 In this table .000 indicates that the deaths were too few to give a rate of .0005. 1 See footnote (2), page 5. 2See footnote (1), page 5. Diagram XVII. Typhus Fever. Diagram XXI Enteric Fever. Diagram XX. Enteric Fever. DiagramXVIII -Enteric Fever.- DiagramXIX - Diarrhœa. - 35 The death-rate in each year since 1868 in relation to the mean death-rate of the period 1869-1900 is shown in diagram XVII. Seven persons were notified as suffering from typhus during 1900. It appears, however, that there were six actual cases of the disease. The first was a child aged nine years, who was admitted into the Eastern Hospital on the 6th February, from a house in Dorset-street, Whitechapel, in which, in November of the previous year, two cases of this disease had occurred. The second case was that of a boiler-maker and stevedore in Poplar, who had been working in Millwall Docks. He was removed to the Eastern Hospital on the 4th May. The source of his infection was not discovered. The third case was a Board School teacher in Islington, and occurred in June; the source of infection was not discovered. The fourth case was a nurse in the Chelsea Infirmary, who was taken ill on the 24th August; the source of her infection was not discovered. The fifth was a gas-fitter's assistant in Hackney, who was taken ill on the 24th August, and was removed to the Eastern Hospital on a certificate that he was suffering from enteric fever. In the hospital his disease was recognised to-be typhus; the source of infection was not discovered. The sixth case was that of a woman living in Peabody-buildings, in Eburystreet, St. George, Hanover-square. Her illness was at first certified to be enteric fever, and she was removed to the Tooting Hospital, when the disease was recognised as typhus. Some two weeks before she was taken ill her husband had died of " capillary bronchitis." A woman also died in August, the cause of death being certified to be typhus. She had lived in Paddington, where she was in service. Much doubt attaches to the nature of her illness. Enteric Fever. The number of cases of enteric fever notified in the Administrative County of London during 1900 (52 weeks) was 4,317, compared with 4,467 in 1899; the number of deaths from this disease belonging to the administrative county was 717 compared with 759 in 1899. The rates per 1,000 living in 1900 and preceding periods were 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 * - 1881-90 019 * - 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 0.131 0.7 17.6 1897 0.131 0.7 18.0 1898 0.121 0.7 18.3 1899 0.171 1.0 17.0 1900 0.161 1.0 16.6 The death-rate in each year since 1868 in relation to the mean death-rate of the period 1869-1900 is shown in diagram XVIII., and the seasonal prevalence of the disease in 1900 and in the period 1890-1900 is shown in diagram XXI., while diagram XX. shows the monthly case-rate and case mortality in each of the years 1891-1900 in relation to the mean of the whole period. The relation of enteric fever mortality to season will also be seen on reference to diagram V. (F.), page 15, showing the average weekly deaths occurring from the disease in the 30 years 1871-1900. In the distribution of enteric fever mortality throughout the year 1900 the northern and eastern groups of districts were above and the western and central groups below the average of London. Of the several districts Bermondsey has the highest death-rate (0.33) and St. Olave, Southwark, the lowest, no deaths, belonging to the latter district, occurring during the year. During the first quarter of the year the eastern group of districts had the highest death-rate and the central group the lowest; during the second quarter the southern group of districts had the highest death-rate and the eastern group the lowest; during the third quarter the eastern group of districts had the highest death-rate and the western group the lowest; during the fourth quarter of the year the northern group of districts had the highest death-rate and the central group the lowest. The case-rates of each sanitary district in 1891-9 and in 1900, and the death-rates in 1900 and the preceding ten years are shown in the following table— * The Infectious Diseases (Notification) Act came into force in 1889. 1 See footnote (1), page 5. 36 Sanitary district. Cases, 1900. Case rate per 1,000 living. Deaths, 1900. Death rate per 1,000 living. 1891-9. 1900. 1890-9. 1900. Paddington 56 .5 .4 8 .11 .06 Kensington 106 .6 .6 17 .11 .10 Hammersmith 103 .6 .9 17 .12 .15 Fulham 92 .5 .7 18 .11 .14 Chelsea 81 .7 .9 19 .13 .20 St. George, Hanover-square 55 .6 .7 11 .12 .14 Westminster 31 .6 .6 9 .11 .17 St. James 12 .7 .6 3 .17 .14 Marylebone 82 .7 .6 12 .14 .09 Hampstead 50 .6 .6 9 .09 .11 Pancras 356 .8 1.5 64 .14 .27 Islington 267 .7 .8 49 .12 .15 Stoke Newington 24 1.0 .7 6 .17 .18 Hackney 228 1.0 43 .20 St. Giles 33 .7 .9 5 .16 .14 St. Martin-in-the-Fields ... 10 .8 .8 3 .11 .25 Strand 10 .6 .5 4 .15 .19 Holborn 24 1.0 .8 4 .18 .13 Clerkenwell 60 .9 .9 6 .17 .09 St. Luke 32 .7 .8 6 .12 .16 London, City of 29 1.0 1.1 2 .20 .07 Shoreditch 126 .9 1.1 14 .15 .12 Bethnal-green 153 1.0 1.2 18 .18 .14 Whitechapel 79 .7 1.0 9 .13 .11 St. George-in-the-East 65 1.0 1.3 10 .15 .21 Limehouse 75 1.1 1.3 7 .17 .12 Mile-end Old-town 119 .9 1.1 22 .17 .20 Poplar 268 1.3 1.6 47 .21 .28 St. Saviour, Southwark 27 .5 1.2 6 .08 .26 St. George, Southwark 179 .6 3.0 12 .12 .20 Newington 101 .7 .8 21 .12 .17 St. Olave 7 .6 .6 - .14 — Bermondsey 120 .7 1.5 27 .13 .33 Rotherhithe 77 1.1 2.0 10 .17 .26 Lambeth 279 .6 .9 53 .11 .18 Battersea 205 .7 1.2 32 .13 .19 Wandsworth 153 .6 .7 27 .10 .12 Camberwell 186 .6 .7 33 .11 .13 Greenwich 177 1.1 1.0 23 .17 .13 Lewisham 70 .5 .6 15 .08 .12 Woolwich 23 .6 .6 3 .14 .07 Lee 18 .7 .4 4 .09 .09 Plumstead 39 .6 9 11 .13 Port of London 30 - - — — — London 4,317 8 10 717 .131 .161 In discussing the causes of enteric fever in London, the reports of several medical officers of health give account of the communication of infection from one person to another. Dr. Reginald Dudfield observed this in four instances; Dr. Parkes shows the extension of the disease in Chelsea from one member of a family to seven others; Dr. Sykes gives account of two households in St. Pancras, in one of which the first case of the disease was followed by six others, and in the second by nine others. Dr. Newman connects directly or indirectly nine cases in Clerkenwell with one or other of three cases occuring among children attending the same Sunday school; Dr. Bryett gives particulars of six series of such cases occurring in Shoreditch; Dr. Kempster attributes a group of cases, occurring in a street in Battersea, to the same cause; and Dr. Bond mentions two nurses who were infected while in attendance upon cases of the disease. Shell-fish is mentioned in several of the reports as a cause of enteric fever. Dr. Sykea refers to an inquiry by him into a localised prevalence of enteric fever in St. Pancras, comprising fifty-seven cases (of which a very few were in Hampstead), and occurring in November in a circle with a radius of three-quarters of a mile. He found that " a large proportion of those falling ill gave a history of eating mussels from the same source." Dr. Newman states that in five cases occurring in Clerkenwell " the only traceable source was the eating of oysters and other shell-fish, procured in each case from a particular stall in a certain street." Dr. Caldwell Smith states that in six cases in Wandsworth "the patients had eaten shellfish within the period of incubation of the disease," and Dr. Millson, referring to special prevalence of enteric fever in Newington from the middle of September to the middle of November, reports that he camel to the conclusion that the disease was due to some article of food, and that shell-fish had been eaten by a large proportion of the persons affected. Dr. Kempster 1 See footnote (1), page 5. 37 states that in a few cases in Battersea patients had consumed shell-fish, but that it could not be proved that this had been the cause of the illness. Of cases occurring in Plumstead, Dr. Davies writes that eleven cases had, within a few weeks of the illness, eaten shell-fish. Some of these were in the habit of frequently partaking of molluscs, while others had taken some just about two or three weeks before illness commenced. Five had taken celery shortly before the illness, one was a greengrocer's boy, and one was a gardener who visited Stratford-market daily. Three of the remaining patients were people of markedly dirty habits. A localised outbreak of enteric fever of some magnitude occurred in St. George-the-Martyr between the 4th and 24th September, upwards of one hundred persons being attacked. This outbreak was investigated by Or. Waldo, the medical officer of health of the district, and inasmuch as it raised question of more than local interest, and as a localised prevalence of the disease appeared simultaneously in Lambeth, while increased prevalence was manifested in Kensal-town, Dr. Hamer was instructed to enquire into the cause of the disease on behalf of the London County Council, see Appendix I. Dr. Hamer's report is appended to this report and it is, therefore, unnecessary here to discuss the subject in any detail, and it will suffice to say that Dr. Hamer came to the conclusion that the outbreak in St. George-the-Martyr was due to the coasumption of fish, in the main, fried fish, from a particular shop in the district. As to the outbreak in Lambeth there was much evidence that a similar cause was operative, but this evidence was perhaps less conclusive than in the case of St. George-the-Martyr, and in Kensal-town the evidence did not justify any other conclusion than that, in the absence of any other explanation of the illness of a number of persons, there was possibility that most of the cases might have arisen from the consumption of fish. The localised outbreak in Lambeth was investigated by Dr. Priestly, the medical officer of health, who presented to his authority a special report on its circumstances. Dr. Priestley associated the occurrence of the cases of enteric fever with the use of particular mangles, the inhabitants of the locality being in the habit of sending their clothes to be mangled. He thus found that linen from three persons attacked in separate houses was sent to one mangle. These three persons were attacked almost simultaneously, and there is no evidence in his report that any person suffering from enteric fever had been resident in the house in which the mangle was situated or that clothes from any previously infected house had been sent there. He describes this mangle, however, as an infected mangle. A second group of six cases occurred in five houses whose occupants sent their linen to another mangle, one of the cases was that of a women who lived in the house in which the mangle was kept; as this case, however, began about the same time as some of the others, the woman could not have acted as the source of their infection. There was, as in the preceding group, no evidence that the mangle had been infected by an antecedent case. In two other groups of cases the circumstances were different, linen from a patient, regarded by Dr. Priestley as the source of infection, and in whose house a second case occurred, had in one instance been sent to be mangled in a house to which the linen from other invaded houses was sent; in the other instance an antecedent case of enteric fever occurred on the premises on which was a mangle to which linen was sent from houses subsequently invaded. It is, of course, matter of common experience that persons engaged in the washing of linen infected by patients suffering from enteric fever frequently contract the disease, but it has not hitherto been suggested that the use of mangles might lead to the conveyance of infection from one person's linen to that of another. Even if the last two groups of cases are accepted, as supporting this hypothesis of the origin of the disease, a considerable balance of cases is left without explanation, and other cause of the prevalence of enteric fever at this time in Lambeth is required to explain the observed phenomena. The circumstances mentioned by Dr. Priestley do not, therefore, appear to me to deprive the Lambeth outbreak of significance in connection with Dr. Hamer's observations. Enteric fever—Age and sex distribution. The following table shows the case-rates, death-rates and fatality of enteric fever during the year 1900. The case rate at "all ages" was greater among males than among females, as were also the death-rate and case mortality. In the age groups adopted for the purposes of this table the greatest incidence of attack was upon both males and females aged 10-15 years. The greatest incidence of death was upon males aged 20-35 and upon females aged 25-35. The fatality was greatest among both males and females aged 55 and upwards. Enteric fever*, 1900. Age-period. Males. Females. Caaes. 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. 2,385 455 19.1 112 21 1,907 313 16.4 80 13 0— 4 1 2 - 51 40 2 1— 8 3 6 - 2— 26 5 13.8 47 7 16 - 3— 31 4 22 1 4— 47 3 53 4, 5— 318 18 5.7 145 8 287 25 8.7 130 11 10— 385 25 6.5 187 12 320 35 10.9 152 17 15— 352 67 19.0 170 32 278 43 15.5 120 19 20— 331 79 23.9 153 37 258 37 14.3 100 14 25— 510 138 27.1 138 37 362 90 24.9 83 21 35— 243 70 28.8 87 25 188 44 23.4 61 14 45— 91 26 28.6 47 13 80 19 23.7 37 9 55 and upwards. 39 16 41.0 20 8 35 15 42.9 14 6 3* See footnote (*), page 25. [6 ] 38 Diarrhœa. The deaths in the Administrative County of London attributed to diarrhoea and dysentery in the year 1900 numbered 3,537, compared with 4,196 in the year 1899. The death rates in 1900 and preceding periods are shown in the following table— Diarrhæa—Death-rates per 1,000 living. Period. Death-rate per 1,000 living. Period. Death-rate per 1,000 living. 1851-60 1.03 1894 0.411 1861-70 1.04 1895 0.821 1871-80 0.95 1896 0711 1881-90 0.75 1897 0921 1891 0.571 1898 0.981 1892 0601 1899 0.93l 1893 0.801 1900 0.78 The diarrhoea death-rate in each year since 1840 in relation to the mean death-rate of the period 1841-1900 is shown in diagram XIX. The mean temperature of the summer quarter of each year in relation to the mean of the period 1841-1900 is also shown. The intimate relation between the temperature of the summer quarter and the prevalence of diarrhoea is most marked. The age distribution of the deaths2 from this disease in the Registration County of London in the year 1900 was as follows— Under 1 year. 1-5. 5-20. 20-40. 40-60. 60-80. 80 and upwards. 2,857 475 6 22 38 128 38 It will thus be seen that over 80 per cent, of the total deaths occurred among children under one year of age and over 93 per cent, among children under five years of age. It will be seen from the following table that the London diarrhoea death rate was lower than that of any of the undermentioned towns except Bristol and Bradford in the year 1900, and in the period 1890-99 was lower than that of any except Bristol— Diarrhæa—Death-rates per 1,000 living. Towns. 1890-99. 1900. Towns. 1890-99. 1900. London 0.742 0 .792 Bristol 0.63 0.53 Manchester 1.29 1.39 Nottingham 1.11 1.08 Liverpool 1.32 1.44 Bradford 0.91 0.29 Birmingham 1.23 1.21 Hull 1.45 1.68 Leeds 1.09 1.05 Salford 1.54 1.41 Sheffield 1.35 1.52 West Ham 0.89 1.30 During the year 1900 the eastern group of districts had the highest death-rate from the disease and the northern the lowest. Of the several sanitary districts the death-rate was highest in St. George, Southwark (1.45) and lowest in the City (015). During the first quarter of the year the western group of districts had the highest death-rate (0.15) and the northern, eastern and southern groups the lowest (0.11); during the second quarter of the year the central group of districts had the highest death-rate (0'19) and the northern group the lowest (0.10); during the third quarter of the year, when the mortality from this disease usually attains its maximum, the' eastern group of districts had the highest death-rate (3.39) and the central group the lowest (2'04); during the fourth quarter of the year the eastern group of districts again had the highest death-rate (0'45) and the northern group the lowest (0.28). The death-rate of each sanitary district in the year 1900 and the preceding ten years 1890-9 will be seen from the following table— 1 See footnote (1), page 5 2 See footnote (2), page 5. 39 Sanitary district. Deaths, 1900. Death-rate per 1,000 living. Sanitary district. Deaths, 1900. Death-rate per 1,000 living. 1890—9. 1900. 1890—9. 1900. Paddington 95 .61 .75 Shoreditch 152 1.17 1.29 Kensington 107 .53 .62 Betlmal-green 105 .89 .81 Hammersmith 95 .86 .86 Whitechapel 49 .68 .62 Fulham 145 1.18 1.09 St. George-in-the- East 50 1.37 1.03 Chelsea 75 .69 .80 Limehouse 65 .95 1.12 St. George, Hanover- Mile-end Old-town 106 .87 .95 square 17 .32 .22 Poplar 217 .90 1.29 Westminster 22 .64 .42 St. Saviour, Southwark 27 .79 1.15 St. James 7 .36 .32 St. George, Southwark 88 1.15 1.45 Marylebone 88 .58 .66 Newington 118 .95 .97 Hampstead 22 .29 .27 St. Olave 3 .86 .28 Pancras 202 .73 .86 Bermondsey 78 .80 .95 Islington 178 .61 .53 Rotherhithe 36 .79 .93 Stoke Newington 14 . 70 .41 Lambeth 176 .73 .59 Hackney 210 .97 Battersea 152 .78 .91 St. Giles 19 .53 .54 Wandsworth 146 .63 .65 St. Martin - in - the - Camberwell 195 .72 .76 Fields 4 .30 .34 Greenwich 147 .78 .80 Strand 8 .54 .39 Lewisham 81 .57 .64 Hol born 24 .74 .80 Woolwich 55 .75 1.33 Clerkenwell 54 .97 .84 Lee 20 .42 .44 St. Luke 46 1.13 1.21 Plumstead 35 .60 .52 London, City of 4 .22 .15 London 3.537 .74l 781 It needs to be stated that the above figures and diagram relate only to deaths which are classified by the Registrar-General under the heading " diarrhoea." There is no question that alteration in nomenclature is largely affecting the number of deaths in London classified under this heading, the increasing use of the terms " enteritis " and " gastro enteritis," as shown by the reports of the Registrar-General, leading to the registration of deaths under these headings which in earlier years would have been classified with " diarrhoea." The number of deaths in London recorded by the Registrar-General under the heading "enteritis" during the ten years 1881-90 did not in any one year exceed 745, and this number was recorded in 1890, while in the decennium 1891-1900 the maximum number recorded in any one year exceeded 3,000, viz., in 1899. The subject was under discussion by the Royal College of Physicians, and the following summary of the minutes of the proceedings of the Royal College of Physicians, London, of 25th January, 1900, is published in the 62nd report of the Registrar-General. The Royal College of Physicians is convinced, after careful enquiry—(a) that various unauthorised and misleading terms, such as "gastroenteritis," " muco-enteritis," "gastric catarrh," &c., are now commonly employed to designate the disease officially known as "epidemic diarrhoea," whereby its specific character is in danger of being ignored, and great confusion ensues ; (6) that the present confusion of terms renders it impossible to determine accurately either the prevalence of the disease in special places and at special times, the extent to which it influences the public health, or the effects produced by sanitary measures; (c) that there is a wide-spread objection, on the part of medical practitioners, to the employment of the term " diarrhoea " in certifying the cause of death, probably because that term is generally held by the public to imply a mild disease, insufficient by itself to cause death. The College, therefore, has sought to discover as an alternative for the authorised term (epidemic diarrhoea) some other name, which, whilst equally accurate, should convey to the public the idea of a more serious affection. But the College regards it as essential that the idea of specificity, intended to be conveyed by the term " epidemic," should be retained. As the result of much deliberation the College has agreed to authorise the use of the term " epidemic enteritis" (or if preferred by the practitioner, " zymotic enteritis") as a synonym for epidemic diarrhoea. The College has further decided to urge upon practitioners the entire disuse, in medical certificates of death, of such terms as " gastro-enteritis," " muco-enteritis," or " gastric catarrh," as synonyms of epidemic diarrhoea. Cholera. During the year 1900 five persons were certified to be suffering from cholera. The cases were thus distributed— Chelsea, 1. Lambeth, 2. Newington, 1. Port of London, 1. Enquiry into each of these cases showed that none of them could be regarded as cases of Asiatic cholera. The number of deaths attributed to cholera and choleraic diarrha was 76, of these deaths 57 occurred among children under one year of age. Erysipelas. The deaths2 attributed to erysipelas in the Registration County of London in 1900 numbered 182; the corrected annual average of the preceding ten years being 246. 1 See footnote (1), page 5. 2 See footnote (1), page 5. 40 The number of cases notified and the number of deaths registered in the Registration County of London since 1890 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 1.31 184 .04 1898 5,169 1.16 165 .04 1899 5,606 1.25 213 .05 1900 4,762 1.06 182 .04 The number of cases notified and the case-rate of the year 1900, together with the mean case-rate of the period 1891-9 for each sanitary district of the Administrative County of London are shown in the following table— Sanitary district. Cases, 1900. Case-rate per 1,000 living. Sanitary district. Cases, 1900. Case-rate per 1,000 living. 1891-99. 1900. 1891-99. 1900. Paddington 123 11 1.0 Whitechapel 128 1.7 1.6 Kensington 160 1.3 0.9 St. George-in-the-East 85 1.6 1.7 Hammersmith 113 1.0 1.0 Limehouse 107 1.7 1.8 Fulham 153 1.1 1.1 Mile-end Old-town 176 1.7 1.6 Chelsea 71 1.4 0.8 Poplar 194 1.9 1.2 St. George, Hanover-sq. 47 0.7 0.6 St. Saviour, Southwark 23 1.4 1.0 Westminster 53 1.1 1.0 St. George, Southwark 75 1.5 1.2 St. James 16 0.9 0.7 Newington 134 1.5 1.1 Marylebone 200 1.7 1.5 St. Olave 9 1.4 0.8 Hampstead 50 0.7 0.6 Bermondsey 60 1.4 0.7 Pancras 234 1.7 1.0 Rotherhithe 71 2.2 1.8 Islington 294 1.2 0.9 Lambeth 238 1.2 0.8 Stoke Newington 30 1.4 0.9 Battersea 164 1.6 1.0 Hackney 230 1.1 Wandsworth. 206 1.4 0.9 St. Giles 51 2.0 1.5 Camberwell 216 1.2 0.8 St. Martin-in-the-Fields 4 0.8 0.3 Greenwich 239 1.5 1.3 Strand 9 0.7 0.4 Lewisham 78 0.9 0.6 Holborn 41 1.9 1.4 Woolwich 39 0.9 0.9 Clerkenwell 75 1.8 1.2 Lee 24 0.9 0.5 St. Luke 58 2.3 1.5 Plumstead 73 11 London, City of 21 1.1 0.8 Port of London 2 — Shoreditch 171 1.8 1.4 London 4,779 1.4 11 Bethnal-green 234 2.4 1.8 Puerperal Fever. The deaths in the Registration County of London in 1900 attributed to puerperal fever numbered 169, the corrected annual average of the preceding ten years being 249. The number of cases notified and the number of deaths registered in the Registration County of London since the year 1890 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 1898 247 184 1899 326 209 1900 237 169 6 See footnote (2) page 5. 41 If these cases and deaths are considered in relation to the total population and total births, the following rates are obtained— Year. Case-rate per 1,000 living. Case-rate per 1,000 births. Death-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 1898 .05 1.86 .04 1.39 1899 .07 2.45 .05 1.57 1900 .05 1.81 .04 1.29 Influenza, Bronchitis and Pneumonia. The deaths attributed to influenza which in 1899 numbered 1,817 rose to 1,950 in 1900, the corrected annual average for the preceding ten years being 1,462. The deaths attributed to bronchitis in 1900 numbered 8,699, being 1,527 below the corrected annual average for the preceding ten years; the deaths from pneumonia, however, were 848 in excess of this average, and numbered 7,189. The deaths from these diseases in the Registration County of London 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 70 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 11,2300 6,164 5,171.9 1893 1,526 556.2 10,413 11,2500 7,198 5,341.6 1894 750 715.5 7,816 11,292.3 5,321 5,632.5 1895 2,156 795.2 10,633 11,1671 5,989 5,755.7 1896 496 1,039.0 7,558 11,385.0 5,537 5,9960 1897 671 1,0690 7,408 10,754.0 5,053 5,9620 1898 1,283 1,1380 7,779 10,4460 5,440 5,9880 1899 1,817 1,2720 9,195 10,2030 6,666 6,069.0 1900 1,950 1,462.0 8,699 10,226.0 7,189 6,3410 The following table is of interest as showing the rapidity with which influenza may increase from small to epidemic proportions, and the fact that the mortality from the disease ha's usually attained its maximum in the late autumn or winter months. Influenza—Deaths1 registered in London in four-weekly periods, 1890-99. Number of weeks. 1890. 1891. 1892. 1893. 1894. 1895. 1896. 1897. 1898. 1899. 1900. Weeks 1—4 303 9 1,308 52 272 59 37 40 244 66 1,016 „ 5-8 167 7 637 96 96 164 58 55 368 259 298 „ 9-12 75 8 119 162 69 1,343 61 94 193 430 130 „ 13—16 39 29 42 180 56 257 50 121 140 302 172 „ 17-20 13 770 33 125 32 106 50 96 61 121 105 „ 21-24 5 1,044 22 72 27 35 33 54 51 82 57 „ 25—28 6 242 15 49 19 28 17 26 25 42 16 „ 29—32 6 51 7 23 17 14 15 18 27 27 12 „ 33—36 3 32 9 23 20 17 10 13 10 11 11 „ 37—40 6 13 6 18 14 15 12 19 17 19 15 „ 41—44 5 15 20 28 29 22 27 29 46 55 17 „ 45—48 13 35 18 152 41 47 56 35 49 61 55 „ 49—52* 6 81 28 546 58 49 56 71 52 342 46 Phthisis. The deaths from phthisis in the Administrative County of London during 1900 (52 weeks) numbered 7,825. 1 See footnote (2), page ">. * The deaths occurring in the 53rd week of the years 1890 and 1896 are excluded from these figures. 42 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 2.861 1894 1.741 1861-70 2.841 1895 1.831 1871-80 2.511 1896 1.731 1881-90 2.091 1897 1.781 1891 2.021 1898 1.791 1892 1.891 1899 l.901 1893 1.911 1900 1.791 The Registrar-General, in the annual summaries relating to London and other large towns, since the year 1893, has distributed the deaths from phthisis, occurring iu 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 death rates (2) in the several groups of districts since 1893 have been as follows— 1894. 1895. 1896. 1897. 1898. 1899. 1900. Central group 2.58 2.65 2.53 2.69 2.66 2.75 2.90 East „ 2.00 2.05 1.89 2.03 2.06 2.19 2.04 South „ 1.54 1.70 1.60 1.62 1.66 1.74 1.63 North ,. 1.60 1.63 1.58 1.55 1.54 1.64 1.61 West „ 1.55 1.55 1.54 1.53 1.52 1.65 1.50 The following table shows the number of deaths and the death rate per 1,000 living in 1900 (52 weeks) in the several sanitary districts of London— Sanitary district. Deaths, 1900. Rate per 1,000 living. Sanitary district. Deaths, 1899. Rate per 1,000 living. Paddington 149 1.18 Bethnal-green 272 2.10 Kensington 204 1.18 Whitechapel 189 2.41 Hammersmith 185 1.67 St. George-in-the-East 128 2.63 Fulham 210 1.58 Limehouse 145 2.50 Chelsea 165 1.76 Mile-end Old-town 193 1.72 St. George, Hanover-sq. 110 1.43 Poplar 305 1.81 Westminster 124 2.38 St. Saviour, Southwark 74 3.15 St. James 35 1.61 St. George, Southwark 221 3.65 Marylebone 278 2.09 Newington 276 2.27 Hampstead 69 0.85 St. Olave 29 2.71 Pancras 472 2.01 Bermondsey 169 2.05 Islington 556 1.66 Rotherhithe 47 1.22 Stoke Newington 37 1.09 Lambeth 521 1.75 Hackney 260 1.19 Battersea 262 1.56 St. Giles 110 3.14 Wandsworth 252 1.12 St. Martin-in-the-Fields 28 2.38 Camberwell 370 1.43 Strand 74 3.58 Greenwich 274 1.50 Holborn 83 2.77 Lewisham 120 0.95 Clerkenwell 169 2.63 Woolwich 106 2.56 St. Luke 128 3.37 Lee 39 0.85 London, City of 67 2.45 Plumstead 96 1.44 Shoreditch 224 1.90 London 7,825 1.732 In the distribution of phthisis mortality throughout the year 1900 the central group of districts had the) highest death-rate (2.90) and the western group the lowest (1.50). Of the several sanitary districts, St. George, Southwark, had the highest death-rate (3'65) and Hampstead and Lee the lowest (0'85). During each of the four quarters of the year the central group of districts had the highest death-rate. The northern group of districts had the lowest death-rate during the fourth quarter of the year and the western group during the first, second and third quarters. The following table shows the number of deaths from phthisis 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 areas in which the deceased had previously resided. (See footnote (1), page 5). 1 See footnote (2), page 5. 2 See footnote (1), page 5. 43 Phthisis (365 days). Sanitary district. 0- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85 & up. ges. Paddington 4 1 1 8 14 25 34 40 16 6 1 _ 150 Kensington 4 3 2 10 13 41 65 41 18 6 3 - 206 Hammersmith 5 2 6 9 17 36 52 34 14 8 2 1 186 Fulham 7 3 5 15 21 48 48 33 22 3 4 - 209 Chelsea 2 — 4 7 11 28 52 43 16 4 - - 167 St. George, Hanover-square 1 — — 3 7 23 34 19 16 2 1 - 106 Westminster 3 — — 1 9 21 44 27 18 4 1 - 128 St. James — — — 1 5 5 14 4 3 1 - - 33 Marylebone 8 1 5 20 21 48 75 57 21 10 4 - 270 Hampstead - 3 1 9 6 10 18 10 7 4 1 - 69 Pancras 10 5 1 22 39 105 119 102 44 17 5 - 469 Islington 12 5 6 30 41 135 130 124 58 14 1 - 556 Stoke Newington - 1 - 1 5 6 8 10 2 2 1 - 36 Hackney 6 2 2 9 27 63 69 46 29 8 2 - 263 St. Giles 6 2 2 1 4 23 26 24 17 6 1 — 112 St. Martin-in-the-Fields - - - - 1 6 10 5 1 3 1 - 27 Strand 1 - — 2 3 19 25 15 3 2 2 - 72 Holborn 5 1 — 2 5 17 30 19 6 - - - 85 Clerkenwell 5 1 3 6 13 35 48 35 18 4 - - 168 St. Luke 3 1 1 3 10 30 46 29 7 2 - - 132 London, City of I _ 1 1 2 18 13 14 7 5 - 1 63 Shoreditch 9 5 3 14 21 53 50 52 17 3 1 - 228 Bethnal-green 7 4 1 14 24 64 68 54 29 13 1 1 280 Whitechapel 2 - 1 4 11 36 61 43 21 6 1 - 186 St. George-in-the-East 2 2 2 1 13 27 39 20 15 5 2 - 128 Limehouse 2 3 1 4 19 27 45 25 13 5 1 - 145 Mile-end Old-town 11 2 6 4 14 47 62 32 16 4 2 - 200 Poplar 2 2 8 16 16 58 87 68 33 18 - - 308 St. Saviour, Southwark 1 1 — 2 2 14 23 16 9 5 1 - 74 St. George, Southwark 6 — 3 10 15 49 64 46 21 7 1 - 222 Newington 7 4 6 8 22 58 70 53 30 17 2 - 277 St. Olave 1 1 — - 4 3 10 4 4 2 - - 29 Bermondsey 5 - 5 8 13 30 46 43 13 3 1 - 167 Rotherhithe - 1 2 3 3 9 17 8 3 1 - - 47 Lambeth 30 2 7 24 39 100 141 97 56 19 2 1 518 Battersea 9 1 11 8 30 48 64 56 19 9 2 - 257 Wandsworth 7 4 2 21 33 43 57 44 31 7 4 - 253 Camberwell 12 6 3 22 25 77 106 63 35 19 1 - 369 Greenwich 3 5 3 19 26 68 69 46 25 8 1 - 273 Lewisham 5 1 4 4 15 27 36 23 10 2 - - 127 Woolwich 1 3 1 2 9 24 29 18 13 1 1 - 102 Lee 1 — - 5 4 11 6 6 2 1 1 - 37 Plumstead 2 1 4 6 14 24 21 9 8 8 . - - 97 London 208 79 113 359 646 1639 2,131 1,557 766 274 55 4 7.831 Cancer. The deaths from cancer in the Registration County of London in 1900 numbered 4,251, the corrected annual average for the preceding ten years being 3,800. 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 areas in which the deceased had previously resided (see footnote (1), page 5). 1 See footnote (1), page 2 See footnote (2), page 5. The death-rates of this disease per 1,000 living in successive periods have been as follows-— Cancer. 1851-60 .42 1894 .79 1861-70 .48 1895 .83 1871-80 .55 1896 .86 1881-90 .68 1897 .88 1891 .78 1898 .92 1892 .75 1899 .95 1893 .80 1900 .952 440 Cancer. Sanitary district. 0- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85 & up. ges. Paddington 1 1 3 11 31 38 31 19 2 137 Kensington - 1 - 1 - 4 19 29 43 39 23 1 160 Hammersmith - 1 — — - 1 10 23 28 21 10 1 95 Fulham - - 1 - - 2 17 28 35 24 7 _ 114 Chelsea - - - — 2 1 13 28 18 22 12 3 99 St. George, Hanover-square - - - - — 2 7 12 21 18 13 1 74 Westminster — - - 1 — - 10 9 10 11 4 - 45 St. James - - - - — — — 8 10 9 1 _ 28 Marylebone 1 - 1 1 1 6 18 27 57 45 12 O O 172 Hampstead - - - - - 1 5 22 25 18 9 - 80 Pancras 3 - - - 1 11 23 41 75 58 27 2 241 Islington 1 - - 2 2 7 31 83 98 65 29 3 321 Stoke Newington - - - - - - 3 8 11 14 1 - 37 Hackney - 1 1 2 3 6 22 40 47 48 16 3 189 St. Giles — - — — - — 6 8 14 12 1 — 41 St. Martin-in-the-Fields - - — — - - 2 2 3 - _ _ 7 Strand 1 - — - - 1 2 7 2 5 3 — 21 Holborn 1 2 6 11 6 2 _ 28 Clerkenwell — — - - _ - 7 14 10 6 3 — 40 St. Luke — 1 - - - 2 3 7 6 12 6 — 37 London, City of — - - — - 5 3 11 3 5 1 28 Shoreditch 1 1 — - 1 1 7 19 19 21 9 1 80 Bethnal-green 1 2 — - - 1 8 22 35 26 13 1 109 Whitechapel 1 - 1 2 1 2 4 15 19 12 4 - 61 St. George in-the-East - - - 1 1 2 9 9 7 1 - 30 Limehouse — - - 1 - - 8 9 14 8 3 — 43 Mile-end Old-town 1 1 — 1 2 2 6 16 29 18 6 - 82 Poplar - 1 1 2 1 4 17 27 45 28 13 1 140 St. Saviour, Southwark — - - - — 2 3 4 8 9 2 — 28 St. George, Southwark — - - - — 1 3 9 13 12 1 1 40 Newington — - - - 1 4 7 31 40 21 12 1 117 St. Olave 1 - _ - — — 1 1 3 3 1 — 10 Bermondsey - - - - - 2 11 26 20 10 1 1 71 Rotherhithe - - — - — 2 2 7 6 2 2 - 21 Lambeth 1 3 1 - 4 15 24 74 81 62 33 — 298 Battersea — — _ 1 - 4 20 17 39 22 9 2 114 Wandsworth 2 3 1 1 3 5 16 34 51 37 18 2 173 Camberwell — 2 — 1 1 6 16 46 80 46 19 4 221 Greenwich 1 1 1 - 1 4 21 33 46 41 14 7 170 Lewisham 1 - 1 - 1 3 11 18 35 29 13 1 113 Woolwich — — - - 1 2 3 3 10 4 4 - 27 Lee — — — — — 3 4 4 8 10 4 2 35 Plumstead - — — 2 - 2 9 1 16 15 3 - 58 London 17 18 9 20 26 114 419 871 1,199 910 388 44 4,035 Plague. During the year 1900 London remained free from plague, although several cases of this disease occurred among the crews of vessels entering the port. The report of Dr. Collingridge, the medical officer of health of the port, gives account of the following cases— On the 22nd April, the s.s. Barbara, of West Hartlepool from Buenos Ayres, arrived at Gravesend. " She had. left Buenos Ayres on the 18th March, calling at Cape Verde on the 7th April and at Madeira on the 14th April. The patient (a foreman cattleman) was taken ill on the 9th April. He was isolated with all his effects, and the vessel thoroughly disinfected before being allowed to pass up the river." No further cases occurred. On the 3rd July the s.s. Rome arrived at Gravesend from Sydney, which she left on the 19th May, calling at Melbourne, Adelaide, Albany, Colombo, Aden, Suez, Port Said, Marseilles, and Plymouth. She arrived in the Royal Albert Lock on the 4th July ; two native firemen were admitted into the branch Seamen's Hospital suffering from dysentery and one native fireman suffered from pleurisy. On the 12th July a deck topaz was admitted to the same hospital with " enteric fever." Dr. Collingridge reports of this man that it was stated that he was first taken ill on the 8th with shivering, followed by sweating, and was feverish up to the time of admission, with slight vomiting and pains in the back and legs. On admission his temperature was 102'4 F., pulse 120, respirations 48, speaks thickly and indistinctly, eyes suffused, staggering gait, tongue thickly coated white, abdomen distended and empty, has taken no food, no appetite, organs apparently normal." He died on the 14th, and the post-mortem examination presented the appearances of enteritis. On the 14th a Goanese iceman from the same ship was admitted into the hospital with a temperature of 105° F., and delirium and enlarged glands in the left inguinal region. Bacteriological examination of material taken from the enlarged gland led on the 27th to the discovery of the plague bacillus, and he was removed to the Port Sanitary 45 Hospital. On the 22nd a native was taken dead from the s.s. Egypt into the hospital. the had no enlarged glands, and was thought at the time to have died from septica?mia. On the 26th another Goanese was removed from the s.s. Egypt to the Port Sanitary Hospital with enlarged glands and fever. On the 29th the plague bacillus was demonstrated in material from the gland. These patients, who had evidently suffered from plague, had formed part of the crew of the s.s. Rome, which had been transferred to the s.s. Egypt. The s.s. Rome had left on the 2Gth for Australia, but no further cases occurred on board that vessel or on board the Egypt. Special precautions were taken to destroy rats on board the Egypt. A suspected case of bubonic plague was sent to the branch hospital from the shore quarters on the 18th August, but bacteriological examination gave negative results. On the 26th October the s.s. Ben Lomond arrived at Gravesend from the Philippines. An engineer was found to be suffering from an enlarged suppurating gland in the groin, and on the 29th Dr. Klein reported that the case was " of the nature of plague." In August, 1900, it was recognised that cases of plague had occurred in the population of Glasgow. Dr. Chalmers, medical officer of health of Glasgow, states in a report on this subject— " When plague was recognised to exist, it had already invaded several parishes, and had been present for at least a fortnight, almost certainly for three weeks. It was suspected to exist on 25th August. On the 27th a man was found who had sickened on the 12th, while his wife was already dead on the 9th, and a grandchild, a baby of two months, living with them, on the 7th of that month." During August and September 35 cases occurred in Glasgow, 15 of which died, another death from the same cause occurring in Govan. Of the 16 deaths, 7 occurred in the houses of the patients, the deaths being attributed at the time to such diseases as acute gastric enteritis, zymotic enteritis, pneumonia and typhus. With trifling exceptions all the persons attacked were found to have been associated with each other, a number of them having been present at " wakes " associated with earlier deaths from the disease; in one case, that of the wife of a man employed in the sanitary department as clothes collector, the husband probably conveyed infection to her. In addition to the usual administrative measures of the removal of the sick to hospital, and the disinfection of their homes and the contents of their homes, persons who had been in contact with the sick were removed to the corporation's reception house. The course adopted with these people was to bathe them, to supply them with clean clothes in substitution for their own, to house and feed them, but not to confine them to the building. During the outbreak a number of persons—70 in all—received injections of from 10 to 20 c.c. of Yersin's serum. Of these, five were "contacts," of whom two subsequently developed the disease in a mild form. Pour other contacts, however, who did not receive injections, also suffered from the disease in a mild form. Of the staff, one person sickened with plague, a ward maid who sickened ten days after receiving injections of 10 c.c. of the serum. The mother of one of the patients also sickened seven days after receiving 10 c.c. of Yersin's serum. Of the patients ten received injections of Yersin's serum and four died, one of these did not come under treatment until the fourth week of the illness. Dr. John Brownlee, whose report is appended to that of Dr. Chalmers, referring to the results of the prophylactic use of Yersin's serum, and to the attack of two persons who had previously received injections, writes— " These two cases prove that a dose of 10 c.c. of Yersin's serum administered subcutaneously does not afford complete protection; yet it is a fair presumption that a certain degree of immunity is afforded, as the symptoms in both cases were of great mildness." Writing of the curative action of Yersin serum, he expresses the opinion that "subcutaneous injection is not of any great curative value," and that " intravenous injection of the serum seems, in most cases, to produce a most marked therapeutic effect, even when given late in the disease." He states, moreover, that " it is probable that the doses given were, in general, too small, and should an opportunity again arise of using this remedy, large initial doses of 60 c.c. and upwards would be given intravenously. Probably it would be advisable, if using the serum subcutaneously at all, to inject it only into the area drained by the lymphatic system which leads directly to the bubo." The occurrence of plague in Glasgow led to consideration of the steps which should be taken in London should the disease appear in the population. On the 19th September the Local Government Board issued an order requiring the immediate notification of all cases of plague to the sanitary authorities and to the Board, and the Chairman of the Public Health Committee sanctioned arrangements being made1 with Mr. James Cantlie, M.B., F.R.C.S., formerly medical officer in one of the plague hospitals in Hong Kong, to prepare an account of the signs and symptoms of plague for issue to medical men practising in London. (See appendix II.) Enquiry had been made in July by the Council's officers in all common lodging-houses and seamen's lodging-houses for cases of illness which might in any way raise question of plague, and this enquiry was repeated in September, and subsequently maintained throughout the year. No such cases were found. On the 20th September the Public Health Committee of the Council met to consider a letter from the Local Government Board referring to the appearance of cases of plague in Glasgow, and to the importance, not only of the early isolation of cases of plague, but to the prompt removal of all persons who have been in contact with the patient to a place of reifuge. Under section 13 of the London County Council (General Powers) Act, 1893, the Local Government Board may assign to the Council any powers and duties under epidemic regulations made in pursuance of the Public Health Act, 1875, which they may deem it desirable should be exercised and performed by the Council. It was not proposed at once to issue such regulations, but the Board desired to know what arrangements the Council could make for the accommodation of 1,000 persons in 200 families. The Public Health Committee expressed the opinion that the Council should undertake this duty, and gave instructions for the necessary arrangements to be made for the various premises in the possession of the Council to be thus utilised. The [7] 46 mittee also authorised a communication being addressed to London medical officers of health, inviting them to give to the county medical officer immediate information of any case or suspected case of plague, and stating that Mr. James Cantlie had been retained to examine and report on any suspected case, and an arrangement had been made with Dr. Klein for the bacteriological examination of material from suspected cases. At a later date questions arose as to the course which should be adopted with respect to persons whose symptoms raised suspicion that they might be suffering from plague. It was thought desirable that such persons should be isolated during the time required to determine, by bacteriological methods or otherwise, whether they were suffering from this disease. After communication with the Local Government Board, it was in the first instance arranged that the London County Council should provide accommodation and nursing for such cases, the Metropolitan Asylums Board providing the ambulances for their removal, and undertaking the washing of all infected articles from the buildings in which they would be housed. Later the Metropolitan Asylums Board expressed their willingness to provide for suspected as well as actual cases, and after conference between members of that Board and the Public Health Committee of the Council, it was agreed that this course should be1 adopted, the Local Government Board approving the arrangement. Only in one instance during the year was any London inhabitant suspected to be suffering from plague. The patient was a carman, resident in Limehouse. He was removed to one of the Council's shelters, and material from his inguinal glands and blood were examined by Dr. Klein bacteriologically. He was not found to be suffering from plague. Notifiable disease in the metropolitan boroughs during the ten years 1891-1900. In my last annual report I published a set of tables showing for each of the notifiable diseases in the nine years 1891-1899, the number of cases notified per 1,000 living in each of the metropolitan boroughs, and I pointed out that these tables furnished useful material for comparing the incidence of notifiable disease on the new areas with that obtaining in previous years before the London Government Act, 1899, came into operation. The following table shows the average annual case-rate per 100,000 living in the ten years, 1891-1900, for each of the notifiable diseases in the several metropolitan boroughs as constituted by the London Government Act of 1899. The mean populations used in the calculation of these rates have been estimated on the assumption that the rate of increase or decrease in the population of each of the metropolitan boroughs during the decennium 1891-1900, as shown by the recent census, has been uniformly maintained— Metropolitan boroughs, 1891-1900—Case-rates per 100,000 living. Metropolitan boroughs. Enumerated population, 1901 (preliminary census)). Smallpox. Scarlet fever. Diphtheria. Typhus. Enteric fever. Other continued fevers.) Cholera. Erysipelas. Puerperal fever. Paddington 143,954 10 389 212 0.4 53 l 0.1 114 6 Kensington 176,623 9 351 173 0.7 59 5 1.0 126 6 Hammersmith 112,245 4 407 217 0.3 72 4 0.4 104 7 Fulham 137,289 8 517 317 0.4 56 2 1.0 110 9 Chelsea 73,856 6 426 288 0.3 71 2 1.0 136 6 Westminster 182,977 13 349 156 0.1 63 3 0.5 84 3 Marylebone 133,329 45 384 176 1.0 73 2 1.0 170 5 Hampstead 81,942 5 373 180 — 62 2 .— 71 6 Pancras 235,284 12 484 225 0.0 89 1 1.0 168 7 Islington 334,928 10 496 233 0.3 76 2 0.3 121 9 Stoke Newington 51,247 6 472 205 — 69 1 — 80 5 Hackney 219,288 8 578 312 0.1 109 3 0.2 142 7 Holborn 59,390 28 437 202 1.0 88 1 1.0 206 4 Fiusbury 101,476 9 531 304 0.4 87 3 0.3 194 4 London, City of 26,897 14 428 178 0.3 97 2 2.0 103 2 Shoreditch 118,705 13 469 265 0.2 91 3 1.0 177 5 Bethnal-green 129,681 24 576 368 0.3 104 2 1.0 238 8 Stepney 298,548 24 560 318 0.4 93 1 0.1 169 6 Poplar 168,838 23 553 389 0.3 133 7 1.0 183 5 Southwark 206,128 13 516 320 0.3 72 1 0.4 146 6 Bermondsey 130,486 19 531 281 1.0 90 1 0.4 164 5 Lambeth 301,873 8 461 251 0.4 66 9 4.0 120 6 Battersea 168,896 11 612 317 0.3 77 3 0.2 158 8 Wandsworth 232,030 3 430 212 0.1 59 3 0.4 130 7 Camberwell 259,258 13 456 331 0.3 62 1 10 118 6 Deptford 110,513 11 613 332 1.0 109 2 01 143 10 Greenwich 95,757 24 493 268 1.0 94 5 -— 141 6 Lewisham 127,460 4 372 256 — 52 0-5 02 89 6 Woolwich 117,165 18 603 218 0.2 69 2 10 93 7 London 4,536,063 14 484 265 0.3 79 3 10 140 6 In this table 0 0 indicates that the deaths were too few to givs a rate of 0 05; where no deaths occurred — is inserted. 47 Meteorology. The tables published iu the annual summary of the Registrar-General, prepared by Mr. J. Glaisher, F.R.S., from observations at Greenwich, show that the mean temperature of the air in 1900 was 50'4° Fahrenheit, or 1.6° above the average of the 129 years 1771-1899. The rainfall during the year amounted to 22.32 inches and was 2.51 inches below the mean of 85 years. The temperature and rainfall in each month of 1900 are shown in the following table— Month. Temperature of the air. Departure from average of 129 years, 1771-1899. 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 53.0 25.9 40.5 + 3.7 22 2.28 February 58.9 18.0 38.2 — 0.6 19 3.58 March 55.3 21.6 38.8 — 2.4 13 0.92 April 76.1 25.7 47.4 + 1.2 11 0.92 May 71.2 34.7 0l.6 — 1.0 9 1.37 June 89.4 45.3 5.5 + 1.1 17 2.82 July 94.0 46.3 66.8 + 5.1 5 1.41 August 82.1 45.9 60.6 — 0.4 12 2.03 September 82.6 40.4 57.9 + 1.3 6 1.14 October 74.2 35.6 51.1 + 1.6 14 1.55 November 62.3 26.8 46.3 + 3.7 19 2.02 December 56.3 30.7 45.5 + 6.4 18 2.28 48 PART II. Dairies, Cowsheds and Milkshops. On the 9th November, 1900, the enforcement of the regulations relating to milkshop premises and the registration of milk vendors was transferred from the County Council to the metropolitan borough councils, and during the year there were 16,620 inspections of milk shop premises. During the year 1900, up to and including the 9th November, the number of applications for registration was 1,386. Of these, 320 applications were for premises not previously entered on the Council's register. In 22 instances legal proceedings were instituted under the Dairies, Cowsheds, and Milkshops' Orders, and penalties amounting to £42 7s. and £16 12s. costs were imposed by the magistrates. In 226 instances cases of infectious disease were reported to have occurred in registered milkshop premises, the number of cases of such disease being 100 of scarlet fever, 77 of diphtheria, 35 of enteric fever, 13 of erysipelas, 1 of smallpox, and 4 of measles. In each of these cases the inspectors visited the premises with a view to ensuring the adoption of measures to prevent contamination of the milk. There were 321 applications for licences for cowsheds, all of which were granted. Nine licences lapsed during the year. During the year Dr. Klein examined for tubercle bacilli 97 samples of milk taken in London, but coming from the country. Seven of these samples were found to contain tubercle bacilli. Of these seven samples, three were derived from milk coming from Essex, one each of the remaining four from Surrey, Sussex, Derbyshire and Wiltshire. The Public Health Committee communicated with the sanitary authorities, and asked if, in accordance with the recommendations of the Eoyal Commission on Tuberculosis, they would supply the Council with full information and veterinary reports regarding the condition of the cows, byres, &c., whence the milk came. Of the seven authorities, two sent reports of their sanitary inspectors, a third offered to obtain a veterinary surgeon's report at the Council's expense, a fourth authority had the cows examined by a veterinary surgeon, who did not find any of them to be suffering from tubercular disease of the udder. This authority asked the Council to repay the veterinary surgeon's fee. A letter was also addressed to 374 sanitary authorities in the home counties, asking them if they would supply full information and veterinary reports when tuberculous milk was found to be supplied to London from cows within their districts. To this inquiry 64 authorities replied in the affirmative without conditions, and 12 agreed to do so if the London County Council would pay for the veterinarv inspection; in four instances the reply was in the negative. On the recommendation of the Public Health Committee the Council resolved to ask the Board of Agriculture to take steps to render the periodical examination of the udders of cows by veterinary surgeons obligatory throughout the country. In February the Council appointed Mr. W. F. Shaw as veterinary inspector to examine cows in London for the purpose of enforcing the Dairies, Cowsheds and Milkshops Order of 1899, prohibiting the sale of milk for human food from cows certified by a veterinary surgeon to be suffering from tuberculous disease of the udder. It was estimated that with the aid of an assistant, who was also appointed, it would be possible to examine all cows in London at intervals of three months. Three inspections were made during the vear 1900 and the earlv part of 1901 of cows in the various London cowsheds. of cows in the various London cowsheds. The following table shows the conditions found in cows there examined— Number of cows examined. Number of cows found free from defects of udder. Clinically affected with tubercular disease of the uddei. Suspected casts of tubercular disease of the udder. Subjects of acute mastitis. Affected with chronic induration of udder. Giving evidence of atrophy of one or more quarters. Injuries, abscesses, simple eruptions, strictures and obliterations of milk ducts. Hypertrophied udders without induration. Giving milk of poor quality (dried-off cows). Recovered or removed from premises. Total number affected with disease or defects of the udder. 1 2 3 4 5 6 7 8 9 10 11 12 4,640 4,253 6 4 41 116 125 30 8 46 11 387 4,510 4,222 8 6 33 28 128 31 7 21 26 288 4,317 3,961 6 10 52 18 137 50 1 35 47 356 In respect of each cow found to be suffering from tubercular disease of the udder the owner was informed that the cow was so suffering. Milk from some of the other cows was examined by Dr. Klein, and one sample was found to contain tubercle bacilli. The Dairies, Cowsheds, and Milkshops Order of 1899 only prohibits the sale of milk from a cow so certified, and leaves the animal in possession of the cowkeeper. The second Royal Commission on Tuberculosis recommended that " when under the certificate of a veterinary surgeon the sale of milk from a given " cow is prohibited, the local authority should slaughter the same, and if, on post-mortem " examination, it appears that the cow was not so affected the local authority should pay com" pensation to the full value of the cow immediately before slaughter." The adoption of this course is evidently necessary for the protection of the consumer. 49 Septic sore throat due to milk. The annual report of Dr. Warry, the medical officer of health of Hackney, contains an interesting account of an outbreak of throat illness which there was good ground for associating with the distribution of a particular milk supply. The cases occurred in the north of the district, and in reply to a circular letter to medical practitioners enquiring as to whether they had met with "cases of sore throat illness accompanied by much enlargement of the glands of the neck and considerable weakness," Dr. Warry was informed of 151 cases of throat illness in 88 households, of which 138 cases occurring in 75 households received their milk from one vendor. Having failed to obtain from the milk vendor information as to the distribution of his milk supply, Dr. Warry selected two areas for house-to-house inquiry, and found that incidence of recent throat illness had been almost entirely on persons receiving the milk under suspicion, and further that "one or two remarkable cases occurred in distant parts of the parish, in households supplied by X., but where his milk was not expected to be supplied." Dr. Warry includes in his report the following account of symptoms of the malady met with in ten cases occurring in the practice of Dr. H. S. Powell, of Upper Clapton, to whom he was indebted for it— (a) In every case there was tonsilitis (not follicular); (6) In two cases there was as well superficial ulceration of the tonsil; (c) In every case there was considerable swelling of the cervical lymphatic glands, more marked on the one side than the other ; in two cases the swelling was very great; (d) In one case the lymphadenitis proceeded to suppuration ; (e) In every case the temperature was raised, in a few cases it was 105 F., and there were rigors. In all the cases the temperature persisted after the tonsilitis had disappeared, lasting in nearly all for at least a fortnight; (f) The temperature assumed the remittent type, and there was in every case profuse sweating at nights; (g) There was great prostration in most cases, and considerable cachexia in all ; (h) In one case acute septicaemia supervened, followed by acute septic pneumonia and death; (i) In two cases in the same family, acute nephritis with hematuria came on about a week after the onset of symptoms ; (J) In one case the child had an attack of purpura hsemorrhagica ; (k) In all cases convalescence was protracted. The symptoms described resemble broadly those met with by Dr. Kenwood in Horusey in 1895, occurring in an outbreak attributed to the distribution of a particular milk supply. They also present resemblance to cases described by Dr. Wheaton in a paper contributed to the Epidemiological Society in 1894, and to cases described by Dr. Reid, medical officer of health of Staffordshire, in a paper contributed to the Society of Medical Officers of Health in 1896. In the two last-mentioned papers the cases were not attributed to milk. Offensive Businesses. The administration of the by-laws regulating offensive businessee was on the 9th November transferred to the metropolitan borough councils. During the year the inspectors of the Council made 4,470 inspections of such premises; proceedings were instituted in five instances in respect of which fines amounting to £12 5s., with £8 11s. costs, were imposed by the magistrates. The number of applications for renewal of licences to slaughterhouses was 405, of which 393 were granted. The number of applications for renewal of licences to knackers' yards was five, all of which were granted. The number of applications for licences to slaughterhouses during the ten years ending 1900 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 1898 442 429 1899 419 411 1900 405 393 Complaints to the London County Council. In 1900 the Council received 837 complaints concerning insanitary conditions in connection with which 1,226 inspections were made by the Council's inspectors. Where complaint had not previously been made to the sanitary authority, the complainant was advised to adopt this course. In other cases the sanitary authority was coumunicated with. In all cases the matter was kept under observation until the conditions complained of were remedied. Nuisances. Smoke Nuisances. Reference is made to the action taken by the several sanitary authorities in respect of smoke nuisances in the majority of the annual reports of medical officers of health. Proceedings were instituted against electric light companies in Westminster and Lambeth. At the instance of the Westminster Yestry the Westminster Electric Light Company, Millbank-street, was fined £40 and costs on four summonses, and, as the result of proceedings by the Lambeth Vestry, the South London Electricity Supply Corporation was fined £150 and costs on 16 summonses. 50 Dr. Priestley states that complaints were received as to effluvium nuisauce as well as smoke from the destructor chimney in Bengeworth-road, Loughborough-junction. In this destructor, the heat from which is used for the production of electricity, house refuse is burnt as in Shoreditch, and the plant is constructed for this purpose, and is entirely new. " The magistrate decided, however, that the burning of house refuse was not necessary for the production of electricity, but that proper fuel (e.g., Welsh coal) was to be used; and no refuse has been burnt in the destructor since." In Hammersmith proceedings were successfully instituted against the Electric Traction Company. Railway companies were proceeded against in Hammersmith, Shoreditch, Whitechapel, and Wandsworth district (Streatham parish). In other districts nuisances from various premises were dealt with ; thus proceedings before the magistrate were instituted in Fulham in 3 cases, in Westminster in 3, in the City in 2, in Islington 3, in Shoreditch in 5, in Whitechapel in 2, Limehouse in 7, Rotherhithe in 1, Lambeth in 2, Wandsworth (Streatham) 1, (Wandsworth) 3. The medical officers of health of Shoreditch and Clerkenwell say that there has been appreciable improvement in the condition of these districts in respect of smoke nuisance as the result of the action that has been taken in recent years, and the medical officer of health of Hackney reports that " the general result of the service of the notices has been to cause a more general use of anthracite coal in the furnaces of factories, and the adoption of proper smoke-consuming apparatus." The chief officer of the Public Control Department of the Council has reported that, during the twelve months ended 31st March, 1901, 1,018 cases of smoke nuisance were reported by the Council's inspectors of explosives and coal officers. Removal of offensive matter and stable manure. In my last report I stated that the Public Health Committee had had under consideration the need for amendment of the by-law relating to the removal of offensive matter. Under the existing by-law the carriage of horse dung manure is exempted from the requirements of the by-law, and the increasing use of peat moss litter made it necessary to require that offensive manure should be dealt with as other offensive matter. A by-law was therefore drafted and forwarded to the several sanitary authorities. This by-law limited the exemption of horse dung manure from the requirements of the by-law to " manure consisting only of horse dung with a suitable proportion of straw." It was further proposed to extend the hours during which offensive matter might be removed. The by-law at present in force is as follows— Every person who shall remove or carry by road or water in or through London any fæcal or offensive or noxious matter or liquid, whether such matter or liquid shall be in course of removal or carriage from within or without or through London, shall not remove or carry such matter or liquid in or through London except between the hours of 4 o'clock and 10 o'clock in the forenoon during the months of March, April, May, June, July, August, September, and October, and except between the hours of 6 o'clock in the forenoon and 12 o'clock at noon during the months of November, December, January, and February. Such person shall use a suitable covering so as to prevent the escape of any such matter or liquid therefrom, and so prevent any nuisance arising therefrom. Provided that this by-law shall not apply to the carriage of horse dung manure. The by-law as proposed was as follows— 1. Every person who shall remove or carry, or cause to be removed or carried, by road or water in or through London any fæcal or offensive or noxious matter or liquid, whether such matter or liquid shall be in course of removal or carriage from within or without or through London, shall use or cause to be used therefor a suitable carriage or vessel, properly constructed and furnished with a sufficient covering so as to prevent the escape of any matter or liquid therefrom, and so as to prevent any nuisance arising therefrom. Such person shall not remove or carry, or cause to be removed or carried, such matter or liquid by road in or through London, except during the following periods, viz.— Between 5 o'clock a.m. and 10 o'clock a.m., or during the period commencing two hours before sunset and ending one hour after sunset, in any day during the months of March, April, May, June, July, August, September, and October. Between 6 o'clock a.m. and 11 o'clock a.m., or during the period commencing two hours before sunset and ending one hour after sunset, in any day during the months of November, December, January, and February. This by-law shall not apply to any person removing or carrying manure consisting only of horse dung with a sufficient proportion of straw to render it inoffensive, and shall not apply to any person removing or carrying in a suitable carriage or vessel, as aforesaid, manure consisting of horse dung and litter other than straw. This by-law was made by the Council on the 24th July, 1900. Application was made to the Local Government Board for confirmation of the by-law, but in the meantime the Board had received a letter from a firm acting on behalf of soap makers, tallow melters, and bone boilers in London objecting to the proposed by-law. The Local Government Board invited the observations of the Council on this letter. The Public Health Committee subsequently received a deputation from the firms referred to These firms desired that the by-law should be amended so as to exempt from its requirements the systematic clearing of and the collection of fat and bones from butchers' shops and shops of marine, store dealers, and they objected to the curtailing of the winter morning hours of collection. They stated, moreover, that the proposed additional three hours, viz., two hours before and one hour after sunset, was of no practical value to them. The Council subsequently, on the recommendation of the Public Health Committee, proposed to adhere to the hours in the existing by-law, and to amend the by-law so as to bring within its provisions offensive manure. This proposal is now before the borough councils. The need of an organised system for the removal by the sanitary authorities of offensive trade refuse has been from time to time under consideration. Such system is established in Woolwich, and in 1898 the Poplar District Board instituted an inquiry as to whether fishmongers, 51 butchers, and others would be prepared to pay the expenses involved in the provision of properlyclosed, air-tight receptacles and their daily removal by the board. Removal by the sanitary authority and the supply of clean receptacles in exchange for those which are removed is obviously the course which would best ensure the systematic removel of such matter without causing nuisance. The subject was discussed at a conference of sanitary authorities held at the County Hall in 1900, and the following resolution was passed— " That in the opinion of the conference the sanitary authority should be empowered to employ a sufficient number of scavengers, or contract with any scavengers, whether a company or individuals, for collecting and removing trade refuse of an offensive or noxious nature from any premises within their district at a charge to be fixed by the local authority; or, in the event of dispute, by a police magistrate." In a number of instances sanitary authorities instituted proceedings before a magistrate for neglect to remove manure. Thus in St. Marylebone such proceedings were taken on two occasions, in Fulham on fourteen occasions, in Shoreditch on one, in Westminster one, and in Wandsworth (Clapham) on one occasion. In the case in Shoreditch the London General Omnibus Company had been advised to provide suitable vans which could be loaded direct from the stables, and which, when full, could be removed without disturbing their contents. Dr. Bryett reports that " as a result of the magistrate's order for the abatement of the nuisance the steps suggested have been taken, and no further complaints have been received." In connection with the difficulties of securing the removal of stable manure, Mr. Wynter Blyth, writing of St. Marylebone, says—" The borough, owing to the extension of the suburban districts, is continually being, as it were, removed farther and farther from the country districts where the manure is required. The railway rates for such an article as stable manure are prohibitive, and at certain seasons it is only possible to get manure removed by paying a relatively high price. It may, however, be stated generally that the manure was better and more regularly removed than in any previous year." Dr. Newman, referring to Clerkenwell, writes—" There can be no doubt that owners of manure have increasing difficulties, especially in the harvest time, in complying with sanitary requirements. Considering the very serious nuisances created in the hot summer months by collections of manure there certainly should be no relaxation of effort to secure regular and prompt removal." The increasing difficulty in securing the removal of manure, and especially to the owner of small quantities indicates the desirability of the work being undertaken by the sanitarv authorities, who must for this purpose have larger powers given to them than they now possess. At the present time they can only undertake the business of collecting manure when the owners of the manure are in agreement with them or when a particular collection is in such condition that the sanitary inspector is of opinion that it ought to be removed. At the conference of sanitary authorities, held during 1900 in the County Hall, already referred to, the conference had before it a suggestion by the Public Health Committee of the Council that a change in the law should be effected by which the local authorities might be empowered to collect manure from all stables in their districts, and might make some charge on the tenants of the stables. The conference adopted the following resolution—" That in the opinion of the conference the sanitary authority should be empowered to employ, if they think fit, a sufficient number of scavengers or contract with any scavengers, whether a company or individuals, for collecting and removing the manure and other refuse matter from any stables and warehouses within their district at a charge to be fixed by the local authority; or, in the event of dispute, by a police magistrate." Removal of house refuse. In previous reports I have given account of the steps taken in London consequent upon the County Council having made a by-law in 1893 requiring the removal of house refuse from all premises not less frequently than once in each week. During 1900 no further inquiries were made by the Council's Public Health Department as to the extent to which the removal of house refuse throughout London was carried out in the manner required by the by-law. The annual reports of medical officers of health, however, show that in a number of districts satisfactory results were being obtained. The reports in which the subject is discussed are the following— Fulham.—" The weekly service of house refuse has been fairly regular, but some better system of dealing with the arrears consequent upon public holidays should be devised, the complaints respecting the delay in removal being always numerous after these." Paddington.—" The house refuse of the parish is removed once a week." Kensington.—" A call is made at every house once a week, and further improvement is scarcely possible until the objectionable practice of refuse-harbourage shall have given place to the more rational system of daily collection from moveable receptacles." Islington.—" The number of applications for the collection of house refuse has fallen from 10,138 in 1891 to 234 in 1900, consequent upon the establishment of a system of calling at each house." Hackney.—In this district the number of applications has fallen from 893 in 1894 to 205 in 1900. Clerkenwell.—"The dust bins or dust boxes throughout the district have been emptied weekly, and in courts or sets of buildings common to many families, bi-weekly." City.—" The skip system for house refuse removal, which commenced in 1892, has been extended as circumstances demanded, and much benefit has accrued to the persons for whose relief the method was adopted." St. Olave.—" This important service continues to be carried out regularly and efficiently, 52 as for the sixth year in succession not a single complaint of neglect or inattention has been received." Woolwich.—" The pail system continues to work 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." Since the Council's bye-law was made in 1893, prescribing the kind of dust receptacle to be provided when dust receptacles were newly provided, moveable receptacles have largely replaced the old fixed receptacles. There is, however, uo power to require the abolition of old fixed dustbins when new moveable receptacles are provided, and the Council has not been able to do more than make a bye-law prohibiting the use of the old receptacles under these circumstances. The time has come when the question should be considered whether this power should not be obtained, and further, whether the remaining fixed receptacles should not be abolished throughout London, and moveable receptacles substituted for them. Such change would give increased facilities to the scavenger in removing the refuse, and would, moreover, abolish a source of nuisance. At the conference of sanitary authorities at the County Hall a resolution was adopted " That in the opinion of the conference it is desirable that fixed ash-pits should be abolished and moveable receptacles provided in their place." The difficulty which is experienced in storing house refuse in flats emphasises the need for more frequent collection than once in each week. The medical officer of health of Paddington writes : " The use of gas stoves in flats adds very materially to the difficulty in dealing with household refuse. In a well-ordered household, using coal ranges, all green and other wet refuse is burned in the fire and not put into the dustbin. This cannot be done if all cooking is by gas. In many of the blocks of flats the buildings are so arranged that no proper accommodation is provided for the dustbin, while the accommodation provided is often too close to the windows of the lower fats. Given these two sets of circumstances, the only remedy which will prove effective is a more frequent removal of dust." The medical officer of health of Fulham also writes : " It is also to be regretted that the local authority had not provided for more frequent removal of the refuse from flats, the necessity for which I have frequently pressed upon them, as owing to the limited open space in connection with these buildings an accumulation of over three or four days' refuse gives rise to a serious nuisance." The subject of a more frequent removal of dust than now exists was discussed at the conference of sanitary authorities already referred to, and a resolution was adopted " That in the opinion of the conference house refuse should be removed daily where practicable." The need for the employment of a more suitable cart for the removal of refuse is referred to in the report of the medical officer of health of Plumstead. He states that the carts have been better covered than formerly, " but nuisances continue to occur of overloaded carts dropping refuse behind them, of refuse falling in the road in the process of loading, and offensive dust being blown about at the same time. The collection cannot be satisfactory until it is made with suitably-constructed carts." In 1898 the London County Council offered a prize for the best designed dust cart, and Mr. Henry Law, chairman of the Sanitary Institute, adjudicated on 'behalf of the Council upon designs represented in models and drawings which were submitted. The conference of sanitary authorities adopted the following resolutions—" (1) That, in the opinion of the conference, carts and waggons for the removal of dust, &c., should be so constructed as to prevent, while loading and removing, the escape of their contents, and also, as far as possible, bad smells; and that the open carts of the fashion at present in use should be fitted with a tarpaulin cover supported by a horizontal bar; (2) that, as an alternative system to an improved scavenger's cart, the best system of removing dust, &c., would be by using duplicate bins, one containing the refuse being removed from the house and placed on a trolly and an empty one left in its place at the house." In other districts the refuse is removed by rail or by barges. Referring to the wharves on the canal basin in Paddington, Dr. Reginald Dudfield states the requirement of the County Council's by-law that refuse may not be deposited in the course of removal for more than twenty-four hours, and that of the Paddington Act, 1826, which limits the time to twelve hours, cannot be fully complied with. He says—" The exact fulfilment of these conditions is practically impossible, and legal proceedings are, in consequence, not instituted except in extreme cases." Of the various refuse and manure depots in Lambeth, the medical officer of health of that district writes that their condition has been more satisfactory during the year. His report contains the following paragraph— " No single complaint has been received in connection with the Herne-hill Siding Manure Depot during 1900 ; and in the case of the Nine-elms siding the manure traffic was carefully supervised, with the result that at no time was there a nuisance with which the late vestry could have dealt, at least with any prospect of success, remembering the provisoes mentioned in the Public Health Act and the London County Council's By-laws. Commercial-road (at the north of the parish) contains three dust depots belonging to neighbouring sanitary authorities, viz., Lett's-wharf (City of London), Shot-tower-wharf (Strand District Board), and Phoenix-wharf (Clerkenwell Vestry), and these have been kept under special observation so as to prevent, or at least minimise as far as possible, any nuisance connected therewith. Such dust yards, unless carefully attended to from day to day, become sooner or later a nuisance. In connection with Lett's and Phoenix wharves, the house refuse is hand-sorted by men and boys, women and girls, and a more disgusting occupation it would be difficult to find, the workpeople at times standing waist deep in offensive matters of all sorts. At Lett's-wharf the City of London Corporation employ 60 women (and girls) and 40 men (and boys), the wages of the former being 12s. to 14s. per week, and the latter 12s. to 26s. per week, with sick pay in addition. At Phoenix-wharf the Clerkenwell Vestry employs 12 women (and girls) and 9 men (and boys), the wages of the former being 3d. per hour (making an average of 2s. per day), and of the latter from 13s. to 26s. per week, with sick pay in additio Hand-sorting of house refuse is also carried on in other parts of the parish, viz., Cookson's and Clarkson's yards, Tinworth-street. At the former yard 15 women and 9 men are employed at average 53 wages of 14s. and 24s. per week respectively, without sick pay ; whilst at the latter 10 women (and girls) and 6 men (and a boy) at average respective wages of 14s. and 24s. per week, without sick pay. At these two yards in Tinworth-street the refuse sorting is under a sub-contract. The Strand Board of Works has recently erected a Horsfall destructor on their wharf (Shot-tower) for the destruction (by burning) of refuse. It remains to be seen if any nuisance arises in connection with the working of such a destructor. By degrees the system of disposing of refuse by burning it in a destructor is being adopted in London, and the following sanitary authorities have now provided themselves with destructors, in which the whole or a part of the house refuse produced in their districts is destroyed—Fulham, Hampstead, St. Pancras, St. Luke, the City, Shoreditch, WEtechapel, Poplar, Battersea, and Woolwich. The Strand authority also has a destructor in Lambeth, which is on probation; the Lewisham authority has for some time burnt refuse in a destructor which is now not in use; the Clerkenwell authority has a two-cell furnace in which certain parts of the refuse are burnt; the Hackney authority has a destructor in process of construction, the heat from which will be used in connection with the provision of electric light. Nuisance from sewers. But few references to nuisance from sewer ventilators are made in the annual reports of medical officers of health. In Kensington, the medical officer writes—" Complaints were received from different parts of the borough of stinks which were usually traced to the presence of untrapped street gullies or sewer ventilators in the roadway. The offending apertures were in connection with sewers under the jurisdiction of the County Council and the borough council alike. The worst spot, perhaps, was that in Warwick-road, where there is a large circular ventilator to the Counter's-creek sewer, near to the entrance to the Earl's-court Exhibition, which has proved the subject of many complaints at different periods of the year, even when the exhibition has not been open. This subject has been referred to in several previous reports, but no effectual remedy of general application has been found for the nuisance." In my last report I stated the steps taken by the Council in connection with the flooding of houses from sewers. The only references to this subject in the annual reports of medical officers of health are made in the reports relating to Fulham and Kensington. In Fulham the flooding of the basements in the neighbourhood of Field-road, owing to the inadequacy of the County Council's main sewer, was again brought under the notice of the Council. In Kensington past occurrences of flooding of basements in numerous houses and the inefficiency of the Counter screek sewer are mentioned. Nuisance from the Regent's-canal. A serious nuisance emanating from the Regent's canal was experienced at the end of July in St. Pancras. Following heavy rain occurring during the hot weather of July, and after the disturbance of the water from the fall of a building consequent upon a fire, a strong and most offensive odour was produced, the smell, resembling that of sulphuretted hydrogen, extending to a considerable distance. Complaints were received by the Council, and inquiry into the occurrence was made by Dr. Young on behalf of the Council, and on receipt of his report the Public Health Committee reported to the Council as follows— On July 29th, 30th and 31st complaints were made to the Council by residents in the neighbourhood of Regent's-park as to serious nuisance arising from Regent's-canal, the water in which was stated to be in a very foul condition. Inspection of the canal by Dr. Young was made on July 31st, and it was found that the complaints were well founded, the water in the canal above Chalk Farm-road, in Regent's-park, and in the Collateral Cut leading to Cumberland basin being inky black in colour and very offensive. Bubbles of gas were being copiously emitted from the water, and dead fish were floating on the surface. Samples of the water were taken. A communication was made on August 1st to the Regent's Canal and Dock Company as to the serious nuisance which existed, and a copy was at the same time sent to the Vestry of St. Pancras. The secretary of the canal company replied on August 2nd that, as soon as the company became aware of the nuisance steps were taken " to change the water as quickly as possible by allowing it to flow down into the lower levels of the canal," and that at the time of writing "295 locks, equal to 15,930,000 gallons of water," had been let down. The reply also contained the following statement—" The company use their best endeavours to keep the water in a proper sanitary condition, and I am glad to say that usually they are successful in so doing, but unfortunately for them a fire occurred at the London and North Western Railway Company's goods depot during the night of Wednesday, July 25th, 1900, and a quantity of liquid and material was allowed to get from the premises into the adjacent dock of the railway company, and so pass into the canal. The effect of this had been to decompose the canal water, causing it to smell very badly and to assume a dark colour." The Vestry of St. Pancras replied on August 3rd, stating that on 31st July, " intimation notices were issued and served on the Regent's Canal and Dock Company as well as the London and North Western Railway Company, requiring the abatement of the nuisance arising from the present condition of the Regent's-canal, and that in consequence of non-compliance therewith statutory notices were issued and served upon the 2nd instant on the companies referred to, and a report has been made to the effect that the canal company is taking measures for dealing with the matter." It was added in this letter that "in all probability the present condition of the canal is due to the recent fire at the goods depot of the London and North Western Railway Company, Chalk-farm," and that steps were being taken to dam off from the canal a dock belonging to the railway company . In the meantime inspection was made daily of the canal, and the conditions found by one of the Council's inspectors were as follows— On August 1st—In Cumberland-basin at the end of the Collateral Cut, which is a dead end off the main waterway of the canal, the water was very black and foul-smelling. In that portion of the canal along Albert-road as far as St. Mark's Church, where the Collateral Cut commences, the water had regained its normal condition, while from St. Mark's Church downwards to High-street, Camden-town, the water was very foul and offensive. On August 2nd—The water at "Camden" locks and in the part of the canal below was veryfoul. The pollution had reached as far down as New North-road-bridge, Islington, and at the lower opening of the tunnel through which the canal passes, a large number of dead fish were seen floating on the surface. [8] 54 On August 3rd—The water at "Camden" locks was almost in its ordinary condition. In Cumberland-basin it was still foul, as also in the dock at the London and North Western Railway Company's goods depot, which is situated just above the locks. The conditions found to exist on these days confirmed the statement of the company that they had taken steps to pass water from the upper to the lower reaches of the canal, with a view to removing the foul water down the canal and into the river. The fact that Cumberland-basin is a dead end off the main waterway accounts for the water remaining in a foul condition at a time when that in the canal had regained its usual appearance, and the company found it necessary on August 4th to deal with the conditions here by adding lime to the water. The dock of the London and North Western Railway Company to which reference is made is also off the main waterway, which it joins by a narrow entrance. The dock is in the goods depot of the railway company, situated alongside the canal immediately above the highest lock (via Hampstead-road lock) on Regent's-canal. and previously to July 25th, the dock was immediately underneath a part of a large storage shed in the depot. On the evening of the 25th a fire occurred on these premises, with the result that a great part of the shed together with its contents fell into the dock. The water here remained in a foul condition for some time, and steps had to be taken to disconnect the dock from the canal. So far as the Council has information, the water after August 3rd remained in its ordinary condition and further complaints were not received, but inspection was made frequently for some time after this date both by the Council and the local sanitary authority. Samples of water were also taken for analysis on three occasions, namely, on July 31st, August 13th, and August 24th. In his reports to us the chemist states as follows— As regards samples taken on July 31st— " Neither sample had any distinct acid or alkaline re-action. " The samples were offensive both in appearance and odour, and I am of opinion, both from the analytical figures and the results of the microscopical examination, that the source of contamination is principally of an animal and vegetable nature, most probably sewage. The condition of the water and consequent low aeration would, I think, easily account for the large numbers of dead fish floating on the surface. There is no evidence in either sample of contamination with chemicals." As regards samples taken on August 13th— " I have to report to the Committee the result of the analysis of four samples of water collected on the 13th instant, two being taken from the Regent's-canal, one from the Collateral Cut, and one from Cumberland-basin. " The details of the results obtained are set out in the table attached, from which it will be seen that the oxidisable organic matters present in the samples are less than one-third of the quantity present in the samples reported to the Committee on the 7th instant. The water collected on the 13th instant is altogether of a different character to the samples collected on July 31st. The ratio of carbon to nitrogen in the total organic elements clearly indicates that the organic matter present in the water is largely of vegetable origin." As regards samples taken on August 24th— " I have to report for the information of the Committee the results of the examination of further samples of water collected from the Regent's-canal on the 24th instant. " The results obtained on analysis are set out in the appended table from which it will be seen that the samples are similar in character to those collected on the 13th instant. The oxygen absorbed by the oxidisable matters in No. 1 sample is almost the same in quantity as that absorbed by the sample collected at this point previously. In the other three samples there is but a slight increase in the quantity of oxidisable matters. " The ratio of carbon to nitrogen in the total organic elements show that the organic matter is principally of vegetable origin." There is no doubt that the water of the canal in the neighbourhood from which complaints were made was in a state which gave rise to serious nuisance, and it was felt to be a matter of importance to ascertain whether this depended upon some condition or conditions present in the canal which became apparent owing to the heat which prevailed at the time, or whether it arose owing to some accidental occurrence such as a fire on the banks of the canal causing pollution in some way, as was suggested as a possible explanation in the letters from the Vestry of St. Pancras and from the canal company. Inquiry was therefore specially made with a view to arriving at some conclusion. The evidence which has been obtained does not point definitely to any one condition as being the sole cause of the nuisance. The noteworthy points are these— (1.) The canal was stated to be unusually offensive. A man engaged at the cab-rank near the "York and Albany" p.h., and who has been on the rank for a long period, stated that, though he had before noticed smell from the canal, he had never at any time experienced it in a condition at all approaching that at the date of complaint. Its condition was therefor® altogether exceptional. (2.) The complaints, including those to the Council and those to the local authorities, came from residents in the Regent's-park portion of St. Pancras and from the eastern part of Marylebone. Nuisance does not appear to have occurred at the portion of the canal where the stone-yard of the Vestry of Marylebone is situated, i.e., at the western part of the district; and there were no complaints in Paddington, Chelsea, Kensington or Hammersmith, i.e., higher up the canal. (3.) Apart from a complaint to Marylebone Vestry on July 18th, no further complaints were received by the local authorities till after the 26th ; thus the first complaint to the St. Pancras Vestry was dated July 28th, and to the St. Marylebone Vestry, July 29th. Many complaints were then received. Inquiry of residents in Albert-road shows that the nuisance was first noticed on the 26th and 27th. (4.) The appearance of the water when seen by Dr. Young on the 31st, above the highest lock, viz., Hampstead-road lock, was quite unusual. It was inky black, but clear, as if suspended matter had been precipitated. Bubbles of gas were discharging freely from the surface. Dead fish were floating on the water. These appearances are not those usually found where ordinary domestic sewage passes into a waterway ; they tend rather to raise suspicion of some chemical impurity either with or without sewage. The air was permeated with sulphuretted hydrogen. y (5.) There is no evidence which points to the foul water having come down the canal but rather that the condition causing nuisance arose locally and spread up the canal reach which is locked at Hampstead-road. It was stated that the foul water and dead fish did not reach Kentish-town lock, a short distance below, till the morning of 31st July. (6.) A fire occurred just above Hampstead-road lock at a railway goods depot. A large 55 amount of debris fell into a dock in direct connection with the canal. The chief officer of the Metropolitan Fire Brigade has supplied the following information— " A fire occurred in the above yard on the evening of the 25th ultimo. A dock for loading barges ran underneath a portion of the building on the ground level which was burnt, and into this dock some 13 doors from the bonded stores opened. In the bonded stores a number of casks of spirits and wines were destroyed, the contents of which would be washed into the dock, also in the goods shed a quantity of flour and grocery stores were destroyed ; much of this would fall into the canal. I visited the scene of the fire on Wednesday last, and there was a particularly unpleasant sour smell about the dock and ruins of the fire; therefore, I am not at all surprised to hear that the pollution of the canal had caused trouble some distance away from the fire." (7.) Owing to the dry weather the canal company had, as is the usual practice yearly about this period commenced pumping water from the river Thames to the lower reaches, and from the lower to the upper reaches. In other words, this means that, instead of the water being changed by water coming down the canal, the level of the water is maintained by a supply from the Thames, while that in the upper reaches is maintained by intercepting the water as it flows down each time a lock is used and returning it to the higher pond. Thus no change takes place in the condition of the water, except one of deterioration. The pumping commenced on July 23rd and continued till the 29th. (8.) The air temperature at the date of nuisance was high and had been so for a week. (9.) Heavy rain after drought occurred on July 27th (.84 inches), and more rain on the 29th. (10.) The results of analysis of water collected on July 13th, August 13th, and August 24th show that on the first-mentioned date there was contamination of an animal and vegetable nature, in the opinion of the chemist—"most probably sewage." On the later dates the water had improved, and the results indicated that the organic matter present in the water was largely of vegetable origin. We have not been able to obtain any evidence of any sudden influx of sewage matter into that portion of the canal complained about, and from the localised character of the nuisance there is no probability of sewage in any large quantity having come down from the district outside. The canal itself is practically a stagnant waterway, a small portion of the water only being changed in each level when the locks are opened. The secretary of the canal company claims the nuisance to have arisen from the fire at the goods depot, through materials being allowed to get from the premises into the dock and decompose and discolour the water. The samples of the water taken on July 31st and analysed by the chemist do not support this theory. The medical officer, in his report, suggests as a possible explanation that the fall of the goods shed with its miscellaneous contents into the dock "must have caused unusual and sudden disturbance and stirring up of the canal water, which apart from the addition of the contents of the shed may have been enough to cause water of an impure character to become very offensive." " If," the medical officer continues, " this be a correct explanation of the occurrence I think it points to the undesirability of continuing the practice of pumping back impure water from the lower to the upper reaches and to the need for steps to be taken by the canal company to maintain the level of the water in the canal by water obtained from some source free from objection." The canal company have power under their Acts to sell water from the higher levels outside the county. This right the company exercise and the proceeds form part of their revenue, and that is probably the reason why, instead of allowing the purer water of the higher to pass down through the lower levels into the Thames, the company prefer to pump back water which lias been used, and use the by no means pure water of the Thames as its source of supply for that portion of the canal which passes through London. The good effect of using the water from the higher to purify the lower levels passing through London was well evidenced by the quickness with which the nuisance complained of was abated in the main water way when the company poured down nearly 16,000,000 gallons of water from the higher to the lower levels. We may remind the Council that in 1893 and 1894 we reported several times on the unsatisfactory condition of the canal. In December, 1893, we held a conference with representatives of the various sanitary authorities through whose districts the canal passes; and in February, 1894, the Council gave instructions for the opinion of counsel to be taken as to whether it would not be competent for the Attorney-General, if called upon by the Council, to proceed by public indictment against the canal company for creating a public nuisance by their neglect of the proper management of the canal within the metropolis. Counsel, however, advised that this was not a case in which the Attorney-General would be likely to take proceedings until every effort had been made to put a stop to the nuisance under the Public Health (London) Act, 1891. Moreover, he was of opinion that the Council could not pay the expenses of a prosecution by indictment out of the County fund. Having regard to the nuisance which occurred in July last, we think the Council should address a letter to the councils of the metropolitan boroughs concerned, pointing out that the condition of the canal is such that it may during hot weather again give rise to serious nuisance, and asking them to keep the canal under careful observation. We accordingly recommend— That a letter be addressed to the councils of metropolitan boroughs through which the Regent's-canal passes, referring to the nuisance which arose from the condition of the canal in July last, pointing out that its condition is such that it may during hot weather again give rise to serious nuisance, and asking them to keep the canal under careful observation. Nuisance from the river Lea. The medical officer of health of Hackney states that the river Lea has not improved in any way in regard to its foulness, and that this condition was well marked during the hot months of 1900. Two samples, taken on the 11th July, one from the culvert of Leyton and Walthamstow newer and the other from White Hart, Temple-mills, were submitted to analysis, and Dr. Warry states that the chemist reported as to the first that " The sample was very foul, and contained a large quantity of suspended matter. It may be fairly described as muddy sewage water," and as to the account that " This is really a sample of river mud, as the suspended matter settles down directly the sample is allowed to stand. Exceedingly foul and giving off very offensive odours." Housing of the Working Classes. Amendment of the Housing of the Working Classes Act. In December, 1899, the Council had under consideration the) amendments of the Housing of the Working Classes Act which were necessary, and adopted the following resolutions- (a) That it is desirable that an amendment of the Housing of the Working Classes Act, 1890. 56 should be obtained so as to empower the Council to acquire land outside the County of London for the erection of working-class dwellings, and that it be referred to the Committee to consider and report whether the special provisions of the Act as to the compensation payable in respect of property taken within unhealthy areas can be equitably amended so as to reduce the heavy cost of clearance schemes to the ratepayers, and to compel the owners of insanitary property to bear the whole cost of rehousing all persons displaced from such areas. (6) That the Housing of the Working Classes Committee be authorised to appoint a deputation to wait upon the Secretary of State for the purpose of urging him to introduce a bill in the next session of Parliament for the amendment of the Housing of the Working Classes Act, 1890, so as to empower the Council to acquire land outside the county of London for the erection of working-class dwellings. In March, 1900, the Housing of the Working Classes Committee again reported on the subject of amendment of the Act, and in reference to a resolution of the Council of 1896, that power should be sought to modify a scheme after the lapse of three years from the date of the clearance of an improvement area, in order to enable the Council to sell the laud freed from the conditions imposed by the scheme and with the money so obtained to purchase other lands to be devoted to the provision of accommodation for persons of the labouriug class, that the Committee were of opinion the words "in exchange" should be inserted after the word "sell," and that they had so informed the President of the Local Government Board. The Committee also stated that the Secretary of State had expressed his approval of a proposal of the Council that where land is acquired under Part III. of the Act for the purpose of relieving schemes under Part I. or Part II. or street improvements from re-housing obligations, thereby freeing surplus lands under such schemes for disposal at commercial value, the Council may be empowered to make such transfers as between Part I., Part II., or street improvement account, and the Part III. account, as shall cause the accounts to show the proper cost of the schemes with which they deal. The Committee further reported on other points as follows— (1.) As to the inclusion in the scheme of additional properties. With regard to schemes under the Act the confirming authority has power to exclude properties from the operation of the scheme prepared and submitted by a local authority, but has no power to include any further properties. It sometimes happens that after a scheme has been prepared it is found desirable, for the purposes of the scheme, to include certain properties within the area to be dealt with. The persons interested in such properties have not been served with the requisite notices under the Act, and this appears to be the reason why the confirming authority has no power to include such properties. The scheme would therefore have to be proceeded with on the lines as originally drawn, or be abandoned for another year. We think that that there would be advantage if, at the time of the inquiry by the Commissioner of the confirming authority, it is represented that any property not in the scheme should be included in it, that the Commissioner should be authorised to adjourn the hearing, with a view to notices being served on the owners, and any objection they may offer submitted at the adjourned meeting. After hearing such objections, if any, the confirming authority should be authorised, if it thinks desirable, to include such additional property in the scheme. (2.) As to the sale of dwellings within 10 years of completion. Section 12, sub-section (5) of the Act provides that " if the local authority erect any dwellings out of funds to be provided under this part (Part I.) of this Act, they shall, unless the confirming authority otherwise determine, sell and dispose of all such dwellings within ten years from the time of the completion thereof." We are of opinion that this section is of grave importance to the Council. If the Council is required to sell its dwellings as provided for by this section we feel that this course would only be effected at a great pecuniary loss. Moreover, the supervision which the Council is at present able to exercise over its dwellings with regard to keeping them in proper repair, and with regard to administration generally, would be done away with. The rents which at present are regulated under the Council's standing orders would pass out of the control of the Council in the event of a sale, and would in all probability be increased. We feel most strongly that it would be a great misfortune, not only to the Council, but also to the tenants, if the Council were required to part with its dwellings. With regard to the question of financial loss, the accompanying figures, prepared by the Council's valuer, will show how the Council would be affected. Dwellings in respect of which the actual cost has been ascertained— Probable selling value at expiration of 10 years from completion £53,000 Actual cost to the Council, including value of site 102,296 Loss to the Council by selling 49,700 Or over 48 per cent, of the cost. Dwellings now in course of erection, the actual cost of which has not been yet ascertained— Probable selling value £198,000 Estimated cost 326,000 Loss to the Council by selling 128,000 Or nearly 40 per cent, of the cost. In addition there are in course of erection dwellings at Millbank, Westminster, for displaced persons from the Clare-market, Strand, area ; at Somers-town, St. Pancras ; and at Brook-street and Cable-street, Limehouse, estimated to cost, including value of land, about £136,000. Assuming the loss in these cases to be the mean of the above percentages, say 44 per cent., the loss in money to the Council would be £60,000. The total loss on the dwellings under consideration would therefore be £237,000. (3.) As to compensation payable in respect of insanitary property. In consequence of the enormous cost to the Council of clearing insanitary areas, owing to the compensation clauses of the Act, which enable an arbitrator to give commercial value for the land, i.e., the value of the land for the purpose of erecting factories, warehouses, theatres, hotels, and other commercial property, we thought it right to call the attention of the President of the Local Government Board to this point, more especially as the Council has referred it to us to consider by resolution of 19th December, 1899. We have therefore forwarded to the Local Government Board the following expression of opinion— That the law should declare that it is the duty of the freeholder to see that dwelling houses on his property are fit for human habitation by enforcing the repairing clauses in his leases, and taking all other necessary steps. Where an official representation under the Act has declared that the dwelling houses in question are not fit for human habitation, the freeholder should have the power to re-enter into possession, but there should be put upon him the obligation to rebuild upon the site dwelling houses for the working classes. In the event of the freeholder not fulfilling this obligation, the local authority should be empowered to take possession of the land, paying only the market value of land, subject to the obligation to rehouse persons of the working 57 classes, and the local authority should then be required to rebuild dwelling houses for the working classes on that site. The action of the Committee was approved by the Council. During the year the Government introduced a Bill to amend Part III. of the Act, so as to give local authorities power to acquire land outside their districts for the purpose of erecting artizans' dwellings. In July, the Housing of the Working Classes Committee reported that a deputation consisting of members of the Housing of the Working Classes and Parliamentary Committees had waited on the Home Secretary to submit the views of the Council that the Housing of the Working Classes Act, 1890, should be amended as follows—(1) That the period of the sinking fund in respect of working class dwellings should be extended to 100 years; (2) That land should be taken as an asset against debt; (3) That the Council should have power to amalgamate the accounts under Parts I., II., and III. of the Act. At the same time a deputation consisting of members of the Highways Committee submitted the views of the Council on the question of Standing Order, No. 22, of the House of Commons, which requires that the promoters of the Tramway Bill should obtain the consent of the road authority in any case where power is sought to break up a road, thus giving the road authority a veto upon the Bill. The Housing of the Working Classes Committee reported Mr. Chaplin's reply as follows— Mr. Chaplin, in reply, stated with regard to the extension of the sinking fund period to 100 years, that he was afraid he could not hold out much encouragement as to this particular branch of the subject. He pointed out that he had already given his views on the point in the House of Commons, and he felt that if the period were extended, such a course would be throwing a considerable liability on future generations. In respect of the demand that land should be treated as an asset, he regarded this question in a different light. There were, nevertheless, many objections to it. He would, however, lay both points before the Chancellor of the Exchequer, with a view to considering what could be done. As to the amalgamation of the accounts to be kept under Parts I., II., and III. of the Acts, Mr. Chaplin said it appeared to be purely a matter of accounts, and that unless on further consideration he saw some grave objections, he was prepared to favourably consider the matter. We are glad to be able to report that an amendment effecting the object sought has been embodied in the bill. On the question of workmen's trains, Mr. Ritchie expressed keen sympathy with the wishes of the deputation, as he felt that it was useless for the Council to erect dwellings in the suburbs unless facilities were afforded to workpeople to go to and from outlying districts. He was of opinion, however, that the Committee did not give full credit to the powers the law at present possessed. The Board of Trade had very large powers, and he thought that there was little difficulty in securing the provision the Committee asked for, provided that the working classes were living in the district requiring train service. We may point out that the difficulty is that the railway companies cannot be compelled to provide workmen's trains until the dwellings are occupied in a particular district, and that the people will not occupy the dwellings until workmen's trains have been provided. With regard, however, to the point urged that companies should give some guarantee for the provision of workmen's trains to districts where working-class dwellings were about to be erected, Mr. Ritchie said it was a proposition that could not, in his opinion, be defended, and he thought that the existing law would meet the necessities of the case as the Board would consider themselves bound to move in the matter when building accommodation had been provided. The Act passed during the year empowered the county and borough councils to establish or acquire lodging houses for the working classes outside their district, and further contained the provision that where land acquired by a Council under Part III. of the principal Act is appropriated for the purpose of rehousing persons displaced by the Council under the powers of any other part of that Act, or of any other enactment, the receipts and expenditure in respect of that land (including all costs in respect of the acquisition and laying out of the land), and of any buildings erected thereon, may be treated as receipts and expenditure under that part or enactment, but shall be accounted for under a separate head. Administration of the Housing of the Working Classes Act. During the year progress was made in carrying out the schemes for the improvement of unhealthy areas which the Council had undertaken under the Housing of the Working Classes Act. (1) Schemes undertaken by the Council under Part I. of the Act. On the 23rd January the Council resolved to petition the Home Secretary to confirm the schemes for the improvement of the following areas—Nightingale-street, in the parish of St. Marylebone; Garden-row, Roby-street, Baltic-court and Honduras-street, in the parish of St. Luke; Webber-row and King's Bench-walk, in the parish of St. George-the-Martyr; Ayle'sburyplace, in the parish of Clerkenwell; Union-buildings, in the parish of Holborn; and Burford'scourt, Tucker's-court and Favonia-street, in the district of Poplar. On the 12th and 13th March a local enquiry was held as to the Webber-row and King's Bench-walk (St. George-the-Martyr) scheme. On the 15th and 16th March a local enquiry was held as to the Aylesbury-place, (Clerkenwell) and Union-buildings (Holborn) scheme. On the 22nd March a local enquiry was held as to the Burford's-court, Tucker's-court and Favonia-street areas (Poplar) scheme. On the 29th and 30th March a local enquiry was held as to the Garden-row, Roby-street, Baltic-street and Honduras-street (St. Luke) scheme. On the 6th April a local enquiry was held as to the Nightingale-street (St. Marylebone) scheme. On the 26th June the Housing of the Working Classes Committee reported that all these schemes had been confirmed, and later in the year the necessary statutory powers were obtained. Progress was made in carrying out the schemes which had been previously confirmed. 58 Churchway, St. Pancras—On the 6th February the Council approved an estimate of £18,570 for the erection of Wellesley-buildings, and it was resolved that the work be executed by the Council without the intervention of a contractor. The erection of these buildings for 360 persons at an estimated cost of £17,456 was begun during the year. Trafalgar road, Greenwich—This scheme had been sanctioned in 1883, and the land cleared in 1887, 387 persons being displaced. The land had been offered for sale on several occasions on condition that cottages be erected for 280 persons, but without result. Part of the land was subsequently scheduled by the London School Board, sufficient being left for the accommodation of 245 persons in block dwellings, a reduction sanctioned by the Secretary of State. The Greenwich District Board subsequently requested the Council to obtain sanction to a further reduction to 190 persons, so as to permit cottages to be erected on the site. An amending order having been obtained for this purpose, plans for cottages were prepared, but it did not appear that the work could be carried out without involving a charge on the county rate. The Housing of the Working Classes Committee hoped that the opening of the Blackwall tunnel would increase the financial prospects of the cottages, and tenders were invited, but the lowest was much above the estimate upon which the Committee were prepared to proceed. The Council's architect therefore prepared plans for cheaper cottages, but the estimate still showed a charge on the county rate of £30 per annum. The Committee, however, felt that inasmuch as the estimate included a cost for repairs in excess of that provided by some artizan dwelling companies, and as there was an obligation upon the Council to erect cottages and the land had been lying vacant for thirteen years, the work should be proceeded with. The Council therefore on the 13th March accepted an estimate of £12,573, of which £11,978 was for the' building and for the erection of fifty-one cottages, and on the Kith October the Committee were able to report that a tender had been accepted for the erection of the cottages at a cost of £11,293, being £685 less than the original estimate for the building. The erection of Hardv-cottages for 306 persons was accordingly begun. Boundary-street Scheme—The following buildings were opened during the year—Abingdon-buildings, for 360 persons; Benson-buildings, for 180 persons; Hedsor-buildings, for 410 persons; and Laleham-buildings, for 380 persons. Brook-street, Limehouse, Scheme—Crawford-cottages for 128 persons were opened during the year. (2) Schemes undertaken by the Council under Part II. of the Act, to the cost of which the district authorities contributed. Ann-street (Poplar) Scheme—The Local Government Board on the 31st May issued an order confirming their order of the 2nd December, 1899, empowering the Council itself to erect dwellings on this site. Mill-lane (Greenwich) Scheme—The Council having come to an agreement with the Greenwich District Board that cottages and a lodging-house for men should be erected on this area, and that Friendly-street should be widened to 40 feet, the Local Government Board issued orders on the 5th December, 1899, and the 7th July, 1900, permitting the Council itself to erect the dwellings. On the 9th October the Committee reported that the Secretary of State had issued an order fixing the contribution of the district board to the scheme at £10,478. Falcon-court (St. George-the-Martyr) Scheme—During the year the following buildings were opened to provide accommodation in respect of persons displaced by the Falcon-road scheme, viz., Gardiner-buildings for 32 persons. Hunter-buildings for 200 persons, and Murphybuildings for 168 persons, all erected in the Borough-road site, and Cobham-buildings for 280 persons erected on the Green-street and Pocock-street site's, both sites having been acquired under Part III. of the Act. (3) Schemes undertaken by district audhoritiet under Part II. of the Act, to the cost of which the Council contributed. Fulford-street and Bradden-strect (Rotherhithe) Scheme On the 5th December, 1899, the Local Government Board had sanctioned the scheme to which the Council contributed one half of the cost. On the 1st June, 1900, the Board issued an order confirming their previous order, and on the 23rd October the Council approved an estimate of £14,560 for the improvement. King John-court, Limehouse—On the 20th December, 1899, the Local Government Board issued an order confirming their order sanctioning this scheme, to the cost of which the Council contributes one-half, such contribution not to exceed £8,150. Norfolk-square, Islington—On the 21st December, 1899, the Local Government Board had held a local inquiry as to a proposal to devote the whole of this site to artizans' dwellings instead of a part as at first proposed. An order was subsequently issued for this purpose. (4) Proceedings under Part III. of the Act. Millbank site—The following buildings on this site were completed and occupied during the year—Leighton and Millais buildings, estimated cost £12,880, for 120 persons each; Turner-buildings, estimated cost £19,997, for 430 persons; and Romney-buildings, estimated cost £12,056, for 290 persons. The following buildings were commenced during 1900- Reynolds-buildings, estimated cost £16,453, for 400 persons; Gainsborough-buildings, estimated cost £18,893, for 396 persons; Landseer and Mulready buildings, estimated cost £20,244, for 230 persons each; Lawrence and Maclise buildings, estimated cost £28,401, for 296 persons each; Wilkie and Morland buildings, estimated cost £26,448, for 300 persons each. Totterdown-fields—In January the Council adopted a report of the Housing of the Working Classes Committee, recommending the purchase of a site about 38½ acres at Lower Tooting, 59 known as the Totterdown-fields site, near the Tooting terminus of the Council s tramways. It was recommended that this site should be acquired at the cost of £45,000, inclusive of legal costs, or £1,150 per acre, and it was proposed to erect upon it cottages each providing accommodation for two families, in self contained tenements, one of two, and one of three rooms. Separate gardens would be provided for each tenement, and on an average not less than thirty cottages would be built to the acre. The rent of the tenements would average about 7s. 6d. per week. Norbury Estate—Until powers were conferred on the Council by the Housing of the "Working Classes (Amendment) Act, 1900, the Council was unable to acquire land under Part III. of the Act of 1890 for the provision of dwellings for the working classes outside the county boundary. In November the Housing of the Working Classes Committee was able to recommend the Council to purchase an estate at Norbury on the western side of the main road from Streatham to Croydon, and about a quarter of a mile from the county boundary. The site is about 31 acres in extent, and a plan for developing the estate prepared by the architect and tentatively approved by the Committee, provided for the erection of 551 single cottages, of three, four and five rooms each, and of 211 double cottages, each containing tenements of two and three rooms. It was estimated that about 5,800 persons could be accommodated on the site, or 195 persons per acre, and the average number of cottages per acre would be about 25. The rents proposed to be charged were—single cottages, three rooms, 7s. to 9s.; double cottages, three rooms, 6s. 6d.; two rooms and small kitchen, 6s.; four rooms, 9s. Gd.; and five rooms, 11s. to 11s. 6d. The return fare from Nor bury to London-bridge by workmen's trains is 4d., the estate being about a quarter of a mile from the Norbury station. The estimated cost was £20,000, certain brick making plant on the estate to be purchased at a valuation, and it was estimated that when all the buildings are completed there would be an annual surplus of £470 per annum. The Council resolved in December to purchase the site. Wedmore-strect, Holloway, site—In December the Council resolved to purchase for £12,500 a site in Wedmore-street, containing an area of 52,600 square feet. The Committee reported that plans and estimates had been submitted showing that block dwellings, affording accommodation for 1,050 persons in five one-room tenements, 140 two-room tenements, and 80 threeroom tenements, could be erected without a charge upon the county rate. Other provision which the Council decided to make was the erection of buildings on a plot of land situated at the corner of Little Europa-place, which had been set aside for dwellings in connection with the Battersea-bridge improvement of 1884. The land was offered for letting by tender in 1893, and had for some time been occupied by the manager of the Works department. Plans which had been prepared showed accommodation for 286 persons in 143 rooms, comprising 10 one-room tenements, 44 two-room tenements (four of which are in two-storey cottages), and 15 three-room tenements. The total estimated cost of the buildings was £15,900, the value of the site being £1,350. The estimated annual surplus was £11 6s. 4d. During the year the alteration of 97, Southwark-street, already in possession of the Council, was completed, and accommodation thus provided for 72 persons. Holborn-to-the-Strand-slreet and Clare-market Improvement Scheme—Under the Clareluarket scheme about 3,038 persons will be displaced, and the rehousing scheme sanctioned by the Home Secretary, provided for the accommodation of 750 persons on the cleared land at Claremarket, and for 1,500 persons at Millbank, or 2,250 in all. In connection with the Holbornto-Strand-street, the Council had in 1898 resolved that provision should be made for the rehousing, within about a mile of their residences, of all persons of the labouring class displaced who were dependent on fixed employment in the neighbourhood, and that adequate provision should be made elsewhere for the remainder of the persons displaced. Later in November, 1898, the Council decided that accommodation should be provided for a number of persons equal to the number of persons of the working class displaced by the formation of the new street. In October, the Improvements Committee reported to the Council that it had been ascertained that 3,700 persons of the labouring class would be displaced, and obtained the Council's sanction to a scheme for rehousing 250 on the Duke's-court site and Marquis-court site, 799 in a lodging house at the corner of Kemble-street and Drury-lane, 1681 on the Reid's Brewery-site, G80 on the Herbrand-street site, and 290 on the Millbank-street site, thus providing for the 3,700 displaced by the new street. By this scheme the whole of the available space on these sites was not exhausted, thus on the Duke's-court and Marquis-court site accommodation still remained for 750 persons displaced by the Clare-market scheme, and it was proposed to ask the Home Secretary to sanction the rehousing on that site of this number of persons displaced by the Clare-market scheme instead of on the Clare-market area, and to appropriate a part of the Clare-market area for the purposes of the Kemble-street lodging house, and the remainder for the purpose of the new street. This scheme was approved by the Council. Displacement of the working classes by private action. In October the Council passed a resolution instructing committees to confer with the Housing Committee before bringing up to the Council any proposal coming before them, the carrying out of which would involve the displacement of 20 or more persous of the labouring class, and in all cases where the displacement of any such persons is involved to state in their report what action is proposed with a view to provision being made for the rehousing of such persons. In November the Housing Committee reported to the Council on an application for the formation of a new street and the widening of others in Bethnal-green, by which 1,728 persons would Be displaced and 1,692 rehoused. In connection with the Housing of the Working Classes, the following references were made by medical officers of health in their annual reports as to proceedings under the Act or as to unhealthy areas. 60 Kensington—Attention is directed to the condition of the James-street area which, it was hoped, would have been completed under a private Act. Dr. Dudfield states that James-street is in a woe-begone condition, many of the houses have been pulled down and few of the old inhabitants remain. The time allowed for the compulsory purchases of properties required for the improvement expired in August, 1899, and for the completion of the scheme expires in August, 1901. Fulham—“The surveyor has prepared a list of vacant lands in Fulliam, embracing some 190 acres which are available, but it is found that the price of land in the borough, which probably could not be bought under £2,500 an acre and the increased cost of building would preclude the erection of houses which would return the interest on the capital borrowed, if let at the rents they should be if they are to benefit those for whom they are intended, i.e., about 2s., or at the most 2s. 6d. per week a room.” Westminster—The medical officer of health and surveyor reported on various areas "most likely to come within the meaning of the Housing of the Working Classes Act," and pointed to William-place in Tufton-street, York-buildings in Grubb-street, and Blue Anchor-court in Great Peter-street; of these, York-buildings is in the area which will be acquired by the County Council under the Embankment Improvement Scheme. Attention was also directed to Lionbuildings with a view to the vestry, at some future time, entering into negotiations with the owners for the purchase thereof and erecting upon the site more suitable dwellings. The officers did not see their way to dealing with any of these areas under the Housing of the Working Classes Act. St. Pancras- As the result of a decision of the Home Secretary in 1893, on a representation of the medical officer of health, it devolved upon the St. Pancras Vestry to improve certain areas under the Housing of the Working Classes Act. Mr. Sykes gives the following information as to the steps taken—The area, including Christopher-place and to the west of Chaltonstreet and north of Drummond-street, was to be dealt with by the vestry without contribution from the Council. The vestry in 1893 served " notices on the owners of the individual houses to abate nuisances and execute such works and do such things as might be necessary, and did not direct any scheme for demolition and reconstruction to be prepared. “With respect to the area lying to the east of Chalton-street, to the cost of which the Council contributes one-third, the vestry prepared two schemes—(a) for Eastnor-place, and (b) for Chapel-grove. The Local Government Board held an inquiry in 1899 as to these schemes, and, inasmuch, as it was decided to modify the Chapel-grove scheme by the compulsory purchase of three houses in Chapelstreet not in the scheme, service of notices and a further inquiry by the Local Government Board as to theise three houses became necessary. Concerning Prospectterrace area and Brantome-place area, to the cost of which the Council contributes one half, schemes were prepared in 189G, and an enquiry was held by the Local Government Board in 1897. Dr. Sykes reports that the Board required the vestry to “provide additional land for rehousing in order that at least 800 persons of the 1,300 to be displaced from the two sites should be rehoused in new buildings," and in 1898 stated that the vestry must agree to the purchase of additional land before the Board would make an order sanctioning the schemes with the necessary modifications. The London County Council considered that the Local Government Board have no power to add additional land to a scheme under Part II., and declined to contribute to the additional cost. The vestry communicated with the Home Secretary on the 22nd September, 1900, as to the interpretation of his award, and received a reply that provisions as to rehousing are an integral part of the scheme to which the London County Council can be required to contribute. The County Council have been informed that the Borough Council will prefer a claim when the proper time arrives. Instructions have been given to prepare the necessary plans, estimates, and details to be forwarded to the Local Government Board to add to the schemes before confirmation. Hackney—The medical officer of health states that in 1900 he represented, under Part I. of the Act, an area in the neighbourhood of Duncan-road. The total number of premises concerned is 71. Dr. Warry also states that he represented, under Part II. of the Act, 36 houses in Tyssenplace, Tyssen-passage, and Tyssen-street, Dalston-lane, and that in May closing orders were made. “Since that date the houses have been demolished to make room for the erection of a factory.” St. Martin-in-the-Fields—Dr. Skegg reported on the condition of Turner's-court on the east side of St. Martin's-lane, of which he gives account. Strand—Dr. Allan states that overcrowding of existing houses has resulted from the displacement of 1,200 persons in the district, and that he has been informed that none of the persons displaced in the Strand district have become tenants of the buildings erected at Millbank. St. Luke—Dr. Yarrow gives statistics of the four areas which the Council resolved to improve, viz., Garden-row, 69 houses, population 407; Roby-street, 50 dwellings, population 218; Baltic-street, 55 buildings, population 351; and Honduras-street, 17 houses, population 217. He also gives particulars of six smaller areas, viz., Bedford-square, 14 houses, population 166; Tilnev-court, 9 houses, population 37; Young's-buildings with 86 and 90 Old-street and 189 to 209 Whitecross-street, 20 houses, population 95; Central-street, including 2 to 36 Central-street, Whitby-court, 81 and 83 Old-street, and 2 and 4 Mitchell-street, 25 houses, population 125; 13 to 38 Bastwick-street, 26 houses, population 275; Ludlow-street, 14 houses, which with houses in Gee-street hold a population of 161 persons. Poplar—The medical officer of health states that in 1900 he represented to the Council two areas—(1) Providence-place area, with 67 dwelling-houses and a population of 411 persons; (2) King-street area, with 10 dwelling-houses and a population of 49 persons. 61 St. George- the- Martyr— Referring to the areas he has represented to the London County Council, two of which the Council has already resolved to improve, hef urges the improvement of the third, viz., the Grotto-place area, the houses in which, he is of opinion, it is unwise to allow to remain. He states that he had under consideration a further area, which comprises a triangular space of ground bounded by Rephidim-street, Weston-street, and Potier-street. The owners have closed the houses presumably with a view to demolition, and Dr. Waldo suggests that the site should be acquired, to be used as an open space. Other areas to which he thinks “the future attention of the London County Council might with advantage be directed are— (a) the group of streets in Ward III. around Sterry-street, Providence-place. Fisher's-buildings, and Fox's-buildings, with about 20 houses in Tabard-street; (b) an area in Ward II. comprising more or less of St. George' s-market, Butcher-row, Dantzic-street and Parliament-street." St. Olave—Dr. Bond reports on Barnham-buildings, some blocks of which he had represented as obstructive buildings. Considerable improvements have been effected, and many of the dark rooms on the ground floor have been converted into washhouses. Plumstead—The medical officer of health gives particulars of an area in the south-west part of Plumstead for which he thinks an improvement scheme is desirable. The area comprises Barnfield-place, Barnfield-road, Princes-road, Brookliill-row, Portland-place and May-place. The number of houses in the area is .187 and the population 9G0 persons. The average death rate of the population for the three years 1897, 1898 and 1899 is 23'9 per 1,000. 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, 1900-~ Local Authority. Total number of houses concerning which the Council has received information that representations have been made from the 1 1 00 to the 31/12/00. Number of houses closed, demolished or improved by owners without Magisterial intervention. Number of houses for whi^h 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 5 - - — - - - 4 4 - 1 Camberwell - - - - - - - - - - — Chelsea - - - - - - - - - - — Clerkenwell - - - - - - - - - _ - Fulham 3 - - 3 3 - - - - _ Greenwich - - - - - - - - - _ — Hackney 37 - - - - 37 - - 37 - - Hammersmith - — - - - - - - - — — Hampstead - - - - - - - - - - - Holborn - - - - - - — - - - - Islington - - - - - - - - - - — Kensington 3 3 - - 3 - - - - - - Lambeth 23 - - - - — — - - _ 23 Lee 16 - - - - - - 16 16 _ Lewisham - - - - - - - - - _ _ Limehouse - - - - - - - - — _ Mile-end Old-town 7 1 - 3 4 - - - _ _ 3 Newington - - - - - - - - - - — Paddington - - - - - - - - - - - Plumstead — - - - — - - — — _ _ Poplar - - - - - - - - - _ _ Rotherhithe - - - - - - - - — _ _ St. George, Hanover-sq. - - - - T - - - - _ _ St. George-in-the-East - - - - - - - - - _ _ St. George, Southwark - - - - - - - - _ St. Giles — - — - - - _ — _ _ _ St. James, Westminster - - - - - - _ - _ _ __ St. Luke - - - - - — — - _ _ St. Martin-in-the-Fields - - - - - - - - _ _ __ St. Marylebone 1 - - - - - - - - _ i St. Olave, Southwark — - - - - - — - _ _ _ St. Pancras - - - - - _ _ - — _ St. Saviour, South wark - - - _ - _ _ - — _ Shoreditch - _ - — - - - _ _ _ Stoke Newington - - - - - - - - - _ _ Strand - — - - — - _ — _ _ _ Wandsworth - - - - - _ _ _ _ _ Westminster 1 - 1 - 1 - _ _ _ _ _ Whitechapel - - - - - - - — _ _ Woolwich 4 - - - - - - - - - 4 Total 100 4 1 6 11 37 - 20 57 - 32 From the above tabular statement it will be seen that during the past year ten of the local authorities have taken action for the closing of houses under Part II. of the Housing of [9] 62 the Working Classes Act, 1890. It does not necessarily follow that in the other districts proceedings have not been instituted for closing houses, the explanation being that many of the local authorities have found it more convenient to proceed under the Public Health (London) Act, 1891. Houses let in lodgings. A point of considerable importance in connection with the regulation of tenement bouses has been recently before the Courts. The Vestry of St. George- the- Martyr decided to register under section 94 of the Public Health (London) Act a block of artizans' dwellings in Gun-street, and summoned the owner for not furnishing them with the particulars of the house after having received notice to do so. The magistrate held that the block did not constitute a house let in lodgings. A case as stated showed that the block is entered directly from Gun-street by a single entrance. There is a front door to the entrance, but no means of fastening the same beyond a Norfolk latch. The figure " 2 " is affixed to the transome of the door frame; The entrance passage branches into two passages about the centre of the building, and there are two doubleroomed tenements and oue single-roomed tenement on each outer side of the passage, and one single-roomed tenement between and two single-branch passages. This is the arrangement on each of the floors. Each of the two-roomed tenements and the single-roomed tenement is let to a separate family. Thus No. 1, two rooms, was occupied by a man, wife and four children; and No. 2, two rooms, by a man, wife and three children. The two-roomed tenements are let at a weekly rent of 6s. and 6s. 0(1. per week, and the single-roomed tenements at 4s. per week. At the back end of each passage on each of the floors there is a water-closet, sink, water-tap, and dust-shoot opening. On the south side this convenience serves for the use in common of four tenements, and on the north side for the use in common of three tenements. The staircase and passages are used in common. The tenements are generally occupied by a class of people who are not cleanly in their habits. The landlord does not live on the premises. A caretaker lives on the ground floor who attends to minor repairs. He has no power to let the premises, but he receives deposits from tenants, and, without the authority of the landlord, has let four tenements, furnished, at Ts. per week. He also cleans the common passages and staircases and the waterclosets. The names of the occupiers of the various tenements in the building appear on the ratebook, and each of the tenements is rated separately, but the landlord compounds for the rates. On behalf of the respondent it was contended that, as the tenements were in separate sets and the landlord did not reside on the premises, the building was not a lodging-house; that the by-laws were not intended to apply to houses of this character, but to lodging-houses where people live there in common; and that under the authority of the various cases decided under the Registration of Electors' Acts with regard to inhabited occupiers and lodgings, the tenements were separate dwelling-houses, although they were not actually separated. The case has since been argued before the Lord Chief Justice, Mr. Justice Lawrance, and Mr. Justice Phillimore, and the decision of the magistrate upheld. The large majority of the annual reports of the medical officers of health give information of the proceedings of the sanitary authorities in connection with the regulation of houses let in lodgings. The following is a brief summary of the statements made in these reports— Paddington—In consequence of proposed alterations in the by-laws, the work of registration has been in abeyance since 1898. The vestry were desirous of exempting from registration houses in which unfurnished tenements of single rooms were let at a rate of 4s. 6d. per week and upwards, and furnished tenements of single rooms at a rate of 6s. per week and upwards, and where each of such rooms is occupied by not more than two persons of ages exceeding ten years. The Local Government Board took exception to the words " of ages exceeding ten years," on the ground that the addition of such words would under certain circumstances exempt a lodging occupied by a man and wife with a family of children under ten years of age, if it consisted of a single room, while it would not exempt it if it consisted of more than two rooms. The Vestry, therefore, withdrew the words, and the by-law was confirmed. Although no houses were newly registered, a considerable number of those already registered " were completely inspected and brought up to the standard prescribed by the by-laws." Kensington—By-laws made in 1885 are in force in this district, and upwards of 1,700 houses have been since registered. Certain other by-laws have been submitted to the Local Government Board. These require (1) that the landlord shall give notice to the sanitary authority when intending to carry out the annual cleansing (of the competency of this by-law the Board has expressed doubt); (2) that the landlord shall give notice of overcrowding; (3) that the landlord of furnished rooms shall cause the bedding and other articles to be maintained in a clean and wholesome condition, and free from noxious insects. The decision of the Board as to (2) and (3) is still awaited. Hammersmith—Directions were given for the registration of 129 houses during the year, making a total of 635 on the register. The medical officer of health states that it has not been found possible to regularly inspect the premises which were registered, and that it is absolutely necessary to appoint another inspector for the purpose. Fulham—Difficulties having arisen in connection with the definition of the term “landlord” in the by-laws, new by-laws were drafted and submitted to the Local Government Board, and “pending their approval the registration of houses let in lodgings remains in abeyance.” Westminster—Over one thousand houses are on the register, and summonses were issued in two cases and penalties inflicted. Hampstead—The number of houses registered is 840. St. Pancras—The number of houses on the register was at the end of the year 834, “and of these 104 inspections and 158 re-inspections (after notice) were made. In addition, 2,090 house- 63 to-house inquiries in tenemented streets were made as to the number of dwellings, &c., in each house, and 41 houses were measured and entered for registration." Islington—During the year 41 additional houses were registered, making 459 on the register. One inspector is wholly employed in connection with their inspection, and another employed partly upon this work and partly in taking samples under the 1 ood Adulteration Acts. The principal adopted in placing houses on the register has been to select houses whose owners neglected their sanitary state to the detriment of the tenants, or those in which the tenants were dirty in their habits, and, therefore, required supervision. " In this way neglected properties and uncleanly tenants have come under sanitary control, which has proved much to their advantage. Stoke Newington—At the end of the year 135 houses were on the register. St. Martin-in-tlie-Fields—The inspector appointed to inspect houses let in lodgings has regularly carried out this duty. Strand—113 premises have been inspected under the by-laws. In addition to numerous cases in which dirty conditions were found, overcrowding was found in eleven instances. St. Giles-in-the-Fields—The number of houses on the register is 012. Holborn—The number of houses on the register is 84. Clerkenwell—At the end of the year 176 houses were on the register. Dr Newman writes— "Steady but continued progress should be made with the work of placing suitable houses on this register, as it is one of the1 most satisfactory and reliable ways of maintaining a good standard of sanitation in such houses, and of preventing overcrowding." St. Luke—By-laws have been in operation since 1896, but only a few were registered until 1898 on account of the rent limit, which was then altered. The number on the register in 1900 was 175. City—The number of houses on the register is 396, containing 3,051 lodgers in 1,274 tenements, or 2.39 persons per tenement. In the enforcement of the by-laws 481 notices were served. Slioreditch—The number of houses registered during the year was 31, and the number on the register was 156. Bethnal-green—The medical officer of health states that his authority has decided to enforce the by-laws. St. George-in-the-East—The number of houses on the register was 83. No houses were newly registered during the year, and the medical officer of health writes—"It is satisfactory to be able to report a marked improvement in their general sanitary condition in comparison with what obtained before registration."The number registered "includes, as far as is known, all the tenement houses in the parish that can be registered by reason of the retats." Poplar—The County Council having, in 1898, called attention to the rent limit in the by-laws exempting houses from registration being so low as to militate against their usefulness, inquiry was made in a number of streets as to the effect of this by-law. The medical officer of health reported—"It will be seen from the tabulated statement that 4s. 6d. and 5s., also 5s. 6d. are the rents or charges for the most part payable for portions of houses, and only in a few instances would any of the premises dealt with come under the Board's by-laws with respetet to houses let in lodgings, by lodgers having to pay a rent or charge less than 3s. per week." The rents specified in the by-laws, viz., 3s. and 4s., were* therefore raised to 10s. and 12s. 6d., and the by-law thus altered confirmed by the Local Government Board. St. George-the-Martyr—The number of houses on the register was 309. Newington—The number of houses on the register was 27. "Various lists of houses deemed suitable to be placed on the register, chiefly on account of the difficulty of keeping them in a fair state of repair, have been rejected from time to time." St. Olave—There were 19 houses on the register. In five instances summonses were taken out for infringement of the by-laws and penalties inflicted. 1{ other hi the—The number of houses registered during the year was five. Lambeth—The number of houses registered during the year was 26, and there were 411 houses oil the register. The medical officer of health states that in some cases the landlord who lives on the premises has no money to expend on annual cleaning, and that it is desirable that this duty should devolve on the owner. liattersea—There were 49 houses on the register, and these werg regularly inspected. If the number of the staff were increased " the number on the register might possibly be increased." Wandsworth (Clapham)—The registered houses were inspected twice a year, and five notices served. (Putney)—Certain houses were put on the register. " The landlord, however, made such structural alterations in the houses in question, that each flat became a separate tenement, with a separate door, so that they could no longer re'main under the by-laws." (Wandsworth)— There were 36 liouses on tlie register, being an increase of 14 npon tlie number in tlie preceding year. Camberwell—The by-laws were under consideration, especially with respect to the definition of the word "landlord," the medical officer of health being of opinion that the sanitary authority " should be able fo look to some person of a more responsible holding than that of a weekly tenancy of the whole house" to carry out the work of annual cleansing. Woolwich Ihe number of houses on the register was 66. These were systematically inspected. I I umstead There were 22 houses 011 the register, 4 having been registered during the year. Common Lodging-houses. The year 1900 was the seventh 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 64 at the end of the year was 528, providing accommodation for 28,311persons. Seven of these houses were registered for the first time in 1900. In the supervision of these houses the Council's inspectors made 29,097 inspections, of which number 28,428 visits were made to registered, and 1,069 visits were made to unregistered houses. In addition to these, 1,539 visits have been made to seamen's lodging-houses, 662 night visits to common lodging-houses, and 6 night visits to unregistered houses where it was suspected that lodgers were received. Preliminary notices have been served in 240 cases. Proceedings before the magistrate were instituted in 16 cases, resulting in 13 convictions, fines being inflicted amounting in the aggregate to £90 15s. and £12 costs. Of the remaining three cases, one summons was dismissed, one adjourned sine die, and the other was withdrawn. The number of cases of infectious disease reported in these houses was as follows— Diphtheria 6, enteric 9, erysipelas 21, measles 1, scarlet fever 3, or 40 in all. The number of deaths from various causes reported in these houses was 91. The following table shows the number of common lodging-houses, the authorised number of lodgets in such houses at the end of 1900, and the number of houses registered for the first time in each sanitary district during the year— Common lodgina-houses. Sanitary district. Number of common lodging-houses. Authorised number of lodgers. Number of houses registered in 1900. Battersea 6 234 - Bermondsey 3 208 — Bethnal-green 15 484 3 Camberwell 10 622 — Chelsea 17 841 — Clerkenwell 5 299 — Fulham 1 51 — Greenwich 16 753 — Hackney 10 475 — Hammersmith 9 550 — Hampstead. 1 35 — Holborn 12 667 — Islington 44 1,347 1 Kensington 33 968 1 Lambeth 10 701 — Lewisham 2 46 — Limehouse 21 864 — Marylebone 18 873 — Mile-end 3 122 — Newington 12 1,423 — Paddington 3 71 — Poplar 13 948 — Rotherhithe 3 116 — St. George-in-the-East 18 527 ] St. George-the-Martyr, Southwark 30 1,533 — St. Giles 30 1,707 — St. James 1 88 — St. Luke 4 240 — St. Martin-in-the-Fields 4 170 — St. Olave 1 533 — St. Pan eras 18 975 1 St. Saviour, Southwark 17 885 — Shoreditch 14 760 — Stoke Newington 1 37 — Strand 11 620 — Wandsworth 10 2294/2 — Westminster 14 1,253 — Whitechapel 53 5,213 — Woolwich 35 *841½ — Total 528 28,311½ 7 * £ = 1 child under 10 years of age. During the year the Council had under consideration reports as to disturbances in common lodging-houses, and as to the need for better control of such houses in respect of disorderly conduct. The Council resolved to inform the Local Government Board that the Council was of opinion that the power of annually licensing common lodging-houses was needed. The Local Government Board informed the Council that the question of proposing legislation on the matter was under consideration. Customs and Inland Revenue Acts, 1890 and 1891. The proceedings of medical officers of health under these Acts as shown in the annual reports were as follows—In Paddington " no certificates had been issued, but much work was in 65 hand for obtaining the same In Fulham certificates were granted in respect of 78 separate tenements and refused in respect of 262. In Westminster certificates were issued with respect to four blocks of buildings. In Hackney 3 certificates were granted, the tenements covered by these certificates being 54 in number. In Shoreditch applications were received concerning 115 dwellings, 75 of which belonged to the borough council, and certificates were granted to them. In Bethnatgreen certificates were granted in respect of 285 tenements and refused in others, as the medical officer of health was not satisfied with their sanitary condition. In Lambeth 130 certificates were granted unconditionally, 138 conditionally, whilst in no single instance has a certificate been refused. In Battersea 93 certificates were granted. In Clapham parish (Wandsworth district) certificates were granted in the case of 15 buildings, comprising 73 flats. Underground Rooms. In the following districts underground rooms (illegally occupied) were dealt with— Paddington, 1; Kensington, several; Chelsea, 4; St. James, Westminster, 7; Marylebone, 486 inspections were made; Hampstead, 2; St. Pancras, 2; Islington, 38; St. Giles, 5; Strand, 7; Holborn, 17; Clerkenwell, 17; St. Luke, 7; Bethnal Green, 6; Whitechapel, 54; St. Georgein-the-East, 44; Limehouse, 3; Mile End Old Town, 8; St. George-the-Martyr, 10; Lambeth, 84; Battersea, 8. Workmen's Trains. In February the Housing of the Working Classes Committee reported on the results of a decision of the Railway and Canal Commissioners, that two additional workmen's trains should as an experiment be1 put on from Enfield to Moorgate-street, starting at 6.25 and 6.48 a.m., and that all the 3½d. fares on the route, viz., those from Wood-green, Hornsey, and Harringay should be reduced to 3d. The Committee gave the results of an inquiry into the extent of use of these trains, and reported that they " show that the company erred in its anticipation of the result of the experiment, and that the evidence submitted by the Council was correct.'' In July the Council instructed the Housing of the Working Classes Committee to consider and report what fresh legislation is necessary in order to obtain additional facilities for workmen on the lines run by the several railway companies having termini in the metropolis, and as to the advisability of the Government being approached in the matter. Inspection of Workshops. With few exceptions, in all the reports of medical officers of health, reference is made to the subject of inspection of workshops. In a number of the reports it is discussed in some detail, while in others the proceedings during the year are shown in tabular form. In districts where officers are especially allotted to this branch of the work of sanitary administration, considerable progress has been made. In several districts female sanitary inspectors have been appointed for this particular duty. Thus the reports show that such inspectors were employed in Kensington, St. Pancras, Hackney, Islington, Marylebone, Poplar, and St. George-the-Martyr, Southwark. The medical officer of health of Lambeth urges the appointment of a female inspector, and states that such appointment was made subsequent to the termination of the year 1900. In the reports relating to Paddington, Hammersmith, and Clerkenwell, it is stated that insufficiency of the staff had prevented the work being adequately performed. Dr. Newman, writing of Clerkenwell, states that " it has been found impossible to set apart a special inspector for workshops, though undoubtedly this is the only way to ensure efficient inspection." The reports generally tell of the keeping of a register of workshops, and of the results of their inspection. Of the legal proceedings of which account is given may be mentioned a case heard on appeal. The question at issue was whether a stable and stable-yard was a work-place, so as to make it necessary for the owner or occupier to provide sufficient and suitable sanitary conveniences for the persons employed in or in attendance at such premises. The horse-keepers and cab-cleaners, when not at work, lived with their respective families in different rooms, having sanitary conveniences situated over different portions of the premises. Hirers of cabs and horses were in attendance on these premises. Mr. Justice Grantham and Mr. Justice Channell decided that the premises constituted a work-place. Bakehouses. In many of the reports of the medical officers of health, the number of bakehouses in occupation in the district is given—Kensington, 134; Fulham, 85, of which 70 are underground; Chelsea, 48, of which 42 are below ground; St. Georgei, Hanover-square, 40; St. James, Westminster, 42; Marylebone, 92; Hampstead, 39; St. Pancras, 182; Islington, 273, of which 166 are either entirely or partly below the level of the street; Hackney, 122; St. Giles, 24; Strand, 23; Holborn, 23, of which 21 are underground; Clerkenwell, 45; St. Luke, 30; City, 40; Shoreditch, 91, of which 59 are underground; Bethnal-green, 102; St. George-in-the-East, 27, of which 17 are below ground: Limehouse, 40; Poplar, 86; Bow, 22; St. Saviour, 15; St. George, 52, of which 36 are above ground and 16 below; Newington, 70; St. Olave, 5; Lambeth, 246, of which 30 were empty at the time the report was written; Battersea, 110, of which 48 were below the ground floor level; Chapham, 47; Streatham, 38; Wandsworth, 39; Lewisham, 99; Woolwich, 40; Plumstead, 37; Eltham, 7. Unwholesome Food. A table in the annual report of the medical officer of health of the City shows that in 1890 .234 per cent., of the meat entering the Corporation markets at Smithfield was seized, and of the meat seized 101 per cent, was diseased, 85 9 per cent, putrid, and 4 per cent, was unsound Go from accident or other causes. The total amount seized was 9G2 tons, giving a proportion of one ton in 427 tons entering file markets. Beyond the boundary of the City in Holborn (now in Fins bury) lie premises in which a large trade in meat is carried on. In Holborn 1,249 stone of diseased and 1,615 stone of decomposed meat was seized during the year 1900 to the 9th November, when the transfer to Finsbury of the area chiefly concerned in this matter took place. In the period from the 9th November to the end of the year further seizures occurred of which account is given in Dr. Newman's report relating to Clerkenwell. The seizures of meat in Islington come next in importance. In this district 6½ tons of meat, mostly unsound, were seized in butchers' shops, and 10¾ tons of meat, mostly diseased, were seized in private slaughter-houses, of which there are 44 in the district. The amount of meat seized in any of the other districts bears no comparison with the amount seized in Islington. The large amount seized in Islington is interesting in connection with the fact that an inspector, apnointed especially for this purpose, endeavours to inspect at the time of slaughter the animals which are killed in these slaughterhouses. To make inspection at such time, as Dr. Harris points out, is not an easy task, " especially when slaughtering is for the most part confined to two days in the week, and is consequently carried on simultaneously in many places." In Islington, it will be seen, attempt is being made to secure for the public protection against the sale of diseased meat in the same way as if the animals had been killed in a public slaughter-house. The reports of medical officers of health show that in Fulham one seizure of meat was made; in St. Pancras, 3 livers, 25 lbs. of beef and 7 lbs. of mutton; in Hackney, 25¾ cwts. of meat; in St. Luke, 516 lbs. of meat, with a few livers and sheep's heads; in Shoreditch, of mutton 3 legs, 11 necks and 2 pieces, of beef 9 legs, pork and mutton 2½ cwt., beef and mutton in joints ½ ton; in Bethnal Green, over 3 cwt. of meat; in Limehouse, 2 cwt. of meat; in St. George-the-Martyr, 13 rib pieces; in Newington, sheep's heads, beef and mutton; in St. Olave, 9 pieces of beef and 1 of mutton; in Lambeth, 23 lbs. of meat; in Camberwell, there were 11 seizures; in Battersea some pork was seized. In my last report I showed how readily, under existing circumstances, meat unfit for food can enter London, and how meat was supplied from a knacker's premises in a provincial town to a cat's meat vendor in London who was convicted of supplying for human consumption meat unfit for human food. The report of the chief sanitary inspector of Bethnal Green, appended to the annual report of the medical officer of that district, contains the following statement— " With the assistance and permission of your Committee I have been enabled to again get on the track of some of those persons who were prosecuted and very heavily fined about a year ago for selling and using for human food stuff that was purchased from a cat and dog's meat dealer, having premises (a railway arch) in an adjacent parish. Although two fines of £50 each were then imposed, I had reason some time since to suspect that this filthy trade had only been diverted, not in any way stopped, so far, at least, as the prime movers were concerned. After weeks of enquiry and a considerable amount of difficulty, I ascertained that railway and other waggons were again delivering consignments of exactly similar parcels to those reported a year ago. Careful observation kept on the premises abovementioned, which are situate in the district of a neighbouring authority over our southern boundary, showed that a more extensive trade than ever was being carried on. For a time I was unable to get clear evidence of what was done with the stuff so delivered. Sausage manufacturers, and makers of various seductive, if unwholesome, relishes, seemed one and all to have deserted the place; not one of them came near ; but what was more suspicious to me, not a single barrow of cat's meat left the place, neither was a genuine cat's meat man seen to enter. I was about to give the matter up for a time, when a lucky accident solved the mystery, and we ascertained that the stuff was removed in a most roundabout and surreptitious manner to a small private house, then in a parish over our northern boundary, but now in our own district, from whence it was fetched, not by cat's meat men, but by makers of sausages and other mysterious things, who came from the adjoining districts. I communicated with the officers of the several authorities concerned, and placed an agent and my information at their disposal, with the result that one butcher in the Hackney district was followed home with a consignment, and as soon as it was at his shop it was seized by the sanitary officers and subsequently condemned at the North London Police Court." Seizures of other articles of food took place in Chelsea, Westminster, Hampstead, St. Pancras, Strand, Hackney, Shoreditch, Bethnal Green, Whitechapel, St. George-in-the-East, Limehouse, Poplar, St. George-the-Martyr, Paddington, St. James, Westminster, Marylebone, St. Giles, St. Luke, City, Mile End Old-town, Newington, Clapham, Wandsworth, and Battersea. The articles consisted for the most part of fruit, vegetables, rabbits, fish, bacon, eggs, and tinned food of every description. The largest amount of fish destroyed was in the City, in which the Billingsgate market is situated, and in which 769 tons of fish were dealt with. In some of the districts the amount of tinned food seized was considerable. Thus in St. James, Westminster, 1,115 tons of food were seized, and the medical officer of health is of opinion that the material would probably have been used iu cheap restaurants had the seizure not taken place. In Limehouse a van load of potted meat was seized, in Hackney 270 tins of preserved food. In Mile Eud Old Town there were numerous seizures of tinned food, and in one case it was found that more than half the tinned lobster, salmon, and sardines in the shop were found to be unfit for human consumption. Dr. Taylor, the medical officer of health of Mile End Old-town, also states that it had come to his knowledge that a certain dealer in manure had been allowed to remove tinned food as refuse from certain wholesale dealers, and strong suspicion was entertained that some of the tins were finding their way elsewhere than to the rubbish heap. The cart of the manure dealer was followed to a jam factory, which after a short interval was visited by the sanitary inspector, who found blown tins of fruit being manufactured into " pure home-made jam." The usual practice is to seize tins which present signs of being " blown," but Dr. Reginald Dudfield states that in a case which was subject of proceedings by the Paddington Yestry, it was found that tins of condensed milk may be in a bad state of decomposition without manifesting the " bulging " or " blowing " usually associated with decomposed tinned goods. 67 As a result of the action taken by the officers of the sanitary authorities, numerous proceedings were instituted in the police-courts. In many cases substantial penalties were inflicted, in some instances the defendants being sent to prison without the option of a fine. There is probably no trade more profitable than the traffic in unwholesome food. The opportunities for carrying on this trade without detection in a place the size of London is very considerable, and the loss of money which pecuniary penalty involves must often make but small reduction of the profits of the business. An interesting account of poisoning through the accidental contamination of a summer drink deserves to be noted. Dr. Bryett, the medical officer of health of Shoreditch, gives the following account of the occurrence— "On September 6th complaint was received that some six or eight men employed in the Whistonstreet Gas Works had been suddenly taken ill with symptoms of poisoning after drinking of a temperance beverage which they were in the habit of consuming in the summer time. The chief symptom complained of was vomiting. Enquiry showed good reason for believing that the drink was the cause of the symptoms, and the manufacturer thereof was at once communicated with and the necessary steps were taken to prevent any further sale of the beverage and to recall what had already been distributed for sale. The contents of some of the bottles containing the drink were submitted to Dr. Stevenson, the public analyst, and it was found that water, tartaric acid, sugar, flavouring and colouring matters entered into the composition of the beverage. It was found also to contain an injurious proportion of salt of copper. The analyst stated that the copper salt had not been introduced as an ordinary soluble salt of copper, but had doubtless been formed by allowing the liquid to remain in contact with metallic copper in the presence of air, the sugar in the liquid rendering the salt soluble. The explanation of the presence of the copper, from what the manufacturer stated, appeared to be that on a certain date a portion of the drink had been made in an apparatus, constructed partly of copper, which had not been in use for several months ; during the time the apparatus was out of use some of the copper salt referred to by Dr. Stevenson had doubtless collected on the interior of the apparatus, and had been taken into solution in the portion of the drink manufactured in the apparatus when it was brought into use again. The remainder of the drink made on the particular date in a different apparatus was found not to give rise to any of the symptoms complained of." Poisoning by arsenic. In the latter part of November a number of persons in Manchester and in some other places were found to be suffering from illness which was attributed by Dr. Reynolds to poisoning by arsenic. It was then discovered that arsenic was present in the beer which was being consumed by the sufferers, and that its presence was due to the use of glucose or other substitutes for sugar prepared with commercial sulphuric acid in which arsenic was accidentally present. In London enquiry was made by the Council's Public Health Department with a view to learning whether there was reason for thinking that there was any excess of cases of peripheralneuritis (the disease caused in Manchester by the arsenic) in London poor law institutions. No such evidence was forthcoming, and further numerous samples of beer and articles into the composition of which glucose enters were analysed by the Council's chemist and by the analysts of the several sanitary authorities, but arsenic was not found to be present in the articles examined. The regulation of milk and cream. In -January a departmental committee was appointed by the Board of Agriculture to enquire and report as to what regulations, if any, may with advantage be made by the Board under section 4 of the Sale of Food and Drugs Act, 1899, for determining what deficiency in any of the normal constituents of genuine milk or cream or what addition of extraneous matter or proportion of water, in any sample of milk (including condensed milk) or cream, shall, for the purposes of the Sale of Food and Drugs Acts, 1875 to 1899, raise a presumption, until the contrary is proved, that the milk or cream is not genuine. The report of the Committee was sigued by all the members except one, and the conclusions were as follows— I.—That regulations under Section 4 of the Food and Drugs Act, 1899, be made by the Board of Agriculture with respect to milk (including condensed milk) and cream. II.—(a) That in the case of any milk (other than skimmed, separated, or condensed milk) the total milk-solids in which, on being dried at 100 degrees Centigrade, do not amount to 12 per cent., a presumption shall be raised, until the contrary is proved, that the milk is deficient in the normal constituents of genuine milk. (6) That any milk (other than skimmed, separated, or condensed milk) the total milk-solids in which are less than 12 per cent., and in which the amount of milk-fat is less than 3 25 per cent., shall be deemed to be so deficient in milk-fat as to raise a presumption, until the contrary is proved, that it has been mixed with separated milk or water, or that some portion of its normal content of milk-fat has been removed. In calculating the percentage amount of deficiency of fat the analyst shall have regard to the above-named limit of 3 35 per cent, of milk-fat. (c) That any milk (other than skimmed, separated, or condensed milk) the total milk-solids in which are less than 12 per cent., and in which the amount of non-fatty milk-solids is less than 8.5 per cent, shall be deemed to be so deficient in normal constituents as to raise a presumption, until the contrary is proved, that it has been mixed with water. In calculating the percentage amount of admixed water the analyst shall have regard to the above-named limit of 8'5 per cent, of non-fatty milk-solids, and shall further take into account the extent to which the milk-fat may exceed 3 25 per cent. III.—That the artificial thickening of cream by any addition of gelatine or other substance shall raise a presumption that the cream is not genuine. IV.—That any skimmed or separated milk in which the total milk-solids are less than 9 per cent, shall be deemed to be so deficient in normal constituents as to raise a presumption, until the contrary 19 proved, that it has been mixed with water. Y.—That any condensed milk (other than that labelled " machine-skimmod milk " or " skimmed milk," in conformity with section II. of the Food and Drugs Act, 1899) in which either the amount of milk-fat is less than 10 per cent., or the amount of non-fatty milk-solids is less than 25 per cent., 68 shall be deemed to be so deficient in some of the normal constituents of milk as to raise the presumption, until the contrary is proved, that it is not genuine. The Committee beg further to submit the following expressions of opinion on points raised before them in evidence— (а) That it is desirable to call the attention of those engaged in the administration of the Food and Drugs Act to the necessity of adopting effective measures to prevent any addition of water separated or condensed milk, or other extraneous matter, for the purpose of reducing the quality of genuine milk to any limits fixed by regulation of the Board of Agriculture” (б) That it is desirable that steps should be taken with the view of identifying or " ear-marking separated milk by the additional of some suitable and innocuous substance, and by the adoption of procedure similar to that provided by section 7 of the Food and Drugs Act, 1899, in regard to margarine. . (c) That it is desirable that, so far as may be found practicable, the procedure adopted in collecting, forwarding and retaining pending examination, samples of milk (including condensed milk) and cream under the Food and Drugs Acts should be uniform. (d) That it is desirable that, so far as may be found practicable, the methods of analysis used in the examination of samples of milk (including condensed milk) or cream taken under the Food and Drugs Acts should be uniform. (e) That it is desirable in the case of condensed milk (other than that labelled " machine-skimmed milk " or " skimmed milk," in conformity with section II. of the Food and Drugs Act, 1899), that the label should state the amount of dilution required to make the proportion of milk-fat equal to that found in uncondensed milk containing not less than 3 25 per cent, of milk-fat. (f) That it is desirable in the case of condensed whole-milk to limit, and in the case of condensed machine-skimmed milk, to exclude, the addition of sugar. (g) That the official standardising of the measuring vessels commercially used in the testing of milk is desirable. The regulations made by the Board of Agriculture and which came into force in September, 1901, were as follows— Milk. 1. Where a sample of milk (not being milk sold as skimmed, or separated, or condensed milk) contains less than 3 per cent, of milk-fat, it shall be presumed for the purposes of the Sale of Food and Drugs Acts, 1875 to 1899, until the contrary is proved, that the milk is not genuine, by reason of the abstraction therefrom of milk-fat, or the addition thereto of water. 2. Where a sample of milk (not being milk sold as skimmed, or separated, or condensed, milk) contains less than 8 5 per cent, of milk-solids other than milk-fat, it shall be presumed for the purposes of the Sale of Food and Drugs Acts, 1875 to 1899, until the contrary is proved, that the milk is not genuine, by reason of the abstraction therefrom of milk-solids other than milk-fat, or the addition thereto of water. Skimmed or separated milk. 3. Where a sample of skimmed or separated milk (not being condensed milk) contains less than 9 per cent, of milk-solids, it shall be presumed for the purposes of the Sale of Food and Drugs Acts, 1875 to 1899, until the contrary is proved, that the milk is not genuine, by reason of the abstraction therefrom of milk-solids other than milk-fat, or the addition thereto of water. Disinfection. The annual reports of medical officers of health show that in Paddington, Kensington and Battersea a contractor is employed in the work of disinfection, and that though in the two firstmentioned districts the question of having their own apparatus has been under consideration, it is not likely to be provided at present. In Battersea, however, towards the end of November, the Borough Council decided to erect a disinfection chamber with duplex machinery, and they accepted an estimate for the work, which was to be commenced at once. The new station in Hackney was almost completed in 1900, and that in Fulham is stated by the medical officer of health to be now in use. The authorities in the district of Poplar resolved that further provision was necessary and have therefore extended the disinfecting station and erected a saturated steam Equifex apparatus. The medical officer of health of Lambeth states that the Equifex machine continues to give satisfaction, and that though the old Neville's machine in the district has not broken down during the year, it is hardly satisfactory, and that it would be well to purchase another Equifex in the event of a breakdown or any extra pressure of work arising from epidemics. The medical officer of health of Camberwell also reports that there is but one disinfecting machine, and that during the year on one occasion it was necessary to make use of the station at Lambeth, and also on another occasion to make use of that in Bermondsey; he therefore suggests that it would be well to provide another machine, and that it should be placed in another part of the borough, which now is of large extent. It may be expected that the London Government Act of 1899 will lead to alterations in the arrangements of those authorities who utilised apparatus belonging to hospitals or to other authorities, such as those of St. Georgein-the-East, St. Olave, Holborn, Stoke Newington, Lee, Eltham, and some districts of Wandsworth. Provision of Shelter during Disinfection. The reports of the following districts show the extent of use of the shelters which have been provided for people whose rooms were being disinfected. Paddington by 15 families, Westminster by 12 families, Marylebone 10 times, St. Pancras 4 times, Islington 3 time's, Strand by 7 persons, Holborn by 16 families, Clerkenwell 19 times, Limehouse by 12 families, St. George-the-Martvr 108 times, St. Olave 14 times, Rotherhithe by 2 persons, Plumstead once. In Hackney the local authority paid for accommodation on two occasions for persons who applied for rooms while they were deprived of their homes, but the new shelter is almost completed, and will consist of four entirely separated and furnished tenements, with water-closet and bath-room to each. In the City the new shelter was opened but not ready for occupation in October, 1900, so that the old one was in use during the whole year, and accommodated 18 families or 68 persons during the 69 disinfection and cleansing of their rooms. In Shoreditch the new shelter is approaching completion, and will be ready for use in 1901, but the old one was used during the year under consideration on six occasions by 27 persons. The medical officer of health of Lambeth states that Lambeth is now well supplied with refuges in the event of a serious epidemic breaking out, but "there appears to be a prejudice against the use of such refuges," and "at present these are but little used, and apparently a somewhat useless expense," only on two occasions were they used during the year. A new shelter was erected in Woolwich and opened towards the end of the year, three families were admitted into the old shelter and two into the new one. The medical officer of health of Hampstead reports that in 1892 "a shelter with day accommodation for two families was provided. This building was taken over by the electric lighting department in 1900, since which period the borough has been without a day shelter." In Kensington there is as yet no shelter, though the medical officer of health reports that 53 cases of infectious disease occurred in families occupying one room, and he considers the need for such provision is sufficiently indicated by this fact. Infectious disease—Bacteriological examination Examination of material from persons suspected to be suffering from infectious disease was undertaken by the sanitary authority in a number of districts. The annual reports show that in Paddington material from 36 suspected cases of diphtheria and from 25 suspected cases of enteric fever was examined; in Fulham, from 247 suspected cases of diphtheria, from 23 of enteric fever, and from 19 of tuberculosis, the examination being made at the Jenner Institute; in St. George, Hanover-square, from 26 suspected cases of diphtheria, and from 11 of enteric fever among parishioners, and from 4 suspected cases of diphtheria and 1 of enteric fever among persons who were not parishioners; in St. Marylebone, from 43 suspected cases of diphtheria, the examination being made at the Jenner Institute; in St. Pancras, from 113 suspected cases of diphtheria and 85 of enteric fever; in Islington, from 105 suspected cases of diphtheria, 78 of enteric fever, and 79 of tubercular disease; in Stoke Newington, from 33 suspected cases of diphtheria and 6 of enteric fever, the examination being made at University College; in Hackney, from 6 suspected cases of diphtheria and 1 of enteric fever, arrangements having been made in October with the Jenner Institute for the purpose; in St. Giles, from 8 suspected cases of diphtheria and 2 of enteric fever; in the Strand district, from 4 suspected cases of diphtheria, the examination being made by Mr. Cribb, the bacteriologist appointed by the Board; in Holborn, from 84 suspected cases of diphtheria, the examination being made at the Jenner Institute; in Clerkenwell, from 54 suspected cases of diphtheria, enteric fever and phthisis, material being sent to the Jenner Institute; in Shoreditch, from 4 suspected cases of diphtheria, arrangements having been made in the latter part of the year for material to be sent to the London Hospital; in Limehouse, from 17 suspected cases of diphtheria and enteric fever; in Poplar, from 100 suspected cases of diphtheria, material being sent to the Jenner Institute; in St. Olave, from 4 suspected cases of diphtheria; in Lambeth, 469 samples from suspected cases of diphtheria, 115 of enteric fever, and 118 of tubercular disease, the material being examined in a laboratory provided by the sanitary authority at Arlington Lodge, Wanless-road, Loughborough; in Camberwell, material being sent to the vestry's bacteriologist; in Wandsworth parish, from 6 suspected cases of diphtheria and 3 of enteric fever; in Clapham parish, from 4 suspected cases of diphtheria; in Plumstead, from 19 suspected cases of diphtheria, material being sent to the Jenner Institute. The Cleansing of Persons Act. Only a few of the reports of the medical officers of health mention the provision made in their districts for carrying out the provisions of this Act. In Kensington an arrangement has been made with the guardians to use the cleansing and disinfecting apparatus at the workhouse, but it has been little used "probably to some extent owing to the locality and ownership of the apparatus." In Westminster one person availed himself of the provision made, and the medical officer of health states "this is the first application in this district under this Act since it came into operation." In Marylebone an additional steam disinfector was erected adjacent to the baths for the purpose of disinfecting separately the clothing of persons who came to the baths; there is also accommodation for both setxes, and steps were taken to notify the fact to institutions and common lodging-houses. During the year 3,352 males and 28 females underwent the cleansing process and had their clothing disinfected. In Islington two men had their clothing passed through the steam disinfector, they themselves occupying the shelter during the process. The medical officer of health of Stoke Newington reports that on two occasions clothing and bedding were disinfected with steam to free them from vermin. In the Strand "two persons applied ; they were given a warm bath while their clothing was purified by being passed through the disinfecting apparatus." In Hackney accommodation is being provided. Mortuaries. In my last report I stated that the Council has approved plans for a mortuary at Sunstreet, Woolwich. This mortuary was completed in November, 1900. The plans of the proposed mortuary in Latchmere-road, Battersea, were approved by the vestry, and the medical officer of health states that its erection will be speedily commenced. He recommends that the old mortuary should be utilised for special purposes, particularly the reception of bodies recovered from the river. The number of such bodies in 1900 was 15. The medical officer of health of Lambeth recommends the provision of an additional mortuary for the Norwood district. He writes, " It will be sufficient for a small mortuary to be provided, such building to be able to deal with [10] 70 (a) infectious cases, and (b) other dead bodies." The medical officer of health of Whitechapel expresses his regret that in future all bodies on which inquests will be held will be removed to the Limehouse mortuary, and he fears that delay will result iu the removal of bodies from the numerous common lodging-houses in Whitechapel. Water Supply. The Water Examiner under the Metropolis Water Acts states in his report to the Local Government Board that the character of the seasons during the year was, on the whole, favourable for the operation of the companies which derive their supplies from the rivers Thames and Lea, and that the Thames water was in good condition during 317 days, moderately discoloured and turbid during 35 days, and exceptionally muddy and turbid on 13 days. He urges the importance of sufficient provision of subsidence and storage reservoirs to enable the necessarv dailv supplies to be delivered during periods of flood, while keepiner the intakes closed. Referring to storage reservoirs the Water Examiner states— The river deriving companies have during recent years largely increased the capacity of their storage reservoirs, and are actively engaged in constructing or in making arrangements for the construction of additional reservoirs. At present some of the companies which have large storage reservoirs take water direct from the river or merely run it through some of their smaller reservoirs before passing it into the filter beds. The benefit of thorough settlement in precipitating micro-organisms as well as suspended matter has been clearly demonstrated, and so impressed was the Royal Commission, presided over by Lord Llandaff, with this fact, that one of its recommendations was that it should be made imperative on the companies to pass water drawn from the river into a storage reservoir before letting it on to the filter beds. Excellent as the quality of the filtered water usually is there are undoubtedly occasions when a better result would have been obtained by a longer settlement, and it is hoped that the companies will keep in view the recommendations of the Royal Commission and so arrange their system of treatment of the river water that no river water which has not been subject to proper settlement shall be passed into the filters. The Grand Junction Company particularly is working at a great disadvantage for want of proper storage capacity. During the year full monthly examinations of the water have been made by Dr. Thorpe, as formerly made by the late Sir Edward Frankland. There have also been made by Dr. Thorpe tri-weekly examinations which were usually confined to the determination of the amounts of " oxygen consumed " and " albuminoid ammonia." Water fittings. At the close of the year the eight metropolitan water companies made new regulations as to water fittings in substitution for those made in 1872. The Council resolved to inform the Local Government Board of its desire to be represented at the enquiry which would be held before confirmation of the regulations. A conference was subsequently held in the County Hall between the Council and the borough councils, and it was resolved to oppose the confirmation of the regulations which were objectionable in many respects. The enquiry was subsequently held at the Westminster Town Hall, and in view of the opposition of the various authorities the regulations were withdrawn. The London Equalisation of Rates Act, 1894. The Equalisation of Rates Act provides that the London County Council shall in each vear form a fund equal to a rate of sixpence1 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 parishe's 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 the 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 The capacity of subsidence reservoirs belonging to the several companies and the monthly average of filtration are shown in the following table— Names of Companies. Capacity of subsidence reservoirs. No. of days' supply. Monthly rate of filtration per square foot per hour. tean monthly averages. Maximum monthly averages. Chelsea 14.8 1.75 1.75 East London 28.8 .99 1.50 Grand Junction 2.9 1.22 1.45 Lambeth 4.9 2.03 2.20 New River 4.3 2.34 2.63 Southwark and Vauxhall 13.4 1.50 1.50 West Middlesex 18.7 1.27 1.50 71 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 has been guilty of such default as in suck 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 an estimate of population 011 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 of the parish. The following table shows the estimate of population on the 6th April, 1900, anc amount of excess of contribution over grant, or of grant over contribution in respect of district for the year ended 31st March, 1901. Sanitary District. Estimated population, 6th April, 1900. Equalisation charge, being excess of contribution over grant. Net grant, being excess ot' grant over contribution. £ s. d. £ s. d. Paddington 124,252 7,777 18 7 - - - Kensington 170,705 18,309 4 - - - - Hammersmith 108,212 - - - 6,822 18 8 Fulham 127,645 - - - 9,533 8 3 Chelsea 97,864 395 4 8 - - — St. George, Hanover-square 79,462 34,021 15 7 - - - Westminster 50,068 12,817 14 8 — - — St. James 22,778 15,934 1 6 — - — Marylebone 139,188 11,793 17 5 - - - Hampstead 82,083 4,866 2 8 - - - Pancras 237,382 - — - 7,255 7 9 Islington 337,442 - - - 24,185 5 5 Stoke Newington 35,033 - - - 1,550 15 3 Hackney 220,198 - - - 17,802 5 9 St. Giles 36,370 3,555 18 3 - - - St. Martin-in-the-Fields 12,350 12,305 12 8 - - - Strand 23,654 12,350 15 - - - — Holborn 30,669 4,513 12 7 - - — Clerkenwell 67,801 - - - 3,289 11 9 St. Luke 40,979 1,258 - - - — — London, City of 29,880 107,171 12 3 - - - Shoreditch 121,046 - - - 7,176 17 — Bethnal-green 125,654 - - - 14,413 13 6 Whitechapel 73,837 - - - 4,099 5 8 St. George-in-the-East 46,288 - - - 4,516 18 10 Limehouse 56,962 - - - 4,140 9 2 Mile-end Old-town 109,342 _ _ _ 12,614 12 11 Poplar 169,180 — — — 16,281 19 3 St. Saviour, Southwark 22,333 4,461 12 8 - - - St. George, Southwark 63,640 - - - 5,618 3 5 Newington 121,131 - - - 12,138 5 7 St. Olave 10,256 3,269 19 9 - - — Bermondsey 83,370 - - - 6,316 15 11 Rotherhithe 39,740 - - - 2,726 2 3 Lambeth 300,378 - - - 18,804 — 7 Battersea 174,557 - - - 12,895 7 4 Wandsworth 221,095 - - - 10,798 17 1 Camberwell 259,297 - - - 23,503 15 9 Greenwich 185,154 - - - 12,237 2 2 Lewisham 128,947 - - - 7,151 7 - Woolwich 41,284 - - - 1,612 16 4 Lee 44,631 - - - 1,412 5 11 Plumstead 67,096 - - - 8,074 3 - The Charterhouse 139 295 8 - - - - Gray's-inn 264 338 18 1 - — — The Close of the Collegiate Church 393 25 3 6 - - - of St. Peter Inner Temple 148 556 8 2 - - - Middle Temple 105 340 14 11 - - - Lincoln's-inn 18 467 16 10 - - - Staple-inn 9 74 12 9 - - - Furnival's-inn - 70 7 - — — — 72 Sanitary Officers (London) Order, 1891. In July the Council received a letter from the vestry of St. George, Southwark, stating that the vestry had recently considered a proposal for the appointment of a female sanitary inspector, part of whose duty should be to teach mothers and other inmates of houses habits of cleanliness and the best methods of utilising food, and also to give them instruction in the feeding and bringing up of children. The Local Government Board had been unable to approve the appointment, inasmuch as these duties were not among those assigned to sanitary inspectors by the Sanitary Officers (London) Order, 1891, and pointed out that the work of instructing mothers in the feeding, care and nurture of infants is one which requires training of a high order to be carried out with advantage, and that the possession of the certificate of the Sanitary Institute or Sanitary Inspectors' Examination Board is no evidence that its possessor has had any such training. The Board was, however, prepared to sanction the appointment for the purposes of the repayment of a moiety of the salary of such office, so far as related to that portion of her time which would be employed upon the duties specified in the Order. The vestry were of opinion that the Order should be altered so as to include the duties to be assigned to such an office as the one contemplated. The Council, on the recommendation of the Public Health Committee, resolved to inform the Local Government Board of its willingness to pay half the salaries of female sanitary inspectors who, in addition to their other duties, would take opportunities of inculcating cleanliness and the best methods of utilising food. The following table shows the month in which the annual reports of the medical officers of health of London sanitary districts, relating to the year 1900, were received by the Council—• February, 1901 1 July, 1901 7 March 5 August 3 April „ 2 Sept. „ 9 May „ 6 Oct. „ 3 June „ 14 In the case of three districts no reports have yet been received. Shirley F. Murphy, To the London County Council. Medical Officer of Health. December, 1901. 73 Medical Officers of Health of London Sanitary Districts in 1900. Sanitary district. Medical officers of health. Battersea W. H. Kempster, M.D. Berinondsey J. Dixon, M.D. Bethnal-green G. P. Bate, M.D. Camberwell F. J. Stevens, M.R.C.S. Chelsea L. C. Parkes, M.D. City of London W. S. Saunders, M.D. (since deceased). Clerkenwell G. Newman, M.D. Fulham J. C. Jackson, L.R.C.P. Greenwich—Deptford H. W. Roberts, M.R.C.S. Greenwich C. H. Hartt, L.R.C.P. Hackney J. K. Warry, M.D. Hammersmith N. C. Collier, L.R.C.P. Hampstead E. Gwynn, M.D. Holborn W. A. Bond, M.D. Islington A. E. Harris, L.R.C.P. Kensington T. O. Dudfield, M.D. Lambeth J. Priestley, M.D. Lee—Charlton H. L. Bernays, M.R.C.S. Eltham T. Moore, F.R.C.S. (since deceased). Lee H. C. Burton, L.R.C.P. Lewisham S. B. Jolly, M.B. Limehouse I). L. Thomas, M.R.C.S. Mile-end Old-town T. Tavlor, L.F.P.S. Newington G. Millson, L.R.C.P. Paddington R. Dudfield, M.B. Plumstead S. Davies, M.D. Poplar—Bow R. M. Talbot, L.R.C.P. Bromley and Poplar F. W. Alexander, L.R.C.P. Rotherhithe J. Shaw, M.R.C.S. (since deceased). St. George-in-the-East B. R. Rygate, M.B. St. George, Hanover-square W. H. Corfield, M.D. St. George-the-Martyr F. J. Waldo, M.D. St. Giles S. R. Lovett, L.R.C.P. St. James J. Edmunds, M.D. St. Luke G. E. Yarrow, M.D. St. Martin-in-the-Fields J. J. Skegg, M.R.C.S. St. Marylebone A. W. Blyth, M.R.C.S. St. Olave W. A. Bond, M.D. St. Pancras J. F. J. Sykes, M.D. St. Saviour A. C. Elliman, L.R.C.P. Shoreditch L. T. F. Bryett, M.D. Stoke Newington H. R. Kenwood, M.B. Strand F. J. Allan, M.D. Wandsworth—Clapham O. Field, M.D. Putney W. Y. Orr, M.B. Streatham F. F. Sutton, M.D. T ooting C. de L. Brock, L.R.C.P. W andsworth P. C. Smith, M.D. Westminster J. Norton, M.D. Whitechapel J. Loane, M.R.C.P. Woolwich W. R. Smith, M.D. Sanitary districts mentioned in Schedule C of the Metropolis Local Management Act, 1855. St. Peter, Westminster (Close of the Collegiate Church) J. Norton, M.D. Grays-inn E. G. Younger, M.D. Lincoln's-inn S. R. Lovett, L.R.C.P. Inner Temple F. J. Waldo, M.D. Middle Temple Liberty of the Charterhouse G. Newman, M.D. Staple-inn Furnival's-inn Appendix I. London County Council. ENTERIC FEVER IN LONDON. REporet by the Medical Officer submitting a report by Dr. Hamer on certain localised prevalences of Enteric Fever in London in September, 1900. (Printed by order of the Public Health Committee, 6th December, 1900.) Public Health Department, 8, St. Martin's-place, W.C., January, 1901. 1.—In presenting to the Public Health Committee Dr. Hamer's report on outbreaks of enteric fever occurring in September, 1900, in Southwark, Lambeth and Kensal-town respectively, having regard to the conclusion at which Dr. Hamer has arrived, that an article of food not hitherto suspected of causing enteric fever has done so, I may refer to the method adopted in the inquiry into the circumstances of these outbreaks. 2.—Dr. Hamer has in each case selected a defined area in which the persons attacked with enteric fever resided, and has so far as practicable compared all the circumstances of those persons with those of other people living in the same area, but not infected with this disease. As the result of this comparison he has been able without any difficulty to negative the possibility that any of the agencies, commonly accepted as producing enteric fever, were concerned in the first two of these outbreaks, and the evidence he obtained has failed to show that any such agency was the cause of the third outbreak. It became obvious quite early in his inquiries in Southwark and Lambeth that the behaviour of the disease, its rapid appearance in a considerable number of persons, its multiple invasion of houses, and the peculiarities of the age distribution of the cases, were probably explicable on the hypothesis that infection had been received with a food supply. In his inquiry, one fact presented itself to him with overwhelming evidence, viz., that fried fish purchased at particular shops, one in Southwark the other in Lambeth, was the one and only article of food of common origin which had been partaken of by the sufferers as a whole in these areas. In the absence of any other adequate explanation of the phenomena he has intimately examined the possibility of this food being related to these outbreaks, and has come to the conclusion that the evidence on this question is so strong that this relation must be accepted. He has therefore stated all the circumstances bearing upon this hypothesis. In Lambeth, however, the connection between this article of food and the cases of enteric fever is perhaps less obvious than in Southwark, but there is much reason for thinking that this is due more to the smaller number of cases occurring and to conditions special to this area and which relate to peculiarities of topography and to distribution of persons of different social conditions and habits, than to any fundamental difference in the value of the evidence which is adduced. In the case of Kensal-town, the evidence which would tend to incriminate fish is in no way conclusive, but in the absence of other explanation of the attack of a number of persons with enteric fever, and in view of the evidence obtained in the investigation of the other outbreaks, it suggests the possibility that this food may have been the cause, of a number of cases of enteric fever in that district. 3.—It needs to be stated at the outset that Dr. Hamer's inquiries have related to areas in which apart from the special cause under consideration, some amount of enteric fever may be expected, and especially in the month of September, when the natural autumnal prevalence is established. He has, therefore, in his examination of the circumstances of each case of this disease endeavoured to exclude such cases as would, without any special superadded cause, have occurred in the defined areas, and further, to separate from cases which he believes to have been directly due to the special cause those which may be presumed to be due to personal infection received from an antecedent case. The result of so doing has left him with a large balance of cases which do not fall under either of the above headings and which he has described as the cases constituting in each area the " special outbreak." [5726 2 4.—If Dr. Hamer's explanation of the outbreaks in Southwark and Lambeth be correct it must obviously meet certain requirements. It necessitates that all the persons included in the special outbreak shall have eaten fried fish from a particular vendor at a time when they must have received infection, and it must be accepted that this requirement is substantially complied with. To those familiar with the difficulties attending such an inquiry it will be admitted that the cases concerning which Dr. Hamer speaks with less certainty on this point are exceedingly small in number. There are, indeed, only six cases in Southwark, among those in the special outbreak, which Dr. Hamer does not feel justified in definitely including among the consumers of fried fish from the particular vendor, at a time corresponding with the probable date of infection. Two of these may have done so, but the fact could not be ascertained from themselves. Of the remaining four, all were consumers of one fish or another from this vendor, who had two shops practically adjoining each other, one in which he sold wet fish, shell fish, &c., the other restricted to the sale of fried fish. Of these four, two may possibly have eaten fried fish purchased from this vendor. 5.—Dr. Hamer found that if he took a particular fried fish shop in Southwark for a centre and drew a circle of a quarter of a mile radius round it, he practically covered the ground in which the exceptional incidence of enteric fever was manifested in this locality. The cases of disease were found to be more thickly distributed near the centre than further away. In order to test the proportion of persons eating fried fish from this particular shop, two areas within the circle were taken for the purposes of detailed inquiry, and it was found that in these areas 42 per cent, of a total of 900 persons had eaten fried fish from this particular shop at a time when the Southwark population became infected. If we were to assume that these proportions obtained throughout the whole circle, which includes a population of about 25,000 persons, the incidence of disease upon the two classes of population, viz., those who purchased at this shop and those who did not, would be as shown in the following table. I have taken the facts relating to September for the statement of these proportions, so as to ensure inclusion of all cases possibly concerned with this cause. Total notified cases in tivo estimated populations in circle occurring in September.* Persons eating fried fish Persons not eating fried fish from particular shop. number infected. from particular shop. Number Infected. 10,500 101 14,500 11 Total notified cases in two estimated popndations in circle occurring in September* after deduction of secondary cases. 10,500 97 14,500 8 Total notified cases in two estimated populations in circle occurring in September* after deduction of secondary cases and of cases not regarded as associated with special outbreak. 10,500 96 14,500 0 * Exclusive of two cases concerning which there is doubt as to whether fried fish was eaten, and inclusive of four cases concerning which it was ascertained that fish but not that fried fish was eaten. 6.—It is however probable that this division of population into two classes on the basis obtained by inquiry in two areas, both of which it should be stated are situated between about 100 and 200 yards from the centre, may not represent the actual proportions in the whole circle.†In areas nearer the centre the proportion of persons dealing at this fried fish shop would, caeteris paribus, be greater, in areas more remote would be smaller. The matter may be further tested by limiting consideration to the population resident in a ring between 110 and 220 yards from the centre in which these areas are situated. The figures then obtained are as follows — Total notified cases in two estimated populations in ring between 110 and 220 yards from the centre and occurring in September. Persons eating fried fish Number infected. Persons not eating fried fish Number infected. from particular shop. from particular shop. 1,969 ... 39 2,718 ... 4 Total notified cases in two estimated populations in ring occurring in September after deduction of secondary ccwes.‡ 1,969 37 2,718 2 Total notified cases in two estimated populations in circle occurring in September after deduction of secondary cases and of cases not regarded as associated with special outbreak.‡ 1,969 36 2,718 0 † If we adopt the minimum percentage given by Dr. Hamer on page 12, namely, 25 per cent, instead of 42 per cent., the two populations would then be, respectively, 6,250 and 18,750. † Exclusive of one case concerning which there is doubt as to whether fried fish was eaten and inclusive of one case concerning which it was ascertained that fish but not that fried fish was eaten. 3 7.—Dr. Hamer has. in the majority of instances, not experienced much difficulty in Southwark in deciding which cases should be regarded as primary and which should be treated as secondary. Cases occurring in the same house within a day or two of each other and not preceded by an earlier case in the same house are necessarily regarded as primary, cases occurring a number of days after an antecedent case in the same house have been classified as secondary. As matter of fact, however, the number of cases occurring in September in which doubt can be entertained is so small as not to affect the general result, and especially as the majority had eaten fried fish from the particular shop. Concerning the exclusion of primary cases not regarded as associated with the special outbreak (9 in number in the circle and 3 in number in the ring), the facts which led to such exclusion will be found in the appendix to Dr. Hamer's report. Two of the nine, although notified as cases of enteric fever, were not found after admission to hospital to be cases of that disease, two others, there was reason for assuming, had contracted their disease outside London, and the remainder are not in larger proportion than must often be found occurring during an autumn month in a population of 25,000 persons without any common cause being assignable as explanation of their origin. So far, therefore, Dr. Hamer's hypothesis meets the requirement that the whole of the increment of cases occurring at that time in this population should have been subject to the particular cause which he is associating with the outbreak. 8.—This hypothesis may, however, be examined in another way. The habit of consuming particular articles of food is not shared equally by the population at all ages. An outbreak of enteric fever, shown by Dr. George Turner to be due to the consumption of ice cream (Deptford, 1891), had, as might be expected, a much greater incidence upon the younger ages, including children under 5 years of age. The age incidence of an outbreak of enteric fever, shown by Dr. Theodore Thomson to be due to water (Newport, 1894), had an age incidence different from that of an outbreak of this disease shown by Dr. Davies to be due to milk (Plumstead, 1895). If Dr. Hamer's hypothesis be correct, the age incidence of the Southwark outbreak should be exceptional if fried fish is not consumed equally at all ages. This, indeed, is found to be the case, for, while inquiries by the Council's inspectors showed that boys and girls, young men and young women, have been the principal customers of the particular shop, it will be seen that infants and older persons have escaped disease, and young persons have been especially affected, the incidence on the ages 10-20 years being particularly marked. This peculiarity of the age incidence of the Southwark outbreak is not only conspicuous when comparison is made with that of certain outbreaks due to food, but becomes much greater when comparison is made with the age incidence of enteric fever in London generally, which must be regarded as the total result of all the causes operating within the county. 9.—In conclusion of this part of the subject it may be said («) that the behaviour of the outbreak directly suggests that it was caused by the ingestion of an infected food; (b) that while all other food supplies commonly known to be capable of conveying infection can be excluded and many other foods also, fried fish cannot be thus excluded; that whether tested by the population in the circle or the ring taken for consideration, practically the whole incidence of the disease has been on the consumers of fried fish purchased at a particular shop, and that inquiries as to other articles of food pointed to no similar result; (c) that the age distribution of the disease in the outbreak is explicable on the hypothesis that infection was communicated by fried fish from the particular shop, having regard to the ages of purchasers and consumers of fried fish from this shop. After careful examination of Dr. Hamer's report, I am satisfied that these conclusions are well founded. 10.—While the positive evidence adduced by Dr. Hamer, that only fried fish eaters were attacked, points directly to the fact that this cause was operative, not less important is the exemption from attack of those who did not partake of this food, although the latter class constituted more than half the population in the area involved in the outbreak. This fact, moreover, obtains greater significance when the facts relating to particular families are considered, for Dr. Hamer found that, in numerous instances, the disease singled out the fried fish eaters for attack, and left unaffected the other members of the family who did not eat fried fish. 11.—It might be thought to be within the limits of possibility that explanation of the infection of purchasers at this fried fish shop could be found in some circumstances incidental to visiting the shop, but not necessarily including the consumption of the fried fish. Such hypothesis would, however, not afford explanation of the attack of persons who did not visit the shop themselves, but who received the fish in their own homes. 12.—In connection with the Lambeth outbreak it must be pointed out that the cases are less than half as numerous as those which occurred in Southwark, and do not therefore so well lend themselves to arithmetical statement. In the Lambeth outbreak, only one actual case of enteric fever occurred in September in which fried fish from the suspected source was not eaten, while in particular streets close to the shop, taken for the purposes of detailed inquiry, some 24 to 59 per cent, of the population had not obtained fried fish from this source. The topographical distribution of the cases was different from that of the Southwark cases, but Dr. Hamer's explanation of this circumstance is probably the true one (see p. 16). While the facts ascertained in Lambeth do not by themselves present the same amount of material for separate conclusion in their detail, they do not on any material point differ from those obtained in Southwark. 13.—The facts obtained in Kensal-town cannot be said to be in close agreement with those either of the Southwark or Lambeth outbreaks. A considerable proportion of the persons attacked had obtained wet fish or shell fish from a particular source, and a slightly smaller proportion had also obtained their milk from a common source. The proportion of cases which could not be associated with a common supply of any sort of food was much larger than in either of the two other districts. 4 14.—The question how fried fish should be capable of conveying the infection of enteric fever is one to which no answer can at present be given. If due to surface contamination before cooking it is probable that this process would destroy the infection ; if due to infection within the fish it is improbable that the fish would be sterilized thereby. These points could be determined only by experiment. With respect to the question generally, as to how the fish acquired infective property, Dr. Hamer found no reason for thinking that specific contamination occurred on the Southwark premises, and if both the Southwark and Lambeth outbreaks were due to the consumption of fish, this fact would strongly militate against the view that such contamination had occurred in either of these districts, and points to some earlier period at which the fish became infected. 15.—It will be noted in connection with the four cases of enteric fever mentioned as possible exceptions in the Southwark outbreak, that the consumption of fish purchased as wet fish cannot be wholly excluded as a possible cause, and in this relation it may be stated that not infrequently fried fish shops are owned by the vendors of wet fish, and transference of fish from one to the other is, under these circumstances, of likely occurrence. Fish purchased as fried fish in Southwark comprises plaice, haddock and skate. The fish is fried in cotton-seed oil, and, beyond the batter in which it is cooked and the occasional addition of potatoes, no other foods are generally associated with the sale of fried fish. Shibley F. Murphy, Medical Officer of Health. Diagram shewing the number of ca.ses of. enteric feva- notified in london during the, 33rd 48th weekk of- 1900, in relation, to the mean notifications in the corresponding weeeks of the periods 1890- 99 NB The black columnsrepresent the nuiriber of cases notified itv fhest'^ Weeks in Lambeth/, Chelsea & StGeorge, Soutav. Diagram II. 5 Dr. HAMER'S REPORT. On the 20th September, 1900, the medical officer of health received from Dr. Parkes, medical officer of health of Chelsea, a list of 15 cases of enteric fever which had been notified since the first day of the month in Kensal Town. Dr. Parkes wrote saying that he had made careful inquiry concerning this outbreak, but was unable to find anything definitely pointing to a particular cause. He discussed the question of milk supply in some detail, inasmuch as he had at that time found that 7 of the 15 cases had been obtaining milk from a particular local vendor; moreover, milk from one of the sources of supply of this vendor was traced to four other cases supplied through the agency of a second local vendor. On this day, September 20th, and the following day, more or less contradictory statements appeared in the press concerning prevalence of enteric fever in various parts of South London, and I was instructed to inquire into the question generally. The Council not being the authority receiving copies of certificates under the provisions relating to notification, some difficulty was at first experienced in following the matter up, but ultimately it was ascertained shortly before two o'clock on Saturday, the 22nd September, that upwards of 20 cases had been notified within the past few days in St. George-the-Martyr, Southwark, while it was also observed that in London as a whole the cases notified during the week ending September 15th showed a marked increase as compared with the preceding week, the numbers notified in the two weeks being 74 and 128. As question was thus raised as to the possible distribution over widely-separated areas of some infected article of drink or food, further inquiry was obviously necessary. Here again difficulty was experienced, as Dr. Waldo, the medical officer of health of the district in which the larger outbreak had thus suddenly declared itself, had been ill, and was out of town. I was, however, afforded every assistance by the chief inspector and other officers of the authority of the district, and was able, having in view the facts already ascertained by them, to form a rough provisional conclusion that milk, which was especially the object of suspicion at the moment, was not at fault. On reporting the result of my inquiries to Mr. Shirley Murphy, he decided to himself prosecute further inquiry the same evening, at certain hospitals to which the patients had been removed, and it was arranged that we should meet the following day (Sunday, 23rd September), and endeavour to learn certain additional particulars in the affected area. The age distribution of the cases in Southwark was from the first seen to be quite exceptional, the age groups 5-10 years, 10-15 years and 15-20 years being especially affected, and this, as well as certain other considerations, led to careful investigation being made concerning ice-cream. As the result of inquiry on September 23rd, it became, however, practically certain that neither milk nor ice-cream had caused the outbreak. The question of water supply was not, of course, lost sight of, but here again the facts as they came to light pointed to a negative conclusion. Exact knowledge as to the origin of the water supplied to all the houses in the area was not forthcoming until some days later, when it was obtained from the officers of the Lambeth Water Company. It was then quite clear that water had not been concerned in conveying infection. On conferring with Dr. Waldo on the morning of the 24th September, water, milk and icecream could be practically excluded from consideration as causes of the observed prevalence. The sudden appearance of the outbreak and the simultaneous attack in several instances of two or more members of one family were facts strongly suggestive of food as the medium of infection. We decided therefore to make thorough inquiry as to possible collections of persons—and more particularly, having regard to the age distribution of the cases, of young persons—at "parties" and "school treats," and in connection with "days in the country" and the like. The question of shell-fish also presented itself, and a suggestion was made by Dr. Waldo that the subject of public swimming-baths required to be considered. This last-named hypothesis seemed to somewhat closely fit the facts as to the age incidence of the disease in the light of such knowledge as in the first instance came to hand; when, however, more extended inquiry was made, it was found to altogether fail to explain the phenomena observed. Meantime it had become apparent, as the result of examination of the notification returns, that there was a third well-marked localised prevalence of enteric fever in London, affecting certain streets in Lambeth, and this third outbreak was found to present, though in much less marked degree, peculiarity of age incidence similar to that observed in the Southwark outbreak. The age and sex incidence in the three outbreaks is shown in diagram I., the age and sex distribution in London as a whole, in 1899, being given for purposes of comparison. In diagram II. the extent to which the prevalence of enteric fever, in the three sanitary districts concerned, affected the notifications (in the 37th, 38th and 39th weeks) for the whole of London, is shown. In Kensal Town the question of milk supply was still the subject of careful attention. As case after case was notified and inquired into, the judgment leaned now on the side of suspicion and now on that of complete acquittal of the milk. The problem was a very difficult one, inasmuch as though a large percentage of the persons attacked in Kensal Town had, it was ultimately found, been supplied with milk derived from one company, that company was ascertained to be supplying, through the agency of various retail vendors, at the very least, more than half the inhabitants of the streets attacked. Again matters were complicated by the fact that a group of cases occurred in St. Pancras, at about this time, and among the sufferers were eight consumers of milk supplied by a particular local vendor; question arose as to whether the source from which this vendor obtained his milk was identical with the source from which the Kensal Town supply was derived.* In North Kensington too a slightly increased prevalence * It transpired that the St. Pancras vendor, whose main supply was from his own cows, 14 in number, supplemented this to the extent of about two gallons daily, and from time to time obtained the additional milk from the company which was supplying the Kensal-town vendor. This company conducted a very large business and, in the north-west of London more particularly, was supplying a great many local vendors with milk. 6 of enteric fever was noted, and here again a similar question arose.† Further inquiry was seen to be necessary in Southwark with a view to tracing in each instance the remote source from which local vendors were obtaining their milk, and, with a view to obtaining the same information as to the Lambeth cases, Dr. Priestley, the medical officer of health of Lambeth, was communicated with, and he made similar inquiries in his district. The result of these inquiries was to show that in Lambeth no milk from the source in question was distributed, in St. George-the-Martyr only a small percentage of those attacked was supplied from this source, and even in Kensal Town, where the incidence upon persons drinking milk supplied by the particular company was marked, a considerable percentage of the sufferers from enteric fever obtained milk from entirely different sources. It became, therefore, in the course of a very short time clear that, striking as was the incidence of enteric fever in Kensal Town upon consumers of milk obtained from the particular source, and curious as was the fact that in distantly remote parts of London, milk supplied by the same company had been in a few instances partaken of by persons who had developed enteric fever, these circumstances were really devoid of special significance, having regard to the extensive scale on which the supply in question was distributed. In St. Pancras the incidence upon consumers of the local vendor's milk was striking, eight cases of enteric fever, which developed symptoms between August 24th and October 1st in a circumscribed area, all obtaining milk from this source. The local vender's supply may, however, have been contaminated on his own premises.‡ There was in any case no reason for regarding the St. Pancras outbreak as possessing more than local significance. From the particulars to be presently given, it will be seen that milk could be definitely excluded from consideration as cause of the outbreaks in Southwark and Lambeth, and could almost certainly be excluded in the case of Kensal Town. Such time as could be found for the work was meanwhile devoted to house to house inquiry, with a view to recording any facts that were ascertainable in St. George-the-Martyr, where inquiry was then prosecuted. Questions of sewerage, drainage and refuse disposal were of course considered, but no indication of a source of infection was forthcoming under these heads. The manner of grouping of the dates of attack in time was seen to be suggestive of infection on a particular day or limited number of days, and this fact, taken in conjunction with facts already referred to, pointed strongly to infection by some kind of drink or food. The difficulty, so far as most of the possibilities passed in review were concerned, was felt to be the exceptional age incidence of the disease. All attempts to find explanation of the phenomena in some gathering together of persons attacked proved unavailing; the baths and ice-cream hypotheses, which would have to some extent met the requirements as to age incidence, failed to comply with other necessary conditions. The question of shell-fish had from the first been kept in mind, and indeed the extent to which the streets of the area were strewn with periwinkle shells made it impossible, in the light of recent discussion concerning shell-fish and enteric fever, to ignore the possibility of infection having been thus conveyed. But a shell-fish hypothesis proved quite untenable on closer examination. Oysters, it was found, had not been eaten by persons living in the affected area; only cooked shell-fish, generally speaking, appeared to be consumed there. But it was soon evident that even on grouping together the comparatively numerous consumers of periwinkles and the far less numerous consumers of mussels, cockles and whelks, and indeed, on further adding to these the persons who occasionally purchased shrimps, there would still remain, outside the group so constructed, a considerable percentage of the total number of those attacked by enteric fever. The question of age in relation to shell-fish consumption was never reached, inasmuch as this article of food did not fulfil the cardinal requirement of having been generally eaten by persons suffering from the disease. Many other articles of food and drink were made the subject of inquiry. The mother of one of the patients, on being asked to state, as far as she was able, what food and drink her boy was in the habit of consuming, remarked, " The only thing he ever did eat in this house (her son lived away from, and only visited in, the affected area) besides bread and butter was a bit of fried fish." This remark prompted more particular inquiry in subsequent cases concerning fried fish, and it then became speedily apparent that most of those who had been attacked, and who were questioned on this subject, had consumed this article of food, and, moreover, had obtained it from a particular shop. Again, on examination of the distribution of affected houses, it was evident that they were grouped about this shop as a centre, and further, that the intensity of incidence of house attacks rapidly diminished at increasing distances from the shop. This was not all; in several instances it was found, in particular families, that it was the fried-fish eaters who were attacked, to the exclusion of other persons not eating fried fish. Four principal difficulties stood in the way of seriously considering the hypothesis that infection had been conveyed by fried fish. In the first place the heat to which the fish was subjected in the process of frying would be not unlikely to destroy the typhoid bacillus. Secondly, question arose as to how it was possible for the fish to have been originally infected. Thirdly, there was the age incidence difficulty, and fourthly, it was of course conceivable, in the absence of precise knowledge of the customs of persons living in the area in regard to fried-fish eating, that almost everyone was in the habit of consuming fried fish from the particular shop, and that no special significance could therefore be attached to the observed fact that practically all the sufferers from enteric fever had eaten this fish. †In this district it was ultimately found that of the group of eleven cases which had to be dealt with, only three were obtaining their milk, at the time when infection presumably occurred, from the company already referred to. ‡The first case of enteric fever, in the St. Pancras group of cases, occurred in a woman living on the milk vendor's premises who had recently returned from Wales, and this case may possibly have been the source of infection of the others. 7 Of these the first objection in itself might have been regarded as a fatal one, had it not been for the recollection of certain experiences in connection with cholera. In the report of the medical officer of health of the County of London on Cholera in London in 1893 (appendix II., annual report for 1893) there is noted the fact that two persons suspected to be suffering from cholera in Clerkenwell in that year had consumed fried fish said to have come from Grimsby (cases 8 and 9). Again, case 1, "the Westminster case," which proved, on bacteriological examination, to be a case of Asiatic cholera, had also a history of having eaten fried fish—for supper three days before the date of attack. In cases 8 and 9 the bacteriological examination gave a negative result, but these cases were included by Dr. Barry in his report to the Local Government Board as cholera cases; they seem to have been so included mainly on account of the existence of the thread of connection between them and Grimsby, afforded by the history of their having eaten fish from that port. With these cases in view it did not appear justifiable to altogether dismiss the fried fish hypothesis from consideration on mere a priori grounds. Moreover, a little observation made it clear that the ages of consumers of fish would have to be made the subject of study. Persons entering and leaving the fried-fish shop were seen to be for the most part young persons; inquiries made on this point as to fried-fish eaters in other parts of London corroborated this impression, and it was clearly, therefore, desirable to pursue the matter further and obtain precise information on this head. On September 27th inquiry was made as to the sources from which the particular fish shop was supplied. The origin of most of the fish could be traced, but certain supplies were purchased concerning which detailed information was not available. On the same day the suspicion entertained concerning fried fish, together with the information obtained with regard to sources of supply, was communicated both to Dr. Parkes and Br. Priestley. From this date onwards much time was spent in studying the facts as to the Southwark cases, and this necessitated, since the large majority of the patients were removed to hospital, a number of visits to hospitals of the Metropolitan Asylums Board ; this work was much facilitated by the cordial aid given by the medical superintendents and assistant medical officers of these institutions. While this work proceeded careful observation was kept by the Council's inspectors under the direction of Mr. Jury, the chief inspector of common lodging-houses, upon the fried fish shop, and, for purposes of comparison, upon several other fried fish shops, and as the result of these inquiries it became clear that the ages specially attacked in the Southwark outbreak were the same as those observed by the inspectors to be represented in large proportion among the persons consuming fried fish. Age incidence, in place of being a difficulty, was, in so far as importance could be attached to it in the face of other difficulties, suggestive of fried fish as the cause of the outbreak. It was now clear that the fish hypothesis required to be carefully examined from the statistical side, and this was accordingly done. The particulars gradually accumulated in Southwark showed more and more clearly that while the question as to whether the observed relation between consumption of fried fish and enteric fever was one of cause and effect or of mere chance coincidence was a complicated one,, there was good reason for deciding that the relation was one of cause and effect. It became important therefore to study the facts in regard to the outbreaks which had occurred practically simultaneously in other parts of London, in the light of the Southwark experience. In Lambeth Dr. Priestley had formed the opinion that the disease had been spread in the main by infection transmitted in the course of wringing and mangling operations. He caused inquiries to be made, however, with regard to fish, and pointed out certain difficulties in the way of accepting a fried-fish hypothesis as explanation of the Lambeth outbreak. These difficulties required to be carefully examined. In the outcome it appeared that the Lambeth case, considered by itself, did not do more than raise a suspicion, but it assumed larger importance when it was borne in mind that its occurrence nearly coincided in point of time with the Southwark outbreak. Lastly, the question of Kensal Town had to be considered. Dr. Parkes had given directions for the facts to be ascertained, and Mr. Metzler, the sanitary inspector, readily gave me all the assistance I desired in this connection. The chief inspector of Kensington, Mr. Pettit, moreover, obtained for me particulars concerning cases occurring in North Kensington, in the near neighbourhood of Kensal Town. The facts as to Kensal Town were found to be in marked contrast in several respects with those of the other two prevalences; in themselves they afford little or no support to the hypothesis of distribution by fish, but they are perhaps deserving of study in connection with the other outbreaks. I therefore proceed to give a brief resume of the particulars ascertained in each of the three districts. Southwark. The locality affected in St. George-the-Martyr, Southwark, was of very limited extent, inasmuch as with three exceptions all the cases belonging to that parish, in which symptoms of enteric fever commenced between September 4th and September 24th, were notified from houses within an area of considerably less than a quarter of a square mile. A few cases occurred at about the same time in an adjoining portion of the parish of St. Saviour, Southwark, and it was found that these cases and the St. George-the-Martyr cases (with the exception of the three already referred to) could all be included within a circle having a radius of a quarter of a mile. The precise position of the limiting circle was determined by considerations to be afterwards specified; it will be sufficient here to say that the area as defined on the accompanying map includes all the cases above referred to, with the exceptions noted. The circle was found to cover, at its south-eastern border, a small strip of land in the parish of Newington. The area thus defined contains a group of large blocks of tenement dwellings six storeys high, with gloomy courtyards, dark staircases, and other 'sanitary defects; these dwellings afford accommodation 8 to about 3,000 persons, and were fully occupied at the time of inspection. The area also contains several streets of tenement houses, occupied to a large extent by families apparently possessed of the very narrowest means, and some courts and alleys which have been officially represented as constituting an unhealthy area under the Housing of the Working Classes Act. It includes, moreover, large business premises, the fire brigade headquarters, and a limited number of houses, for the most part fronting upon main thoroughfares, occupied by tradespeople and others above the border line of poverty. The behaviour of enteric fever in this area may be best appreciated by reference to the table annexed. On the left-hand side of the page on this table are exhibited the cases of enteric fever developing within the circular area in Southwark on successive days between August 16th and October 10th.* The cases are numbered consecutively, and are grouped in three columns; the first and third columns contain " primary cases," the second column cases in which the sufferer was apparently infected by a person previously attacked and living (save in three instances specified in the appended notes) in the same house as that in which the presumed " secondary case " occurred. The reason for grouping the primary cases in two columns and for printing the numbers in different colours will presently appear, but for the purpose of indicating the time relations of the onset of attacks of enteric fever in the area, these distinctions may be disregarded. It will be seen for example that in the latter part of August enteric fever was of relatively rare occurrence in the area, only three cases developing between August 16th and the end of the month. Early in September, however, marked increase in prevalence of the disease manifested itself, and on September 6th two persons (Nos. 8 and 9), on September 7th three persons (Nos. 10 to 12), and on the 8th four persons (Nos. 13 to 16) were attacked on one and the same day. The number of persons attacked (and subsequently notified) reached a maximum on September 15th; the daily number then somewhat irregularly declined until, on September 24th (for the first time for nearly three weeks) only one patient was attacked in the twenty-four hours. From this time onwards the number of attacks did not exceed two in the day. Indeed, if secondary cases (in column 2) be excluded from consideration, it will be seen that the number of cases developing in the area had, at the end of September and in October, returned to what may be thought of as approaching normal limits; for though the cases are of somewhat more frequent occurrence in this post-epidemic period than they were in the pre-epidemic period, it must be remembered that seasonal influence has to be taken into account, and that the period to which the lower part of the table relates would, on this account, be expected to yield more cases than the period covered by the upper part. The dates to which cases have been allocated in the table just referred to are dates of onset of symptoms; these dates have been determined, in those cases in which patients were removed to hospital (and they form the large majority of the cases), after consideration of the hospital notes and temperature charts, and from information kindly furnished by the medical superintendents of the hospitals. The dates of notification of the cases are given in the appended notes. The two cases marked with an asterisk (*) proved not to be cases of enteric fever. The red dagger (†) which adjoins case 39 indicates another case, one which was not notified but was probably a case of enteric fever. Drainage and refuse removal.—Direct means of access of sewer air to the interior of houses was only quite exceptionally found to exist; sink wastes were disconnected, and water-closet appliances as a rule of a fairly satisfactory character. The drains themselves were in certain instances found to be faulty. Dr. Waldo, in reporting to the vestry on the drainage of the affected locality on October 18th, remarked that " several of the house drains—which are both separate and combined—are only imperfectly ventilated and are apparently not disconnected by any trap from the sewers. In 17 instances the house drain was found on examination with the chemical test (an imperfect one) in use by your authority to be defective. Steps have been taken to remedy these defects. The sewers into which the sewage drains are mostly imperfectly ventilated or not ventilated at all, and some of them (three particular sewers are specified) have been condemned by your surveyor." These conditions do not, of course, afford adequate explanation of the outbreak. As regards refuse disposal, it should be noted that there are dust shoots in the blocks of buildings referred to above, and serious nuisance was caused by these in several instances. Speaking generally, but few accumulations of dust were noted in the course of inspections made in the area. Water supply.—It was found that about half the houses in the area specially invaded were supplied by the Lambeth, and the other half by the Southwark and Yauxhall Water Company. The cases of enteric fever were distributed just about equally between the two companies—i.e., practically in the proportion in which they might a priori have been expected to he distributed. Complaints were made concerning pollution of water in storage cisterns in some of the blocks of dwellings above referred to; this question, however, while serious in itself, could not be regarded as of importance in connection with the outbreak of enteric fever. Milk supply.—The milk supply of infected houses was very varied. In about one-third of the houses involved in the outbreak condensed milk only was consumed. The brand of condensed milk used Vwas ascertained in many instances, and it was found that at least four different brands were represented, though one brand attained a decided position of predominance. As regards the remaining two-thirds of the houses involved, in a few both condensed milk and ordinary milk were used, in the large majority cows' milk only was employed. A particular local vendor, indicated by the letter B in the appended notes, supplied rather more than half these houses—i.e., about one-third of the total number of houses involved in the *This period includes rather more than a fortnight before, and after, the period of special prevalence in Southwark. Cases of Enteric Fever belonging to three areas and beginning on successive days from August 16th to October 10th, 1900. Date of onset of symptoms. Southwark. Lambeth. Kensal-town. Cases§ probably not associated with special outbreak. Secondary cases. Cases constituting "special outbreak." Cases§ probably not associated with special outbreak. Secondary cases. Cases constituting "special outbreak." Cases§ probably not associated with special outbreak. Secondary cases. Cases constituting "special outbreak." Aug. 16 1 „ 17 „ 18 „ 19 2 „ 20 1 „ 21 l „ 22 „ 23 2‡ „ 24 3 „ 25 2 „ 26 3 „ 27 3 „ 28 4 4 ,, 29 † 5‡ „ 30 5 6 7 „ 31 6 † 8 9 10 Sept. 1 4* 7 8 9 11 „2 „ 3 5 10 11 12 12 „ 4 6 13 14 15 16 13 „ 5 7 „ 6 8 9 14 15 „ 7 10 11 12 17‡ 16 „ 8 13 14 15 16 18* 18a 17 „ 9 17 18 19 20 21 22 23† 19‡ „ 10 24 25 26 27 28 29 30 31 20 21 „ 11 32 33 34 35 36 37 38 39‡† 22 23 24 18 „ 12 40 41 42 43 44 25 19 20 „ 13 45 46 47 26 „ 14 48 49 50 51 52 53 54 27 28‡ 21 „ 15 55 56 57 58 59 60 61 62 63† 29 30 31 „ 16 64 65 66 67 68 69 70† 71‡ 32 „ 17 72 73 74 75 76 77 78 79 33 34 22 „ 18 80 81 82 83 84 35 36‡ 23 „ 19 85 86 87 88 89 37 ,, 20 90* * 91 92 93 94 95 96 97 38 „ 21 98 99 100 101 39* 40 24‡ „ 22 102 103 104 105† 41 „ 23 106 107 108 109 42 25 „ 24 110 43 44 45 45A „ 25 111 112 46 26 27 „ 26 113 47* 28 29‡ ,, 27 114 „ 28 115 30 „ 29 116 31‡ „ 30 117 32 Oct. 1 48 49 „ 2 50 33 34‡ „ 3 118 51 „ 4 52 „ 5 119 53 54 „ 6 120 7 121 122 55 „ 8 123 124 „ 9 125 56 „ 10 126 35 36+ § The reasons for regarding some eases as contributing to the "special outbreak " and others as not will be seen later. The significance of the asterisks, &c., in the above table will also be shown. [5726 9 outbreak. No other local vendor supplied more than a very small number of houses. B's business was a considerable one, and his premises were situated not far from the centre of the area affected, so that it might be anticipated that a considerable percentage of persons attacked would be supplied with milk by him. B was the occupier of cowshed premises, with accommodation for 16 cows, and his milk was obtained almost exclusively from his own cows. The wholesale supplies of all the local vendors were made the subject of inquiry; the facts have now no special interest; in the early days of the outbreak it had been noted as remarkable that four of these local vendors Messrs. A, D, G, and I—were obtaining milk from the company supplying the vendor in Kensal Town, in connection with whose business the question of the relation of milk supply and enteric fever was at the time being carefully investigated.* Use of swimming baths.—In the early days of the outbreak importance was attached to the fact that a number of the sufferers had been in the habit of visiting a twopenny swimming bath in connection with some public baths situated a little to the north of the affected area. It was from the first obvious that considerable difficulty must be experienced in endeavouring to connect the use of a swimming bath, situated as this one was, with the outbreak of enteric fever, inasmuch as the bath was quite outside the locality invaded by the disease, and while it was largely used by residents in that locality, was also unquestionably used by many other persons, all of whom had escaped infection. The number of those attacked who had attended these baths led, however, to careful inquiry being made into the matter. On October 5th Dr. Waldo and I obtained, by the courtesy of the superintendent of the baths, full particulars concerning them. Most of the sufferers from enteric fever who made use of the twopenny swimming bath were school children, and it was found to be the practice for parties of such children to be taken to the baths for the purpose of being taught to swim. During the week ending August 25th 1,296 males used the twopenny swimming bath, and 67 boys, scholars at various schools, were also taken there. Thirty females and 42 girl scholars used the bath in that week. In the week ending September 1st the numbers were 792 males and 615 boy scholars; 18 females and 285 girl scholars. In the week ending September 8th, the corresponding numbers were 906 males and 727 boy scholars; 19 females and 248 girl scholars. Most of the swimmers (other than boy and girl scholars) were said to be under thirty years of age, so that prima facie the bath hypothesis afforded some promise of fitting in with thepeculiar age incidence of the enteric fever, but, on the other hand, it appeared difficult to understand how it was that, whereas the scholars were only about half the total number of swimmers, the cases of enteric fever, in which a history of attendance at the baths was given, were, for the most part, confined to them. Again, the cases of enteric fever among scholars had principally affected those attendin g two particular schools, and there were some dozen schools sending scholars to the swimming baths; thus scholars attending the rest of these schools had almost entirely escaped. The facts were fully ascertained as regards use of the baths by scholars, and they may be summarised as follows— On Mondays boys from schools A, B, C and D attended the baths. On Tuesdays boys from schools B, E and F attended the baths. On Wednesday girls from schools A, C, D, F, G, I, J, L, M and two other institutions attended the baths. On Thursdays boys from schools G, H, F and I attended the baths. On Fridays boys from schools C, H, J, K, L and M attended the baths. All these children used the same swimming bath. This bath was cleansed and scrubbed on the following dates—August 14th, 16th, 18th, 21st, 25th and 28th; September 1st, 4th and 8th. The particulars as to attendance of individual sufferers at the baths are given in the appended notes, in which these particular baths are referred to as the " X" baths. Limiting consideration to the cases numbered 6 to 110 (i.e., to the cases occurring at the time of special prevalence) particulars as to attendance at the baths in question were ascertained in 83 instances. In 52 of these the patient never attended at the particular baths, and in some of the 31 instances in which such attendance was made, it is noted as having occurred some weeks before the onset of illness; again, in one or two cases it was the " first-class bath," and not the twopenny swimming bath which was visited. Most of the cases occurring among scholars who attended the baths were cases of boys and girls going to the school J (the girls from this school attended the baths on Wednesdays, the boys on Fridays). A few boys attending the school B, who attended on Mondays and Tuesdays, were also attacked. Girls from this school are not taken to the baths. These two schools, it may be noted, are the schools attended by the majority of children living on the area, but school J accommodates more children from the area than school B does. Lists of children who attended the baths on particular days were obtained by Dr. Waldo; they corroborate the particulars as to bath attendance obtained from the patients themselves. It was at first thought to be conceivable that infection of the water in the bath occurring, say, after the bath was cleansed on August 28th (Tuesday), might have led to infection of boys *The local vendor B on very rare occasions, " when he ran short," obtained a gallon extra, but could not specify whence such extra supply would be derived. He was sure he had not had any extra milk for about a month before the commencement of the outbreak. B's manager subsequently confirmed this last statement, and enumerated the sources from which extra milk had been obtained in the past summer; these sources did not include the company supplying milk in Kensal Town, and the manager on being asked said no milk had been obtained from that company. It may be noted that even supposing B to have received a gallon of milk from this company, the proportion of sufferers supplied with milk derived from the large company would still, under these circumstances, be less than half the total number of persons attacked. [ 2 ] 10 in school B who attended the baths on that day, of the girls from school J who went to the baths on the 29th (Wednesday), and of boys from school J who went on the 31st, (Friday), and then have ceased to operate after the next cleansing of the baths on September 1st (Saturday). The escape, however, of scholars from other schools, who attended on the days in question, and of persons other than scholars who attended on those days, is not explained on this assumption. In the light of the fuller knowledge as to attendance at the baths which was ultimately obtained it was clear, having regard to the large number of sufferers from enteric fever who had never attended the baths at all, that the bath hypothesis was altogether untenable. The facts as to attendance at the baths were seen to be very much what might have been predicted, given an outbreak of enteric fever having an exceptional incidence upon young persons, in an area sending children mainly to the two schools J and B. Ice cream.—There were several premises in the area upon which ice-cream was manufactured. At one of these all the ice-cream was sold by barrow-men who disposed of their wares at a considerable distance from the area. At another several barrow-men were employed, most of whom sold their ice-cream away from the area, but two, the C and E of the appended notes, had as their standing places points in the area. At the establishment from which C and E came icecream was retailed, but this establishment, though within the area, does not appear to have been supplying directly any of the sufferers from enteric fever, though doing so intermediately through the agency of C and E. Neither of these men supplied any considerable number of the, enteric fever patients with ice-cream. The vendor A (see appended notes) was concerned with two barrows standing within the area; he took charge of one of these himself, while in connection with the other he employed an Italian barrow-man (called in the notes " A's man "). These two men between them appear to have supplied several of the enteric fever patients. The vendor B, it was found, had from time to time supplied nearly one-third of the sufferers from enteric fever with ice-cream. His shop was situated near the centre of the area, and his business was a large one, so that the incidence of disease upon his customers was, having regard to the habits of the population in regard to icecream, not greater than might have been expected. All the above vendors were Italians. One English vendor, D, supplied, it will be seen, one or two infected households with ice-cream. More than one-third of those attacked by enteric fever either denied having ever eaten ice-cream, or said they had not partaken of it within at least a month of the onset of their illness. It was clear from consideration of these circumstances that ice-cream was not the cause of the outbreak. Inquiry was made concerning many other articles of food and drink. The bread consumed in infected households was obtained from very varied sources; watercress was rarely eaten in the area, several persons whom I questioned intimated that it was a luxury quite beyond their means. Fruit, lemonade, ginger-beer and other beverages sold on the area were found to be obtained from a variety of sources, and these articles were not very generally consumed by the inhabitants, who, indeed, could not, as a rule, afford to buy them. The question of possible influence of laundry operations was also carefully considered, and, early 'in the course of the outbreak, many circumstances were inquired into in connection with the schools already referred to as the J schools, inasmuch as many children attacked had attended those schools. As the history of the outbreak was more fully ascertained it became quite clear that these schools were not at fault, nor could any connection be established between school operations and the disease. Fish.—The only article of food or drink, emanating from one source, which had been generally consumed by persons attacked during the outbreak was fried fish. The circle of a quarter of a mile radius which has been already referred to as covering the area specially attacked has at its centre a fried fish shop. Moreover, if the circle in question, of a quarter-mile or 440 yards radius, be subdivided into four by three circles, 110 yards, 220 yards and 330 yards respectively in radius, and having the same centre, it will be found (limiting consideration to the cases occurring between September 4 and September 24‡) that in the inner circle of 110 yards radius, described about the fried fish shop, 47 cases (involving 38 houses) occurred; in the ring outside this circle, between it and the circle of 220 yards radius, 39 cases (involving 33 houses) occurred; in the next ring eight cases (involving eight houses) occurred, and in the outermost ring ten cases (involving eight houses) occurred. If the area of the innermost circle be taken as the unit, the areas of the three concentric Tings outside it will be three, five and seven times this unit respectively. Hence, in order to compare the intensity of incidence of enteric fever, upon equal elements of area, in the four portions into which the affected area has been divided, the numbers 47, 39, 8 and 10, given above as pertaining to these portions, must, taking the outer zone as a standard, be multiplied by seven, 7-3rds, 7-5ths, and 7-7ths respectively, and there result the comparative numbers 329, 91, 11 and 10. These numbers give the relative intensity of incidence of enteric fever on equal elements of area, for the areas within 110, between 220 and 110, between 330 and 220, and between 440 and 330 yards from the fried fish shop. But another point must not be lost sight of; in an area in London of the size of the affected area an appreciable number of cases of enteric fever is likely to be met with, particularly at the time of year under consideration, apart from the existence of any cause of special prevalence. Roughly speaking, the affected area contains about 200 th of the total population of the County of London, and in London during October the cases of enteric fever rose to nearly 200 per week; thus as a mere matter of chance, cases at the rate, approximately speaking, of very nearly one a week might be expected to occur in the affected area. As a matter of fact, during the period September ‡These cases correspond to the cases 6 to 110 of the appended notes, excluding case 22, and they occurred in houses indicated on the accompanying map. On the map, however, the houses corresponding to cases 73 and 107, which were "secondary cases," are not represented, nor are the houses corresponding to case 90, which proved not to be typhoid, nor to case 22, as this girl lived outside the affected area. 11 4th to 24th there were seven cases to which particular attention may be directed in this connection. Five of these cases have been placed in column 1, as distinguished from the cases in column 3, of the diagram already referred to. In the remaining two cases infection was apparently traceable to previous cases which had occurred in the area; these two are placed in column 2. Of the former group of five cases one proved not to be a case of enteric fever. There remain four cases in column 1. Two of these patients were certainly, and a third probably, living away from the area at the date at which, having regard to the course of their disease, they were presumably infected. The fourth patient lived on the extreme boundary of the infected area. The question arises whether these cases should not be excluded from consideration in discussing the special cause of the outbreak. If they be so excluded, the numbers giving the intensity of incidence of enteric fever, upon equal elements of area, for the four portions of the affected area are 329, 84, 11, and 6, showing, in an even more striking manner than was the case before, the diminution in the intensity of incidence noticeable on proceeding outwards from the fried fish shop as a centre. Two cases occurred in houses altogether outside the quarter-mile radius to which reference may here be made. In one of these the girl attacked worked in the area, and her case has been referred to the place at which she worked, and she is thus included in the above summary. The facts concerning her are given in the appended notes, case 47. A second case is that of a girl, case 22 in the appended notes, who worked at premises only just outside the affected area.* The consumers of the fish of a particular vendor in each area have been indicated by red figures. Two of the cases in column 1, Southwark, Nos. 3 and 17, might perhaps more properly have been indicated in black, but all the cases in column 3, with the possible exception of six, undoubtedly ate fish from the particular fried fish shop at a time corresponding to the date of infection. As regards these six possible exceptions, in four there is a history of uncooked fish, obtained from a shop next door but one to the fried fish shop and in the same ownership, having been consumed, and two of the four may also have eaten fried fish, but this cannot be stated with certainty. These cases are marked thus—23†, 63†, 70† and 105† As regards the other two cases—39‡ and 71‡—there is some likelihood that they ate fried fish from the particular shop, though the history is on the whole less conclusive as regards the former than as regards the latter case. Further, as regards case 71, it may be noted that the girl had been staying away from home for a few days at a time corresponding with a part of the period which may be looked upon as the probable period of infection. On the whole, therefore, after making a not unreasonable allowance for the sporadic cases which might have been expected to occur in an area of the size and character of the affected area, there is high probability that all the rest of the cases ate fried fish (in four cases fish from the same source, but not fried) at a time which must be regarded as corresponding with the date of infection. The particulars as to individual cases given in the appended notes show the extent to which wet fish, dry fish, fried fish, and shell fish from this shop were consumed by persons attacked. They may be summarised as follows so far as cases given in the third column (which were attacked between September 4th and 24th) are concerned— Fried fish.—All, with the possible exception of four, who bought their fish uncooked, (but from the same source as that from which the fried fish shop was supplied) and two others discussed above, in the case of whom the history is not conclusive. Uncooked fish.—In only 34 of the 98 cases was there a history of purchasing uncooked fish. Fish in this form was said by several of those questioned to be beyond their means. To these 34 cases should perhaps be added a few others who may have exceptionally purchased a haddock or a bloater from the particular shop. It is quite clear, however, that uncooked fish from this shop was not eaten, during the period when infection must have occurred, by more than half the persons attacked. Shell fish.—In 65 cases shell fish or shrimps had been consumed. In several of these it was said to be a common thing to buy shell fish (usually winkles) or shrimps for tea on Sunday. In the majority it was only exceptionally that such luxuries were purchased. Apart from periwinkles very little shell fish was eaten in the area. Occasionally mussels were consumed; in only one instance was mention made of oysters. The question that now arises is what proportion of the whole population of the affected area was consuming fried fish obtained from the particular shop. This question has been made the subject of inquiry, the result of which it is necessarv to state. Before doing so, however, it may be well to briefly indicate the distribution of fish shops (fried fish shops and others) in the neighbourhood of the affected area. This will be seen on reference to the map, on which fried fish shops and ordinary fishmongers' shops existing in the locality are indicated. The particular fried fish shop referred to above, and indicated in the appended notes as Mr. X's shop, is at the centre of the circle; next door but one to it is an ordinary fishmonger's shop, also in the occupation of Mr. X. It will be seen that the latter shop, which is practically at the centre of the circle, has no other fishmonger's shop within some distance of it. -Tust at the circumference of the circle, which is approximately a quarter of a mile—i.e., 4'40 yards—from this shop, are four fishmongers' shops which are indicated on the map. The fried fish shop, on the other hand, has other fried fish shops within a much smaller distance of it. At the nearest of these, which is situated a little to the north-west of the centre of the circle, a similar class of business to that at Mr. X's shop is carried on, but on a considerably smaller scale. At the shop situated to the east of Mr. X's shop a large business *A third case was heard of in the course of the inquiry, which might perhaps have properly been also inciuded in the above summary. It was that of a man living at some distance from the area, who was employed for some days, at about, the time when he must have been infected, on premises in the near neighbourhood of the fried fish shop; he may have bought fried fish at the particular shop in the affected area, as he was often in the company of a young man who was certainly in the habit of doing so (see the case indicated by the red dagger adjoining case 39, and referred to in the appended notes), but the case was a fatal one, and the question could not be determined. 12 appears to be conducted, but it is of a different character from that at Mr. X's shop. It was explained by more than one inhabitant of the area that at the latter " a halfpenny bit" could be procured, and it will be seen from the notes that it was common for children (presumably because they had no more than a halfpenny to spend) to patronise Mr. X's shop, when other members of the family were in the habit of going elsewhere. With a view to ascertaining what percentage of the inhabitants of the area purchased fish, fried fish, shell fish, etc., from Mr. X, a house to house inquiry was conducted in two portions of it by the Council's inspectors. The portions of the area dealt with are indicated by cross hatching on the map. Inquiry concerning persons attacked had shown that it was a not uncommon thing for the habits of different members of the same family to vary in respect of the articles purchased from a fish shop, and particularly in respect of fried fish eating. Hence the inspectors did not limit their inquiry to asking questions of the head of the family, but ascertained concerning each individual, making, if necessary, a second visit for the purpose, whether he or she was in the habit of obtaining fried fish, etc., and if so, whence it was obtained. It was of not infrequent occurrence to find, for example, that the elder members of a family did not consume fried fish, while the younger ones did so. In such cases the whole family has been classed as fried fish eating. In a very limited number of instances fried fish, shell fish, etc., were stated to have been procured from more than one source; in such instances, if one of the sources was Mr. X's shop, the case has been classed accordingly, the fact of there being an alternative source being neglected. In making their inquiry the inspectors were careful to ascertain the facts as to fish eating shortly before the outbreak of fever, that is at a time which must be regarded as the date of infection. The following results were obtained in the areas in which house to house inquiry was made— Number of families. Wet fish. Shell fish. Shrimps. Fried fish. Dry fish. From X. From other sources. None. From X. From other sources. None. From X. From other sources. None. From X. From other sources. None. From X. From other sources. None. Area A 77 41 9 27 35 9 33 32 9 36 37 17 23 41 19 17 Area B 100 60 25 15 40 6 54 37 10 53 49 22 29 57 26 17 Total 177 101 34 42 75 15 87 69 19 89 86 39 52 98 45 34 Percentage 57 19 24 42 9 49 39 10 51 49 22 29 56 26 18 57 43 42 58 39 61 49 51 56 44 X not X X not X X not X X not X X not X It will be seen that the results in the two areas closely correspond; so far as fried fish is concerned the percentages will be found to be identical. It thus appears that 49 per cent., or just about half the families, contained one or more members who ate fried fish from Mr. X's shop.* If, instead of dealing with families, the facts relating to individuals be considered, it transpires from the inspectors' inquiry that— 42 per cent. of the population did not eat fried fish. 16 per cent. ate fried fish not obtained from X's shop. 42 per cent. ate fried fish obtained from X's shop.† The areas A and B are of somewhat different character. Area B includes some of the blocks of tenement buildings already described. Area A consists of some houses, tenemented for the most part, fronting upon a main street, and a number of cottages in two alleys at the rear.‡ The facts as to fried fish are identical for the two small areas, and may, I think, be regarded as fairly typical of those of houses situated from 100 to 200 yards from the shop. The percentage of persons obtaining fried fish from Mr. X would probably somewhat exceed 42 per cent. in two of the streets close to the shop, which consist of the poorer class of tenement houses; on the other hand it would probably fall considerably short of 42 per cent. in the more outlying portions of the area. It may doubtless be stated with certainty that Mr. X's percentage for the area considered as a whole lies somewhere between 25 and 40 per cent. If the facts as to fried fish, shell fish, etc., for the entire area be compared with those ascertained for persons (Nos. 6-110 in the notes appended) attacked by enteric fever between September 4th and 24th, the contrasts are striking. Thus, while less than 40 per cent, of the in- * For the most part persons who obtained one of the five commodities referred to in the above table from X, obtained the others, if they purchased them at all, from the same source, Thus the 101 purchasers of wet fish from X in the above table include almost all the 75 purchasers of shell fish and the 69 purchasers of shrimps; they include, too, the majority of the 86 purchasers of fried fish and of the 98 purchasers of dry fish. If- the families be grouped into those in which one or more members obtained food of any sort from X, and those in which no member did so, the former group contains about 70 per cent, of the whole number of families. †The number of persons not eating fried fish at all was 381, the number eating fried fish not obtained from X's shop 149, and the number obtaining fried fish from X 370; the total number thus amounts to 900. In the case of 12 of the 177 families, while it was ascertained that fried fish was consumed, particulars as to which members of the family were in the habit of consuming it were not recorded ; in tabulating these persons, it has been assumed that all the members, save those under 4 and over 60, were fried-fish eaters. As regards one other family, there is some doubt as to the way in which the particulars recorded should be tabulated. If all cases in which any kind of question arises were relegated to X, the number would only just exceed 42 per cent. of the total. ‡This area has at its southern boundary a fried-fish shop already referred to as being a shop at which a similar class of business to that of Mr. X, but one on a considerably smaller scale, is carried on. 13 habitants of the area ate Mr. X's fried fish, at least 88 per cent. of those attacked by enteric fever did so; indeed, excluding cases grouped in columns 1 and 2 for reasons already given, and including as consumers of Mr. X's fried fish the cases 23, 39, 63, 70, 71 and 105, for the reasons which have also been already specially discussed, the 88 per cent. becomes 100 per cent. In making their house to house inquiry the inspectors took a census of the inhabitants of the houses visited and ascertained particulars as to consumption of fried fish by each individual included in their census. From these particulars diagram III.* on the annexed page, which gives the facts as to fried fish consumption by males and females at different age periods, has been constructed. Two points are specially noticeable in this diagram— (a) The age distribution of the entire population is a somewhat unusual one, and particularly noteworthy is the smallness of the number of representatives of certain intermediate ages ; this is especially marked in the age group 25-35. (b) It is clear that there is an undue preponderance of persons eating fried fish at ages 5-20 years. This fact appears partially attributable to (a) and partially to manifestation of a greater tendency to consume fried fish at those ages than at the earlier or later age periods. In conjunction with this diagram, diagram IV. beneath it may also be referred to. This shows the result of observations kept upon the fried fish shop during those hours of the day when frying was proceeding.† It will be seen that the persons purchasing were divided according to whether they themselves ate or merely carried fried fish away with them; a third group comprises those concerning whom there is doubt as to which of the other groups they should be included in. The following points may be noted concerning diagram IV.— (a) Consumers at ages 5-20 predominate; indeed, the disproportion between consumers at those ages and those at other ages is now seen to be more marked than in the upper diagram, doubtless not merely because there is a greater proportion at 5-20 years of age of persons who eat fried fish, but because persons at the ages 5-20 years purchase fried fish more frequently than persons at other ages, and therefore form a larger proportion of the people found leaving the shop on any one day. (b) The proportion borne by persons who themselves ate to the total number of persons who purchased at different age groups is higher at the ages 5-20 than at other ages. The height of the red columns may perhaps be taken as the best indication available of fried fish consumption at different ages ; it certainly corresponds more closely to the actual facts as to such consumption than do the complete columns, which include persons who may have visited the shop merely to fetch fried fish for other persons. Two minor points may be here noted. In the upper diagram the total number of persons at ages 0-5 is seen to be less than at ages 5-10. This is probably accounted for by the fact that the inspectors in inquiring concerning age, did not distinguish between age last birthday and age next birthday. Any error arising on this account would tend to be more or less compensated for in later age groups, but in the 0-5 age group there would of course be under-statement of the number of persons in the group. Again, in the lower diagram the height of the columns for the ages 15-20 is excessive. From the nature of the observation kept it was impossible to do more than guess at the age of the persons leaving the shop. There has clearly been a tendency to over-estimate the ages of persons between 10 and 20; probably a few lads and girls at ages 13 and 14 have been transferred in this way to the group 15-20. It is further probable that this error has operated to a greater extent with young girls than with young lads, and this is borne out on comparing the heights of the columns for females between 10-15 and 15-20 respectively with those of males at the same ages, for if the excess of females over males at the latter age is accounted for by transference from the former age, this would explain the deficiency of females as compared with males in the earlier age group. Broadly the facts ascertained by the two methods, first of house to house inquiry, and second of keeping observation on the fish shop, confirm one another and indicate a considerable preponderance of fried fish eaters at the ages 5-20. It has been already noted that the incidence of the outbreak of enteric fever was especially upon these ages. The blackened columns at the lower part of diagram IV. give the age and sex distribution of the cases which may be regarded as constituting the special outbreak. The age and sex distribution of notified cases of enteric fever in London as a whole in the year 1899 has already been given (for the purposes of comparison with the age and sex distribution in the special outbreaks) in diagram I. The correspondence between the exceptional age incidence of the disease and the preponderance of persons at the ages specially attacked among the consumers of fried fish is a striking one. In the absence of accurate knowledge as to relative susceptibility to the disease at different ages under equal conditions of exposure, it is not of course possible to calculate exactly what proportion of cases should occur at each age if fried fish from the shop to which the above observations relate were the medium of infection, but it is interesting, in this connection, to contrast this outbreak with the water-borne outbreak at Newport which occurred in 1894, the milk-borne outbreak at Plumstead in 1895, and the outbreak in South-east London in 1891, attributed by Dr. Geo. Turner to ice-cream. It will be found that while in all four outbreaks there is markedly exceptional incidence upon ages under 25, in Southwark this incidence is particularly excessive at ages 10-20, while, in the other outbreaks, it is manifested to a relatively larger extent at younger ages. This fact is important in the light of the knowledge obtained as to the ages especially represented among fried-fish eaters. *See the second footnote on page 12. †The observations relate to the morning frying 12 to 2 of a Wednesday, and the evening frying 7 to 12 of a Friday. 14 A further point is made apparent on consideration of particular families in infected households. In many instances it was found that the suiferer or sufferers from enteric fever in a particular house were also eaters of fried fish obtained from Mr. X's shop, while other persons in the house either ate fried fish from that source only quite exceptionally, if they ate it at all, or were in the habit of procuring what they ate elsewhere. As instances in which the sufferer or sufferers ate Mr. X's fried fish, and other members of the same family did not, the following cases of which account is given in the appended notes may be referred to—Nos. 6, 7, 8, 15, 21, 29, 36, 37, 45, 46, 47, 54, 57, 58, 65, 83 and 89, and 87. See also in this connection Nos. 42, 49, 74, 85 and 110, 94 and 99 and 95. In these instances the fact of purchase by the individual attacked of something not eaten by the rest of the family was determined— (а) By the fact that the sufferer went to work and was thus led to obtain certain meals from sources not supplying the rest of the family. (b) By the fact that it was a not uncommon practice in the area for children to be given a penny or a halfpenny with which to purchase food for themselves, more especially on washing days or under other circumstances in which cooking at home was attended with difficulty. (c) By the fact that the individual attacked was specially fond of eating fried fish and usually devoted any pennies or halfpennies of which he or she became possessed to purchasing it. Such expressions as " a craving for fish," " a dreadful child for fish and taters," "terrible fond of fried fish," which I heard from mothers of patients attacked, in the course of my inquiry, indicate the extent to which the growing, and in many cases vigorous, hungry child appreciated its " halfpenny bit," and the extent to which repeated requests for halfpennies to spend had led the mother to look upon fried fish eating with concern and apprehension. I was told, moreover, that those children who were sent away for a summer holiday specially manifested this craving on their return from the country, and it was manifest that children described as particularly fond of fried fish were the more vigorous specimens and presumably those with the best appetites. In the affected area in Southwark it was not unusual to find' that it was considered extravagant to spend money on watercress, lemonade, periwinkles, or ice-cream, but the " bit of fish and taters " was looked to by children and young people themselves,, and by their parents for them, as the most suitable and economical means of supplementing, when the halfpenny or penny was available, such scant provision for satisfying hunger as could be made at home. The cases Nos. 40, 55 and 56, 59, 79, 103, 104 and 109 further illustrate some of the points above referred to. In these cases other members of a family as well as the actual sufferer or sufferers may have procured fried fish from the special source, but, inasmuch as the sufferer or sufferers consumed fried fish independently, and in most instances to a larger extent than did the other members, these cases may fittingly be referred to at this point. The cases 9, 11, 12, 22, 28, 35, 44, 53 and 100 present instances of sufferers from enteric fever obtaining their fried fish from the special source ,while other 'members of the same family were in the habit of eating fried fish, but obtained it elsewhere. Finally certain cases, of which the particulars are given in the appended notes, may be referred to as containing information as to particular dates on which fried fish from the special shop was consumed. In the cases numbered 27, 36, 38, 62 and 97 the consumption of fried fish from the particular source can be fixed with high probability, in some instances with certainty, as having occurred either on August 31st or September 1st, and on no other day. The course of the outbreak is such as to suggest that infection occurred at about that time, and that it was not in operation for more than one or two days. Lambeth. The outbreak in Lambeth presents certain points of similarity, and, on the other hand, certain contrasts as compared with the Southwark outbreak. In the former, as in the latter, there was no reason for supposing that drainage defects, water, milk, shell fish or ice-cream were accountable for the spread of infection, while there was strong reason for suspecting fried fish. Particulars as to the four last-named articles are given in the appended notes. The age distribution of the Lambeth cases was unusual, and its departure from the ordinary distribution in ages was to some extent in the direction observed in the Southwark outbreak, though the abnormality of the distribution in ages was much less marked in the case of Lambeth. For convenience of comparison with Southwark, a circular area extending a quarter of a mile in all directions from a particular fried-fish shop has been taken, and this area is indicated on the accompanying map, on which are shown all the cases in which symptoms of enteric fever commenced between August 26th and September 24th. The dates of onset of the disease will be found indicated on the table facing page 8. It will be seen that the special prevalence commenced about a week earlier than the outbreak previously considered, and that it terminated at the same time. As in the case of Southwark, the cases have been arranged in three columns. Column 1 includes cases regarded for one reason or another as unconnected with the special outbreak; column 2 contains secondary cases, while the third column contains the cases which remain, the cases that is which constitute the outbreak. As regards column 1, which contains the sporadic cases probably unconnected with the special outbreak, it appears that these were somewhat less numerous than in Southwark. In the western portion of the Lambeth area was a considerable extent of ground unoccupied by houses, and, partly on this account, the population at risk of contracting enteric fever in the Lambeth circle was somewhat less than in the Southwark circle. As regards column 2, there is in one or two instances more difficulty in Lambeth than 15 there was in Southwark in distinguishing between a " secondary " case infected by a previous sufferer in a household, and a case which, though developing shortly after the occurrence of a first case in a house, might also itself be regarded as a primary case. This difficulty will be further discussed later. Of the cases occurring at the time of special prevalence which have been allocated to column 1, three (Nos. 18, 39 and 47) were notified as enteric fever, but after removal to hospital it was found that the patients were not suffering from that disease. In the fourth case (No. 46), the patient was at the seaside at a time which would correspond with the date of infection, and he had eaten some oysters, to which he attributed his attack, while away from Lambeth at that time. As regards the cases in column 3, there was a clear history of consumption of fried fish from a particular shop (referred to as Mr. T's in the appended notes), at a time which would correspond with the date of infection, in all the notified cases with the exception of four (Nos. 17, 19, 28 and 36), and there was, a similar history in two other cases indicated by a dagger, thus (†), which, although not notified, were probably cases of enteric fever. As regards the four exceptions particulars will be found in the notes; No. 17 was a fatal case, and, while it is certain that the man frequently purchased fried fish, it could not be ascertained where he obtained it; Nos. 19 and 28 almost certainly purchased fried fish at Y's shop at about the time when their illness must have been contracted, but the evidence was less conclusive with regard to them than with regard to the other cases in column 3; case 36 was that of a child (related to cases 6 and 16, who were frequent purchasers of Y's'fried fish) who was staying, at the time when she must have been infected, with an aunt who lived close to Y's shop. So far, the Lambeth outbreak presents much similarity to that in Southwark, though in the former, owing to the smaller number of attacks, the figures form a less reliable basis upon which to found conclusions. Two special difficulties, however, must now be mentioned as deserving of consideration in connection with the Lambeth outbreak. In the first place there is the difficulty of distinguishing between primary and secondary cases in dealing with certain members of households which had been already attacked. Thus— Cases 3, 21 and 25 were members of the same family. Case 8 was the sister of case 4. Cases 6, 16 and 36 belonged to one family. Cases 7 and 15 were brothers. Cases 12, 20, 43, 44 and 52 belonged to one family. Cases 29, 30, 33, 35 , 49 and 54 belonged to one family. Cases 34 and 37 were sisters. Cases 41 and 51 were sisters; and case 42 was the child of a lodger living in the same house. Some of these cases were no doubt " secondary cases," but it is probable that several of them (in addition to the first case occurring in each house) were really primary cases, in which the date of onset of symptoms was later than it was in the 'case which first declared itself in the household. Thus—Case 8 sickened only 4 days after case 4. 16 „ 4 „ „ 6. 15 „ 3 „ „ 7. 20 7 12. 33 „ 2 " „ cases 29 and 30. 1 35 ,, 3 „ ,, ,, „ 37 „ 2 „ case 34. 42 „ 1 day „ 41. There can be little doubt that in the above instances the second case (in the case of Nos. 33 and 35 the third and fourth cases) must really be regarded as a primary case, and not as a "secondary " one. As regards cases 21 and 25, which occurred in the house in which case 3 occurred, the interval of time was longer, and the possibility of the later cases being infected by case 3 cannot be ignored. It is interesting, however, to note, as regards case 3, that the patient was in the habit of buying fried fish from Y's on his own account, and independently of the rest of the family, and it is of course conceivable that he and they were infected on distinct and separate occasions. The course of the outbreak in Lambeth is not, as in Southwark, such as to suggest limitation of infective agency to only one or two days. The agency, whatever it was, took effect in Lambeth about one week earlier than in Southwark. The falling off in the number of cases after September 4th, and the recrudescence on the 7th and succeeding days corresponding with the time of maximum prevalence in Southwark, rather lead to the suspicion that infective property may have been manifested in Lambeth on two separate occasions, one about a week earlier than the other, and the later one corresponding in date with the time of distribution of infective material in Southwark. If this supposition be correct it is easy to understand why the difficulty as regards distinguishing between secondary and primary cases should be more marked in. Lambeth than in Southwark. The second difficulty arises from the fact that whereas in Southwark the cases showed a striking tendency to group themselves around the fried fish shop as a centre, and further to show diminishing intensity of incidence upon area as the distance from the fried fish shop was increased, in Lambeth the outbreak was especially manifested in three or four streets in the western half of the area, while the streets in the eastern half of the area almost entirely escaped. This difficulty was at once pointed out by Dr. Priestley when I first told him of the direction in which the 16 experience in Southwark seemed to point, and he later, as the result of further inquiry which he caused to be made, came to the conclusion that an average of 80 per cent. of the houses in a non-infected street were supplied with fried fish from Y's, whereas only 33 per cent. of the 24 infected houses were so supplied. From investigation which I had already personally made, and which included inquiry addressed to the patients themselvesi while in hospital, it was clear that the large majority, if not all the infected persons, were supplied from Y s. In order to obtain further material on which to base an opinion as to the extent to which different parts of the area were supplied from the fried fish shop, house to house inquiry was again made by the Council's inspectors. The result of this inquiry was to show that— In the three streets mainly affected in the western half of the area 31 out of 36 families, or 161 out of 212 persons—i.e., 76 per cent. of the population—had been in the habit of obtaining fried fish from Y's. In four other streets in the western half of the area, adjoining the three streets already mentioned, 28 out of 46 families, or 99 out of 175 persons—i.e., 57 per cent. of the population—had been in this habit; and in three streets close to Y's shop, but situated in the eastern half of the area, only 38 out of 98 families, or 160 out of 390 persons—i.e., 41 per cent.—had been in this habit. This house to house inquiry showed a considerably larger percentage of purchasers of Y's fish among the persons living in the streets mainly affected than in those living in the other streets. But the amount of fish consumed by inhabitants of a particular street depends not only upon the number of purchasers, but also upon the frequency and extent of their purchases. Inquiry in the streets mainly affected showed that many of the inhabitants were in the habit of buying fried fish very frequently, while, on the other hand, one of the Council's inspectors who made inquiry in two streets in the eastern half of the area, but quite close to the fried fish shop, reports " if the statements of the occupiers are to be believed, they all partake very sparingly of fish." In this connection it is deserving of note that while the streets mainly affected to the west of the fish shop are occupied by a very poor class of persons, the corresponding streets just to the east of the shop appear to be occupied by a class a little less poor. Another point which must be borne in mind is that two of the affected streets form practically a cul de sac, and people who live in them and in two adjoining affected streets are from the topography of the locality necessarily compelled to go eastwards to do their shopping. To the west are extensive premises occupied by a railway company; to the north and south houses are occupied as residences and not for bus:ness purposes, so that the only available shops are in the main road to the east of the specially-affected streets. In this road, close to the opening of the cul de sac already referred to, and immediately opposite one of the streets mainly affected, is the fried fish shop. On the other hand, inhabitants of the streets in the eastern half of the area, while they no doubt largely make use of the shops in the main road, in which the fried fish shop is situated, are not necessarily constrained to go westwards; there are shops on all sides of them, and that they go to the shops on their east and north and south, as well as to those on their west, is shown by the results of the house to house inquiry made by the Council's inspectors. The attempt was made to gauge the extent to which the inhabitants of different streets frequented the fried fish shop, by keeping observation on the shop, and noting the streets to which purchasers of fried fish returned. It was found, however, that purchasers of fish, after leaving the shop, did not, in a large number of instances, go straight home, but that they either proceeded to make other purchases, or in some instances went into a place of entertainment situated near the shop, and in one way or another many persons were lost sight of and could not be traced. As the outcome of the observations made, it transpired that 101 persons out of a total of 481 who came out of the fish shop returned to the three streets mainly affected in the outbreak. While it may be inferred that most of the 101 persons lived in the three streets to which they returned, it is probable that a number of the other persons making up the total of 481 also did so. Apart, however, from the difficulty of allocating persons leaving the shop to the houses in which they lived, it became clear in the course of the inquiry that no estimate based upon observations made subsequent to the outbreak could be precisely accurate, as several of the families, particularly those living in the streets mainly affected, were found to have then ceased to purchase fried fish at Y's shop. A fact of some interest in connection with the observations made with regard to persons leaving the fish shop was that the proportion of persons returning to the three mainly affected streets showed considerable variation at different times : thus, on a particular Tuesday morning, it was only 13 per cent. of the total number leaving the shop, while on the following Friday morning it was 30 per cent. On Saturday evening it was 19 per cent., but at this time in particular it was clear that only a comparatively small number of those visiting the shop returned, on leaving it, straight to their homes. Having regard to the facts ascertained in Southwark as to the connection between fish eating and modifications of ordinary domestic routine (occasioned, for instance, by washing days), it may well have happened, in view of what has just been said, that on a particular day or days a very considerable percentage of the persons visiting the shop came from the three streets mainly affected. The marked incidence on these three streets is none the less in contrast with the greater uniformity of distribution of cases around the Southwark fried fish shop, and the facts stated in the latter instance as to marked diminution of intensity of incidence, on proceeding outwards from the particular shop, have not a parallel in Lambeth. In connection with these circumstances the smaller magnitude of the Lambeth outbreak must not be lost sight of as being likely to yield a less symmetrical distribution of cases, and the peculiar topography of the area taken in conjunction with differences in the character of the populations to the east and west of the fried fish shop are certainly considerations to which weight may be attached, as possibly affording explanation of the greater incidence of disease upon the streets which were mainly affected. 17 In water epidemics of cholera and typhoid fever the question of the escape of particular communities has repeatedly been urged as a difficulty; it is only necessary to refer to the escape of the East London Industrial School and other institutions in the cholera outbreak of 1866, and to the escape of the village of California and certain groups of houses in the Tees Valley outbreak of enteric fever. Having in view the smallness of the total number of cases in Lambeth, it might be anticipated that in some streets three or four households would be attacked, while other streets would altogether escape, even if the matter were one of pure chance; having regard to the certainty that inhabitants of the streets specially affected purchased to a greater extent than inhabitants of other streets, and to the possibility of their having purchased on a particular occasion or occasions to an altogether disproportionate extent, the fact that in certain streets to the west of the shop there were six, seven and eight infected households, while in other streets there was only one infected household, or there were none at all, cannot be regarded as a serious difficulty. In Lambeth, as in Southwark, it is noteworthy that in several instances there is a history of the person attacked by enteric fever obtaining fried fish from the particular shop, while other members of the household who escaped probably did not. Cases 7, 12, 14, 15, 19, 20, 45 and 45a afford instances of this. In the family to which case 12 belonged the facts were particularly striking. This child and her two sisters, cases 20 and 43, were stated to be the only customers of Y in the family, which is a large one. Cases 12 and 20 were both attacked by enteric fever. Case 43 and the baby of the family, case 44, did not sicken until quite towards the end of the outbreak, and these cases may have been really secondary cases. As regards the baby she is not definitely known to have eaten fried fish, but her three sisters, who were frequently left in charge of her, all did so, and as it is a not uncommon practice of purchasers of fried fish in the neighbourhood, if they take a baby into the shop, to give it a bite, it is probable that this particular baby did have some. The evidence afforded by, the history of cases 12, 13, 19, 22 and 28 is of interest, as showing that in all instances in which fried fish was definitely stated to have been consumed on a particular day, that day was either Friday or Saturday. In case 41 the usual day for purchasing fish was Friday, but just about the time when infection must have occurred there was a birth in the family, and the children, cases 41, 42 and 51, were, by reason of this circumstance, given money each day to buy their food out of doors, and the mother of case 41 stated that they purchased fried fish from Y daily at that time. Kensal Town. The facts as to Kensal Town need be only very briefly referred to. In this locality there was no marked incidence upon consumers of fried fish from any particular shop. There was, however, a somewhat strinking incidence upon persons purchasing fish or shell fish at a general fishmonger's shop, and also upon persons ultimately obtaining their milk from a milk company doing a very large business. For purposes of comparison with the other areas, an area within a one-quarter mile radius of the fishmonger's shop, referred to in the appended notes as the shop of Mr. Z, has been taken. The distribution of the disease in point of time is indicated on the table facing page 8.* The total number of cases occurring in the area was considerably smaller than 'in Lambeth and much smaller than in Southwark. The cases in which no connection with Z's shop was definitely traceable are indicated by the numbers in black in the first column of the table. In some of these there was reason for concluding that infection had been contracted altogether away from the district. The cases in the first column of the table are actually less numerous in Kensal Town than in the other districts, but the proportion they bear to the total number of cases is far greater, the outbreak in Kensal Town not attaining the magnitude reached in the other districts. All the other cases, those numbered in red, had made purchases at Z's shop, though, as regards the cases marked J, it should be noted that the fact of such purchase was only stated by case 29, a secondary case; the member of the household first attacked, case 5, being a girl who was unable to recollect from what source she had obtained fish or shell fish. Of the 21 cases which occurred within a quarter of a mile radius of the shop between August 25th and September 17th, 16 (if case 5 just referred to be included) certainly obtained fish or shell fish at Z's shop. There may be some question as to whether two of the remaining 5 cases did not also do so; one of these two, and a third case, lived, at the extreme boundary of the quarter-mile circle; with' such a small total number of cases the fact of the inclusion or exclusion of a case living at the limits of the area considerably affects the numerical result. The incidence upon purchasers of fish or shell fish from Z can, however, only be regarded as assuming some importance by reason of the phenomena coincidently manifested in Southwark and Lambeth. As regards milk, the supplies of the local vendors, A, B, C, H, I, and on occasion that of F, were in part derived from one large company. It will be seen therefore that of the 21 cases referred to above, and occurring between August 25th and September 17th, 14 almost certainly, and possibly one other case, were obtaining milk supplied by this company. The incidence upon persons supplied through one or another agency by the milk company was therefore nearly as great as upon persons who purchased fish at Z's shop. Having regard to the extent to which milk derived from this company was being distributed in the neighbourhood of the area affected in Kensal Town, the former incidence cannot be regarded as specially remarkable. It is interesting to note that a fried fish shop is situated close to the centre of the area of one quarter-mile radius already defined, but in only one of the families affected by enteric fever was fried fish from this shop consumed. On the other hand seven of the 21 cases mentioned above ate * The facts ascertained concerning one of the cases indicate that in all probability in this case infection occurred on August 23rd. The child (case 7 in appended notes) had been away from home for three months, and returned to Kensal-town on the 23rd of August. She and other members of the same family (cases 3, 4, and 9) were attacked between August 27th and August 31st. If the child who had been away was infected in Kensaltown, it is probable she was infected immediately on her return. [3] 18 fried fish obtained from a shop in the south-western quadrant of the circle of one-quarter-mile radius. This shop is referred to in the appended notes as that of Mr. z. / The attempt was made in each instance to learn the source from which the fish sold byMessrs. X, Y and Z was obtained. It was not, however, found possible to pursue this matter. The three vendors obtained their fish from Billingsgate. Mr. X also obtained considerable quantities of fish direct from Grimsby.t It was said to be impossible to trace for each day the source from which the consignments purchased came; so many different middlemen were dealt with by Messrs. X, Y, and Z, and complete records of purchases effected were not kept. Inquiry was, moreover, made as to the existence of cases of illness, just before the time of the outbreak, among the persons living at the fish shop premises, or employed by Mr. X, with a negative result. The conclusion to which the facts which have been summarised appears to me to point is that the local prevalence of enteric fever observed in Southwark during September, 1900, must be attributed to the consumption by the sufferers of fish, purchased from a particular vendor, and almost entirely in the form of fried fish. In the light of this conclusion the outbreaks of enteric fever occurring at about the same time in Lambeth and in Kensal Town must, in the absence of any adequate explanation of their cause, and in view of the fact that so considerable a percentage of sufferers in the one case consumed fried fish from a particular fried fish shop, and in the other were in the habit of making purchases at a general fishmonger's shop, be regarded as possibly, and, in the case of Lambeth, probably admitting of similar explanation. W. H. Hamer, Assistant Medical Officer of Health. APPENDIX. Notes as to cases of Enteric Fever in Southwark, Lambeth and Kensal-town. The inquiries as to milk, fish, &c.. were of course directed to ascertaining from what source those articles of food were obtained, at a time which would correspond with the period when infection must have occurred. Local milk vendors are indicated by letters A, B, C, &c., and ice-cream vendors by the same series of letters, but the two sets of letters must not be in any way connected with one another; again there is no connection between the letter3 A, B, &c., used to designate vendors in the three districts Southwark, Lambeth and Kensal Town. Southwark. (The cases which may be regarded as constituting the special outbreak are those numbered 6 to 110, excluding those which are placed in the first two columns of the table facing page 8.) No. Date cf unset of illness. Dale of notification. Sex and age. Milk supply. Ice-crcam. As to consumption of fish, fried fish, shell fish, &c. As to use of swimming baths. Remarks. 1 Aug. 16 Sept. 22 M. 21 Head brand Never Obtained from three sources, which he names. Never from X Never ... 2 Aug. 19 Sept. 6 F. 20 ... ... Was living away from the district at the time when her illness must have been contracted ... ... 3 Aug. 24 Sept. 7 F. 34 Condensed Never Sometimes buys winkles from X, but never obtains fish or fried fish there Never ... 4 Sept. 1 Sept. 14 M. 3 A Never Obtained from a source named. Never from X Never Proved not to be enteric fever. 5 Sept. 3 Sept. 21 M. 35 B Never Never from X. Was much away from affected area. Never See case 73. 6 Sept. 4 Sept. 23 M. 11 Condensed Never Mother buys winkles, skate and plaice from X. The boy himself, just before his illness, was in the habit of buying fried fish there, but other members of the family do not have fried fish Goes to the X baths Eats watercress sometimes. 7 Sept. 5 Oct. 3 F. 18 Condensed Yes, but source not ascertained Fond of fried fish, which she obtains from X. Other members of family do not have it. She often purchases it for her mid-day meal, which she eats away from home Also obtains winkles from X Never ... †The supply for Mr. Y's shop and for two other fried-fish shops at some distance from it but in the same management was, according to the statement of the manager, purchased at Billingsgate-market by the same individual, and as a rule came from market to the three shops in the same cart. There had been no marked prevalence of enteric fever in the neighbourhood of these other shops. 19 No. Date of onset of illness. Date of notification. Sex and age. Milk supply. Ice-cream. As to consumption of fish, fried fish, shell fish, &c. As to use of swimming baths. Remarks. 8 Sept. 6 Sept. 17 F. 14 Condensed A Fish and shell fish practically never consumed at home, but the girl herself often buys fried fish and winkles from X Never ... 9 Sept. 6 Sept. 18 M. 12 C Frequently from A's man, also from B The lad, who is very fond of fried fish, buys it from X ; he also buys winkles there. Other members of family obtain fried fish from another source To X baths on Mondays ... 10 Sept. 6 Sept. 17 F. 10 D Frequently from B Frequently obtained fried and other fish, shrimps and winkles from X ... ... 11 Sept: 7 Sept. 22 F. 23 ... Never This patient and her brother used often to buy fried fish for supper from X, the rest of the family not obtaining it. Occasionally fish was eaten at home, source then uncertain Never ... 12 Sept. 7 Sept. 22 M. 13 ... From B To X baths ... 13 Sept. 8 Oct. 13 M. 17 Condensed. Head brand ... No fried fish ; wet and dry fish from a source named. Not from X To X baths "Hopping" from Aug. 25 to Sept. 3; probably infected then. 14 Sept. 8 Sept. 16 M. 14 ... Probably, if so from B The family deal at X's shop. Three of the children, according to the mother, viz., this boy, an elder brother and a younger brother (case 66) often obtain fried fish there on their own account for supper Never ... 15 Sept. 8 Oct. 5 M. 8 Condensed. Cup brand Occasionally, but source not ascertained Fish and shell fish from X. The boy often has fried fish obtained from same source Never, an elder brother goes Drinks ginger-beer and lemonade occasionally, obtained from a shop named. 16 Sept. 8 Sept. 16 M. 15 None C Fried fish, shrimps and winkles obtained from X. The first-named often To X baths "on a Saturday night" Lemonade occasionally from a shop named. 17 Sept. 9 Sept. 18 F. 17 B Also condensed milk Never Family deals at X's, but the patient rarely eats fish and does not care for fried fish Never At Southsea for 14 days, returned at end of Aug. Probably infected there. 18 Sept. 9 Sept. 21 F. 6 E B Sister of cases 14 and 66. Her mother does not think she would have money to buy fried fish on her own. account, as her brothers did, but they might have given her some and she would in any case have obtained it at home. Never There is some doubt as to the diagnosis in this case. 19 Sept. 9 Sept. 14 F. 14 Various sources On one occasion from a source some distance away from the area Plaice and shell fish and fried fish on Fridays from X ••• ... 20 Sept. 9 Sept. 17 F. 12 B F. sometimes A's man Fish generally from a source named, not X ; but often obtains fried fish from X and occasionally winkles and shrimps also To X baths, but only rarely ... 21 Sept. 9 Sept. 22 M. 16 B Never Had a penny piece of fried fish almost every night from X. The others would not have this. Also shrimps occasionally from X To X baths, but not for a month prior to beginning of illness Never eats watercress or drinks mineral waters, ginger-beer, &c. 22 Sept. 9 Sept. 21 F. 18 ... Probably not Used to obtain fried fish for supper at X's and almost certainly did so on night of Friday, Aug. 31st Other members of the family die not buy from X To X baths on Friday, Aug 3lst A fatal case. Lived at some distance from affected area, but, passed through it on her way to work. 20 No. Date of onset of illness. Date of notification. Sex and age. Milk supply. Ice-cream. As to consumption of fish, fried fish, shell fish, &c. As to use of swimming baths. Remarks. 23 Sept. 9 Sept. 27 M. 10 A Very rarely The family usually deal at a fish shop named, not X's, but occasionally a piece of fish is procured from X Never Sometimes drinks lemonade. 24 Sept. 10 Sept. 16 M. 15 D Very seldom. Fish and fried fish obtained from X To X baths occasionally No ginger-beer, &c. 25 Sept. 10 M. 11 B A's man Fried fish from X, also from another source. Occasionally winkles and shrimps from X To X baths A doubtful case of enteric. 26 Sept. 10 Sept. 16 F. 10 G A's man Fried fish and winkles habitually obtained from X Never Occasionally gingerbeer. 27 Sept. 10 Sept. 23 F. 12 B Never Bought "fried fish and taters" at X's shop on a Saturday night, about 5 weeks before the 8th Oct. (i.e., probably Sep. 1st). Sometimes obtains winkles from X ... ... 28 Sept. 10 Sept. 20 F. 13 H B Mother does not deal at X's shop and the fried fish consumed by the family is not obtained there. The girl herself, who is very fond of fried fish, bought from X occasionally just before her illness To X baths Ginger-beer frequently. 29 Sept. 10 Sept. 15 F. 11 Condensed Possibly, but not certainly Fried fish from X on Saturday nights. The patient was a "dreadful child for fish and taters."The others, father, mother and five children, rarely had any. Never shell fish or shrimps Never Watercress on Saturdays. Never lemonade, gingerbeer or kaola. 30 Sept. 10 Sept. 19 F. 13 ... B Fried fish from X frequently. Never shell fish or shrimps ... Lemonade, sometimes. 31 Sept. 10 Sept. 23 M. 5 B B Very fond of " fried fish and taters " from X's shop. Never buys winkles To X baths Very fond of fruit. 32 Sept. 11 Sept. 22 F. 14 B B or C Fried fish, wet fish, and winkles from X ... See cases 91,32 and 126. 33 Sept. 11 Sept. 27 M. 14 Goat brand Occasionally, probably from A Fried fish and winkles habitually obtained from X Not to X baths but swims occasionally Drinks kaola. 34 Sept. 11 Sept. 17 F. 24 G B Frequently obtained fried fish and winkles from X ... ... 35 Sept. 11 Sept. 20 F. 12 Head and goat brands B The family obtain fried fish from a particular source, not X's shop. The girl herself has been in the habit of buying from X. All eat winkles and eels from X occasionally To X baths Ginger - beer and lemonade frequently. 36 Sept. 11 Sept. 26 F. 9 B D or C "On a Friday, about a fortnight before she began to be ill" (probably August 31st), bought a bit of fried fish at X's. She remarked at the time how nasty it was, and indeed it gave her " a shuddering against fish." None of the other members of the family had any. They buy winkles, mussels and shrimps from X occasionally Never Never eats watercress. Drinks kaola. 37 Sept. 11 Sept. 24 M. 16 I B The family do not eat fish. The boy and a friend (case 42) obtained "fried fish and taters" from X on night of September 1st To X baths, the "first - class swim" on September 1st No ginger-beer, lemonade, &c. 21 No. Date of onset of illness. Date o notification. Sex and age. Milk supply. Ice-cream. As to consumption of fish, fried fish, shell fish, &c. As to use of swimming baths. Remarks. 38 Sept. 11 Sept 21 M. 16 Head brand Never His mother says the only thing she had ever seen him eat at home, except bread and butter, was a bit of fried fish from X's. This he had on a Sunday, probably September 2nd. He himself corroborates this and says the bit of fish was bought by his sister on Saturday night, i.e., probably September 1st To X baths, but some time before his illness Lived away from home, but visited there on Wednesday afternoons and on Sundays. 39 Sept. 11 Oct. 2 M. 11 Head Brand Never The family does not obtain it s fish from X, but the patient, who runs errands, and thus gets pennies, may have done this. His mother thinks it likely, as he is a friend of a boy (case 42) who is in the habit of obtaining his supper there. Occasionally has winkles from X Never Drinks ginger-beer and kaola. † Sept. 11 ••• M. ... ... Obtained fried fish and other fish from X frequently for his mid-day meal. A friend of the man referred to in footnote on p. 11 ... Illness said to be "double pneumonia," it proved fatal on Sept. 19. 40 Sept. 12 Sept. 17 F. 12 ... Probably not Mother deals at X's, and often buys fried fish there. Child may have also bought independently; she spends her pennies in the street. She would not have bought shell fish Never ... 41 Sept. 12 Oct. 2 M. 7 B. Also Cup Brand A and B The family obtain fish and fried fish from X's Never See cases 48 and 113. 42 Sept. 12 Sept. 29 M. 16 B. B Occasionally purchases winkles, and habitually buys fried fish at X's. On Saturday, Sept. 1, he and the boy case 37, went to the baths and then ate a number of things, including " fried fish and taters " at X's. He was upset next day To the X baths, "First class," on Sept. 1 Fond of ginger-beer, also of fruit. 43 Sept. 12 Sept. 20 M. 13 Nestle Yes. From a shop away from the infected area Obtains fried fish from X's shop quite frequently To X baths, but not to the swimming bath ... 44 Sept. 12 ... F. 13 Condensed B., or elsewhere Mother did not deal at X's. The children, particularly this child, were '' terribly fond of fried fish, and they went for the half-penny bit at X's" ... Case notified in Camberwell. Family lived, however, in infected area up to Sept. 11. 45 Sept. 13 Sept. 17 M. 14 Head brand "Not lately" The family obtain winkles and occasionally a haddock from X. The boy often bought " fried fish and taters " from X on his own account Not for more than a month before illness Never watercress. Occasionally ginger-beer. 46 Sept. 13 Sept. 25 M. 20 Cup brand Never Patient often used to buy " fried fish and taters " from X, but about the end of August, during the hot weather, he took a dislike to the fish. The family rarely or never bought fried fish; they still buy " taters " and occasionally wet fish Never Never watercress. Mineral water and ginger-beer occasionally. 47 Sept. 13 Oct. 8 F. 19 Squirrel brand Possibly Lives at some distance from infected area, but works at premises within it, and was in the habit of baying fried fish at X's. Other members of the family did not do this ... ... 48 Sept. 14 Sept. 22 F. 13 Cup brand A and B The family obtain fish and fried fish at X's Fever A sister of case 41. 22 No. Date of onset of illness. Date of notification. Sex and age. Milk supply. Ice-cream. As to consumption of fiah, fried fish, shell fish, &c. As to use of swimming baths. Remarks. 49 Sept. 14 Sept. 25 F. 13 B B Family buys skate, haddock and shrimps, and occasionally winkles for Sunday from X. The girl herself was in the habit of buying " fried fish and taters " there. The other members of the family very rarely have fried fish Never ... 50 Sept. 14 Sept. 22 M. 5 ... A The family obtain fried fish from X's Never ... 51 Sept. 14 Sept. 17 F. 11 Condensed Fond of ice cream; source not ascertained Fried fish, also winkles and shrimps occasionally from X's ... Never ginger-beer or mineral waters 52 Sept. 14 Sept. 20 M. 12 Head brand B "Fried fish and taters" from X frequently. A bloater occasionally To X baths Fond of ginger beer. 53 Sept. 14 Sept. 22 M. 15 Head brand Never The family obtain fried fish and taters " from another source, not from X, but the patient is a friend of the boy, case 52, and would buy with him from X To X baths on August 22nd ; not since Never buys mineral waters of any kind. 54 Sept. 14 Sept, 28 F. 15 J Rarely, and then from a source quite away from the area Family do not buy fish from X. The girl bought " fish and taters " from X for supper very frequently Never Occasionally gingerbeer. 55 Sept. 15 Sept. 22 F. 13 Condensed Never Family obtain fish and shrimps from X. These two children bought " fried fish and taters " for themselves for supper on Saturdays, and sometimes on other nights too ... Sec cases 116 and 120. 56 Sept. 15 Sept. 22 M. 10 Condensed Never 57 Sept. 15 Sept. 17 F. 17 Condensed Occasionally Whole family used to eat fried fish from X. Latterly the father had stopped their having it and none was brought home. The girl continued up to the time of her attack to buy on her own account, usually elsewhere, but on occasion still from X. Shell fish also from X ... Fond of watercress. Never mineral waters. 58 Sept. 15 Sept. 18 M. 14 K C Also ate some at King's - cross on Sept. 15 Family buy winkles and shrimps from X. The boy is very fond of getting " fried fish and taters" there. None of the others do this To X baths on Saturdays and Mondays A very mild case. No lemonade or ginger-beer. 59 Sept. 15 Oct. 3 M. 7½ Head brand A "Gets his bit of fried fish at X's, never anywhere else." Is fond of fried fish ... "Hopping " from September 5th to 28th. Drinks ginger-beer and lemonade. 60 Sept. 15 Sept. 24 M. 8 B B Occasionally Fond of fried fish from X's Never Drinks mineral waters. 61 Sept. 15 Sept. 21 M. 17 E E Buys fried fish at X's frequently ... Ginger-beer occasionally. 62 Sept. 15 Sept. 18 M. 10 B and I Never "About six weeks ago " (from date October 6th) " had a piece of fried fish from X's" To X baths ... 63 Sept. 15 Oct. 1 F. 17 B B The family have a piece of wet fish from X's frequently, but not fried fish, shell fish or shrimps Never Fond of ginger-beer and lemonade. 64 Sept. 16 Sept. 28 M. 12 B A's man Fried fish from X; a haddock or kipper from same source occasionally To X baths No watercress. Drinks ginger-beer and lemonade. 23 No. Date of onset of illness. Date of notification. Sex and age. Milk supply. Ice-cream. As to consumption of fish, fried fish, shell fish, &c. As to use of swimming baths. Remarks. 65 Sept. 16 Sept. 26 M. 13 Condensed Never Wet fish and shrimps from X. The boys, the patient and his brother, buy fried fish there To X baths Drinks mineral water. Does not eat watercress. 66 Sept. 16 Sept. 21 M. 11 E B Fried fish from X frequently (see cases 14 and 18) Never ... 67 Sept. 16 Sept. 21 M. 15 G; also goat brand A's man Fried fish, and sometimes winkles from X To X baths at end of August ... 68 Sept. 16 Sept. 25 F. 7 ... Never Fried fish and winkles habitually obtained from X Never A very mild case. 69 Sept. 16 Sept. 24 M. 14 Condensed Never Fried fish for supper, obtained from X. Never winkles or shrimps Never ... 70 Sept. 16 Sept. 21 M. 7 Head brand Never A haddock bought from X on Saturday 1st or 8th of September, and some eaten by patient. Fish usually obtained by family elsewhere, but childmay have obtained fried fish on his own account ... ... 71 Sept. 16 Sept. 30 F. 17 L Never Shell fish from X, but fish for family obtained from another source. The girl, however, buys on her own account, and may have bought fried fish at X's, the nearest shop. The girl was away from home Sept. 1-4 and may have been infected then ... Family used to live close to X's shop, but removed to some little distance from it about Sept. 16th. 72 Sept. 17 Sept. 23 M. 15 None None Never bought anything at X's shop so far as he can remember ... Lived on extreme boundary of infected area. 73 Sept. 17 Sept. 24 F. 30 B Never This patient is the wife of No. 5 Never Drank mineral waters. 74 Sept. 17 Sept. 19 M. 12 I Occasionally Mother buys winkles but rarely buys fish from X. The children buy " fried fish and taters " for themselves from X Never Brother of girl, case 85. See also case 110. 75 Sept. 17 Sept. 25 M. 8 B B Mother deals at X's. " The children are very fond of fried fish and taters, but they always procure it at X's, the shop they know." Another case (108) in this family To X baths Never ginger beer or mineral waters. 76 Sept. 17 Sept. 25 F. 12 B B Not to baths Never ginger beer or mineral waters. 77 Sept. 17 Sept. 25 M. 16 F Never Fond of fried fish. Obtains this and also haddock, bloaters and shrimps from X To X baths on Wednesdays Drinks ginger beer. 78 Sept. 17 Oct. 13 M. 19 • •• Never Fish of all kinds from X's shop frequently • •• A relapse on Oct. 1st, and this 2nd attack was diagnosed as enteric. 79 Sept. 17 Sept. 26 F. 11 Condensed Various sources Used to deal at X's, but changed early in Sept., because they had "some they did not fancy." Child often bought fried fish there Never No mineral waters. 80 Sept. 18 Sept. 25 F. 8 B Never The family deal at X's ; they buy most of their fish uncooked, but sometimes have fried fish ... Not removed to hospital. A very mild case. 81 Sept. 18 Sept. 25 F. 13 Condensed C Fried and wet fish from X Never ••• 82 Sept. 18 Sept. 27 F. 14 ... Never Fried fish from X frequently To X baths Sister of case 96 24 No. Date of onset of illness. Date of notification. Sex and age. Mi!k supply. Ice-cream. As to consumption of fish, fried fish, shell fish, &c. As to use of swimming baths. Remarks. 83 Sept. 18 Sept. 29 M. 12 Cup brand Never Family rarely have fish, if they do they do not buy it from X. The two boys, however, very frequently purchase " fish and taters " from X's shop To swimming baths but never to X baths Brother of case 89. Never has gingerbeer or mineral waters. 84 Sept. 18 Sept. 25 M. 3 M Never The family frequently consumes X's fried fish. The child eats it often, also the mother, the father is not so fond of it Never No ginger-beer or mineral waters. Case 96 is this child's mother. 85 Sept. 19 Sept. 19 F. 8 I Occasionally See case 74 ... Children at Ramsgate from Sept. 10-17. 86 Sept. 19 Oct. 8 M. 13 G Probably Fried fish and shrimps from X To X baths ... 87 Sept. 19 Sept. 25 F. 13 Condensed. Never Winkles and shrimps occasionally from X. The girl " if ever she had a halfpenny to spend would go to X's for a bit of fish and taters." Probably did so on night of Sept. 1st. Never Drinks kaola. Left for Kent on night of Sept. 1. 88 Sept. 19 Oct. 1 M. 16 B A Bought fried fish from X until quite recently, i.e., a few days before his illness commenced To swimming baths, but not to X baths Drinks lemonade and kaola. 89 Sept. 19 Sept. 29 M. 5 Cup brand Never See case 83 (the brother of this boy) To swimming baths but never to X baths Brother of case 83. 90 Sept. 20 Sept. 29 M. 4 ... ... This case proved to be one of pleural effusion and not enteric fever ... ... 91 Sept. 20 Oct. 3 F. 4 B B or C Fried fish, wet fish and winkles from X Never Sister of cases 32 and 126. Daughter of case 92. 92 Sept. 20 Oct. 8 F. 36 B Never See above. In addition to fish has had cockles and oysters from X Never See case 91. 93 Sept. 20 Oct. 1 M. 11 B Never Family often have fried fish and sometimes winkles and shrimps from X To X baths on Monday mornings Drinks ginger-beer. See cases No. 125. 94 Sept. 20 Sept. 27 F. 15 Condensed Yes, but source not known Family deal at X's. This girl and her sister (case 99), often buy fried fish there. The others (father mother and baby, set. 2), do not, eat fried fish as a rule To swimming baths but never to X baths Eats watercress. Drinks mineral waters. A very mild case. See case 99. 95 Sept. 20 Sept. 29 M. 4 B A's man Often buys fried fish for supper from X. Other members of family rarely do so, but occasionally buy winkles there Never Drinks kaola. 96 Sept. 20 Sept. 28 F. 30 M Never See case 84 (the child of 96) Never Lemonade occasionally, 97 Sept. 20 • • • F. 18 Condensed • •• Fried fish and other fish from X. Probably had former on Sept. 1st, but not after that until commencement of illness • •• Went hopping on Sept. 1st. May have been infected while away. 98 Sept. 21 Oct. 8 F. 30 N Lives at an ice cream shop Fried fish, wet fish, and shell fish from X Never A very mild case. 99 Sept. 21 Oct. 12 F. 10 Condensed ... See case 94. Very fond of " fish and taters " Never A mild case,but gave marked Widal's reaction. 100 Sept. 21 Sept. 28 F. 12 Head brand B Family buy winkles from X, fried fish elsewhere. The child, however, gets "fried fish and taters " from X regularly on Saturdays Never Very rarely has lemonade orgingerbeer. 25 No. Date of onset of illness. Date of notification. Sox and age. Milk supply. Ice-cream. As to consumption of fish, fried fish, shell fish, &c. As to use of swimming baths. Remarks. 101 Sept. 21 Oct. 1 F. 10 B Never Fried fish, winkles and shrimps from X. The former usually on Wednesdays (washing day) for dinner. Sometimes on other days Never Eats watercress. 102 Sept. 22 Sept. 27 F. 8 B B Mother dealt at X's before child was ill. Child was fond of fried fish Never No mineral waters. 103 Sept. 22 Sept. 25 M. 12 ... B Family occasionally eat fried fish from X. The boy " mostly spends his own half-pennies, when he does spend them, at X's, on fish and taters, but he is a saving boy." Never eats winkles Never A fatal case. Peritonitis. 104 Sept. 22 Oct. 6 F. 10 Head brand also from B D Family occasionally has fried fish. Child often buys " fish and taters " at X's on her own account Never Eats watercress. No mineral waters. 105 Sept. 22 Oct. 2 M. 16 Head brand A and elsewhere Mother does not deal at X's. Boy buys winkles and fish there but is not sure about fried fish. He often buys fried fish on his own account but usually elsewhere To X baths Often buys fruit and ginger beer for himself. 100 Sept. 23 Sept. 27 F. 9 ... ... Stayed from 21st to 23rd September with an aunt living in the infected area. Had also stayed with her on September 9th and possibly on September 2nd. Lived some distance away. The family of the aunt obtained milk from B and fish (when they have it, they do not like fish) from a source named, not X ... ... 107 Sept. 23 Oct. 1 M. 12 B Never Fried fish from source named, not X. This lad is the cousin of case 42. Never A doubtful case, not removed to hospital. 108 Sept. 23 Sept. 28 M. 5 B B See cases 75 and 76; his brother and sister Never ... 109 Sept. 23 Oct. 7 M. 14 E also head brand B Often buys fried fish at X's for his supper. Family eat it occasionally and also obtain mussels from X Never Eats watercress. 110 Sept. 24 Sept. 28 M. 6½ ... ... Brother of cases 74 and 85 ... ... 111 Sept. 25 Oct. 1 M. 17 L Sometimes has "16 dips at a time" Fish from source named, not X Not to X baths Drinks mineral waters. 112 Sept. 25 Oct. 9 F. 12 Condensed ... Mother does not buy from X. Child is a great friend of case 115, and " may have bought things " when out with her. Used to go to a house where cases of enteric fever had occurred (see case 115) To X baths. Has won prizes for swimming Fond of fruit and watercress. 113 Sept. 26 Sept. 27 F. 4 B also cup brand A and B See cases 41 and 48 ; child belongs to same family. Another case was notified from this family on September 29th, a child, female, set. 4 ... ... 114 Sept. 27 Oct. 2 M. 22 B B Family deal at X's. This patient is the brother of case 46, he washed this brother when he wa3 lying ill of " influenza " on September 16th ... ... 115 Sept. 28 Oct. 3 F. 8 Head brand Never Fried fish, fish and winkles from X. This child and the child, 112 above, were in the habit of visiting a house in which cases of enteric fever were under treatment at home ... Never lemonade or ginger-beer. [4] 26 No. Date of onset of illness. Date of notification. Sex and age. Milk supply. Ice-cream. As to consumption of fish, fried fish, shell fish, &c. As to use of swimming baths. Remarks. 116 Sept. 29 Oct. 5 M. 17 ... ... Brother of cases 55 and 56 ... See case 120. 117 Sept. 30 Oct. 7 M. 18 B Never Eats very little fish Never Drinks ginger-beer. 118 Oct. 3 Oct. 28 F. 13 ... Various places Fried fish from source named, not X ... ... 119 Oct. 5 ... F. ... ... Sister of case 44 ... ... 120 Oct. 6 Oct. 15 F. 39 ... ... Belongs to same family as cases 55, 56 and 116 ... ... 121 Oct. 7 Oct. 18 M. 20 Goat brand Never Buys fish at X's, not shell fish Never ... 122 Oct. 7 ... M. ... ... Father of case 44 ... ... 123 Oct. 8 Oct. 14 M. ... ... Removed from a common lodginghouse, only there a few hours. Had come on October 8th from Dover, where he had been 7 months ... ... 124 Oct. 8 Oct. 10 M. 6 ... ... Brother of case 29 ... ... 125 Oct. 9 Oct. 9 Oct. 20 Oct. 20 F. 35 M. 3 ... ... The mother and younger brother of case 93 ... 126 Oct. 10 Oct. 18 F. 12 ... ... Belongs to same family as cases 32, 91 and 92 ... ... Lambeth. (The cases which may be regarded as constituting the special outbreak are those numbered 3 to 45a, excluding 18, 39, 43 and 44.) No. Date of onset of illness Date of notification. Sex and age. Milk supply Ice-cream. As to consumption of fried fish. As to consumption of other kinds of fish and shell-fish. Remarks. 1 Aug. 20 Aug. 27 F 22 ... Never Often bought fried fish from Y Winkles from B See case 2. 2 Aug. 23 Sept. 18 M. 50 ... Never Usually bought fried fish elsewhere, but may have eaten some purchased by his daughter from Y ... Father of case 1. 3 Aug. 26 Sept. 12 M. 21 Condensed Never Often bought fried fish from Y on his own account and independently of rest of family Never winkles or shrimps See cases 21 and 25. 4 Aug. 28 Sept. 12 M. 17 Various sources ... Family often had fried fish from Y up to the time the children became ill ... Brother of case 8. † Aug. 29 ... M. 10 ... ... Habitually bought fish from Y, other people living in same house did not do so ... Supposed at time of illness to be influenza, Case 50 a playmate of his, lived in same house 5 Aug. 30 Sept. 7 M. 35 A Never Fried fish from Y frequently Shell fish from A Never watercress; fond of mineral waters. 6 Aug. 31 Sept. 20 M. 7 . . . Never All members of family frequently ate fried fish obtained from Y ... See cases l6 18 and 36. 27 No. Date of onset of illness. Date of notification. Sex and age. Milk supply. Ice-cream. As to consumption of fried fish. As to consumption of other kinds of fish and shell-fish. Remarks. † Aug. 31 ... M. adult Condensed ... Frequently ate fried fish obtained from Y Other fish from A This man was supposed to have " congestion of the lungs and bronchitis." He lived in the same house as case 27. 7 Sept. 1 Sept. 21 M. 16 B Never Often bought fried fish from Y, as did also his brother, case 15, other members of the family rarely did so Shell fish from A See case 15. 8 Sept. 1 Sept 10 F. 11 Various sources ... See case 4 ... Sister of case 4. 9 Sept. 1 Oct 4 F. 24 C Never Early in September was staying at a friend's house where she frequently had fried fish from Y's shop ... ... 10 Sept. 3 Sept. 15 F. 5 ... Never Family obtained fried fish from Y frequently Winkles from various sources ... 11 Sept. 3 Sept. 21 F. 50 D ... Family obtain fried fish from Y Winkles occasionally Eats watercress. 12 Sept. 3 Sept. 17 F. 11 Mother does not buy fried fish. This girl and her two sisters, cases 20 and 43, often buy "fish and taters" at Y's, more often on a Friday than any other day Winkles and shrimps from various sources 13 / Sept. 4 Sept. 14 M. 25 E Never Has eaten some 6 pieces of fried fish since February last. Two of these he remembers buying from Y on two Saturday evenings, probably in 2nd and 3rd weeks of August. He bought lfd. pieces A, but very rarely. No shell fish 14 Sept. 4 Sept. 14 F. 8 Condensed ... The child used to buy fried fish from Y ; her mother very rarely did so B Drinks kaola and lemonade. 15 Sept. 4 Sept. 21 M. 18 B Never... See case 7 Shell fish from A ... 16 Sept. 4 Sept. 14 F. 34 ... ... Often ate fried fish obtained from Y ... Mother of case 6. 17 Sept. 7 ... M. ... ... Fond of fried fish but it is not known where he obtained it ... A fatal case, his relatives cannot be traced. 18 Sept. 8 Sept. 15 F. 32 ... ... Says she did not eat fried fish. This case was found, at the hospital to which she went, not to be one of enteric fever ... A lodger in the house where cases 6 and 16 lived. 18a Sept. 8 ... F. 2 ... ... This child stayed during the daytime when her mother was at. work with her grandmother who lived in the affected area. She played in front of Y's shop, and almost certainly ate fried fish purchased there B Played frequently with the boy, case 28. 19 Sept. 9 Sept. 19 F. 28 Nestle At a shop close by Used to buy fried fish from Y on a Saturday night but does not rememberdoing soforsome few weeks before Sept. 19. Other members of family never bought from Y. A, but very rarely ... 20 Sept. 10 Sept. 17 F. 4 ... ... See case No. 12 See above Sister of cases 12, 43, 44 and 52. 28 No. Date of onset of illness Date of notification. Sex and age. Milk supply Ice-cream. As to consumption of fried fish. As to consumption of other kinds of fish and shell-fish. Remarks. 21 Sept. 10 Sept. 16 F. 18 Condensed ... Frequently ate fried fish from Y's shop Never winkles or shrimps Sister of case 3. See also case 25. 22 Sept. 11 Sept. 17 F. 10 Very little Never Fried fish from Y every Saturday night Winkles from A ... 23 Sept. 11 Sept. 20 F. 19 ... Occasionally Fried fish from Y frequently No other fish No shell fish A fatal case. 24 Sept. 11 Sept. 20 M. 19 F Very fond of ice cream Bought fried fish from Y occasionally No other fish No shell fish ... 25 Sept. 12 Oct. 18 F. 55 Condensed Never Mother of cases 3 and 21. Frequently ate fried fish from Y's Never winkles or shrimps A fatal case. 26 Sept. 13 Sept. 22 M. 6 Condensed ... Fried fish from Y frequently No shell fish or other fish ... 27 Sept. 14 Sept. 20 F. 26 Condensed ... Fried fish from Y frequently No other fish or shell fish Notified as "continued fever." 28 Sept. 14 Sept. 18 M. 9 ... ... Fond of fried fish and fruit. Had 1d. on a Saturday which he spent, as a rule, on one or the other. Would probably buy his fried fish at Y's ; moreover, his mother says he used to frequent the front of Y's shop on the chance of being given a bite of fish by his friends who purchased there 29 30 Sept. 15 Sept. 15 Oct. 1 Oct. 1 M. H M. 3 ... ... ... ... All the family fond of fried fish, which they buy at Y's Shell fish and shrimps from A See cases 33, 35, 49 and 54. 31 Sept. 15 Sept. 22 F. 8 Nestle No ice cream... Fried fish from Y's ... Winkles from B ... 32 Sept. 16 Sept. 21 M. 18 G ... Fried fish from Y frequently No other fish... Watercress occasionally. 33 Sept. 17 Oct. 4 F. 14 ... ... See cases 29 and 30 Shell fish and shrimps from A Sister of cases 29 and 30. 34 Sept. 17 Sept. 21 F. 10 Condensed ... Often bought fried fish from Y A Sister of case 37. 35 Sept. 18 ... M. adult ••• ... See cases 29 and 30 See cases 29 and 30 Father of cases 29, 30, 33, 49 and 54. 36 Sept. 18 Sept. 25 F. 9 ... ... Lived some distance from Y's shop, but stayed shortly before her illness with an aunt, who lived close by it. A cousin of the boy, case 6 ... See also cases 16 and 18. 37 Sept. 19 Sept. 26 F. 12 Condensed ... Often bought fried fish from Y A Sister of case 34. 38 Sept. 20 Oct. 7 F. 8 Name of shop not known ••• All the family fond of fried fish. They buy it at Y's < Winkles and shrimps very rarely; from A's ... 39 ... Sept. 22 M. 9 ... ... Not a case of enteric; notified in error ... ... 40 Sept. 21 Sept. 28 M. 4 Condensed Fond of ice cream Frequently obtained fried fish from Y A and B for mussels ... 41 Sept. 22 Sept. 27 F. 4 Condensed Once a week, usually on Fridays, children have fried fish from Y. At the end of August they had it more frequently Winkles and fish occasionally from A Sister of case 51. 29 No. Date of onset of illness. Date of notification. Sex and Milk supply. Ice-cream. As to consumption of fried fish. As to consumption of other kinds of fish and shell-fish. Remarks. 42 Sept. 23 Sept. 25 M. 4 ... ... Lived in same house as case 41. Obtained fried fish from Y ... A fatal case. 43 Sept. 24 Oct. 2 F. 6 ... ... Sisters of cases 12, 20 and 52 ... A fatal case. 41 Sept. 24 Oct. 9 F. 2 ... ... ... ... 45 Sept. 24 Sept. 25 M. 12 Condensed ... Family dealt at Y's, but these two patients also bought fried fish there " on their own " A Very mild case. 45a Sept. 24 Sept. 26 F. 18 Condensed ... A Said not to be enteric. 46 Sept. 25 Oct. 7 M. 19 G ... Never fried fish. At Margate first week in September, and while there ate some oysters, to which he attributes his illness ... ... 47 Sept. 26 Sept. 26 F. 40 Cup brand ... Not a case of enteric. Discharged a few days after admission to hospital ... ... 48 Oct. 1 Oct. 9 F, 17 ... ... Does not care for fried fish Various sources ... 49 Oct. 1 Oct. 3 M. 11 ... ... Belonged to same family as cases 29, 30, 33, 35 and 54 ... ... 50 Oct. 2 Oct. 16 F. 5 ... ... Case apparently secondary to the case marked f between cases 4 and 5 above. The child (50) played with the boy† during his illness, which was at first thought to be influenza, but was afterwards, on the two children being taken to hospital (after the second child sickened), suspected to have been enteric fever ... ... 51 Oct. 3 Oct. 9 F. 6 Condensed See case 41 ... Sister of case 41. 52 Oct. 4 Oct. 9 F. baby ... Belonged to same family as cases 12, 20, 43 and 44 ... ... 53 Oct. 5 Oct. 14 F. 33 H Never Used to obtain fried fish from Y A ... 54 Oct. 5 Oct. 13 F. 8 ... Belonged to same family as cases 29, 30, 33, 35 and 49 ... 55 Oct. 7 Oct. 14 M. 17 Head brand Never Bought fried fish, but not from Y... B ... 56 ... Oct. 18 M. 9 ... ... Bought fried fish from Y ... ... Kensal-town. (The primary cases occurring at the time of the special outbreaks in the other districts are those numbered 2 to 22.) No. Date of onset of illness. Date of notification. Sex and age. Source from which milk was supplied* As to consumption of fried fish. As to purchase of shell fish and fish other than fried fish. Remarks. 1 Aug. 21 Sept. 10 ... ... ... ... Only came to live in area three days before she was taken ill. 2 Aug. 25 Sept. 4 M. 26 A No fried fish Dry and wet fish from Z Fatal case. 3 Aug. 27 Sept. 15 M. 36 B Fried fish from z Dry and wet fish from Z Fatal case, 4 Aug. 28 Sept. 1 F. 16 B * The supply of seven of the local vendors lettered A to K was in large or small part derived from one large dairy company. A second dairy company supplied milk to a few of these vendors, and there were one or two other sources of supply in the case of individual vendors. The first mentionod company supplied directly or indirectly A, B, C, F, H, I and J. 30 No. Date of onset of illness. Date of notification. Sex and age. Source from which milk was supplied. As to consumption of fried fish. As to purchase of shell fish and fish other than fried fish. Remarks. 5 Aug. 29 Sept. 26 F. 16 Condensed No fried fish Does not remember where fish is bought(see case 29) See cases 24, 29, 31, 34, and 36. 6 Aug. 30 Sept. 8 M. 19 A ... Does not buy fish from Z At Tarmouth from Aug. 4th to 7th; did not eat shell fish but had shrimps there. 7 Aug. 30 Sept. 1 F. 8 B Fried fish from z Dry and wet fish from Z Same family as cases 3, 4 and 9. 8 Ang. 31 Sept. 11 F. 18 Not known Ate no fried fish so far as is known when in affected area Ate fish while on one of her visits, but it was not obtained from Z Only visited in affected area ; did not live there. 9 Aug. 31 Sept. 4 M. 10 B Fried fish from z Dry and wet fish and possibly shell fish from Z Same family as cases 3, 4 and 7. 10 Aug. 31 Sept. 9 F. 25 A Fried fish not from z Dry and wet fish and possibly shell fish from Z ... 11 Sept. 1 Sept. 10 M. 44 C Fried fish not from z Dry and wet fish and possibly shell fish from Z A fatal case. 12 Sept. 3 Sept. 12 F. 9 Various † No fried fish Dry and wet fish and possibly shell fish from Z, and also from another source ... 13 Sept. 4 Sept. 15 F. 19 A Fried fish from z, but very rarely Dry and wet fish and possibly shell fish from Z ... 14 Sept. 6 Sept. 11 M. 20 H and I ... Dry and wet fish and possibly shell fish from Z ... 15 Sept. 6 Sept. 12 M. 16 C Fried fish, not from z Dry and wet fish and possibly shell fish from Z ... 16 Sept. 7 Sept. 23 F. 18 D and G Fried fish from z Wet and dry fish and possibly shell fish from Z ... 17 Sept. 8 Sept. 14 F. 14 D and E Fried fish from z Wet and dry fish and possibly shell fish from Z ... 18 Sept. 11 Sept. 20 M. 25 J No fried fish Passes close to Z's shop on his way to work, but said not to buy wet fish Out of town for three days at beginning of September. A fatal case. 19 Sept. 12 Oct. 17 F. 25 K Fried fish, but not from z Passes close to Z's shop on her way to work, but said not to buy wet fish Not notified until her sister, case 32, was attacked. 20 Sept. 12 Oct. 18 F. 10 No milk No fried fish Dry fish from Z ... ... 21 Sept. 14 Oct. 3 M. 50 Condensed Often ate fried fish; not from z Does not eat wet fish as a rule Lived just on boundary of area. 22 Sept. 17 Sept. 24 F. B ... Buys from Z occasionally ... 2d Sept. 18 Sept. 29 F. 11 H and I Not from z Diy and wet fish from Z... A sister of case 14. 24 Sept. 21 Sept. 26 M. 4 Condensed No fried fish They buy from Z at times Same family as case 5. 25 Sept. 23 Sept. 27 M. 9 Hand I Not from z Dry and wet fish from Z... Brother of case 14. 26 Sept, 25 Sept. 27 M. 5 H and I Not from z Dry and wet fish from Z... Brother of case 14. 27 Sept. 25 Oct. 2 M. 14 A From z but very rarely Dry and wet fish from Z... Brother of case 13. 28 Sept. 26 Sept. 29 F. 13 C Not from z Dry and wet fish from Z.. Visited at house in which case 14 lived. 29 Sept. 26 Sept. 26 F. 10 Condensed See case 5 This child remembers having some winkles which were bought from Z. They usually obtain wet fish from a shop further away Same family as case 5. f May on occasion have purchased from a local vendor F, supplied by the first of the two companies above referred to. 31 No. Date of outset of illness. Date of modification. Sex and age. Source from which milk was supplied. As to consumption of fried fish. As to purchase of shell fish and fish other than fried fish. Remarks. 30 Sept. 28 Oct. 3 M. 21 A No fish No fish Visited at house in which case 2 resided. 31 Sept, 29 Oct. 9 F. 2 Condensed See case 5 See case 5 Same family as case 5. 32 Sept, 30 Oct. 17 F. 25 K Fried fish occasionally, not from z Never wet fish Sister of case 19. A fatal case. 33 Oct. 2 Oct. 16 M. 15 Condensed Fond of fried fish, not from z Rarely have any other kind of fish A fatal case. 34 Oct. 2 Oct. 9 M. 12 Condensed See case 5 See case 5 Same family as case 5. 35 ... Oct. 21 F. 30 D and E See case 17 See case 17 Sister of case 17, whom she nursed up to within a few weeks of being herself attacked. 36 Oct. 10 Oct. 15 F. 14 Condensed See case 5 See case 5 Same family as case 5. Three more members of this family were subsequently taken ill— F. 37, notified Oct. 21, attacked Oct. 17. M. 38, notified Oct. 21, attacked Oct. 20. M. notified Oct. 21, attacked Oct. 20. The mother of case 3, and grandmother of cases 4, 7 and 9 was attacked on Oct. 20, and notified on Oct. 26. An aunt of the child, case 5, was notified on Nov. 20, she had then been ill some time. APPENDIX II. London County Council. THE SIGNS AND SYMPTOMS OF PLAGUE. By James Cantlie, M.B., F.R.C.S., D.P.H. (Ordered by the Public Health Committee to be printed.) Public Health Department, 8, St. Martin's Place, W.C. October, 1900. JAS. TRUSCOTT & SON, PRINTERS, SUFFOLK LANE, CANNON STREET, E.C. [4577 2 THE DIAGNOSIS OF PLAGUE. London County Council, Public Health Department, 8, St. Martin's-place, W.C., October, 1900. The Local Government Board having made an Order requiring the notification by medical practitioners of cases of plague, the London County Council has thought that it would prove of assistance if a concise and accurate description of the malady, by a medical man who has had experience of it, were placed in the hands of all practitioners in London. The Council has therefore requested Mr. James Cantlie, M.B., F.R.C.S., formerly medical officer in one of the Plague Hospitals in Hong Kong, to prepare the accompanying memorandum. Inasmuch as few medical men have had the opportunity of seeing cases of plague, the Council has engaged the services of Mr. Cantlie to visit any person in London suspected to be suffering from this disease with a view to assisting in the diagnosis. Any medical practitioner desiring to avail himself of these services should apply at this office. Shirley F. Murphy, Mcdical Officer of Health. 3 THE SIGNS AND SYMPTOMS OF PLAGUE. The term plague, in former days employed to designate almost any and every epidemic ailment, has in recent years come to mean a specific disease, caused by a definite bacillus, and characterised by signs and symptoms of pronounced clinical features. Of the several adjectives associated with the name "plague," "bubonic " is the one most frequently heard; but our increasing knowledge of plague has justified the recognition of a " pneumonic " and a " septicaemic," as well as a bubonic type, each possessing signs and symptoms of a sufficiently staple pathological character to justify their recognition as true varieties. The different varieties may be classified as follows— Varieties of type—Clinical. Common to all varieties of plague there are certain signs, symptoms and post-mortem appearances. When, however, one special clinical feature predominates, it is usual to group the cases in which it occurs under one heading. This is convenient, and although the classification is for the most part based on clinical evidence merely, it serves further to draw attention to the many covert ways in which plague may appear, and the great difficulty in recognising its presence in every case, even when a fairly prevalent outbreak has taken place. In enumerating the types only the distinctive feature of each type is notified. 1. Bubonic plague is characterised by the development of a bubo or buboes during some period of the attack. It is by far the most common variety, buboes seldom occurring in less than 70 per cent, of the cases met with during an epidemic. 2. Septicemic plague—No bubo occurs in this variety of the disease. During life the glands may be felt enlarged to a small extent in exposed parts, but post mortem examination shows every gland to be swollen to some extent. Septicaemic plague is very fatal. 3. Pneumonic plague—As the name implies the lungs are primarily affected, and so far as can be elicited by clinical examination they are the only organs which develope definite lesions. The glands are not enlarged, nor are they found swollen after death. In some epidemics the pneumonic type of the disease is more prevalent than in others. Patients with plague pneumonia seldom recover. 4. The nervous type—When delirium, mania, convulsive seizures, aimless wanderings, tremors, deafness, dumbness, &c., constitute prominent features of the attack, they are sometimes referred to as belonging to a nervous type of the disease. Convulsions in children and delirium in adults may usher in the disease. In children this is a fact to be remembered as the convulsions may continue to occur and the child die before other symptoms suggesting plague have developed. 5. Such terms as toxic and fulminant as applied to plague, imply a rapidly fatal issue, the patient succumbing within 24 hours; so sudden is the onset and development that the system seems paralysed in its effort to attain a reaction; the pallor of the face, the prostration, the low temperature, and the feeble pulse would seem to indicate that the person attacked is struck down as if by severe shock. 6. Cases of plague are referred to a puerperal type, when abortion or miscarriage has occurred. Haemorrhages from the uterus and appendages occasionally occur independently of pregnancy. Women in the later stages of pregnancy abort when attacked by plague. After abortion due to plague few women recover. 7. Pestis ambulans indicates a mild type of the disease in which the patient may go about his ordinary duties. The buboes may give rise to no inconvenience and no feeling of illness. It is most commonly met in children. Several members of the household may be attacked severely by plague, but one child may escape with a painless swelling merely. This is a very dangerous type so far as infection is concerned, and a careful watch must be kept on the possible development of such cases. 8. Pestis minor—What is termed the larval or abortive type of plague, but which is perhaps best designated pestis minor, is an interesting form of the disease from every point of view. During many epidemics of true plague observers have recorded a mild form of the disease, which occurred not only when the epidemic was at its height, but which for several months (or years) before, and for several months (or years) after, spread amongst the community. The importance of this ailment is that it may precede an outbreak of plague, and should be carefully watched and recorded. The symptoms are swelling of a groin gland, inflammatory effusion in the periglandular tissue, some initial fever and gradually increasing temperature, and a feeling of general malaise. The skin over the bubo reddens, suppuration develops, and the pus finds its way to the surface by two, three or more fistulous openings. The gland when excised is found surrounded by a thin purulent fluid, and when a section is made several small necrosed or purulent foci are seen to stud the gland tissue, which has become soft and diffluent. After removal of the gland the parts gradually heal, and by the end of a month, with the exception of a scar, all traces of the disease disappear. 4 In Calcutta the plague bacillus was reported present in cases of pestis minor amongst soldiers of a regiment which arrived in Calcutta from Hong Kong whilst plague was raging in Hong Kong. It is important that cases of so-called Bubon d'emblee, that is buboes occurring independently of a venereal cause, should be carefully examined for plague bacilli when plague threatens or is prevalent. The plague bacillus—Microscopic characters. When from within a gland, or from the periglandular tissues, a small quantity of fluid is drawn off by a hypodermic (or antitoxin) syringe and examined, bacilli will be found plentifully distributed in the fluid. In the blood the bacilli may not be found until late in the disease. Search may also be made for the bacillus in the faeces, in the urine, or in the sputum of pneumonic cases. In the pus of recently opened buboes, or in the scrapings from the surface of an incised gland, a luxuriant crop will usually be found. Old standing purulent discharges seldom show the bacillus. Post-mortem, almost every organ of the body shows the presence of micro-organisms. They may be readily demonstrated when a smear from any of these sources is spread on a slide, allowed to dry, and a staining fluid added. The stain may be any one of the basic aniline dyes. The plague bacillus is a short, thick rod, with rounded ends. In length it measures about 1.5u and in breadth 0.7u. The ends of the rod-like bacillus stain much more deeply than the centre, and around the stained portion a clear area or envelope is sometimes to be made out. In stained preparations made from artificial culture, the bacillus may present the appearance of a diplococcus, but occasionally four to six or more of the bacilli join end to end, resembling streptococci. Diagrammatic representation of the plague bacillus showing its relation in size to the red corpuscles of the blood. The plague bacillus, examined by 1/12-inch oil immersion lens. Conditions as to the spread of plague. Exposure to infection—It is most important to institute a careful inquiry into the possible source of infection in every instance. This is especially important during the initial phase of an outbreak, when by its detection valuable assistance may be rendered in devising immediate steps to arrest the spread of the disease. 5 A ship arriving from an infected port, plague-infected rats found in a previously healthy locality, a traveller arriving by land or sea from a district or town in which plague is raging, may each and all prove to be the cause of an outbreak of the disease. The spread of the disease in a healthy town may be distinctly traced to its origin and focussed upon a particular house, as has been the case in Glasgow. How the disease reached the abode in question in Glasgow has not yet been ascertained, but that in one particular household the disease primarily developed and infected others is an undoubted fact. The importance of tracing the infection to a focus will be understood by a study of the means by which plague is spread. So far as is known it is largely by human intercourse that the plague is spread, and with this fact in view the question of dealing with all persons who have been in contact with plague-infected persons is simplified. All " contacts ' must be isolated until the period of incubation is over. This is perhaps the most important point to be remembered by medical men and public authorities in their attempt to limit or to stamp out the disease. The means by which plague is spread—Plague is spread chiefly by human agency; but rats, body and household parasites, wounds, food and drink, and infection by the air are all possible agents in the spread of the disease. Contact with plague-infected persons may or may not directly influence infection by plague; all depends on the circumstances and environment. Doctors, nurses, and attendants in hospitals are not markedly subject to attack, in fact the plague hospital seems to be the one place in a plague-stricken city where contagion is least potent. This is to be accounted for by the cleanliness of hospitals and by the care taken to disinfect clothing, bedding, utensils and excreta. In uncleanly abodes where disinfection, &c., is not practised, contact with persons sick of plague is dangerous in the extreme. Plague germs leave the body by way of the respiratory tract, by the fasces and by the urine. The sputum is the most directly infectious of all these, but the excreta are more likely to convey the bacillus either by soiling the clothing, the bed-room furniture, or by inoculating rats and other vermin. Faeces are found to contain plague bacilli for four weeks after the crisis of the illness has passed, and the danger of convalescent patients mixing with the community is thus readily understood. Clothing soiled by vomited or expectorated matters, by faeces or urine, retains infective powers for some time (months) if packed away whilst yet moist. Food, such as grain, fruit, &c., has been found impregnated with plague bacilli, but proof that food or water has directly conveyed infection is wanting. Rats are very prone to plague. The first warning that plague is incident may be deaths amongst rats. Plague-infected rats leave their runs, they appear dazed, become seized with convulsions and speedily die. Whether the rat is seized with plague before man and thus infects him, or whether man infects the rat, is a question as yet undecided. Many epidemics are believed to have been traced to rats, yet in other localities, and markedly so in Glasgow, the rats have not been found infected by plague, either before or after the outbreak. It is by the vermin in the rat's coat that infection is probably conveyed to man. The vermin leave the rat soon after the animal dies, and as it is found that the vermin contain the bacilli, the poison may gain entrance to the human body by vermin bites or by the abrasion of skin consequent on the scratching they induce. Parasites, such as fleas, bugs, and lice, acquire the bacillus from feeding on plague-sick persons, or they may gather it from clothing, bedding, &c., soiled by excretions. Infection by the air is open to question, as although the bacillus has occasionally been found in the dust of rooms, on earthen floors, and even on the walls, it has never been isolated from the air. It is conceivable, however, that in an ill-ventilated room the atmosphere may become so impregnated with the emanations from the sick as to become infectious of itself. Entrance to the body—The plague bacillus may gain entrance by the skin, and possibly by the breath and the mouth. Entrance by the skin is considered probable for several reasons. In the first place it is the groin (femoral) glands that are most usually the seat of buboes. The selection of this group is frequently attributed to the fact that the majority of persons affected by plague in warm countries go bare-footed. Against this conclusion are the facts that skin abrasions are but seldom found, and that persons not going bare-foot have their groin glands most frequently attacked. The axillary glands, affected by way of the hands, would a priori seem to be more liable to such a method of inoculation seeing the hands are exposed and that soiled articles, dead bodies, rats, &c., are touched by them. Such, however, is not the case. It is possible, however, that if vermin are the intermediaries of contagion that they could settle more quietly and undisturbedly on the lower extremities, even beneath the garments, than on the more exposed parts such as the hands or face, where they are liable to be disturbed or brushed off. Plague has been acquired by post-mortem wounds, by the sputum alighting on the conjunctiva, and in many instances the marks of insect bites and scratchings on the lower limbs would point to the skin as being the medium of entrance to the body. Cracks in the lips and inflamed tonsils are assumed to be the mode of entrance of plague poison when the cervical glands are primarily enlarged. Proof that the bacillus can be inhaled, or that the body may be contaminated by the alimentary canal, is wanting, and however much these channels may swarm in bacilli, the mere fact does not prove that they were infected directly from without. 6 Signs and symptoms. Bubonic plague. The bubonic type is taken as the standard for descriptive purposes, as the number of persons suffering from plague, in whom this variety is met with, outnumber by a large proportion those attacked by all the other varieties. Three-fourths of plague patients develope buboes. Incubation—Three to five days is the usual period of incubation, but there is ample proof that a person exposed to plague infection may develope symptoms in thirty-six hours, or the period of incubation may extend to ten (or fourteen) days. The prodromal symptoms are either nil, or of so indefinite a character that no specific importance can be attached to them. Invasion—The onset of plague is sudden:—A rigor or mere chill, a splitting headache, nausea and vomiting, backache, a quick pulse, quickened breathing, congested conjunctive, a white coated tongue with reddened edges and tip, a rise in temperature, sudden weakness or prostration, and a marked mental disturbance, with or without glandular pain or swelling, constitute the initial indications of an attack of plague. The majority of these symptoms are common to many forms of illness, and two or three only are special. In no other disease, not even excepting cholera, does the physical strength so suddenly decline, and in no other does mental aberration develope so quickly. The presence of glandular swellings, or a bubo in combination with these, is well-nigh diagnostic of the disease being plague. As the illness proceeds the signs and symptoms present at the onset continue or increase in severity. Vomiting may persist for a day or two or throughout the illness. The pulse at first full and rather tense, becomes weak and compressible, and towards the end in fatal cases intermittent, irregular or running. The breathing increases in rate with the rise in temperature and the quickness of the pulse. The temperature may continue to rise say from 101° F. at the onset to 103°-105°-107° F. during the first two days, or it may reach 105° F. within a few hours after invasion. After three to five days the temperature usually falls to near the normal, but after the fifth day it may rise again to fall on the seventh or eighth. A clearer conception of plague will be gathered by a categorical study of the several organs and tissues of the body. The digestive system—The white fur on the tongue, present from the beginning of the illness, speedily acquires a mahogany colour and finally changes to a brownish-black hue. At first the tongue is swollen and the edges indented by the teeth, but after two or three days the dorsum is cracked and fissured and the whole organ seems contracted in size. The tonsils are usually reddened and may be swollen with mucous puncta on their surfaces; or they may be actually inflamed. Vomiting and nausea, frequently present from the onset, may continue for a day or two or occasionally, in unfavourable cases, persist to the end. The vomited matters appear of a bilious character at first, but later on consist merely of the food and drink that has been taken, combined with an inordinate amount of clear fluid. Occasionally the vomit presents a coffee-ground appearance, but this is not due to hæmatemesis. Constipation obtains for the most part during the first day or two ; it may persist or give place to a profuse intestinal flux. On the other hand diarrhoea may be present from the onset. Blood occasionally appears in the stool. The abdomen may be swollen or retracted. The liver is somewhat enlarged, and tender to percussion; the spleen is always swollen and tender, the enlargement may be such that the spleen occupies three or four times its normal size. The circulatory system—The pulse, increased in frequency from the first, gains in rapidity as the disease progresses. At first full and tense it fails after a day or two and becomes soft and compressible and finally dicrotic or running in fatal cases. The heart beat at the apex is more diffuse than normal; and a praecordial thrill may be occasionally felt. The right side of the heart shows evidence of dilatation; the first sound of the heart is short and the second feeble ; a systolic murmur is occasionally present. Pulsation of the carotids is frequently apparent. The respiratory system—In bubonic plague it is the exception to find any lesion of the organs of respiration. Should bronchial or pulmonary symptoms develope, they seldom occur before the fourth or fifth day, and usually immediately before death. The lung affections peculiar to the pneumonic type of the disease are discussed under "pneumonic plague." The urinary system—In some epidemics it is the rule to find a trace of albumen from almost the onset of the disease; in other outbreaks, however, few urinary derangements occur. The urine is always scanty, especially at the onset of plague, the specific gravity is high, and the reaction intensely acid. Urea, uric acid and chlorides are deficient in amount; granular casts are not infrequent, and blood in some quantity is occasionally met with. In all cases retention of urine is the rule, but actual suppression may complicate the illness in fatal cases. 7 The nervous system—From the onset of plague the mental faculties are affected. The paindrawn, haggard expression of countenance would seem to indicate that the patient is suffering from pain probably arising from the glandular swellings. This speedily gives way to, or may be wholly supplanted by, a peculiar listlessness and apathy of feature well-nigh characteristic of the disease. Delirium may, on the other hand, usher in the disease, accompanied by what would appear to be a suicidal tendency, inasmuch as the patient may rush to the verandah or window, to the staircase, or out into the street. The outburst is, however, unattended with any fixed idea or purpose. If gently restrained the patient is soon turned from his apparent purpose, and his aimless intention may assume the form of wandering in the street or taking passage by train to an uncertain destination. It would appear by the answers to questions that the patient is sensible, but his statements are frequently untrue, the memory being at fault. Deafness, thickness of speech, laryngeal paralysis, muscular tremor, loss of co-ordination in almost any group of muscles are common features in the disease. Sleeplessness is a distressing symptom, and of so constant an occurrence as to constitute one of the most trying conditions to deal with. In fatal cases, picking at the bed clothes, busy delirium and coma prevail, and usually herald death. The cutaneous system—Petechiæ occasionally appear, especially in fatal cases, over the seat of the bubo or on the limb affected by the bubo, or still more rarely on other parts of the body or limbs. Subcutaneous haemorrhage of an extensive character may occur around a bubo, or smaller hæmorrhages may develope elsewhere. Small patches of skin may slough, buboes suppurate, leaving foul, deep, ulcerated surfaces with ragged edges. Boils and so called carbuncles are exceptional, and a distinctive rash is very uncommon ; when a rash occurs it closely resembles the rash of typhus. The lymphatic system,—The toxic agency in plague seems to expend its virulence largely on the glands. Although a bubo may be apparent in only one region of the body, post mortem examination reveals the fact that almost every gland in the body is swollen. Buboes occur most frequently in the groin, and the order of frequency with which buboes appear in the groin, axilla, and neck, stand as 50, 30, and 15, in every hundred cases which show buboes. The bubo may appear at the onset and may be present even with the initial rigor; more usually, however, it does not develope until the second day, when it will be found as a large, smooth, bun-shaped swelling. On palpation it feels resilient and rather elastic and resistant. The bubo may disappear, but suppuration is the rule at the seventh to the ninth day of the illness. The glands in the neighbourhood of the bubo are obscured and incorporated in the swelling. (Edema may extend over a wide area around the bubo, and a subcutaneous haemorrhage may in the case of the groin buboes extend down the thigh, backwards to the gluteal region, and upwards on the abdominal wall. When the axillary glands are involved the swelling and oedema may extend over the chest, down the side to the ilium, and backwards to the scapular region. In the neck the effusion is at times sufficient to press upon the trachea and larynx. The pain caused by the adenitis and bubo may be so great as to be excruciating, and causes the affected limb to be placed in a position calculated to best relieve tension; the lower limb is flexed on the abdomen ; the upper limb placed away from the trunk, the patient lying on the back, or inclined towards, or altogether turned on, the affected side. Septiccemic plague. Although the term "bubonic " is usually associated with what is called true plague, it is now known that glands may enlarge and toxic symptoms develope without the formation of a bubo. The dose of poison seems so large that a general infection of the blood ensues and the patient is struck down suddenly without much chance of recovery. There is but little reaction after the onset; the pulse fails from the first; the temperature rises suddenly, it may be to a hyperpyrexic height; the prostration is extreme; delirium or coma may suddenly set in and continue to the end. The glands never attain a large size, although every gland in the body may be swollen. Deep and firm pressure may elicit pain over the groin, iliac, axillary, or cervical group of glands, but usually this is obscured by the mental condition of the patient. The septicaamic type is a very fatal variety of plague. Pneumonic plague. During the epidemic of plague in Bombay in 1896 attention was drawn by Childe to the abnormal number of deaths returned as ' pneumonia'. A bacteriological investigation of such cases showed that the plague bacillus was present in the sputum in almost a pure culture, and since that time the pneumonic variety of plague has been recognised as a distinct and very fatal form of the disease. The symptoms are—expectoration of a quantity of watery sputum, frequently tinged with blood, and occasionally some frothy mucus; hurried or laboured breathing, cardiac discomfort, restlessness, sleeplessness and early delirium. The local signs are patchy, irregular, pneumonic consolidation of the lungs, congestion of the bases, and intermittent evidences of bronchial catarrh. Buboes do not occur, nor are the glands found swollen either during life or after death. Duration of the disease. The most fatal period in bubonic plague is from the fifth to the seventh day, but death may take place earlier or later. Suppuration of the bubo and bursting of the abscess occurs usually between the eighth and twelfth day, and should the patient survive until that period the 8 chances of recovery are hopeful. In septicaemic plague the patient has much less chance of recovery. Death may occur in thirty-six hours or may be delayed until the fourth or fifth day. Few recover from this variety of plague. From the pneumonic variety of plague few recover; death usually occurs from the third to the fifth day. Convalescence in every instance is very slow; the patient is unfit for sustained physical or mental work for several months after an attack of plague. Diagnosis. Conclusive proof that a person is suffering from plague can be arrived at only by proving the plague bacillus to be present in the excretions, in the glands or periglandular effusion, or in the blood. But clinical evidences are usually sufficiently pronounced to suggest that the illness is due to plague. The sudden onset, the marked prostration, the mental aberration, the splitting headache, vomiting and nausea, backache, the rise in temperature, the furred tongue, when taken in conjunction with tenderness and pain in some one of the groups of glands are sufficient to indicate the necessity for a speedy microscopic search for the plague bacillus. Pneumonic plague is apt to be regarded as simple pneumonia. The rapidity of the development of all the signs and symptoms are, however, peculiar to plague infection. The early delirium, the early signs of patchy pneumonia, the presence of blood in the expectoration from almost the onset, combined with extreme prostration would seem to indicate a specific form of illness. " Glandular " fever in children is apt to be mistaken for plague during an epidemic. Convulsions in children may usher in an attack of plague. Typhus fever, although an uncommon disease, presents several of the signs and symptoms characteristic of the plague, but typhus fever developes more slowly; the rash is unlike the plague petechias which are occasionally met with ; the prostration and the delirium come on at a later stage of the disease. Typhoid fever even may be confounded with what is called the " typhoid " variety of plague, but a 48 hours' study of the temperature will generally suffice to differentiate the diseases. Prognosis. The chances of recovery in individual cases are well nigh incalculable, as the most favourable appearances are sometimes delusive, and the most hopeless-looking cases may recover. In China, among patients under treatment by Chinese " doctors," over 95 per cent, of those attacked died. In India, 70 per cent, of natives who were attacked by plague and were, more or less, under European treatment died. Amongst white people the death rate is much less ; about 35 per cent, only died in India. In Sydney, 103 persons died out of 303 attacked. Pathological anatomy. Bubonic, plague. An examination of the surface of the body of a person dead of bubonic plague may reveal petechiae, bites and scratchings, and less frequently boils and 'carbuncles'. The situation of the bubo is generally readily apparent. On examining a bubo that has not formed an abscess and broken, there will be found around the bubo a large accumulation of perivascular inflammatory effusion extending some way, it may be great way, in the surrounding tissues, or an extensive haemorrhage may be found. The glands involved will be found matted together by tissue infiltrated with serum, coagulated blood or inflammatory fluids. One gland of the group may be found as large as a walnut, the others varying in size from a bean to a hazel nut. All the glands are intensely engorged, the smaller on section appear dark in colour, the larger of a bright red or even pink tinge. In consistence, the less swollen glands may be almost normal, but the more enlarged are soft and diffluent to the touch. As a rule every gland in the body is swollen to some degree, and not only is this true of the limb glands but the lumbar, the mesenteric and the mediastinal glands may be all involved. The respiratory organs in bubonic plague are not deeply affected, but subpleural petechiae and haemorrhage both parietal and visceral are frequently seen. The cavity of the pleura always shows a fair amount of pleural fluid which may be occasionally blood-stained. The lungs are oedematous, intensely congested and minute haemorrhages may be seen in their tissues. A frothy mucus, occasionally blood-tinged, occupies the bronchi. The heart and pericardium—Petechiae on the parietal and visceral layers of the pericardium are commonly met with, and some two or three ounces of fluid, occasionally blood-stained, occupies the cavity of the pericardium. The heart muscle appears flabby, and the tissue cloudy as if from fatty degeneration ; the right side of the heart is usually dilated, and the walls of the great veins approaching the heart show small subendothelial haemorrhages in their coats. The abdominal viscera—Beneath both the parietal and visceral layers of the peritoneum haemorrhages are to be seen. Retro-peritoneal haemorrhage, haemorrhages into the mesentery and omentum at times attain wide dimensions, and around the kidneys the largest of all extravasations of blood occur. The mucous membrane of the stomach and intestines are deeply congested, petechiae are common, and occasionally considerable haemorrhages. The solitary glands and Peyer's patches are 9 always prominent, and sometimes even ulcerated. The liver is intensely congested, increased somewhat in size, the tissue pale or brownish red on section, and the parenchyma, if altered at all, softened. The gall bladder is generally found full of bile, and around it a haemorrhage may be found. The spleen is swollen to three or four times its normal size; hyperæmia is usual, and the colour of the organ varies from bright red to deep purple. Haemorrhage may occur beneath the capsule and extend for some distance into the splenic pulp. The kidneys are found enlarged, deeply congested, and occasionally embedded in a mass of coagulated peri-renal blood. The capsule is easily removed, the stellate veins are prominent, and small haemorrhages occur between the capsule and the kidney surface. A thickened cortex and a cloudy swelling of the renal substance are apparent on section. Blood may occupy the renal pelvis, and both the ureter and the bladder occasionally contain blood. The bladder may be distended with urine or quite empty, and the mucous membrane may or may not show petechiae. The nervous system—Meningeal congestion, engorgement of the cranial vessels, œdema, and distinctly marked vascular puncta in the brain substance, are almost constantly met with in plague. Ecchymoses in the pia mater occasionally occur. The spinal cord and the nerve trunks show no pathological changes. Septiccemic plague. The special post-mortem characteristics of this variety of plague are confined to the state of the glands. There are no buboes, but practically every gland in the body is swollen in some degree. In one group and in one gland of the group adenitis is more advanced than in others, but all show signs of engorgement on section. They are of a pink colour and firm in their consistence, although in the largest glands areas of softening are apparent. Congestion of viscera, subendothelial and submucous hæmorrhages and petechias occur in the septicaemic form of plague ; but there is no periglandular effusion or haemorrhage to be found. It would appear as though the intensity of the poison is so virulent and its diffusion so general that the patient is carried off before the bubo had time to develope, for this is a most fatal form of plague. - Pneumonic plague. The pathological changes in the pneumonic variety of plague are almost wholly confined to the respiratory organs. It is quite exceptional to find any gland enlarged, but occasionally the bronchial glands appear swollen. The changes presented in the lungs are:—(Edema, venous engorgement, patches of pneumonic consolidation irregularly distributed and varying in size from a hazel nut to a good-size apple. Around the reddish-grey or claret coloured patches a circle of crepitant and engorged lung tissue exists. Subpleural haemorrhages are usual. The bronchial, the tracheal and laryngeal linings are reddened and injected; a frothy, blood-stained fluid occasionally occupies their lumen. The cerebral, the cardiac and abdominal changes resemble those mentioned as occurring in bubonic plague. James Cantlie, M.B., F.R.C.S., Lecturer, London School of Tropical Medicine. London County Council. need 12.12.02 BACTERIAL TREATMENT OF CRUDE SEWAGE. FOURTH REPORT by Dr. CLOWES. EXPERIMENTAL TREATMENT of LONDON CRUDE SEWAGE in SETTLING-TANKS AND COKE-BEDS AT BARKING AND CROSSNESS. presented To the Main Drainage Committee of the Council, by PROFESSOR FRANK CLOWES, D.Sc. (Lond.), f.I.C. (Chief Chemist to the Council), On April 17th, 1902. JAS. TRUSCOTT AND SON, LTD., PRINTERS, SUFFOLK LANE, CANNON STREET, E.C. [2597 CONTENTS. I.—Brief Summary of the Origin, Method and Results of the Experimental Bacterial Treatment, with a Statement of Conclusions and Recommendations. Introductory. Origin of the Experimental Bacterial Treatment. Description of the Bacterial Experiments. Conclusions arrived at by the Experimental Treatment. Recommendations founded on the above conclusions. Summary of Information furnished by Towns and Districts in which the Bacterial Treatment of Sewage has been employed. Short Summary of the Evidence given before the Royal Commission on Sewage Disposal. II.—Experimental Bacterial Treatment of Crude Sewage at the Northern Outfall Works (Barking). 1. Tabulated List of the Experiments and of the Bacteria-beds. 2. Summary of the previously reported details of the Experiments in the Bacterial or Natural Treatment of Sewage at the Northern Outfall Works, with such additions as are necessary in order to complete the information up to the end of 1901. 3. Particulars of the Experiments on the Bacterial or Natural Process of Sewage Purification at the Northern Outfall Works (Barking) which have not been previously reported. [III.—Experimental Bacterial Treatment of Crude Sewage at the Southern t. Outfall Works (Crossness). 1. Tabulated list of the Experiments and of the Bacteria-beds. 2. Summary of the details, previously reported, of the Experimental Bacterial or Natural Treatment of Sewage at the Southern Outfall Works (Crossness), with such additions as are necessary to complete the information respecting the experiments. 3. Additional particulars of the Experiments on the Bacterial or Natural Process of Sewage Purification at the Southern Outfall Works (Crossness). IV.—Tabulation of the Results of the Chemical Examination of the Crude Sewage and of the Effluents. V.—Tabulation of Information respecting the Bacterial or Natural Treatment of Sewage at various centres throughout the Country. BACTERIAL TREATMENT OF CRUDE SEWAGE. I.—BRIEF SUMMARY OF THE ORIGIN, METHOD AND RESULTS OF THE EXPERIMENTAL BACTERIAL TREATMENT, WITH A STATEMENT OF CONCLUSIONS AND RECOMMENDATIONS. Introductory. The period of experimental treatment by bacterial agency at the Council's Outfalls has for the present been concluded, and. the time appears opportune therefore for briefly stating why the experiments were undertaken, the nature of the experiments, the results which have been arrived at, and the recommendations which they suggest. Origin of the Experimental Bacterial Treatment. The whole of the raw, unsettled sewage of the Metropolis was formerly allowed to flow without any previous treatment into the Thames. The result was that the stream, more especially in summer time, became insupportably foul. The foulness arose partly from sewage mud or sludge deposited on the foreshores, partly from black sewage scum floating on the surface of the river, but also from putrid changes occurring in the sewage substances dissolved in the water itself. It was decided to remove the main source of this nuisance by subjecting the sewage to straining or screening, and then to settling or subsidence, and to pass the more or less clear effluent from this settling process into the Thames many miles below London. Under this scheme the coarse screenings are now disposed of on farm land and the foul settled matter, or sludge, is carried out and discharged on a falling tide in the estuary. The sedimentation of the sewage has in recent years been much facilitated by the addition in moderate proportion of chemical solutions. The above treatment, which is still in operation at the Outfalls, has prevented entirely the fouling of the foreshores and of the river surface with sewage sludge. Those who proposed the above remedial measures, however, stated that the sewage effluent would still carry into the river a large amount of putrescible matter in solution, and recommended that, as opportunity occurred, the effluent should be further purified by land treatment or by other means, before it entered the river. This further treatment has never yet been attempted on the large scale. No suitable land for land treatment existed at the Sewage Outfalls, and no other method of treating the effluent was known at the time. The Massachusetts experiments on the treatment of sewage effluent in cokebeds, which enabled the bacteria present in the sewage to effect the necessary additional purification, were subsequently published. They appeared suitable to the purpose in view, and the Main Drainage Committee of this Council accordingly authorised my predecessor to start an experimental trial of the process at the Council's Outfalls. At the time of my appointment as Chemical Adviser to the Council, the results arrived at by my predecessor were so promising that I strongly recommended their continuance on an extended scale; and for four years, with the assistance of the Chemical staff and with the co-operation of the Superintendents at the Outfalls, I have conducted this experimental purification of the sewage effluent, and have arrived now at results and conclusions which I am convinced are of the greatest importance, and are worthy of the most serious consideration of the Committee and of the Council. Description of the Bacterial Experiments. When I recommended the Committee to continue the experimental treatment, there was a large bacterial coke-bed, one acre in area, at the Northern Outfall which 4 was dealing with a small portion of the present effluent before it entered the river. This bed was arranged only to treat the chemical effluent; it was not of satisfactory construction, nor was it filled with suitable coke material. Further, it was impossible, owing to its low level, to empty it at all states of the tide, and accordingly it could not be filled as often as was necessary, in order to obtain the knowledge which was required. At the desire of the Committee, however, this bed has been maintained in action for over eight years, and it is now still giving admirable results in purifying the present sewage effluent. But with the sanction of the Committee I have had in constant operation, and under most careful observation, a series of smaller coke-beds. These beds have received a special supply of raw sewage which came direct from the main sewer, and was entirely unmixed with chemicals. The process of working these beds has been subject to constant improvements and extensions, which have been suggested by experience and observation. I will only here describe the final method of experimental treatment which has been adopted. The raw sewage, which has been screened from its coarser matters only, is pumped continuously into a settling tank, the rate of supply being so adjusted to the capacity of the tank that the sewage remains about six hours in the tank before it flows away through an elbow pipe from beneath the surface of the liquid into the coke-beds. In this tank practically the whole of the suspended or floating particles of the sewage settle as sludge, and are allowed to remain undisturbed. It is found that a considerable proportion of this sludge disappears by bacterial action. During the first period of six months, before the bacterial action was fully started, 25.6 per cent. of the sludge disappeared, and during a subsequent similar period more than 50 per cent. of the sludge was removed by bacterial action. The portion which disappeared was the most putrescible portion of the sludge, which is at present carried to sea in the Council's sludge boats. Its disappearance would reduce the freight which these boats are required to remove. But it is probable that a considerable further reduction in the "sludge" cargoes might be effected by properly devised detritus settling tanks in which road sand would subside, and from which it might be removed to the marshes without giving offence. This reduction in the amount of sludge, which is secured by bacterial action alone, would be of the greatest importance. The sewage as it flows from the settling tank is less pure than the effluent which is at present discharged into the river at Crossness, and is quite unsuitable for direct discharge into the stream. But by the subsequent coke-bed treatment it is rendered sufficiently pure to support the life of fish, and to insure it against undergoing even in summer time any offensive change. In the experimental treatment, the settled sewage is therefore allowed to flow into a coke-bed, which is a tank filled with suitable coke fragments to a depth of six feet. As soon as the bed is filled to the surface of the coke, the supply is stopped, and the sewage liquid is allowed to remain in contact with the coke for two hours. It is then drained off from the bottom of the bed, and constitutes the "bacterial effluent." After the liquid has flowed away, the coke-bed remains empty for two hours, and is then refilled with a fresh supply of the settled sewage, which is treated in precisely the same way as the preceding charge. The coke-bed receives and purifies four charges of settled sewage in the twenty-four hours. Conclusions arrived at by the Experimental Treatment. The points which have been established by the experimental work are the following:— 1. That by suitable continuous undisturbed sedimentation the raw sewage is deprived of matter which would choke the coke-beds, and the sludge which settles out is reduced in amount by bacterial action to a very considerable extent. This reduction might undoubtedly be increased by the preliminary removal of road detritus. 2. That the coke-beds, after they have developed their full purifying power by use, have an average sewage capacity of about 30 per cent, of the whole space which has been filled with coke. 3. That the sewage capacity of the coke-bed, when the bed is fed with settled sewage, fluctuates slightly, but undergoes no permanent reduction. The bed does not choke, and its purifying power undergoes steady improvement for some time. 4. That coke of suitable quality does not disintegrate during use. 5 5. That the "bacterial effluent" of settled sewage from the coke-beds does not undergo offensive putrefication at all, even in summer heat, and can never become offensive. That this effluent satisfactorily supports the respiration of fish. 6. That the use of chemicals is quite unnecessary under any circumstances when the above method of treatment is adopted. Recommendations founded on the above conclusions. It would appear desirable, therefore, without delay, to commence the treatment of the London sewage by the above bacterial method. The construction of the necessary works will take time and will involve expenditure, but unless it is taken in hand, all considerations tend to show that owing to the increased abstraction of water by the water companies, both at their existing intakes and at the newly constructed reservoirs for storm water at Staines, a large portion of the lower river will continuously deteriorate. This deterioration would arise from the increase in the amount of the discharge of sewage effluent and the decrease in the upper river flush. Possible trouble arising from these causes will be absolutely prevented by adopting, under proper conditions and on a large scale, the treatment which has been strikingly successful on the experimental scale. It must be remembered that the condition of the river cannot be improved by any suddenly adopted action. If the treatment is introduced without delay and is gradually extended it may reasonably be expected that the increasing deterioration in the lower river water will first be checked and will ultimately be prevented; while the gradual development of the treatment will cause the expenditure to be spread over a period of years, and will prevent it from being unduly burdensome. It must be remembered that the present settling channels would serve, as at present, for settling purposes, but by the altered method of working them they would also act as sludge destroyers. They should, however, undoubtedly be preceded by grit chambers. It must be further borne in mind that the expense involved in the purchase and application of chemicals would be dispensed with. By a considerate adoption of the method, therefore, the expenditure might be distributed, and need not be large at any one time. A fuller statement of details is supplied in subsequent sections. Summary of Information furnished by Towns and Districts in which the Bacterial Treatment of Sewage has been employed. Treatment of Sewage has been employed. At the end of this report a tabulated statement of the results of the Bacterial or natural process of treating sewage in some of the principal centres throughout the country, is appended. It has been thought that this information would prove useful as a means of comparing the results of the various experimental and permanent installations with the results obtained by the London County Council, and would show how extensively the method is already in use. It would also serve as a guide in extending the use of this method of treating sewage to fresh centres of population. Some of the authorities have furnished most exhaustive records of the experiments and work which they have carried out, and, with the exception of Glasgow and Huddersfield, the opinion expressed is entirely in favour of the treatment of sewage in bacteria beds by a method suited to the requirements of the district and to the character of the sewage. At Glasgow the results of the treatment of sewage in experimental bacteria beds indicated a purification from putrescible matter of 95 per cent., while the open septic tank was the means of reducing the amount of sludge by 54 per cent. Similar results have been accepted as satisfactory at other centres. The objection to the use of bacteria-beds at this centre appears to be that the area required for their installation at the Dalmuir Sewage Works for the treatment of 49 million gallons, would be 164 acres, while the system of treatment by lime and sulphate of alumina could be satisfactorily carried out on a superficial area of 23 acres. By this latter method it is claimed that every trace of suspended matter is removed, and that 30 per cent, of purification from putrescible matter is effected. At Huddersfield the sewage is of an exceptional character, since 30 per cent, is derived from manufacturing processes, almost wholly woollen, and it contains a quantity of soap, fat, and dyes, and a variety of chemicals used in the dyeing and finishing of woollen goods. The best results were obtained by treating the sewage with a small quantity of lime and sulphate of iron, followed by double contact in 6 bacteria-beds. The beds which were used for this purpose retained their capacity much better than those which dealt with either the crude sewage or with the septic tank effluent. A careful consideration of all the information obtained from the various centres where bacterial treatment has been tried convinces me that the process has been uniformly successful when the construction and use of the necessary plant has been reasonably and properly carried out. The only exception that appears possible to this general statement is interference which is caused by the sewage being of a very unusual character. The following summary includes the opinions which have been expressed by all the authorities who have tried the bacterial system of sewage treatment and have reported to me on their work:— Aecrington—The whole of the sewage is treated by the bacterial method, and the results are satisfactory. Acton—The experimental treatment was successful, and the effluent was approved of by the Thames Conservancy. The whole of the sewage is to be treated bacterially. Aldershot—" When this is done (the construction of secondary coke-beds) I think Aldershot " will have every reason to be proud of the manner in which it has solved the very difficult " question of how to dispose of the sewage in a satisfactory manner, and will have one of the " most efficient systems in the kingdom." Annual Report of the Medical Officer of Health for 1901. Aylesbury—The result of the treatment is considered to be satisfactory*. Barnsley—The result of a temporary experiment was satisfactory. Birmingham—The Engineer to the Birmingham, Thame and Ilea District Drainage Board, states—" The results obtained were perfectly sufficient to warrant me in saying that the sewage " of the Birmingham, Thame and Ilea District can be efficientlv treated on prepared bacteria" beds." Bristol—The degree of purity of the effluent from bacteria-beds is satisfactory. Burnley—"We are convinced that the scheme adopted by your Committee will prove " an efficient one, and that the treatment of the sewage of the Borough will be carried out in a " more satisfactory manner and with less cost by this system (bacterial tank supplemented by laud) " than it could be by any other which has come under our notice." Highways and Sewage Department of the County Borough of Burnley, Report on Sewage Disposal, 23rd April, 1901, p. 20. Bury—"From the results obtained up to the present, the Corporation have decided to " extend the works on similar lines " (i.e., chemical treatment followed by subsidence and by bacteria-beds). Chorley—" If we had to start de novo, we should adopt exactly the same principle " (chemical precipitation followed by bacterial treatment). Darwen—" Having already proper precipitation tanks and filter (coke) beds, we do not " think it advisable to change the system as we are obtaining satisfactory results, but, if a new " scheme were to be laid down, many modifications would be made." Glasgoiv—The effluent from the bacterial treatment was stated on a recent visit from an officer of the Council, to be entirely satisfactory and non-putrescible. Huddersfield—" Owing to the final effluent being frequently unsatisfactory, and also " to the rapid decrease of the capacity of the coarse bed, the use of this system on a large scale " is not contemplated. The sewage of Huddersfield is of an exceptional character." Hyde—A complete scheme of sewage treatment, based upon the results of experiments of bacterial treatment, has been submitted to the Local Government Board for approval. Kcighley—The Borough Engineer states—" In my opinion, bacterial treatment ought to " satisfy any river authority. My Council do not intend putting down a permanent installation " so long as our present system of intermittent land filtration is satisfactory. There is no doubt "the beds will gradually become choked, but to cleanse or .renew, I think, would be cheaper than " chemical treatment.." Kettering—" The provision of filter-beds has very much improved the character of the " effluent." Leeds—The Chairman of the Leeds Sewerage Committee states that the results from a process of continuous bacteria-bed treatment " are very good indeed, giving a purification of " 95 per cent." Leicester—A process of bacteria-bed treatment followed by final purification on land has been favourably reported upon by the Borough Engineer and Surveyor. See report to the Highway and Sewerage and Sewage Works and Farms Committee, 1900, p. 122. Lincoln—The City Surveyor says—" The external authorities (through whose districts the " effluent stream runs), who previously had been dissatisfied with our farm and polarite-bed " effluents, have expressed themselves satisfied with our bacteria-bed effluent, we therefore are " completing an installation to deal with all our sewage." Manchester—Extract from the Annual Report of the Rivers Department for the year ending 27th March, 1901, p. 74—" The result of the work recorded in the foregoing " pages, while emphasising the necessity for care in the construction and management of sewage " purification work, gives the Committee every encouragement in carrying out the scheme for the " bacterial treatment of Manchester sewage according to the general principles advised in the " Experts' Report, 1899, and sanctioned by the Council on September 5th, 1900." The experts recommended preliminary sedimentation and screening followed by bacteria-tank and bacterialied treatment. 7 Miildleton—The Borough Surveyor states—"If of sufficient area and properly managed, " they (bacteria-beds) will act satisfactorily." Nelson—The results obtained by experimental bacteria-beds were quite satisfactory. Oldham— Extract from a report entitled, "The Treatment of Oldham Sewage in the year 1900," by the Medical Officer of Health, p. iii—"With the exception of a few days during the ''year, when the weather was very dry, the method (bacterial treatment) has been entirely " successful." Ormskirlc—The Surveyor states that—" The results obtained at the council's farm, after " the sewage running through lagoons into settling tanks and then run on to the land aud after" wards through the coke breeze filter beds, are very satisfactory and meet the requirements of " the authorities." Oswestry—The Town Clerk states that they " have no doubt as to the success of the " bacterial treatment. Our results are continuously satisfactory, and the effluents keep free from " putrescence." lleigatc—" The result of three years' searching trial is so satisfactory as to encourage the " Council to sanction the outlay and adopt a scheme for treating the whole of the sewage of the " Borough on the lines adopted by the experimental plant." Salford—The Borough Engineer states that " we can fully depend upon the bacteria-beds " to give a satisfactory effluent, even when working night and day, almost without intermission." Permanent beds to treat the whole of the sewage are being constructed. Sheffield—" The degree of purification obtained has been uniformly satisfactory. The loss " of capacity of the beds continues, and experiments are being conducted with the object of " reducing this as much as possible. Permanent works on bacterial principles are contemplated, " but working details cannot be decided upon until further experiments are completed." Southport—The Medical Officer of Health says that the " bacteria-beds are only small " experimental ones. . . . They have, however, worked entirely to our satisfaction so far as we " have tested them, and they have always produced a clear and non-putrescible effluent." Walsall—The Borough Surveyor states that in the Bloxwich district first-class results are being obtained in the bacterial treatment of the sewage. Wolverhampton—The Town Clerk states that the results of the coke-bed treatment are good, but that a permanent installation is doubtful owing to the presence in the sewage of iron salts in large quantities. York—In a Report to the Sewerage Committee, dated October, 1901, the City Engineer states (on p. 41), with respect to an experimental plant consisting of an open septic tank and continuous treatment in coke-beds, that the results were excellent and the filtrate was nonputrescible. That " the system is adaptable for larger quantities per square yard than any other " experiment," and that there is no loss of liquid capacity in the coke-bed. Short Summary of the Evidence given before the Royal Commission on Sewage Disposal. It has been suggested that the results arrived at by the Royal Commission on sewage disposal would be of great value to the Main Drainage Committee of the Council. The Commission have now published their minutes of evidence, and a careful perusal of the evidence given by the independent experts, including engineers, bacteriologists and chemists, shows that they are in general agreement in maintaining that the only known method of producing a satisfactory sewage effluent on a large scale is by the adoption of one or other of the various systems of bacterial treatment. The bacteriologists gave evidence to the effect that the purification of sewage was a combined anaerobic and aerobic process, and that the best results were obtained by a more or less perfect anaerobic treatment, followed by an aerobic treatment. The evidence in support of this view tendered by Professor Marshall Ward and by Dr. Sims Woodhead, is mainly based on theoretical grounds, and will be found to be of great value and interest. On the other hand, Dr. Adeney, Colonel Ducat and others claim that their processes are entirely aerobic in their character. In face of the above evidence this contention appears very doubtful, and it is more likely that the one treatment succeeds in combining the two processes. The great majority of the witnesses agree that crude sewage cannot be successfully treated by contact beds alone, since, although the results are good and a non-putrescible effluent is produced, the liquid capacity of the beds diminishes so rapidly that they soon become useless. In order to prevent this choking of the beds and to maintain their liquid capacity, almost all of the schemes described iuclude a preliminary process of sedimentation which is in most cases also rendered an anaerobic or so called "septic" process. Its main objects are to free the sewage from mineral suspended solids and to cause the complex suspended organic solids to pass into solution and to become simplified in nature. In the subsequent aerobic process, usually carried out in coke-beds, opinion is divided as to the respective merits of a continuous and of an intermittent supply. It must be said that those who support the continuous treatment make out a good case so far as the results obtained are concerned. The continuous system seems to produce nitrates in larger amount than does the intermittent system, but at the same time the effluent is by no means as free from suspended solids which appear to be washed through the bed. Some special method of distribution of the liquid to the bed is required by the continuous treatment, and this is not only a cause of additional expenditure but also of additional trouble in maintenance as compared with the intermittent system of supply. It is generally agreed that the liquid capacity of a new bed falls rapidly when it is first started, but it is maintained that this decrease soon ceases, and that a permanent capacity can be 8 insured by an intelligent working of the bed. The extreme capacity values vary from 20 to 33 per cent, of the whole space represented by the bed when full—including both coke and liquid. An average of about 30 per cent, would represent the average permanent capacity of a working bed. Three fillings of the beds per day were advocated by most of the witnesses, and the quantity of sewage per day dealt with by an acre of bed, three feet in depth, was placed at not more than 800,000 gallons. This is undoubtedly understating the capabilities of the bacterial system. Deep beds have given quite as good purifying results as shallow beds. The quantity of sludge which disappears by anaerobic action in the settling or "septic" tank is variously estimated at from 20 to 60 per cent, of the whole amount deposited in the tank. It is curious to note that Mr. Whittaker claims that no sludge disappears in his septic tank, though he admits that large quantities of gas are found. (Questions 5742-65). In crossexamination on this matter, he can hardly be said to have proved his statement. It was generally admitted that a septic tank effluent is capable of being rendered nonputrescible by one contact in an aerobic bed. Professor Letts, in his evidence with reference to the purification of Belfast sewage, stated that salt prevented the formation of nitrates. This perhaps accounts for the low proportion of nitrates found in the effluents from the Crossness beds, as compared with that found in the effluent from the Barking beds, since Crossness sewage contains an abnormal quantity of salt. Dr. Adeney's evidence will be found to have a bearing on the present and probable future condition of the river Thames. Briefly, it may be said that although the experts differed in small matters of detail, they agreed in the broad principles of sewage purification by bacterial means, and their evidence is a strong confirmation of the results obtained by the experimental work carried out at the Council's Outfalls. 9 II—EXPERIMENTAL BACTERIAL TREATMENT OF CRUDE SEWAGE AT THE NORTHERN OUTFALL WORKS (BARKING). 1.—TABULATED LIST OF THE EXPERIMENTS AND OF THE BACTERIA-BEDS. The various experiments carried out at the Northern Outfall Works in connection with the bacterial or natural treatment of sewage are included in the following list. The bacterial treatment of effluent from chemically treated and sedimented sewage in a coke-bed of one acre area. The treatment of raw sewage in bacteria-beds, with and without previous settlement. (a) Without previous settlement. In beds of Kentish ragstone and of coke, from September 22nd, 1898, to April 15th, 1899. (Series I.) In coarse and fine coke-beds, from July 4th, 1899, to May 19th, 1900. (Series II.) (b) With previous settlement. In coarse and fine coke-beds, from November 7th, 1900, to August 10th, 1901. (Series III.) The one-acre coke-bed, as originally constructed, was three feet in depth, and it was composed of unsifted pan breeze. In 1898 it was increased in depth to 6 feet, by placing on the top of the old bed 3 feet of sifted coke fragments about the size of walnuts; it has not undergone further alteration in depth. It was first used as a 6 foot coke-bed, on April 29th, 1898, and since May 12th, 1898, it has been dealing almost continuously with effluent from the chemically treated and sedimented sewage. This coke-bed has been reported upon in the Third Report, pp. 13 and 14, and the analytical results are given on pp. 25 to 34 of the same Report. Later details of the work of this coke-bed are given on pp. 9, 10, 24, 28 and 29 of this Report. For the purpose of carrying on other experiments on the bacterial or natural process of sewage purification, four galvanised iron tanks were used. In order to facilitate the use of these tanks in pairs, for the treatment of sewage in two consecutive coke-beds by so-called '"double contact," two of the tanks were fixed at a higher level than the other two; by this arrangement the effluent from a higher tank could be allowed to flow into a lower tank bv pravitation. The following table indicates the various uses to which these tanks have been put during the whole of the bacteria-bed experiments— Date. Upper tanks.* Lower tanks* No. 1. No. 2. No. 1. No. 2. 1898. 22nd Sept. Kentish ragstone-bed, primary Coke-bed, primary ... Kentish ragstone-bed, secondary Coke-bed, secondary. 1899. 15th April. End of Experiments of Series I. 1899. 4th July. Primary, coarse cokebed Primary, coarse cokebed Secondary, coarse coke-bed Secondary, fine cokebed 1900. 19th May. End of Experim ents of Series II. 1900. 7th Nov. Settling tank A Settling tank B Single coke-bed A ( coarse") Single coke-bed B ("fine") 1901. 10th Aug. End of Experim ents of Series III. 2.—SUMMARY OF THE PREVIOUSLY REPORTED DETAILS OF THE EXPERIMENTS IN THE BACTERIAL OR NATURAL TREATMENT OF SEWAGE AT THE NORTHERN OUTFALL WORKS, WITH SUCH ADDITIONS AS ARE NECESSARY IN ORDER TO COMPLETE THE INFORMATION UP TO THE END OF 1901. (a) The One-acre Coke-bed dealing with the Effluent from Chemically Treated and Sedimented Sewage. The one-acre coke-bed has been dealing almost continuously with effluent from the chemically-treated and sedimented sewage since May 12th, 1898. Full particulars of the working of the bed up to April, 1900, and details of the chemical analyses of the liquid supplied * Each tank was originally 4 feet square and 6 feet deep.; they were afterwards increased to 10 feet deep. [2] 10 to it, and of the effluent obtained from it, up to December, 1899, were published in the Third Report on the Bacterial Treatment of Crude Sewage, on pp. 13 and 14 and pp. 25 to 34. The following particulars and the table No. 1 on pp. 28 and 29 bring the publication of the information respecting the bed up to the end of December, 1901. Immediately prior to April, 1898, the bed had been increased in depth from 3 feet to 6 feet, by the addition of sifted coke fragments about the size of walnuts, but it was discovered some time afterwards, that the lower 3 feet of the bed, which consisted of unsifted " fine pan breeze," had become very much consolidated, and that the effluent drained away from it very slowly; the effective portion of the bed was, therefore, the upper 3 feet which consisted of sifted coke. The average quantity of effluent dealt with by the bed at each filling, during the years 1900-1 was 344,909 gallons, whereas during the period from May 12th, 1898, to December 30th, 1899, the average quantity per filling was 519,367 gallons. This difference is probably due to— i. The continued consolidation of the lower three feet of the material composing the bed. ii. The difference in the average number of hours during which the bed was allowed to drain throughout the two periods. From May 12th, 1898, to December 30th, 1899, the average number of fillings per day was 1.05, whereas during the two years 1900-1, the average number of fillings per day was 1.55. The time for filling the bed was generally so selected that the effluent could be discharged into the river at low water; this was done in order to avoid the expense of pumping. Under this arrangement two fillings per 24 hours were usually made. The time-table for the bed was as follows— Time occupied in filling 1½ hours Time occupied in standing full (contact period) 2 „ Time occupied in emptying 2½ „ Time occupied in standing empty (aeration period) 6 „ The high efficiency of the bed has been very well maintained, but it should be borne in mind that this bed has been dealing only with the effluent from chemically precipitated sewage and has therefore had a much smaller amount of purification to effect than the beds which have dealt with crude sewage. The average purification of the crude sewage which has been effected during the past two years by the bacterial action of the bed in conjunction with the previous chemical treatment and sedimentation was 91.2 per cent., as measured by the relative quantities of oxygen absorbed from permanganate by the total putrescible matter (both suspended and dissolved) in the crude sewage and in the coke-bed effluent. The average purification effected on the "chemical" effluent by the coke-bed treatment, when estimated in a similar manner, was 85.6 per cent., whereas it was only 81.8 per cent. during previous periods when these estimations were made, namely, from November 8th, 1898, to January 21st, 1899, and from October 18th to December 31st, 1899. The treatment of effluent from the chemically treated and sedimented sewage is being continued in this bed. (b) The Double Bacteria-beds of Kentish Ragstone and of Coke, dealing with Crude Unsettled Sewage at the Northern Outfall Works. (Series I.) These experiments were undertaken in order to determine whether a body consisting largely of carbonate of lime and possessed of neutralising power on acids, was more favourable to bacterial purification than a neutral substance like coke. The treatment of crude unsettled sewage in the bacteria-beds of Kentish ragstone and of coke, was carried out during the period from September 22nd, 1898, to April 15th, 1899. The full details of the experiments were published in the Third Report on the Bacterial Treatment of Crude Sewage on pp. 7 to 10 and on pp. 17 to 19. The material of the beds was contained in galvanised iron tanks four feet square and six feet deep ; these were filled with the material to a depth of five feet. The coke-beds consisted of a primary bed composed of coarse fragments of coke, and of a secondary bed composed of fine fragments of coke; these two were known as the coarse and fine coke-beds respectively. The ragstone-beds consisted of a primary bed composed of coarse fragments of Kentish ragstone, and of a secondary bed composed of fine fragments of Kentish ragstone; they were known as the coarse and fine ragstone-beds respectively. The material of both the coarse beds was of such a size as would pass a. 4-inch mesh and be rejected by a ½-inch mesh; the material of the fine beds was of such a size as would pass a ½-inch mesh and be rejected by a l-16th inch mesh. The method adopted in dealing with these beds, was to fill both of the primary beds as quickly as possible with crude sewage which had passed through a screen of ½-inch mesh. The beds were allowed to remain full for two hours, and the effluent from each of the primary beds was then allowed to flow into the corresponding fine beds. The fine or secondary beds were allowed to remain full for two hours, and the final effluent was then allowed to flow out. Each bed received one filling in the 24 hours for about the first four months of the time during which tbe experiments lasted, and two filling's for about the last three months. The average percentage purification effected by the beds, as measured by the relative quantities of oxygen absorbed from permanganate by the crude sewage and by the effluents from the various beds, is set forth in the following table— 11 During the period when the beds were filled During the period of the whole experiment. once per day. twice per day. Coarse coke-bed 22.3 22.6 22.5 Coarse ragstone-bed 22.2 21.0 20.6 The combined coarse and fine coke-beds. 64.9 61.5 63.2 The combined coarse and fine ragstone-beds 46.8 51.6 49.1 The effluents from the primary beds killed gold and silver fish in a few hours, but those from the secondary beds sustained fish life as readily as fresh tap-water does. The capacity of the coarse beds was measured after they had been in use for about one week, and again after they had been in use for 24 weeks. The loss in capacity during the 23 weeks stated as a percentage of the total capacity of each bed, was as follows—• Coarse coke-bed 6.4 per cent. Coarse ragstone-bed 5.2 „ The fine beds suffered no loss in capacity throughout the experiments. The experiments with these beds indicated— i. That coke produced better results than Kentish ragstone when used in a bacteria- bed, although the latter produced more nitrates. ii. That bacteria-beds rapidly decrease in capacity when they are dealing with sedimented sewage. iii. That when bacterial-beds have attained their full purifying power, they can deal as efficiently with two fillings of sewage per day as with one. iv. That secondary beds effect a considerable additional purification, and dealing as they do with clear liquid, free from suspended matter, they do not decreme in capacity. (c) The Coarse and Fine Coke-beds, nine feet nine inches in depth, dealing with Crude Unsettled Sewage at the Northern Outfall Works. (Series II.) These experiments were undertaken with the object of ascertaining the effect, if any, of increased depth of bed on the purification effected. The iron tanks used in the last experiment, were deepened by bolting on four feet of iron superstructure, the joints being made watertight. The tanks were filled with coke to a depth oi 9 feet 9 inches, and these beds were worked in two series as follows— Series A consisted of— (1) A primary coarse bed (A). (2) A secondary coarse bed (A 1). Series B consisted of— (1) A primary coarse bed (B). (2) A secondary fine bed (B 1). The coarse beds were composed of coke fragments which would pass a 2 inch mesh and be rejected by a inch mesh. The fine bed was composed of coke fragments which would pass a ½ inch mesh and be rejected by l.16th inch mesh. The sewage. supplied to the primary beds was similar to that used in the previous experiment. The average percentage purification effected, as measured by the relative amounts of oxygen absorbed from permanganate by the dissolved putrescible matter in the crude sewage and in the final effluents, is set forth in the following table— During the period when the beds received three fillings per week. About two months. six fillings per week. About three months. twelve fillings per week. About five months. Primary coarse bed A 43.9 43.6 48.9 Primary coarse bed B 43.5 43.9 50.2 The combined beds of Series A 62.3 62.8 64.2 ,, ,, ,, B 79.1 77.0 72.2 The alteration in the capacities of the various beds during the experiments is indicated by the following records of the measurements made at the beginning of the experiments and after the beds had been in use for about eight months, on the 7th February, 1900. A third set of measurements is added; these were made after the publication of the Third Report.. The capacities are stated as percentages of the cubical capacity of the total space occupied by the bed, assuming the coke to be absent. 12 29th May, 1899 (dry coke)* 7th Feb., 1900. Decrease. 15th March, 1900. Decrease. Primary coarse bed A Primary coarse bed B Secondary coarse bed A l Secondary fine bed B 1 68.7 70.3 61.7 53.1 21.8 21.2 50.6 44.4 46.9 49.1 11.1 8.7 20.3 17.9 50.6 44.4 1.5 3.3 nil. nil. During these experiments the temperature of the sewage and of the effluents from the various coke-beds was recorded. The average of these records shows that there was a fall of about 7 degrees Fahrenheit in the temperature of the liquids in the beds, but that while the beds were standing empty their temperature increased by about 3 degrees. The temperature of the atmosphere during these examinations was on the average 10 degrees lower than that of the sewage before it passed on to the coke-beds, and the tanks containing the beds were freely exposed on all sides to the cooling action of the air. The air in the interstices of the coke at the bottom of the primary beds was analysed, and estimations of the proportions of oxygen and of carbon dioxide (carbonic acid gas) present, were made. The average results of these estimations are given in the following table— After the bed had remained empty for an average period of 5 hours. After the bed had remained empty for an average period of 21 hours. Composition of fresh air. Oxygen 8.0 per cent. 10.3 per cent. 20 96 per cent. Carbon dioxide 5.7 „ 5.7 „ 0.04 „ The amount of ntirification effected by the beds is indicated in the following table— Average quantity of oxidised nitrogen present in the sewage and in the effluents from the beds. During the period July 4th, 1899, to December 30th, 1899. During the period January 1st, 1900, to May 19th, 1900. During the whole period July 4th, 1899, to May 19th, 1900. Nitrous nitrogen. Nitric nitrogen. Nitrous nitrogen. Nitric nitrogen. Nitrous nitrogen. Nitric nitrogen. Crude sewage 0.0057 0.2289 0.0291 0.0783 0.0162 0.1617 Effluent from primary coarse bed A 0.1331 0.6391 0.0747 0.3937 0.1069 0.5291 0.0921 0.5089 0.0582 0.3297 0.0769 0.4289 „ secondary ,, ,, Al 0.1096 1.3256 0.1187 1.0325 0.1137 1.1948 „ „ fine „ B1 0.0584 2.2659 0.0540 2.2430 0.0564 2.2557 3.—PARTICULARS OF THE EXPERIMENTS OX THE BACTERIAL OR XATURAL PROCESS OF SEWAGE PURIFICATION AT THE XORTHERN OUTFALL WORKS (BARKING) WHICH HAVE NOT BEEX PREVIOUSLY REPORTED. (a) The Purification of Crude Sewage by Passage through a Settling Tank and Subsequent Treatment in a Coke-bed. (Series III.) Since the loss in capacity of the bacteria beds appeared to have been caused by the suspended matter present in crude sewage, a preliminary process of sedimentation was next tried. This series of experiments was carried out between November 7th, 1900, and August 10th, 1901. It was the third series of experiments with crude sewage in coke-beds at the Northern Outfall and, following previous reports, brings the publication of the details of the experiments and' of the analytical results of the whole of the experiments up to the end of the year 1901.. I.—Particulars as to the arrangement of the tanks and of the beds. The four iron tanks used in connection with the previous experiments were used for this series in the following manner— The two upper tanks, which were on a higher level than the others, and which had been used as primary beds in the previous experiments, were emptied of their coke, and were used as settling tanks (A and B). Each of these tanks was supplied with crude sewage from the mains by a l½-inch iron pipe which dipped into the tank to a depth of 7 feet from the top. * It must be remembered that the dry coke would itself absorb liquid. 13 In order to secure even distribution of the sewage, and to prevent the sediment of sludge on the bottom of the tank from being disturbed, the crude sewage flowed upon a board 8 inches square, fixed about 6 or 7 inches below the open end of the feed pipe. A 1-inch iron pipe was used in each tank as a syphon for conveying the settled sewage from the settling tanks to the coke-beds in the lower tanks. One end of each of these pipes was continued to a depth of 5 feet below the top of the settling tank, the other end of each syption pipe discharged the sewage upon the first of a series of three consecutive wooden platforms; the last platform of each series was perforated and was placed about 2 feet above the surface of the coke in the lower tanks. The object of these platforms was to secure aeration of the settled sewage. The total capacity of each of the subsidence tanks was 1,000 gallons, but the depth at which the tanks were worked was only 9.5 feet and gave a working capacity of 950 gallons. The two lower tanks were used for the coke-beds. The bed which was worked in connection with settling tank A was known as the "Coarse Coke-bed A." It was composed of the coke which had been used in connection with the previous series of experiments, and the size of the fragments was such that they would pass through a 2-inch mesh and be rejected by a ½-inch mesh. The other tank was known as "Fine Coke-bed B." The coke of which it was composed had also been used before and was of such a size as would pass a ½-inch mesh and be rejected by a 1/16 -inch mesh. Both of the tanks were filled with coke to a depth of 6 feet. The beds were underdrained with perforated 2-inch iron pipes arranged as a "fourway," with three open ends, while the fourth end was connected with the outlet tap., Large pieces of coke were arranged around the pipes in order to prevent choking. II.—Method of working the tanks and beds. When the two settling tanks were first started they were filled with roughly screened crude sewage to within 6 inches of the top and this was allowed to settle for 24 hours; sufficient of the sedimented sewage to fill the coke-beds was then syphoned off to the beds. The sewage from tank A was always supplied to coke-bed A, while that from tank B always passed on to bed B. After the beds had been filled from the tanks, the latter were immediately filled up with fresh sewage, which was allowed to settle until it was time for the coke-beds to receive a fresh charge. This method of procedure was maintained throughout the experiments of Series III., except as regards the number of consecutive hours during which the sewage remained undisturbed in the settling tanks. After the coke-beds had been filled, they remained undisturbed for two hours; they were then emptied, and remained with air filling the interspaces until the time arrived for re-charging them with sewage. This rest period necessarily varied with the number of charges which the beds received during the twenty-four hours. The number of fillings per day ranged between one and three. The beds were filled at 4 a.m., 2 p.m. and 10 p.m., when they were receiving three fillings per day. III.—Particulars as to the number of times the coke-beds were filled. By reference to Table III., p. 32, it will be seen that the coarse coke-bed A was filled with settled sewage 287 times between November 8th, 1900, and August 6th, 1901, and that the fine coke-bed B was filled 313 times during the same period. Both of these coke-beds always rested on Sundays. On several days during January, February and March, 1901, it was impossible to fill the coke-beds on account of the tanks having become frost-bound. This was due to their elevated position giving free exposure on all sides to the air. Both beds rested from April 24th to May 5th, 1901. This was thought to be advisable because their purifying powers had apparently deteriorated. By reference to Table III. it will be seen that immediately before this period, the beds had been receiving three fillings per day for nine days ; this was apparently too much work for the beds to deal with satisfactorily. It must be borne in mind that these beds were dealing with sewage which had undergone very imperfect sedimentation, on account of the small size of the settling tanks and the imperfect manner of feeding and discharging them; and it was further shown, later on, that the sewage had undergone very slight anaerobic or septic action in these tariks. The sewage supplied to the beds was therefore not in a suitable condition for undergoing rapid purification in the coke-beds. The coarse coke-bed A rested also from June 6th to 27th, 1901, because it showed a decrease in the efficiency, which was apparently due to overwork. The other days on which the beds rested were either public holidays or times at which the boilers of the engines were being cleaned, or days on which the pumps were being repaired. IV.—Relative to the action of the settling tanks. The settling tanks were primarily arranged for the purpose of intercepting the grosser suspended matter from the sewage which passed through them. Such matters consist principally of sand and road detritus and of substances chemically known as "cellulose," which include water-logged wooden refuse and the husks of cereals. Since sand and mineral road detritus are not acted upon by bacteria at all, and cellulose is only very slowly broken up by aerobic bacterial action, it follows that these substances should be intercepted, since, if they are allowed to enter the coke-beds, the capacity of the beds becomes very rapidly reduced. It was anticipated that bacterial change would occur in the sediment, and the tanks were carefully watched in order to detect any signs of so-called "septic" or anaerobic bacterial action which might take place in them. On December 13th, 1900, an examination of the deposit in the settling tanks was made and indicated that some of the sediment or sludge had disappeared from the bottom of the tanks. 14 During the period of rest from July 12th to l6th, 1901, septic action occurred in the settling tanks, and large masses of sludge were lifted tot the surface by the gas evolved during the anaerobic action. The sludge which had been deposited in the tanks was very much disturbed by this movement, as well as by the alteration of the level of the liquid in the tanks while the settled sewage was being syphoned off for the purpose of filling the coke-beds. Further, on account of the small size of the tanks some of the sludge, which had been lifted by the gas bubbles, was drawn through the syphon pipes and thus gained access to the coke-beds. On January 28th, 1901, the settling tank A was thoroughly cleaned out and a fresh start was made. Throughout the period of experiment the amount of suspended matter or sludge entering the tank in the crude sewage had been carefully determined, and it was known how much should be present as a sediment on the bottom of the tank. But when the quantity of this sludge was estimated, during the clearing out of the settling tank, it was found that the amount was considerably less than that which had entered the tank. No less than 20.2 per cent. of this total solid matter was found to have been liquefied by septic action between January 28th and August 6th, 1901, in settling tank A; this is equal to 37.4 per cent. of the solid organic matter in the sewage supplied to the tank. The reduction of the quantity of solid matter in tank 13 was only (3 per cent. of the total solids, or 12.8 per cent. of the solid organic matter in the sewage supplied to the tank between February 9th and August 6th, 1901. The great difference between the amounts of septic action which had occurred in the two tanks is doubtless due to the fact that tank A, in which the septic action appears to have been the more pronounced, had not been disturbed during three weeks from June 5th to 28th, on account of the period of rest accorded to the coke-bed which was worked in connection with the tank A; whereas tank B was practically in continuous use. As has been already stated the disturbance of the sludge during working was considerable, and undoubtedly interfered with the septic action. There seems also little doubt that the low temperature of these tanks, due to their free exposure on all sides to the air, is inimical to bacterial change. Similar experiments carried out at the Southern Outfall, with settling tanks constructed in masonry and sunk in the ground, gave much more uniform and satisfactory results, and this appears to be due to their maintaining a higher and more uniform temperature, as well as to their feed being so arranged as to avoid disturbance of the sedimented sludge. The amount of sludge produced weekly in each of the two subsidence tanks averaged about 9 gallons, and it contained 89.5 per cent. of moisture. The average quantity of sewage which passed through each tank was 1,620 gallons weekly in the case of tank A, and 1,412 gallons in the case of tank B. V.—As to the action of the coke-beds. The results of these experiments, as far as the action of the coke-beds is concerned, may be considered very satisfactory. Bearing in mind the small size of the settling tanks and the small amount of septic action which took place in them, the chemical condition of the final effluent and the small loss of capacity of the coke-beds compare very favourably with the results of other experiments and prove the great advantage of preliminary sedimentation. The average percentage amount of purification effected by the combined action of the settling tank and of the coarse bed of Series A, as measured by the relative quantities of oxygen absorbed from permanganate by the dissolved putrescible matter in the crude sewage and in the final coke-bed effluent, was 51.8; the highest average purification effected by the double ragstone-beds with two fillings per day amounted to 51'6, but the double coke-beds of this series of experiments yielded the best results with one filling per day, when an average of 64'9 per cent. of purification was effected. It will thus be seen that the purification effected by the settling tank and coarse coke-bed of Series A was equal to that effected by the double ragstonebeds. A more useful comparison between the results of the various experiments may be obtained by comparing the actual amount of purification effected bv the individual beds on the liquid supplied to them. The following table sets forth the figures representing such results. Average percentage purification effected throughout the experiments, by the beds on the liquid supplied to them. Series I. experiment— Coarse ragstone-bed 20.6 Fine ragstone-bed 35.9 Coarse coke-bed 22.5 Fine coke-bed 52.6 Series II. experiment— Primary coarse bed A 46.3 Secondary coarse bed A 1 31.9 Primary coarse bed B 47.0 Secondary fine bed B 1 52.1 Series III. experiment— Coarse coke-bed A 38.8 Fine coke-bed B 51.2 From these results it will be seen that the fine coke-bed in the last series of experiments dealing with settled sewage, effected a purification practically equal in amount to the best results obtained from any single bed in previous experiments. But it will be remembered that in the instances where the amount of purification effected by a single bed in previous experiments was 15 equal to that of the fine coke-bed B of the last experiment, the coke-beds were dealing with sewage which had received previous treatment in a primary coke-bed, whereas in the last experiment the coke-bed had been dealing with sewage which had been only imperfectly settled and which had been subjected to but very slight septic action. In the case of the coarse coke-bed the amount of purification effected was greater in the last series of experiments than that effected by the secondary coarse-bed A 1 in the previous series of experiments. The result obtained by the coarse coke-bed A is hardly comparable with the results obtained by the primary coarse beds of Series I. and II., as the sewage supplied to them had not been treated in any way, whereas in Series III. the sewage had been previously subjected to sedimentation. It will therefore be seen that the coke-beds used in the experiments of Series III. effected practically as much purification on a sewage which had been previously settled as the secondary coke-beds of Series I. and II. effected on a sewage which had been previously treated in primary coke-beds. But the advantage of the method of previous settlement and treatment in a single coke-bed, over that of primary and secondary treatment in coke-beds without previous settlement, is that in the former process the primary coke-beds are rapidly thrown out of action by loss of capacity by choking, while in the latter process the choking is avoided. The results of the experiments at the Council's Outfall Works and at other centres indicate that when the settlement of the sewage is conducted on a large scale, and is accompanied by energetic septic action, the cokebeds do not lose capacity at all by the accumulation in them of sewage sludge, but only by the growth of purifying bacteria upon the coke surfaces. This growth is necessary and desirable if it is kept, as it can be kept, within reasonable limits. From November 7th, 1900, to January 27th, 1901, the samples of sewage supplied to the two settling tanks were mixed together before being analysed, as were also the samples of the settled sewage flowing from the two settling tanks to the coke-beds; on and after January 28th these samples were all separately analysed. 16 III—EXPERIMENTAL BACTERIAL TREATMENT OF CRUDE SEWAGE AT THE SOUTHERN OUTFALL WORKS (CROSSNESS). 1.—TABULATED LIST OF THE EXPERIMENTS AND OF THE BACTERIA-BEDS. The various experiments at the Southern Outfall Works in connection with the bacterial or natural treatment of sewage are included in the following list. The treatment of crude sewage in bacteria-beds, with or without previous settlement— (а) Without previous settlement— In a single coke-bed, from April 22nd, 1898, to February 22nd, 1899 (Series I.). In primary and secondary beds in series from September 1st, 1898, to February 22nd, 1899 (Series I.). In a single coke-bed 13 feet deep from February 27th, 1899, to October 10th, 1899 (Series II.). (б) With previous settlement— In a single coke-bed, 13 feet deep, from October 10th, 1899, to July 28th, 1900 (Series II.). In a single coke-bed, with continuous flow, from November 20th, 1899, to May 26th, 1900 (Series II.). In a single coke-bed, preceded by septic action, from November 1st, 1900, to October 5th, 1901 (Series III.). The history of the three tanks which have been used throughout the experiments in the treatment of London sewage in coke-beds and in settling tanks at the Southern Outfall Works, is set forth in the following table— Tank A. 22 ft. 6 in. by 10 ft. 8 in., 13 ft. deep. Tank B. 22 ft. 6 in. by 10 ft. 8 in., 13 ft. deep. Tank C. 22 ft. 6 in. by 11 ft. 9 in. (average), 6 ft. deep. 1898 Apr. 22 4 ft. single bed. June 21 6 ft. secondary bed. (Used as a single bed at first in order to "mature" the coke.) July 12 6 ft. primary bed. (In course of construction, but dealing with sewage meanwhile.) Sept. 1 In proper working order as a secondary bed. Bed completed and in working order as a primary bed. 1899 Feb. 22 End of experiments of Series I. ,, 27 13 ft. single bed. (Depth being increased from meanwhile.) 6 ft. to 13 ft., but bed working Apr. 11 13 ft. single bed. (In proper working order.) Oct. 10 End of experiment and commencement of experiment Nov. 20 with sedimented sewage. 4 ft. single bed. (Continuous method.) Dec. 24 1900 Jan. 13 During this period the experiments on the sedimentation of raw sewage in the large settling channels were being carried out. None of these coke beds were then in use. „ 15 13 ft. single bed. (Dealing with sedimented sewage and number of fillings per day increased.) July 28 Nov. 1 6 ft. single bed No. 2. End of experiments of Series II. 6 ft. single bed, No. L Used as a settling tank and afterwards as a septic tank also. 1901 Oct. 5 End of experiments of Series III. 17 2.—SUMMARY OF THE DETAILS, PREVIOUSLY REPORTED, OF THE EXPERIMENTAL BACTERIAL OR NATURAL TREATMENT OF SEWAGE AT THE SOUTHERN OUTFALL WORKS (CROSSNESS), WITH SUCH ADDITIONS AS ARE NECESSARY TO COMPLETE THE INFORMATION RESPECTING THE EXPERIMENTS. (a) Treatment of Crude Sewage in a Single Coke-bed and in Primary and Secondary Coke-beds in Series (Series I.). I.—The Single Coke-led. This bed was composed of coke fragments about the size of walnuts, and was made in tank B by filling it with the coke to a depth of 4 feet. The bed was underdrained by a series of parallel loose-jointed stoneware drain pipes. Its capacity was 3,000 gallons. The bed was first charged with crude unsedimented sewage on April 22nd, 1898, and it continued to receive two fillings per day until June 23rd, 1898, except on Saturdays, when it received only one filling, and on Sundays, when it rested entirely. After a fortnight's rest, which was necessitated through overwork in its imperfectly "matured" condition, the bed received only one filling per day until November 7th, 1898, and from November 8th, 1898, to February 22nd, 1899, when this series of experiments was concluded, it received two fillings per day. During the whole period this bed was filled 345 times. The average amount of purification effected on the crude sewage by this bed, as measured by the relative quantities of oxygen absorbed from permanganate by the dissolved putrescible matter in the crude sewage and in the coke-bed effluent, was 51'3 per cent. II.—The Primary and Secondary Coke-beds worked in series. The filling in of the primary bed of this series with coke occupied from July 12th to September 1st, 1898, but during that period it was frequently charged with sewage in order to avoid any delay in "maturing" it. The secondary bed was also "matured" by treatment with sewage during its construction, but after it had been completed on June 21st, 1898, it had to be worked as a single coke-bed until September 1st, on which date the primary bed was completed. From that date these beds were worked in series until February 22nd, 1899. From September 1st, 1898, to February 22nd, 1899, the beds were filled 219 times. The average amount of purification effected on the crude sewage was 69.2 per cent. when measured, as in the foregoing case, by the removal of dissolved putrescible matter. Full information respecting these beds was published in the Second Report on the "Bacterial Treatment of Crude Sewage." (b) Treatment or Crude Sewage in a Coke-bed 13 feet deep. (Series II.) This series of experiments was carried out in order to ascertain whether any variation in the purifying action was caused by increasing the depth of the coke-bed. With this object in view, the 6-foot secondary bed of the previous experiment was deepened to 13 feet and waa then worked as a single bed. The coke fragments of which the bed was composed were of such a size as would pass a 2-inch mesh and be rejected by a 1-inch mesh. On February 28th, 1899, the first addition was made to the bed, and its depth was increased to 7 feet 5 inches, but the full depth of 13 feet was not attained until April 11th, 1899. The bed was, however, worked while it was being deepened, so as to "mature" the new coke as rapidly as possible. The history of the bed may be divided into three periods— i. The bed received crude, unsettled sewage between February 27th, 1899, and October 9th, 1899. It was filled once a day from February 27th to March 25th, 1899, and generally twice a day from March 27th to October 9th, 1899, except on Saturdays, when it received only one filling, and on Sundays, when it rested entirely. Its capacity diminished rapidly, as is shown by the following figures— March 9th, 1899, capacity 7,900 gallons or 41 per cent. of the empty tank capacity; June 8th, 1899, capacity 6,670 gallons or 35 per cent. of the empty tank capacity; October 10th, 1899, capacity 5,530 gallons or 29 per cent. of the empty tank capacity. ii. The bed received very roughly sedimented sewage between October 13th, 1899, and April 5th, 1900, and was filled twice a day until December 22nd, 1899, and then three times a day until April 5th, 1900. In consequence of the loss of capacity suffered by the bed when it was fed with crude sewage (Period I.), it was decided to allow the crude sewage to settle before it reached the bed. This was effected by pumping it into a large wooden tank placed on the top of the bed ; the overflow from this tank passed on tf the bed. The capacity of the bed on January 12th, 1900, was 6,000 gallons or 32 per cent. of the empty tank capacity. The bed had been resting from December 22nd, 1899. [3] 18 iii- The bed received sediuented sewage between May 3rd and July 28th, 1900, and it was filled generally four times a day. The process of sedimentation consisted in allowing the crude sewage to flow through a tank on its way to the coke-bed. It entered this tank through a broad pipe, which descended nearly to the bottom, and was drawn off by a pipe, the end of which was immersed below the surface of the liquid. The passage through the tank occupied about five hours. The capacity of the coke-bed on June l6th, 1900, was 6,000 gallons, after resting from April, 5th to May 2nd, 1900, and on October 8th, 1900, it was 0,290 gallons, after resting from 28th July, 1900. In consequence of the bed having been altered before this last measurement was taken, its capacity was calculated on a measurement of only the lower 6 feet of the bed. The process of filling this bed occupied from 20 to 25 minutes; it was allowed to remain full for two hours, and the process of emptying extended over from one hour to one hour and a half. The number of hours during which the bed rested between the successive emptyings and fillings varied according to the number of times it was filled during the 24 hours. When the number of fillings per day did not exceed two, the fillings were made during the daytime, but when the number of fillings exceeded two, they were distributed evenly over the whole 24 hours. The following table indicates the average amount of purification which was effected by this bed during the different periods referred to above. Two purification averages have been calculated : one from the relative quantities of oxygen absorbed by the crude sewage and by the cokebed effluent, from potassium permanganate by the total putrescible matter (both suspended and dissolved), and the other from the oxygen absorbed by the dissolved putrescible matter only— Percentage removal of total putrescible matter. Percentage removal of dissolved putrescible matter. I. From February 27th to October 9th, 1899 II. From October 10th, 1899, to April 5th, 1900 III. From May 2nd. 1900, to July 28th, 1900 From February 27th, 1899, to July 28th, 1900 - 57.2 56.6 57.0 48.1 54.6 55.7 51.8 Throughout the period during which the coke-bed was filled four times a day, the effluent from it was clear and free from odour. While these experiments were in progress frequent analyses were made of the air in the interstices of the empty coke-bed at depths of 6 feet and 13 feet; the following results were obtained— Six-foot depth. Thirteen-foot depth. Number of hours since sewage drained off. Percentage of oxygen in the air from the bed. Percentage of carbonic acid in the air from the bed. Number of hours since sewage drained off. Percentage of oxygen in the air from the bed. Percentage of carbonic acid in the air from the bed. 4 19.8 0.4 22 18.4 1.4 22 9.8 5.8 26.75 14.0 3.8 24.5 10.0 6.0 50.75 14.8 3.0 37 17.8 2.0 51.25 15.3 3.3 40.5 16.8 2.4 70 14.7 0.8 The results prove that, even in the case of the deep 13-foot bed, the air at the lower part of the bed was not seriously deficient in oxygen. On June 20th, 1900, the depth of the sludge in the brick tank from which the 13-foot coke-bed was filled was between 27/8 inches at the inlet to the tank, to 71/8 inches at the further end of the tank, and 4f inches at the outlet from the tank to the coke-bed. This outlet was at about two-thirds of the distance from the inlet to the further end. The depth of the sludge in this tank at various points is indicated in the accompanying plan. The average percentage of organic matter in the dried sludge from the tank was 35.8. No permanent scum was formed on the liquid in the settling tank, and it was found that the effect produced by the bacteria in the settling tank was independent of the presence or absence of scum. 19 Plan of tanks used in connection with the bacterial or natural treatment of sewage. The figures against the inside of the lines representing the sides of the tank C indicate the depth of sludge referred to on p. 18 (Series II.). The figures against the outside of the lines of the plan indicate the dimensions of the tanks. The pipe with the valves was used in connection with the experiments of Series III. As a result of the whole series of experiments, it was proved that the crude sewage of London could not be satisfactorily dealt with in coke-beds unless it was subjected to a preliminary settling process; since, although the coke-beds deliver a satisfactorily purified effluent, they choke up very rapidly if they are constantly charged with crude, unsettled sewage. Full details of the working of this bed were published in the Third Report on the "Bacterial Treatment of Crude Sewage" on pp. 14-16, and the details of the analytical results up to the end of 1899 appear on pp. 35-37. The averages of the analyses of the crude sewage and of the coke-bed effluent, given in this Report in table 6, p. 35, complete the publication of information respecting this series of experiments. In the Second Report tanks A and B were stated to be 12 feet deep; this measurement was, however, only approximate, and in no way affected the experiments referred to in that Report. On making exact measurements of the depth of the tank for the purpose of this experiment, it was found that the depth was 13 feet. This measurement includes a coping which was not considered in the previous measurement. (c) Experiments on the Rapid Sedimentation of Crude Sewage on a Large Scale and the Subsequent Treatment of a Portion of the Settled Sewage in a Small Coke-bed. During three weeks, between December 24th, 1899, and January 13th, 1900, the coke-bed experiments, then in progress at the Southern Outfall "Works at Crossness, were stopped in order to carry out a large scale experiment on the rapid sedimentation of the whole of the crude sewage received from South London and the subsequent treatment of a small portion of the sedimented sewage in a coke-bed. The sewage received at this Outfall underwent sedimentation in the settling channels, but was not treated with chemicals during the three weeks. It was allowed to flow more rapidly than usual through the channels; the rate of flow averaging 7.4 feet per minute, whilst the usual rate of flow of the chemically-treated sewage is 1.5 foot per minute. Four channels, each of 6,000,000 gallons capacity, were used, and two of 3,000,000 gallons capacity each. Their length was 581 feet each. A portion of this rapidly sedimented sewage was afterwards treated in a small coke-bed contained in a tank of 280 gallons capacity. The bed was filled three times a day. Its capacity remained constant during the experiments, and the bed suffered in no way from choking. The amount of purification effected on the crude sewage by the sedimentation and by the bed was as follows— By the rapid sedimentation in the settling channel— Purification from total putrescible matter, 16.1 per cent. Purification from dissolved putrescible matter, 0.4 per cent. By the bacterial action of the coke-bed on the settled sewage— Purification from dissolved putrescible matter, 52.9 per cent. By the combined action of the settling channel and of the coke-bed— Purification from dissolved putrescible matter, 58.7 per cent. 20 This experiment showed that rapidly settled sewage could be dealt with in coke-beds without reducing their capacity, and that this treatment yielded a satisfactory effluent. The period over which this experiment extended was too short to admit of septic action being set up in the settling channels; but it seems reasonable to anticipate that if the rapid sedimentation were accompanied by septic action, a still greater amount of purification would be effected. 3. ADDITIONAL PARTICULARS OF THE EXPERIMENTS ON THE BACTERIAL OR NATURAL PROCESS OF SEWAGE PURIFICATION AT THE SOUTHERN OUTFALL WORKS (CROSSNESS). (a) Treatment of Settled Sewage by Continuous Feed through a Distributor to a four foot Coke-bed. (Series II.) From November 20th, 1899, to May 26th, 1900, experiments were carried out with the continuous feeding of a coke-bed with settled sewage supplied through a distributor. For this purpose the 4-foot single bed in tank B was used, and various methods of continuously feeding the bed with settled sewage were adopted. A decided decrease in the amount of purification of the settled raw sewage was apparent when a quantity of sewage equal to that dealt with on the intermittent principle was passed continuously through the bed. This decrease was probably due to— (a) The overcharging of the bed with sewage. (b) The reduction of the bacterial action owing to the chilling of the sewage by contact with the cold air during the winter time. It appears desirable that the temperature of sewage should not fall below 53° Fahr. if the bacteria are to rapidly carry on their purifying action. This temperature is always exceeded when the sewage is supplied to the bed on the intermittent system. The continuous feeding of the bed further appeared at times to have the effect of washing the useful deposit from the surfaces of the coke fragments. The various methods of continuous feeding adopted during these experiments did not effect a satisfactory purification, and they did not deal with the sewage as rapidly as it was dealt with by the intermittent treatment. (b) Treatment of Crude Sewage by Continuous Passage through a Settling Tank and by Subsequent Intermittent Passage through Coke-Beds. (Series III.) These experiments were commenced on November 1st, 1900, and lasted until October 5th, 1901. They were undertaken with the view of supplementing the results obtained from the rough experiments (Series II.) on the septic treatment of sewage, which had lasted from May 3rd to July 28th, 1900. I.—Particulars as to the Construction of the Tanks and of the Coke-beds. Tank C, which had been previously used as a 6-foot primary coke-bed, was emptied of the coke and was used as a settling and septic tank for the crude sewage before it underwent treatment in the coke-beds. Tank B, which had been used as a 4-foot single coke-bed, was increased in depth to 6 feet with coke fragments which passed through a 2-inch mesh and which were rejected by a 1-inch mesh. This bed was called the 6-foot single bed No. 1. Tank A was filled to a depth of 6 feet with coke fragments similar in size to those forming bed No. 1. This bed was called the 6-foot single bed No. 2. It had previously contained 13 feet of coke, and the 6-foot bed was simply formed by removing sufficient coke to leave a bed of 6 feet in depth. Both beds were underdrained with loosely jointed earthenware agricultural drain-pipes. The capacity of the septic tank was 9,000 gallons, but the actual quantity of liquid in the tank varied somewhat during the working. II.—Method of working the Tank and Beds. For the purpose of measuring the quantity of sewage which was supplied to the settling and septic tank, a meter was fixed to the delivery pipe which conveyed the crude sewage to the septic tank. From the settling tank an outlet-pipe conveyed the settled sewage to either No. 1 or No. 2 coke-bed, or when the coke-beds were not being filled, to the main effluent discharge culvert. At first the settled sewage was supplied to the beds by allowing it to overflow from wooden troughs, but this method was afterwards replaced by one in which the liquid fell from the distributing pipes into perforated wooden trays placed upon the surface of the beds. The filling of each bed occupied about half an hour ; the bed remained full for two hours and occupied one hour in emptying. The resting period varied with the number of fillings per 24 hours. The crude sewage samples for analysis were taken at the inlet to the tank, and the settled sewage samples were taken at the outlet. The arrangement of the tanks is shown in the diagram on p. 19. It should, however, be borne in mind that the bottom of tank C was on the same level as the top of tanks A and B. III.—An to the Number of Times the Coke-beds were filled. The coke-beds were filled four times a day until the middle of January, 1901 (see table VII., p. 36). From January 14th to 21st, 1901, No. 1 bed was supplied with settled sewage on 21 the continuous principle; from the latter date until April 15th both beds were thrown out of use, first on account of lime water from the chemical treatment of the sewage at this Outfall having gained access to the beds, and afterwards by the choking of the suction pipe of the pump supplying the settling tank with crude sewage. Owing to a change in the pumping arrangements which was made in March, it was impossible to give the settling tank a continuous supply of sewage, and it was also impossible to always fill the beds four times each day. The other days during the specified period on which the coke-beds were not filled were either Sundays, when they never were in use; Saturdays, when the height of the sewage in the main was not sufficient during the morning to work the pump; public holidays and the first week in August, which latter was fixed as the time for the annual holiday of the coke-bed samplers. IV.—Ax to the Capacity of the Coke-beds. The original capacity of the wet coke-beds was not estimated, since in the case of both beds the coke had been previously in use. The measurement of October 8th, 1900 (table VII., p. 36), of coke-bed No. 2 was made when the 13-foot bed of the previous experiments had been reduced to 6 feet. It may, therefore, be accepted as the capacity of the bed previous to starting this series of experiments, as it had been draining since July 28th, 1900, and could hardly be expected to appreciably increase in capacity during the 23 days before the first filling of this series took place. On examining the other figures representing the capacity at various times, it will be observed that the capacity of coke-bed No. 2 gradually decreased while the bed was receiving four fillings per day, but that after it had rested for six weeks its capacity greatly increased; it again diminished, however, immediately after the resting period, and ultimately remained for about six months with a fairly constant capacity. This second decrease in capacity, as would be expected, was slower than before the rest, on account of the reduced number of fillings per day which the bed received. The ease with which the capacity of the coke-bed No. 2 was increased by a short rest indicates that its loss of capacity was mainly due to accumulated organic or putrescible matter in the bed; this would no doubt be largely avoided by more perfect previous sedimentation of the sewage and by more energetic septic action, both of which conditions would be fulfilled when larger settling channels were used. V.—Relative to the Action of the Settling or Septic Tank.. On January 18th, 1901, the septic tank was roughly covered over, and as a result the liquid in it became coated with a thick scum, which, on January 28th, was about one inch thick. This scum continued to grow thicker, and to increase in toughness, especially after the tank had been closed. The bacterial action appeared to have increased, since gas was evolved in larger quantity; but the solution of organic matter was not more marked than before the cover was placed over the tank. The usual method of working the septic tank was to allow a unit volume of sewage about six hours to pass through the tank. This was about equal to the average time which a unit volume of sewage takes to pass through the large settling channels in the chemical and sedimentation process. The solution of organic matter continued, but on February 27th, 1901, the pump feeding the septic tank became choked with sludge, owing to the stoppage of the main pumps at the east end of the engine house for alterations, and the experimental work had to be stopped. The pipe in connection with the pump which took the sewage from the main sewers at the Outfall Works was, therefore, shortened by about 5 feet, in order to prevent choking in the future, and as a consequence of this shortening of the pipe the end of it was often above the level of the sewage in the mains. It was, therefore, only when the level of the sewage rose to a certain height that the feed pipe of the pump was in the liquid, and that the pump could be used for filling the septic tank. The alteration in the pumping arrangements consequently prevented the septic tank from receiving in future a continuous feed of crude sewage. On February 27th, 1901, the scum on the top of the liquid in the septic tank had entirely disappeared. On March 28th, 1901, an examination of the septic tank was made, when it was found that 256 per cent. of the sediment or sludge had been liquefied by bacterial action. During the whole period that the tank had been in action, 41.2 per cent. of the sludge disappeared. The great difference in the percentage reduction of sludge in the tank during the period November 1st, 1900, to March 28th, 1901, and the period November 1st, 1900, to October 5th, 1901, is probably due to— (а) The efficiency of the septic tank increasing with the length of time during which it had been in use, since the sludge was not cleared out of the tank at the end of the first period. (b) The fact that during the first period the sewage was supplied to the tank almost uninterruptedly, whereas during the period March 29th, 1901, to October 5th, 1901, the sewage supply to the septic tank was by no means continuous, owing to alterations in the pumping arrangements. The weekly average quantities of crude sewage which passed through the septic tank were— From November 1st, 1900, to March 28th, 1901, 131,817 gallons, or 21,969 gallons per day. From March 29th, 1901, to October 5th, 1901, 89,898 gallons, or 14,983 gallons per day. By reference to Table X. it will be seen that during the whole period from November 1st, 1901, to October 5th, 1901, the septic action in the settling tank reduced the amount of solid matter deposited therein by 41'2 per cent. This deposited solid matter consisted of— 22 (a) Mineral matter, principally sand, grit and mineral road detritus which are not affected by the septic action, and which, when working on a large scale, would to a great extent be separated, by previous sedimentation, from the other constituent of the deposited solids. (b) Organic matter, comprising, in addition to faecal matter, husks of cereals, chips of wood, paper, etc., which latter are only acted upon by the bacteria in the septic tank with extreme slowness. A much more accurate idea of the action which occurred in the septic tank is obtainable, therefore, when the reduction of the solid matter is calculated as a percentage of the total solid organic matter deposited in the tank. By reference to Table X. it will be seen that this amounted to 71.4 per cent. With respect to the figures given in Table X., the following particulars may be useful— (a) The figures representing the quantity of crude sewage supplied to the tank are obtained by calculation from the quantities indicated in the meter which was fixed to the inlet pipe. (b) The sludge left in the tank at the end of the first period (column 2) was not removed before the second period commenced, but was left in the tank to mix with the sludge which was deposited during the second period. It is noteworthy that the sludge finally obtained contained less liquid than the former quantity since it had been more fully drained. (c) The averages of the amounts of suspended matter in the crude sewage and in the settled sewage are the averages of the daily estimations made during the time over which the experiments extended. The average amount of solid matter in the sludge is the result of an estimation which was made after the sludge had been well mixed in the tank in order to obtain an average sample. (d) The proportions of the mineral and organic constituents of the suspended matter in the sewage have been calculated on the basis of— 41.6 per cent. of mineral matter and 58.4 per cent. of organic matter in the suspended solids in the crude sewage, 40.9 per cent. of mineral matter and 59.1 per cent. of organic matter in the settled sewage. These percentages were obtained from the averages of the daily estimations which were made on the crude and on the settled sewage during the three weeks' experiment from December 24th, 1899, to January 13th, 1900. These components of the suspended solids were not estimated during the experiments lasting from November 1st, 1900, to October 5th, 1901. (e) The figures under the heading "Calculated quantity of sludge left in the Tank" are the differences between the amounts of suspended matter found in the crude sewage and in the settled sewage. (f) The calculated quantity of sludge left in the tank is the quantity which would have been found in the settling tank if no septic action had taken place. The difference between this quantity and that actually found, is the quantity of solid matter which was liquefied by the action of the bacteria in the settling tank. (g) The figures representing the proportions of the mineral and of the organic constituents of the solids in the sludge were obtained by direct estimation made on a portion of the sludge itself. VI.—As to the Action of the Coke-beds. Monthly and general averages of the various chemical estimations made on the crude sewage, on the settled sewage, and on the coke-bed effluent are set forth in Tables VIII. and IX. From these tables it will be seen that the average amount of purification effected on the crude sewage throughout the whole of the experiments, by the combined action of the settling tank and of the coke-beds, was 58.7 per cent. when measured by the amount of total putrescible matter (both suspended and dissolved) removed, and 55.7 per cent. when measured by the removal of the dissolved putrescible matter only. The figures representing the estimations made of the effluents from the two coke-beds will be found to agree very well with each other except in the case of the estimations of nitric nitrogen. The divergence under this heading, however, is not so great as to necessitate any inquiry as to the cause of the difference, since the difference is well within the ordinary variations to which coke-beds are liable in this respect. VII.—As to the Putrescibility of the Crude Sewage, of the Settled Sen-age of the Chemical Effluent and of the Coke-bed Effluent. During this series of experiments the putrescibility of the crude sewage, of the settled sewage, of the effluent from the chemically treated and sedimented sewage, and of the effluent from the coke-beds was tested at the Southern Outfall Works. The observations and estimations made in this connection are set forth in Table XI. The methods adopted in making these tests depended on— (a) The estimation of the amount of oxygen absorbed from permanganate in three minutes at 80° Fahr. by the putrescible matter in the various liquids at the time of the collection of the samples, and the repetition of the estimation after they had been kept for a period of seven days in an incubator at 80° Fahr. (b) The examination of the liquids, after seven days' incubation at 80° Fahr., as to visible signs of putrescence, as to the presence of sulphuretted hydrogen, and as to their offensive nature. 23 It will be seen that the increase in the amount of oxygen absorbe'd by the liquids after incubation for seven days, as compared with the amount absorbed at the time of collection, was 100 per cent. greater in the case of the effluent from the chemically treated and sedimented sewage than it was in the case of the coke-bed effluent. In addition to this comparison it will be observed that out of 10 samples of the coke-bed effluent, 8 were not putrescible, and the other 2, if putrescible, were so only to a very small extent, as the indications were of a very indefinite nature; also the .10 samples were free from sulphuretted hydrogen, whereas, in the case of the 15 samples of crude sewage, of settled sewage and of chemical effluent they were all putrescible and black in appearance, and 14 of them contained sulphuretted hydrogen, and the other sample was very foul. From these observations it is evident that the coke-bed effluent, when compared with the effluent from the chemically treated and sedimented sewage, is one that would abstract from the river water a much smaller amount of its dissolved oxygen than that which is abstracted by the effluent at present discharged into the river. It would also, if discharged into the river, impart to the water no offensive colour or odour, either at first or at any later stage. VIII.—4s to the Extent to which the Liquid Capacity of a Coke-bed is affected by the Size of the Coke Fragments, by the Length of Time during which the Coke has been soaking, and by the Draining Period of the Bed. In the Third Report on the Bacterial Treatment of Crude Sewage the results were given of tests as to the capacity of coke-beds composed of coke of different sizes. The results of the tests tended to show that as the shape of the particles of the materials of which a coke-bed was formed, departed from the spherical form the capacity of a coke-bed became more directly proportional to the size of the fragments of the material of which it was composed. Experiments were conducted during February and March, 1900, to ascertain the variations in the capacity of a coke-bed arising from the length of time during which the material composing the bed had been soaking and by the length of time during which it had been draining. The coke-bed used for thin purpose was composed of fragments of coke of such a size as would pass a ½-inch mesh, and they were contained in an iron tank of 280 gallons capacity. The following figures indicate the results obtained— Date. Capacity as indicated by meter. Capacity as indicated by standard measure. Particulars as to the condition of the coke. 1900. 21st February 150 - Coke new and dry. 27th 127 - Coke soaking from February 23rd. 4th March 97 — „ „ „ 28th. 13th „ 140 — ,, ,, March 6th. 14th ,, 132 135 Drained for 2 hours. 15th ,, 136 144 16 „ 16th „ 137 144 17 „ 24 IV.—TABULATION OF THE RESULTS OF THE CHEMICAL EXAMINATION: OF THE CRUDE SEWAGE AND OF THE EFFLUENTS. previous Reports the figures representing the results of the analyses of the various liquids have been given for each day during the time which the Reports covered. This was found to necessitate the insertion of so large a mass of figures that it has been discontinued, and in the present Report monthly averages only are submitted. The space thus saved has admitted oi the insertion of other tables, without unduly increasing the mass of figures. figures representing the results of analytical estimations are given in parts per 100,000, unless otherwise stated. (To convert parts per 100,000 into grains per gallon, multiply by 0.7; to convert grains per gallon into parts per 100,000, multiply by The following explanation of the headings of the columns in the various tables may be found useful— Oxygen absorbed from permanganate in four hours at 80° Fahr. (a) By the crude liquid (total putrescible matter). The figures in this column represent the amount of oxygen which the crude liquid absorbed from potassium permanganate in four hours when kept in a constant temperature chamber at 80° Fahr. The figures are to some extent a measure of the putrescibility of the liquid, since the oxygen is absorbed by oxidisable matter dissolved in the liquid and floating in the liquid as minute solid particles (total putrescible matter). When sewage is discharged into sea-water it absorbs three times as much of the dissolved oxygen as it absorbs from permanganate, and it would thus very seriously reduce the aeration of the water. (See Report of the Royal Commission on Sewage Disposal, vol. ii., Dr. Letts' evidence, p. 479.) (b) By the clear liquid (dissolved putrescible matter). These figures are obtained in a similar manner to those in the column, headed "By the crude liquid." The only difference is that the estimations are made in the clear liquid produced by passing the turbid liquid through ordinary filter paper; whereas, in the case of the crude liquid estimations, the liquid is dealt with in the unfiltered state. Nitric and nitrous nitrogen. The figures in these columns represent the amount of nitrogen which was found to be present in the form of nitrite and of nitrate. These compounds are produced in the liquid by the oxidising action of nitrifying bacteria in the cokebed. They indicate, to some extent, the amount of oxidation and purification which has taken place. Nitrates are fully oxidised products and nitrites are only partially oxidised products. Both bodies are produced in sewage effluents by the oxidation of nitrogenous compounds present in the sewage. Their presence and permanence indicate that purification of the sewage has taken place, since they cannot exist in impure liquids, as such liquids lead to their deoxidation and destruction. It has been shown that the presence of nitrates in an effluent may prevent the putrefaction of a certain amount of organic substances from occurring in another effluent with which the nitrate effluent has been mixed. Table I.—Averages of Figures relating to the Treatment of Sewage Effluent in the One-acre Coke-bed at the Northern Outfall Works. This table gives the monthly averages of the daily estimations of the amount of oxygen absorbed from permanganate by the crude liquids (total putrescible matter) and by the clear liquids (dissolved putrescible matter). The liquids dealt with were—(a) The sewage as it arrived at the works and before treatment of any kind; (b) the effluent from the chemically treated and sedimented sewage as it was supplied to the coke-bed; (c) the effluent from the cokebed. The table also contains the monthly averages of the daily estimations of the quantity of nitrous and nitric nitrogen in the liquid supplied to the coke-bed and in the effluent from the bed. It should be noted that the averages of the crude sewage were calculated from the results of the daily analysis of a sample of sewage which was obtained by mixing together samples of equal volume collected every hour throughout the twenty-four hours, whereas, the samples of the "chemical" effluent and of the coke-bed effluent, which were taken for analysis, corresponded with only a portion of the day's sewage. It will therefore be seen that the figures for the crude sewage are not strictly comparable with the figures for the "chemical" effluent and for the coke-bed effluent, although any error likely to arise from this cause is minimised by the averages extending over long periods. No estimations were made of the nitrous and nitric nitrogen in the sewage, since nitrogen in these conditions is more often absent than present, and even when present its quantity is usually too small to be worthy of consideration. The records of the analyses of the "chemical" effluent supplied to this bed and of the coke-bed effluent, extending from May 12th, 1898 (the date of the commencement of the experiments after the bed had been deepened to 6 feet), to December 31st, 1899, were published on pp. 25 to 34 of the Third Report on the Bacterial Treatment of Sewage. 25 Table II.—Averages of the Figures relating to the Treatment of Crude Sewage in Double Coke-beds at the Northern Outfall Works. (Series II.) The figures appearing in this table which relate to time previous to 1900 are averages of the figures which were published in the Third Report. The periods over which the different averages extend have been determined by the number of fillings of the coke-bed per day or per week. These were as follows— One filling per day: July 4th to 15th, 1899. Three fillings per week: July 17th to September 18th, 1899. One filling per day: September 21st to December 9th, 1899. Two fillings per day: December 11th to 15th, 1899. Table III.—Treatment of Crude Sewage in a Settling-tank and in a Coarse and in a Fine Coke-bed at the Northern Outfall Works. Record of the Number of Times the Coke-beds were filled per Day and of the Capacity of the Beds. (Series III). The period during which the beds were allowed to drain before their capacities were taken depended upon the number of fillings per day. Generally, when the beds received only one filling each day, the drainage period was twenty-one hours, with two fillings per day the drainage period was nine hours, and with three fillings per day it was five hours. It has already been stated that these differences in the drainage periods did not materially affect the capacity results. Tables IV. and V.—Averages of the Figures relating to the rapid Sedimentation and subsequent Bacterial Treatment of Crude Sewage in a Coarse Coke-bed and in a Fine Coke-bed at the Northern Outfall Works. (Series III.) In this series of experiments the crude sewage and the settled sewage during November and December, 1900, and part of January, 1901, were not separately sampled for the two sets of settling tanks and beds, hence the figures relating to the crude sewage for the first two months are the same for each set. After December, 1900, separate samples were taken of the sewage which was supplied to each bed. In these experiments the whole of the settled sewage passed through the coke-beds, therefore, there is only one set of figures relating to the settled sewage. In the corresponding experiments at Crossness the settled sewage was allowed to run to wast© when the coke-beds were standing fully charged, consequently the average settled sewage obtained from the settling tank was not necessarily similar to the average of that supplied to the beds. Table VI.—Averages of the Figures relating to the Treatment of Crude Sewage in Cokebeds at the Southern Outfall Works. (Series II.) This table gives the monthly averages of the daily examination of the crude sewage as supplied to the 4-foot coke-bed, which was worked on the continuous method of feeding, and of the effluent from the bed. Although this bed was at work during part of the year 1899 the results of the work were not given in the Third Report on the Bacterial Treatment of Sewage, because the work had only been in progress for a few months, and no final results had been obtained. The other part of this table gives averages of the figures obtained by the chemical analysis of the crude sewage supplied to the 18-foot coke-bed working on the intermittent method, and' of the effluent from the bed. The daily analytical figures relating to this bed up to the end of 1899 were published in the Third Report, but in order to bring the whole of the results into one table, averages for three periods during 1899 have been included in this table, together with monthly averages of the results obtained during 1900. Table VII.—Treatment of Crude Sewage in a Settling Tank and in Coke-beds at the Southern Outfall Works. Record of the Number of Times the Coke-beds were Filled per Day, and of the Capacity of the Beds (Series III.) The figures given in this table refer to experiments of Series III. at the Southern Outfall Works. On those days which are not included in this list, the coke-beds were not in use, as is explained on p. 21. Only one measurement was made of the capacity of bed No. 1, namely, on January 9th, 1900. The percentage capacities of the coke-beds given in this table are percentages of the capacity of that portion of the tank which is filled with the coke-bed, assuming that portion to contain no coke. Table VIII.—Averages of the Figures relating to the rapid Sedimentation of Crude Sewage at the Southern Outfall Works. (Series III.) This table gives the monthly averages of the whole of the figures relating to the chemical analysis of the crude sewage as supplied to the settling and septic tank used in connection with the experiments of Series III., and of the settled sewage from the settling tank. [4] 26 Table IX.—Averages of the Figures relating to the Treatment of rapidly Sedimented Sewage in Coke-beds at the Southern Outfall Works. (Series III.) This table gives the monthly averages of the whole of the figures relating to the chemical analysis of the portion of the settled sewage from the settling and septic tank which was supplied to the coke-beds used in connection with the experiments of Series III., and of the effluents from the coke-beds. • Table X.—Particulars as to the Disappearance of Sludge in the Settling Tank at the Southern Outfall Works. (Series III.) The data given in this table are derived from actual estimations. They are given for the purpose of indicating the manner in which the figures representing the amount of solid matter liquefied in the septic tank have been obtained. Full details of the various figures will be found on p. 22 of this report. Table XI.—Results of the Incubation at 80°F. of Settled Sewage, of " Chemical " Effluent and of Coke-bed Effluent at the Southern Outfall Works. (Series III.) This table gives the analytical details and the results of the examination of samples of settled sewage, of "chemical" effluent and of coke-bed effluent which had been kept in an incubator for seven days. Table XII.—Average percentage purification effected by the Chemical Treatment and subsequent Sedimentation of the Sewage, by the Settling Tanks used in connection with Coke-beds and by the Various Coke-beds at the Outfall Works. The purification is calculated from the relative quantities of oxygen absorbed from permanganate by the liquid, both before and after treatment. The two sets oi figures represent the percentage removal of total putrescible matter (the crude liquid), and of dissolved putrescible matter (the clear liquid). Except in the case of the figures representing the purification effected by the chemical treatment and subsequent sedimentation, each set of figures represents the actual purification effected only by the individual tank or bed. Any purification effected on the liquid previous to or subsequent to that effected by the tank or bed in question has not been considered in the calculations. The figures in this table indicate the amount of purification effected by each single bed on the liquid with which it dealt. No preliminary treatment of the liquid before it was supplied to the bed has been taken into account. The percentages merely measure the value of the work performed by each bed. Figures representing the average percentage purification effected by the chemical treatment and subsequent sedimentation during the years 1900 and 1901 are added foT the sake of comparison. Table XIII.—Average percentage purification of the Crude Sewage effected by the Various Methods of Experimental Bacterial Treatment and by the "Chemical Treatment" carried out at the Outfall Works. The amount of purification effected is calculated from the figures representing the amount of oxygen absorbed from permanganate by the crude sewage and by the final effluents from each treatment. Whereas the preceding table affords an opportunity of comparing the amount of work performed by each coke-bed on the liquid with which it dealt, this table sets forth the amount of purification) effected on the crude sewage by the tanks and coke-beds used in the various experiments at both Outfall Works. The amount of purification recorded in this table is that which was effected by the whole process of each experiment. The figures have been calculated from the relative amounts of oxygen absorbed from permanganate by the crude liquid and by the clear liquid of both the raw sewage and the final effluent. IV.—TABULATION OF THE RESULTS OF THE CHEMICAL EXAMINATION OF THE CRUDE SEWAGE, OF THE "CHEMICAL" EFFLUENT, AND OF THE VARIOUS COKE-BED EFFLUENTS. 28 29 IV.—TABULATION OF THE RESULTS OF THE CHEMICAL EXAMINATION OF THE CRUDE SEWAGE, OF THE "CHEMICAL" EFFLUENT, AND OF THE VARIOUS COKE- BED EFFLUENTS. I.—BARKING RESULTS. Table I.—Averages of Figures relating to the Treatment of Sewage Effldent in the One-acre Coke-bed at the Northern Outfall Works. All quantities, except where otherwise stated, are expressed in parts per 100,000. Date. Average daily crude sewage. Effluent from the chemically treated and sedimented sewage as supplied to the coke-bed ("chemical" effluent). Effluent from the coke-bed. Oxygen absorbed from permanganate in 4 hours at 80° F. Oxygen absorbed from permanganate in 4 hours at 80° F. Oxygen absorbed from permanganate in 4 hours at 80° F. Quantity of effluent from the chemically treated and sedimented sewage which was passed on to the coke-bed per month. Gallons. Number of times the coke-bed was filled per month. Average quantity of effluent which was passed on to the bed each time of filling. By the crude liquid. (Total putrescible matter.) By the clear liquid. (Dissolved putrescible matter.) By the crude liquid. (Total putrescible matter.) By the clear liquid. (Dissolved putrescible matter.) Nitrous nitrogen. Nitric nitrogen. By the crude liquid. (Total putrescible matter.) By the clear liquid. (Dissolved putrescible matter.) Nitrous nitrogen. Nitric nitrogen. 1900. January 11.145 5.526 6.629 4.957 0.0555 0.1430 0.890 0.723 0.0330 0.7605 23,356,361 52 449,161 February 11.009 5.299 6.735 5.134 0.1271 0.0907 0.898 0.753 0.0362 1.0868 18,400,442 46 400,010 March 11.910 6.658 7.526 6.074 0.0567 0.0936 0.998 0.866 0.0352 1.0071 18,354,936 52 352,980 April 12.072 6.552 7.781 6.409 0.0181 0.0234 1.086 0.934 0.0439 1.2021 14,391,847 42 342,663 May 12.123 6.239 6.678 5.022 Nil Nil 0.972 0.840 0.0444 0.9490 17,015,411 52 327,219 June 11.441 4.940 6.018 4.355 0.0022 0.0030 0.939 0.760 0.0542 0.9053 13,792,523 43 320,756 July 10.848 4.663 6.136 4.203 Nil 0.0235 0.999 0.792 0.0501 0.6007 16,002,669 50 320,053 August 10.989 4.719 7.019 3.974 Nil 0.0970 1.010 0.808 0.0502 0.8458 12,168,147 38 320,214 September 11.384 5.014 6.997 5.106 Nil Nil 1.029 0.840 0.0991 1.2353 15,823,348 46 343,986 October 11.382 5.247 7.377 5.942 0.0004 0.0377 1.019 0.848 0.0691 1.3078 18,044,051 52 347,001 November 12.056 5.766 7.417 6.175 0.0015 Nil 1.131 0.979 0.0743 1.3023 16,025,918 46 348,390 December 12.281 5.908 7.989 6.650 0.0276 0.0935 1.083 0.942 0.0608 1.3347 15,630,440 44 355,237 Average for the year 11.546 5.543 7.015 5.344 0.0245 0.0504 1.003 0.840 0.0541 1.0429 199,006,093 563 353,474 1901. January 12.440 6.579 8.010 6.785 0.0367 0.1020 1.023 0.919 0.0626 1.1776 18,413,046 52 354,097 February 13.036 7.511 7.350 6.242 0.0358 0.1506 1.161 1.055 0.0872 1.3095 16,121,827 46 350,474 March 12.684 6.557 7.760 6.573 0.0563 0.0755 1.126 1.039 0.0701 1.3298 16,924,070 50 338,481 April 11.865 5.992 7.705 6.278 0.0230 0.0054 1.123 1.011 0.1004 1.1117 15,481,724 46 336,559 May 11.745 5.898 7.366 5.927 0.0036 0.0090 1.158 1.029 0.1176 0.6283 16,558,407 50 331,168 June 11.651 5.393 7.166 5.456 Nil Nil 1.161 1.010 0.1016 0.7862 16,012,550 48 333,595 July 10.897 4.780 5.847 4.248 0.0081 Nil 1.021 0.856 0.0718 0.7253 16,889,950 51 331,175 August 10.578 4.501 5.921 3.965 Nil Nil 1.009 0.845 0.0710 0.6797 15,972,684 48 332,764 September 10.577 4.516 6.337 4.336 Nil Nil 0.914 0.790 0.0637 1.0986 11,751,012 35 335,743 October 11.703 5.615 7.431 5.376 0.0023 Nil 0.910 0.790 0.0685 0.6663 14,976,516 45 332,811 November 12.135 6.282 7.732 5.841 0.0098 0.0154 0.952 0.821 0.0525 0.8259 16,405,221 50 328,104 December 12.219 6.351 7.911 6.410 0.0456 0.0523 0.973 0.861 0.0741 1.1641 14,612,640 44 332,105 Average for the year 11.793 5.825 7.219 5.649 0.0186 0.0346 1.045 0.920 0.0782 0.9513 190,119,647 565 336,495 Average percentage purification effected on the "chemical" effluent by the bacterial treatment during 1900 85.7 84.3 ,, ,, ,, ,,1901 85.5 83.7 ,, ,, ,, ,,1900-1 85.6 84.0 Average percentage purification effected on the crude sewage by the chemical and bacterial treatments combined during 1900 91.3 84.9 ,, ,, ,, ,,1901 91.1 84.2 ,, ,, ,, ,,1900—1 91.2 84.5 30 Table II.—Averages of the Figures relating to the Treatment of Crude Sewage in Double Coke-beds at the Northern Outfall Works. (Series II.) All quantities, except where otherwise stated, are expressed in parts per 100,000. Date. Solids in suspension. Oxygen absorbed from permanganate in 4 hours at 80° Fah. Nitrous nitrogen. Nitric nitrogen. By crude liquid. (Total putrescible matter.) Byclearliquid. (Dissolved putrescible matter.) Cruds sewage as supplied to the coke-beds. 1899. July 4 to 15 • • • • • • 6. 003 Nil 0.1628 July 17 to September 18 • • • ... 6.028 Nil 0.2290 September 21 to December 9 716 11.218 6.157 0.0082 0.2495 December 11 to 31 696 11.114 6.533 0.0933 0.1878 1900. January 6.32 12.091 5.787 0.0152 0.1194 February 68.0 12.160 5.625 0.1064 0.0782 March 5.64 12.936 6.721 0.0312 0.1181 April 71.8 13.477 7.044 0.0016 0.0120 May 74.6 13.100 6.400 Nil Nil Average for 1900 65.0 12.711 6.328 0.0291 0.0783 Average for the whole period 67.6 12.118 6.237 0.0162 0.1617 Effluent from, primary coarse bed A. 1899. July 4 to 15 ... ... 4.048 Nil 01784 July 17 to September 18 ... ... 3.382 0.1911 0.5962 September 21 to December 9 13.3 5.236 3.367 0.1444 0.8071 December 11 to 31 16.2 5.743 3.590 0.0720 0.3520 1900. January 15.3 5.389 3.175 0.0536 0.2905 February 136 4.780 2.810 0.1986 0.5985 March 16.8 5.744 3.276 0.0750 0.4082 April 20.2 7.144 3.600 0.0263 0.3648 May 27.0 7.420 3.020 0.0400 0.3708 Average for 1900 17.7 5.957 3.213 0.0747 0.3937 Average for the whole period 16.1 5.726 3.349 01069 0.5291 Effluent from secondary coarse bed A. 1899. July 4 to 15 • •• ... 2.473 Nil 01817 July 17 to September 18 September 21 to December 9... 6.7 3. 493 2.271 2.241 0.1648 0.1018 1.4117 1.6362 December 11 to 31 8.7 3.867 2.543 0.1153 0.6695 1900. January 6.0 3.631 2.145 0.1264 0.7369 February 7.6 3.008 1.802 0.0871 1.3569 March 7.2 3.600 2.248 0.0828 1.1788 April 7.8 4.422 2.644 0.1461 0.9112 May 8.2 3.960 2.360 0.1840 1.1397 Average for 1900 7.2 3.718 2.241 0.1187 1.0325 Average for the whole period 7.2 3.667 2.279 0.1137 1.1948 Average percentage purification of the crude sewage during the whole period 89.4 69.7 63.5 ... ... 31 Table II.—(continued). Date. Solids in suspension. Oxygen absorbed from permanganate in 4 hours at 80° Fah. Nitrous nitrogen. Nitric nitrogen. By crude liquid. (Total putrescible matter.) Byclearliquid. (Dissolved putrescible matter.) Effluent from primary coarse bed B. 1899. July 4 to 15 ... ... 3.886 Nil 1.8470 July 17 to September 18 ... ... 3.407 0.0647 0.5005 September 21 to December 9... 138 5.334 3.369 01294 0.6125 December 11 to 31 202 5.610 3.667 0.0520 0.3180 1900. January... 14.4 5.259 3018 0.0496 0.2884 February 14.0 4.780 2.625 0.0764 0.3135 March ... 10.8 5.728 3248 0.0858 0.3424 April 13.2 6.500 3.400 00376 0.3264 May 134 5.640 3120 0.0220 0.4255 Average for 1900 130 5.597 3107 0.0582 0.3297 Average for the whole period 139 5.522 3.303 0 0769 0.4289 Effluent from secondary fine bed B. 1899. July 4 to 15 ... ... 1.019 0.2374 1.7681 July 17 to September 18 ... 1.259 0.0376 2.3568 September 21 to December 9... 3.2 1.773 1.474 0.0401 2.4583 December 11 to 31 3.6 2.552 2114 0.0507 1.6514 1900. January 5.8 2.208 1.676 0 0508 2.1327 February 2.6 1.830 1.419 0.0429 2.7167 March 0.8 2.384 1.784 0.0518 21371 April 2.8 2.644 2.055 00739 20999 May 2.4 2.280 1.540 00470 2.3668 Average for 1900 3.0 2.292 1.726 00540 2.2430 Average for the whole period 3.1 2.166 1.583 0.0564 2.2557 Average percentage purification of the crude sewage during the whole period 95.4 32.1 74.6 ... ... 32 Table III.—Treatment of Crude Sewage in a Settling-tank and in a Coarse and in a Fine Coke-bed at the Northern Outfall Works. Record of the Number of Times the Cokebeds were Filled per Day and of the Capacity of the Beds. (Series III.) Date. Number of fillings each day of Capacity of Date. Number of fillings each day of Capacity of Bed A (coarse). Bed b (fine). Bed a (coarse). Bed B (fine). Bed A. Bed B. Bed A. Bed B. 1900. 1901. Nov. 8 1 1 41.7 40.3 Mar. 12 2 2 32.0 26.7 „ 9 2 2 „ 13 to Mar. 20 2 2 „ 10 2 2 „ 21 2 2 327 253 „ 12 to Nov. 14 3 3 „ 22 and 23 2 2 „ 15 „ 19 1 1 „ 25 3 3 ,, 20 1 1 38.5 38.5 „ 26 1 ,, 21 „ 26 1 1 „ 27 2 1 „ 27 1 1 38.8 38.8 „ 28 1 „ 28 to Dec. 3 1 1 „ 29 2 1 Dec. 4 1 1 38.5 37.5 Apl. 1 to Apl. 3 2 2 „ 6 „ 8 1 1 „ 10 2 2 „ 11 2 2 37.8 37.8 „ 11 „ 15 3 3 ,, 12 „ 15 2 2 „ 16 3 3 31.2 21.2 „ 17 2 2 ,, 17 „ 19 3 3 „ 18 2 2 36.1 35.4 „ 20 2 2 „ 19 and 20 2 2 „ 22 3 3 „ 21 1 1 „ 23 2 2 „ 22 1 1 May 6 and 7 1 1 „ 27 1 1 ,, 8 to May 10 2 2 „ 28 to Dec. 31 2 2 „ 13 1 1 „ 14 „ 15 2 2 1901. „ 17 2 2 31.5 25.0 Jan. 1 2 2 35.3 33.3 „ 18 „ 24 2 2 ,, 2 and 3 2 2 ,, 29 to June 3 2 2 „ 4 1 1 June 4 2 2 32.2 250 „ 11 to Jan. 14 2 2 „ 5 1 2 „ 15 2 2 34.7 32.6 ,, 6 „ 10 - 2 „ 16 „ 19 2 2 „ 11 and 12 — 1 „ 21 and 22 2 2 ,, 13 to June 17 - 2 „ 23 2 2 34.7 312 „ 18 — 2 22.9 „ 24 and 25 2 2 ,, 19 and 20 - 2 „ 28 - 2 „ 21 - 1 „ 29 1 2 „ 25 to June 27 — 1 „ 30 2 2 35.4 306 „ 28 to July 1 1 1 „ 31 2 2 July 2 1 1 34.0 222 Feb. 1 1 1 „ 3 „ 2 to Feb. 4 2 2 „ 4 „ 11 1 1 „ 5 2 2 32.7 29.2 „ 17 „ 22 1 1 „ 6 2 1 „ 23 1 1 34.0 243 „ 7 2 - „ 24 „ 29 1 1 „ 8 1 - „ 30 1 1 33.3 25.3 „ 9 and 11 2 2 „ 31 to Aug. 2 ... 1 1 „ 12 1 - Aug. 6 1 1 „ 13 — 1 „ 18 1 „ 19 1 2 „ 20 2 2 33.3 29.2 Total number of fillings 287 313 „ 22 to Mar. 11 2 2 33 Table IV.—Averages of the Figure relating to the rapid Sedimentation and subsequent Bacterial Treatment of Crude Sewage in a Coarse Coke-bed at the Northern Outfall Works. (Series III.) All quantities, except where otherwise stated, are expressed in parts per 100,000. Date. Solids in suspension. Oxygen absorbed from permanganate in 4 hours at 80° F. Nitrous nitrogen. Nitric nitrogen. By crude liquid. (Total putrescible matter.) By clear liquid. (Dissolved putrescible matter.) 1900. Crude sewage as supplied to the settling tank A. November 65.9 14.028 7.940 0.0020 0-0042 December 76.1 13.418 7.118 0.0086 Nil Average for 1900 71.3 13.708 7.509 0.0055 0.0020 1901. January 733 13.573 7.429 0.0143 .0333 February 77.7 13.500 7.756 0.0283 .2197 March 69.4 13.106 7.237 0.0145 .0700 April 50.3 11.273 5.908 0.0353 .0374 May 58.7 12.521 6.380 Nil Nil June 54.0 12.487 5.891 Nil Nil July 60.2 11.725 5.495 00013 Nil August 60.7 13.659 6.339 Nil Nil Average for 1901 64.9 12.680 6.676 0.0134 0.0540 Average for the whole period 66.5 12.933 6.882 0.0115 0.0412 1900. Settled sewage as supplied to coke.bed A. November 15.4 8.410 6.026 0.0021 0.1123 December 15.6 8.000 5.655 0.0023 0.2824 Average for 1900 15.5 8.190 5.827 0.0022 0.2036 1901. January 17.0 8.983 5.856 0.0056 0.3780 February 14.5 8.389 6.167 0.0101 0.3673 March 16.0 7.956 5.881 0.0022 0.1795 April 18.1 7.073 4.596 Nil 0.0910 May 10.8 7.845 5.120 Nil 0.0094 June 29.2 11.131 6.016 Nil Nil July 27.4 9.829 4.159 0.0013 Nil August 32.7 10.195 3.724 Nil Nil Average for 1901 18.4 8.492 5.299 0.0030 0.1578 Average for the whole period 17.7 8.419 5.427 0.0022 0.1689 1900. Effluent from, coke.bed A. November 11.9 5.638 3.981 0.0687 0.8685 December 91 5064 3.418 0.0360 0.8425 Average for 1900 10.4 5.330 3.679 0.0512 0.8546 1901. January 10.2 5.605 3.605 0.0286 0.8525 February 9.3 5.506 3.500 0.0678 0.6844 March 9.3 4.891 3.248 0.0331 0.5137 April 11.3 4.452 2.901 0.0133 0.2416 May 7.8 4.557 3.068 0.0258 0.4396 June 22.0 8.367 4.635 0.0220 1.7951 July 9.2 4.525 2.681 0.0230 1.1078 August 7.3 3.528 2.418 0.0100 1.1347 Average for 1901 9.9 5.026 3.205 0.0311 0.7197 Average for the whole period 10.0 5.100 3.320 0.0360 0.7524 Average percentage purification of the crude sewage during the whole period 85.0 60.6 51.8 — — 34 Table V.—Averages ok the Figures relating to the rapid Sedimentation and subsequent Bacterial Treatment of Crude Sewage in a Fine Coke-bed at the Northern Outfall "Works. (Series III.) All quantities, except where otherwise stated, are expressed in parts per 100,000. Date. Solids in suspension. Oxygen absorbed from permanganate in 4 hours at 80° Fahr. Nitrous Nitrogen. Nitric Nitrogen. By crude liquid. (Total putrescible matter.) By clear liquid. (Dissolved putrescible matter.) 1900. Crude sewage as supplied to the settling tank B. November 65.9 14.028 7.940 0.0020 0.0042 December 76.1 13.418 7.118 0.0086 Nil Average for 1900 71.3 13.702 7.509 0.0055 0.0020 1901. January 73.4 13.459 7.279 0.0119 0.0411 February 71.3 13.244 7.267 0.0422 0.1658 March 70.3 12.862 7.100 0.0118 0.0861 April 54.0 11.166 5.711 0.0297 0.0121 May 64.9 12.679 6.170 Nil Nil June 59.9 12.529 5.700 Nil Nil July 63.7 11.690 5.462 0.0013 Nil August 70.7 13.659 6.993 Nil Nil Average for 1901 65.8 12.574 6.397 0.0121 0.0414 Average for the whole period 67.0 12.829 6.648 0.0106 0.0326 1900. Settled sewage as supplied to coke.bed B. November 15.4 8.410 6.026 0.0021 0.1123 December 15.6 8.000 5.655 0.0023 0.2824 Average for 1900 15.5 8.190 5.827 0.0022 0.2036 1901. January 16.4 8.252 5.695 Nil 0.3750 February 14.0 8.529 6.318 0.0139 0.2232 March 12.4 7.666 5.693 0.0026 0.1321 April 11.6 7.192 4.757 Nil 0.0302 May 6.4 7.419 5 028 Nil 0.0473 June 8.4 8.224 5.034 Nil Nil July 22.0 9.829 4.252 0.0013 Nil August 16.7 9.411 3.594 Nil Nil Average for 1901 13.5 8.248 5.203 0.0023 0.1115 Average for the whole period 13.9 8.235 5.341 0.0022 0.1319 1900. Effluent f rom coke.bed B. November 4.0 3.801 3 .096 0.0537 2.144 December 3 .0 3.609 2.891 0.0196 1.824 Average for 1900 3.5 3.698 2.986 0.0354 1.972 1901. January 3.3 3.659 2.976 0.0274 1.2485 February 2.2 3.471 2.800 0.0789 0.1223 March 1.2 3.253 2.792 0.0440 1.0389 April 3.9 2.942 2.358 0.1416 0.8064 May 2.5 2.860 2.398 0.0890 1.7668 June 4.6 3.688 2.328 0.0722 0.2372 July 4.0 2.996 1.991 002.22 1.3551 August 4./ 2.417 1.568 0.0433 1.7209 Average for 1901 3.1 3.262 2.495 0.0628 1.0997 Average for the whole period 3.2 3.358 2.604 0.0567 1.2931 Average percentage purification of the crude sewage during the whole period 95.2 73.8 60.8 — — 35 II.—CROSSNESS RESULTS. Table VI. — Averages of the Figures relating to the Treatment of Crude Sewage in Cokebeds at the Southern Outfall Works. (Series II.). All quantities, except where otherwise stated, are expressed in parts per 100,000. Date. Oxygen absorbed from ermanganate in 4 hours at 80" Fah. Nitious nitrogen. Nitric nitrogen. Oxygen absorbed from permanganate in 4 h mrs at 80° Fah. Nitrous nitrogen. Nitric nitrogen. By thecrndi liquid. (Total putrefcible matter.) By the clear liquid. (Dissolved putrc-scible matter.) By the crude liquid. (Total putreBcible matter.) By the clear liquid. (Dissolved putrescible matter.) Continuous treatment. Crude sewage as supplied to the 4-foot coke bed. Continuous treatment. Effluent from the 4-foot coke-bed. 1899. November 7.122 4.696 0.0050 0.0209 2.980 2.110 0.1216 0.1857 December ... 7.149 5.736 Nil Nil 4.444 3.117 0.0156 0.0914 1900. January ... 4.610 3.587 0.0124 0.1125 2.782 1.546 0.1216 1.0008 February ... 6.042 4.794 0.0700 0.0944 3.818 2.170 0.1701 0.3544 March 5.070 4.035 0.0161 0.0054 2.827 2.115 0.0567 0.0768 April 5.698 4.405 0.0105 0.0477 3.703 2.356 0.1167 0.1586 May 4.922 3.715 Nil Nil 3.087 2.066 0.0177 0.0284 Average for the whole period 5.708 4.376 0.0124 0.0343 3.379 2.234 0.0781 0.2262 Average percentage purification of the crude sewage ... ... ... ... 40.8 48.9 ... ... Intermittent treatment. Settled sewage as supplied to the 13.foot coke.bed. Intermittent treatment. Effluent from the 13.foot coke.bed. 1899. February 27.March 25 • • • 4.856 0.0026 Nil 2.268 0.0270 0.0693 March 27.October 9 ... 4.826 0.0034 0.0023 ... 2.546 0.0355 0.1673 October 13.December 22 10.110 6.522 0.0044 0.0048 3.748 2.753 0.0540 0.1778 1900. January 7.096 5.195 0.0867 0.1667 3.146 2.204 0.1249 1.0861 February 7.050 5.158 0.1050 0.1549 3.390 2.576 0.1595 4.4163 March 7.334 5.632 0.0241 0.0056 3.519 2.755 0.0244 0.0997 April 9.128 6.849 Nil Nil 4.667 3.391 Nil 0.0191 May 5.480 4.047 Nil Nil 2.560 1.744 0.0342 0.0520 June 5.378 3.944 Nil Nil 2.427 1.896 0.0023 0.0146 July 5.484 3.709 Nil Nil 2.092 1.559 0.0117 0.0074 Average for 1900 6.328 4.644 0.0300 0.0426 2.885 2.150 0.0511 0.2197 Average for the whole period 7.159 4.962 0.0141 0.0186 3.075 2.394 0.0434 0.1829 Average percentage purification of the crude sewage ... ... ... ... 57.0 51.8 ... ... 36 Table VII.— Treatment of Crude Sewage in a Settling-tank and in Coke-beds at the Southern Outfall Works. Record of the Number of Times the Coke-beds were Filled per Day, and of the Capacity of the Beds. (Series III.) Date. Number of fillings per day. Capacity of beds. Date. Number of fillings per day. Capacity of beds. Bed No. 1. Bed No. 2. Bed No. 1. Bed No. 2. Bed No. 1. Bed No. 2. Bed No. 1. Bed No. 2. Gallons. Percentage of empty tank. Gallons. Percentage of empty tank. Gallons. Percentage of empty tank. Gallons. Percentage of empty tank. (Capacity of empty tank at a depth of 6 feet) 9,000 9,000 (Estimated original capacity) 4,500 50 4,500 50 1900. 1901. Oct. 8 (Bed resting from July 28, 1900) 2,900 32.2 July 11 4 4 „ 12 3 3 Nov. 1 to 3 4 4 „ 13 1 1 „ 5 4 4 2,750 30.6 „ 15 2 2 „ 6 to 22 4 4 „ 16 3 3 ,, 26 to Dec. 5 4 4 „ 17 2 2 Dec. 6 4 4 2,550 28.4 „ 18 4 4 „ 7 to 22 4 4 „ 19 3 3 1901. „ 22 3 3 Dec. 27 to Jan. 8 4 4 " 23,24 2 2 Jan. 9 4 4 2,130 23.7 2,150 23.9 „ 25 3 3 „ 10 4 4 „ 26 4 4 „ 14 to 19 continuous 4 „ 27 1 1 „ 29 to Aug. 2 3 3 „ 21 „ 4 2,100 23.3 Aug. 12 2 2 March 7 — — 2,600 28.9 „ 13 2 3 April 15 2 2 „ 14 3 2 „ 16 1 1 „ 15 4 4 „ 17 2 2 „ 16 3 3 „ 18 3 3 „ 19 1 1 „ 19 2 2 „ 20 2 2 „ 20 1 1 „ 21 3 3 2,200 24.4 „ 22 3 3 „ 22 3 3 „ 23 2 2 „ 23 4 4 „ 24 and 25 3 3 „ 24 1 1 „ 26 4 4 ,, 26 to 30 3 3 „ 29 2 2 Sept. 2 to 4 3 3 „ 30 3 3 „ 5, 6 2 2 May 1 3 3 2,475 27.5 „ 9 to 11 2 2 ,, 2 and 3 2 2 „ 13 1 1 „ 6, 7 2 2 „ 16 2 2 „ 8 3 3 „ 17 4 4 „ 9,10 4 4 „ 18 2 2 „ 11 1 1 „ 19,20 3 3 „ 13 2 2 „ 21 1 1 „ 14, 15 4 3 „ 23 2 2 „ 16 3 3 „ 24 4 4 „ 17 4 4 „ 25 2 2 „ 20 to 23 3 3 „ 26 1 1 „ 24 2 2 „ 27 2 2 „ 29 to 31 2 2 „ 30 2 2 June 3 to 6 2 2 Oct. l to 4 3 3 „ 7 1 1 „ 5 — — 2,175 24.2 „ 10 1 1 „ 11 2 2 „ 12 2 2 2,300 25.5 „ 13 3 3 „ 14 2 2 „ 17 to 21 2 2 „ 22 1 1 „ 24 to 28 3 3 „ 29 1 1 July 1 3 3 „ 2,3 4 4 „ 4,5 3 3 „ 6 1 1 „ 8 to 10 3 3 37 Table VIII.— Averages of the figures relating to the rapid Sedimentation of Crude Sewage at the Southern Outfall Works. (Series III.) All quantities, except where otherwise stated, are expressed in parts per 100,000. Date. Solids in suspension. Oxygen absorbed from permanganate in 4 hours at 80° Fahr. Nitrous nitrogen Nitric nitrogen. Solids in suspension. Oxygen absorbed from permanganate in 4 hours at 80° Fahr. Nitrous nitrogen. c nitrogen. By the crude sewage. (Total putreacible matter.) By the clear sewage. (Diesolved putrescible matter.) By the crude liquid. (Total putrescible matter.) By the clear liquid. (Dissolved putrescible matter.) 1900. Crude sewage as supplied to settling-tank. Effluent from settling-tank. November 26.9 5.337 4.124 Nil Nil 12.4 4.726 3.913 Nil Nil December 22.0 4.871 4.066 Nil Nil 10.8 4.470 3.995 Nil Nil Average for 1900 24.3 5.088 4.093 Nil Nil 11.5 4.589 3.957 Nil Nil 1901. January 27.0 4.907 4.060 0.0015 Nil 14.4 4.288 3.868 0.0121 Nil February 37.1 6.583 4.241 0.0033 Nil 12.0 5.439 4.411 0.0162 0.0029 March ... ... ... ... ... ... ... ... ... ... April 14.9 6.554 4.619 Nil Nil 10.8 6.160 4.617 Nil Nil May 23.1 6.630 4.685 Nil Nil 14.3 6.199 4.750 Nil Nil June 34.2 7.944 4.562 Nil Nil 17.9 6.809 4.730 Nil Nil July 28.8 6.539 3.918 Nil Nil 14.5 5.469 3.997 Nil Nil August 23.8 5.118 3.236 Nil Nil 12.8 4.517 3.373 Nil Nil September 20.4 5.099 3.517 Nil Nil 23.1 4.521 3.455 Nil Nil October 28.5 5.080 3.442 Nil Nil 17.7 4.655 3.697 Nil Nil Average for 1901 27.0 6.142 4.087 0.0006 Nil 14.1 5.377 4.133 0.0038 0.0004 Average for the whole period 26.5 5.936 4.088 0.0005 Nil 13.6 5.223 4.098 0.0031 0.0003 Average percentage purification of the crude sewage during the whole period 48.7 12.0 -0.24 38 Table IX.— Averages of the Figures relating to the Treatment of rapidly Sedimented Sewage in Coke-beds at the Southern Outfall Works. (Series III.) All quantities, except where otherwise stated, are expressed in parts per 100,000. Date. Oxygen absorbed from permanganate in 4 hours at 80o Fahr. Nitrous nitrogen. Nitric nitrogen. Oxygen absorbed from permanganate in 4 hours at 80° Fahr. Nitrous nitrogen. Nitric nitrogen. By the crude liquid. (Total putrescible matter.) By the clear liquid. (Dssol ved putrescible matter.) By the crude liquid. (Total putrescible matter.) By the clear liquid. (Dissolved putrescible matter.) 1900. Effluent from rapidly sedimented sewage as supplied to No. 1 coke-bed. Effluent from rapidly sedimented sewage as supplied to No. 2 coke-bed. November 4.993 3.673 Nil Nil 4.881 3.710 Nil Nil December 4.472 3.664 0.0013 Nil 4.519 3.618 0.0010 0.0029 Average for 1900 4.715 3.668 0.0007 Nil 4.688 3.661 0.0006 0.0016 1901. January 4.596 4.021 0.0041 Nil 4.625 3.956 0.0025 0.0058 February ... ... ... ... ... ... ... ... March ... ... ... ... ... ... ... ... April 6.106 4.375 Nil Nil 6.058 4.385 0.0037 Nil May 6.192 4.223 Nil Nil 6.169 4.394 Nil Nil June 6.548 4.151 0.0011 Nil 6.438 4.276 Nil Nil July 5.350 3.599 Nil Nil 5.274 3.603 0.0009 Nil August 4.776 3.220 Nil Nil 4.590 3.243 0.0011 Nil September 4.519 3.382 0.0008 Nil 4.593 3.274 0.0017 Nil October 4.264 3.025 Nil Nil 4.586 3.213 Nil Nil Average for 1901 5.430 3.802 0.0007 Nil 5.390 3.835 0.0012 0.0006 Average for the whole period 5.263 3.771 0.0007 Nil 5.232 3.794 0.0010 0.0008 1900. Effluent from No. 1 coke-bed. Effluent from No. 2 coke-bed. November 2.592 1.987 0.0044 0.0253 2.505 1.930 0.0258 0.1168 December 2.052 1.683 0.0412 0.0770 2.048 1.643 0.0256 0.0586 Average for 1900 2.303 1.825 0.0251 0.0543 2.261 1.776 0.0257 0.0841 1901. January 3.412 2.916 0.0469 0.0696 3.052 2.600 0.0472 0.0971 February ... ... ... ... ... ... ... ... March ... ... ... ... ... ... ... ... April 3.144 2.407 0.2177 0.1215 3.202 2.420 0.1809 0.1576 May 2.688 1.970 0.0765 0.0261 2.852 2.136 0.0784 0.0539 June 2.678 1.764 0.0843 0.0389 2.925 2.037 0.0767 0.0330 July 1.922 1.405 0.0691 0.0340 1.917 1.411 0.0757 0.0393 August 2.165 1.547 0.0527 0.0403 2.052 1.513 0.0403 0.0466 September 2.144 1.672 0.0964 0.0417 2.217 1.635 0.0121 0.0862 October 1.700 1.336 0.2270 0.0462 1.736 1.400 0.2145 0.0640 Average for 1901 2.489 1.858 0.0904 0.0477 2.516 1.887 0.0892 0.0663 Average for the whole period 2.445 1.0850 0.0757 0.0492 2.456 1.861 0.0749 0.0703 Average percentage purification of the crude sewage during the whole period. 58.8 54.7 ... ... 58.6 56.8 ... ... 39 Table X.— Particulars as to the Disappearance of Sludge in the Settling-tank at the Southern Outfall Works. (Series III.) During the period from November 1st, 1900, to March 28th, 1901. During the period from March 29th, 1901,to October 5th, 1901. During the whole period from November 1st, 1900, to October 5th, 1901. 1 2 3 4 Crude Sewage. Quantity of crude sewage supplied to the settling tank gallons 2,768,160 2,427,250 5,195,410 Average amount of suspended solid's in the crude sewage parts per 100,000 28.1 25.3 ... grains per gallon 19.7 17.7 ... Weight of suspended solids supplied to the tank Mineral constituents of solids lbs. 3,241 2,553 5,794 Organic constituents of solids lbs. 4,549 3,584 8,133 Total solids lbs. 7,790 6,137 13,927 Settled Sewage. Quantity of settled sewage which passed out of the settling tank gallons 2,765,548 2,427,593 5,193,142 Average amount of suspended solids in the settled sewage parts per 100,000 12.5 14.3 ... grains per gallon 8.8 10.0 ... Weight of suspended solids which passed out of the tank Mineral constituents of solids lbs. 1,406 1,418 2,824 Organic constituents of solids lbs. 2,031 2,050 4,081 Total solids lbs. 3,437 3,468 6,905 Sludge. Actual quantity of sludge found in the tank gallons 2,612 2,269 2,269 Average amount of suspended solids in the sludge found in the tank percentage ... ... 16.4 Weight of suspended solids in the sludge found in the tank Mineral constituents of solids lbs. ... ... 2,808 Organic constituents of solids lbs. ... ... 1,322 Total solids lbs. 3,240 ... 4,130 Calculated quantity of sludge left in the tank Average amount of suspended solids removed from the sewage and left in the tank parts per 100,000 15.6 11.0 ... grains per gallon 10.9 7.7 ... Weight of suspended solids in the sludge left in the tank Mineral constituents of solids lbs. 1,835 1,135 2,970 Organic constituents of solids lbs. 2,518 1,534 4,052 Total solids lbs. 4,353 2,669 7,022 Quantity of sludge (organic matter only) which disappeared by the septic action in the tank lbs. 1,113 ... 2,892 Percentage quantity of sludge which disappeared, calculated on total solids 25.6 ... 41.2 Percentage quantity of sludge which disappeared, calculated on organicconstituents ... ... 71.4 40 Table XI.— Results of the Incubation at 80° F. of Settled Sewage, of " Chemical " Effluent, and of Coke-bed Effluent at the Southern Outfall Works. (Series III.) All quantities, except where otherwise stated, are expressed in parts per 100,000. Date Settled sewage as supplied to No. 1 coke-bed. Settled sewage as supplied to No. 2 coke-bed. Effluent from the chemically treated and sedimented sewage. Effluent from No. 1 coke-bed. Effluent from No. 2 coke-bed. Oxygen absorbed from permanganate in 3 minutes at 80° Fah. As to whether the liquid was putrescible or not. Oxygen absorbed from permanganate in 3 minutes at 80° Fah. As to whether the liquid was putrescible or not. Oxygen absorbed from permanganate in 3 minutes at 80° Fah. As to whether the liquid was putrescible or not. Oxygen absorbed from permanganate in 3 minutes at 80° Fah. As to whether the liquid was putrescible or not. Oxygen absorbed from permanganate in 3 minutes at 80° Fah. As to whether the liquid was putrescible or not. At once. After incubation for 7 days. At once. After incubation for 7 days. At once. After incubation for 7 days. At once. After incubation for 7 days. At once. After incubation for 7 days. 1900. Dec. 11 1.905 6.250 Yes 2.285 6.538 Yes 3.524 8.077 Yes 0.857 0.481 No 0.857 0,673 No „ 12 3.029 8.835 Yes 3.029 9.709 Yes 3.509 8.738 Yes 1.154 1.651 ? 1.058 1,359 No „ 13 3.725 11.250 Yes 4.020 11.731 Yes 3.431 7.404 Yes 1.078 1.731 ? 1.274 1,442 No „ 14 3.204 8.654 Yes 3.398 8.461 Yes 3.498 6.827 Yes 1.262 1.250 No 1.262 1,346 No „ 15 2.913 8.270 Yes 3.010 8.942 Yes 3.689 7.308 Yes 1.165 1.346 No 1.262 1,250 No Average 2.955 8.652 3.148 9.076 3.530 7.671 1.103 1.292 1.143 1,214 Percentage increase — 192.8 — 188.3 — 117.3 — 17.1 — 6,2 Appearance of the liquid after incubation for seven days. Dec. 11 Black. Strong H2S Black. Strong H2S Black. Very strong H2S Clear and bright. No odour Yellow colour. Earthy odour. „ 12 Black. Much H2S Black. H2S Black. Very foul Yellow. Faint earthy odour Clear. No odour. „ 13 Black. H2S Black. H2S Black. Much H2S Dark. Faint odour Darkish. No odour. „ 14 Black. H2S Black. H2S Black. Small quantity H2S Clear. No odour Clear. No odour. „ 15 Black. H2S Black. H2S Black. H2S No odour No odour. 41 Table XII.— Average percentage purification effected by the Chemical Treatment and subsequent Sedimentation of the Sewage, by the Settling Tanks used in connection with Coke-beds and by the various Coke-beds at the Outfall Works. The purification is calculated from the relative quantities of oxygen absorbed from permanganate by the liquid, both before and after treatment. The two sets of figures represent the percentage removal of total putrescible matter (the crude liquid) and of dissolved putrescible matter (the clear liquid). Except in the case of the figures representing the purification effected by the chemical treatment and subsequent sedimentation, each set of figures represents the actual purification effected only by the individual tank or bed. Any purification effected on the liquid previous to or subsequent to that effected by the tank or bed in question has not been considered in the calculations. One or less number of fillings of the bed per day. Two fillings of the bed per day. Three fillings of the bed per day. Four fillings of the bed per day. During the whole experiment. By the crude liquid. By the clear liquid. By the crude liquid. By the clear liquid. By the crude liquid. By the clear liquid. By the crude liquid. By the clear liquid. By the crude liquid. By the clear liquid. Northern Outfall. The one-acre coke-bed ("chemical" effluent), ... ... 85.6 84.0 ... ... ... ... 85.6 84.0 1900 and 1901 Series I.— Primary coarse ragstone-bed (crude sewage) ... 20.2 ... 21.0 ... ... ... ... ... 20.6 Primary coarse coke-bed (crude sewage) ... 22.3 ... 22.6 ... ... ... ... ... 22.5 Secondary fine ragstone-bed (second contact) ... 33.3 ... 38.7 ... ... ... ... ... 35.9 Secondary fine coke-bed (second contact) ... 54.7 ... 50.2 ... ... ... ... ... 52.6 Series II.— Primary coarse coke-bed A (crude sewage) 53.3 43.7 52.5 48.9 ... ... ... ... 52.7 46.3 Primary coarse coke-bed B (crude sewage) 52.5 43.8 55.2 50.2 ... ... ... ... 54.8 47.0 Secondary coarse coke-bed A (second contact) 33.3 33.9 36.9 30.0 ... ... ... ... 36.0 31.9 Secondary fine coke-bed B (second contact) 66.8 60.1 58.4 44.1 ... ... ... ... 60.8 52.1 Series III.— Single coarse coke-bed A (settled sewage) ... ... ... ... ... ... ... ... 39.4 38.8 Single fine coke-bed B (settled sewage) ... ... ... ... ... ... ... ... 59.0 51.2 Chemical treatment and sedimentation 1900 ... ... ... ... ... ... ... 32.8 Nil Chemical treatment and sedimentation 1901 ... ... ... ... ... ... ... 25.8 Nil Southern Outfall. Series I.— 4-foot single coke-bed (crude sewage) ... ... ... ... ... ... ... ... ... 52.8 6-foot primary coke-bed (crude sewage) ... ... ... ... ... ... ... ... ... 49.9 6-foot secondary coke-bed (second contact) ... ... ... ... ... ... ... ... ... 38.6 Series II.— 13-foot single coke-bed (crude sewage) ... 53.3 ... 47.2 ... ... ... ... ... 48.1 13-foot single coke-bed (roughly settled ... ... 62.9 57.8 52.6 52.2 ... ... 57.2 54.6 sewage) 13-foot single coke-bed (settled sewage) ... ... ... ... ... ... 56.6 55.7 56.6 55.7 4-foot single coke-bed (continuous flow of ... ... ... ... ... ... ... ... 40.8 48.9 settled sewage) Settling channels (Dec. 21st 1899 to Jan. 13th ... ... ... ... ... ... ... ... 16.1 00.4 1900) Small tank coke-bed (settled sewage) ... ... ... ... ... ... ... ... ... 52.9 Series III.— Settling tank (crude sewage) ... ... ... ... ... ... ... ... 12.0 Nil 3-foot single coke-bed No. 1 (settled sewage) ... ... ... ... ... ... 49.7 49.4 53.5 50.9 3-foot single coke-bed No. 2 (settled sewage) ... ... ... ... ... ... 47.2 46.8 53.0 50.9 Chemical treatment and sedimentation, 1900 ... ... ... ... ... ... ... ... 25.9 11.7 Chemical treatment and sedimentation, 1901 ... ... ... ... ... ... ... ... 29.6 12.2 [6] 42 Table XIII.— Average percentage purification of the Crude Sewage effected by the Various Methods of Experimental Bacterial Treatment and by the "Chemical Treatment" carried out at the Outfall Works. The amount of purification effected is calculated from the figures representing the amount of oxygen absorbed from permanganate by the crude sewage and by the final effluent from each treatment. One filling of the bed per day or less. Two fillings of the bed per day. Three fillings of the bed per day. Four fillings of the bed per day. During the whole experiment. By the crude liquid. By the clear liquid. By the crude liquid. By the clear liquid. By the crude liquid. By the clear liquid. By the crude liquid. By the clear liquid. By the crude liquid. By the clear liquid. Northern Outfall. The one-acre coke-bed— Bacterial treatment of the "chemical" effluent 1900 . . . . . . . . . . . . . . . . . . . . . . . . 913 84.9 1901 . . . . . . . . . . . . . . . . . . . . . . . . 911 84.2 Bacteria beds. Series I.— Bacterial treatment of crude sewage in— (a) Ragstone-beds (two contacts) . . . 46.8 . . . 51.6 . . . . . . . . . . . . . . . 49.1 (6) Coke-beds (two contacts) . . . 64.9 . . . 61.5 . . . . . . . . . . . . . . . 63.2 Coke-beds. Series II.— Bacterial treatment of crude sewage in— (a) Coarse coke-beds (two contacts) 68.9 62.8 70.1 64.2 . . . . . . . . . . . . 69.7 63.5 (b) Coarse and fine coke-beds (two contacts) 84.2 77.6 81.4 72.2 . . . . . . . . . . . . 82.1 74.6 Coke-beds. Series III.— Bacterial treatment of settled sewage in— (a) Fine coke-bed . . . . . . . . . . . . . . . . . . . . . . . . 73.8 60.8 (b) Coarse coke-bed . . . . . . . . . . . . . . . . . . . . . . . . 60.6 51.8 Chemical treatment and sedimentation, 1900 . . . . . . . . . . . . . . . . . . . . . . . . 32.8 Nil Chemical treatment and sedimentation, 1901 . . . . . . . . . . . . . . . . . . . . . . . . 25.8 Nil Southern Outfall. Coke-beds. Series I.— Bacterial treatment of crude sewage in— (a) A single coke-bed . . . . . . . . . . . . . . . . . . . . . . . . . . . 52.8 (b) Double coke-beds (two contacts) . . . . . . . . . . . . . . . . . . . . . . . . . . . 69.3 Coke-beds. Series II.— . . . . . . . . . . . . . . . . . . . . . . . . . . . Bacterial treatment of crude sewage in a 13-foot coke-bed . . . 53.3 . . . 47.2 . . . . . . . . . . . . . . . 48.1 Bacterial treatment of roughly settled sewage in a 13-foot coke-bed . . . . . . 62.9 57.8 52.6 52.2 . . . . . . 57.2 64.6 Bacterial treatment of settled sewage in a 13-foot coke-bed . . . . . . . . . . . . . . . . . . 56.6 55.7 56.6 55.7 Bacterial treatment of settled sewage in a 4-foot coke-bed (continuous flow) . . . . . . . . . . . . . . . . . . . . . . . . 40.8 48.9 Bacterial treatment of settled sewage in a small tank coke-bed . . . . . . . . . . . . . . . . . . . . . . . . . . . 58.7 Coke-beds. Series III.— Bacterial treatment of settled sewage in cokebeds (average of 2 single beds) . . . . . . . . . . . . . . . . . . 53.3 54.5 58.7 55.8 Chemical treatment and sedimentation, 1900 . . . . . . . . . . . . . . . . . . . . . . . . 25.9 11.7 Chemical treatment and sedimentation, 1901 . . . . . . . . . . . . . . . . . . . . . . . . 29.6 12.2 V.— TABULATION OF INFORMATION RESPECTING THE BACTERIAL OR NATURAL TREATMENT OF SEWAGE AT VARIOUS CENTRES THROUGHOUT THE COUNTRY. The information set forth in the following tables has been courteously supplied by the various local authorities throughout the country, who have used bacteria beds in connection with the treatment of sewage or sewage effluent, either in a permanent installation or in an experimental form. In consequence of the necessarily complicated nature of any attempt to arrange in systematic order the results of such work carried out under very varying conditions, some explanation of the tables and of their arrangement is necessary. The information has been placed in two main divisions, one dealing with the bacteria beds and the other dealing with the septic tanks; there is also an additional column for remarks. The division dealing with the bacteria beds is divided into three tables, as follows— Table 1.—Particulars of the bacteria beds. Table 2.—Particulars as to the working of the bacteria beds. Table 3.—Particulars as to the capacity of the bacteria beds, and as to the loss of capacity during working. The division dealing with the septic tanks is divided into two tables, as follows— Table 4.—Particulars of the septic tanks (if used). Table 5.—Particulars as to the working of the septic tanks. Table 1 is a record of the details of the construction of the various beds used by the different local authorities. In some instances, more especially in centres where reports have been published of the work which has been carried out in the bacterial treatment of sewage, the details of the various beds are very full, and in these cases each bed is dealt with separately. In other instances, principally where the treatment is of a permanent character and the beds are frequently uniform in size and structure, the groups of beds only are described. In the column "Material and size of the material of which the beds are composed," the size is determined by the mesh of the sieves used in screening the material, unless otherwise stated. Thus, ½ inch to 1/16 inch means that the material is such as would pass through a screen of ½ inch mesh and would not pass through a screen of 1/16 inch mesh. Table 2 is a record of the different experiments which have been carried out at the various centres, but in many instances the records are insufficient to justify the results being set out separately in the table. In such instances only the general details of the manner in which the beds have been worked are recorded. In the case of permanent installations, where the beds have been uniformly dealing with the same class of liquid for some years, only the more recent results are given in the table. It was found convenient to insert the columns under the heading "Particulars of the settling and of the detritus tanks" in this table, although they do not afford any information as to the working of the bacteria beds. The figures in the column "Quantity of sewage treated in 24 hours per acre of bed one foot deep" have been calculated from data given, in order that the quantities dealt with by the various beds at a uniform depth, may be seen at a glance. Table 3.— The importance of information bearing on the capacity of the beds and on the loss of capacity noticed in the working of the beds, rendered it necessary to devote a table to this subject. The records in this table are not intended to correspond with the experiments detailed in the previous table; they are merely such records as have been made of the variations in the capacity of beds. In some instances the records furnished were too extensive to insert in these tables; in such instances extracts have been made from the data supplied. In the column "Capacity, when empty, of the tank containing the bed" figures are given representing the capacity of the tank before the coke was placed in it. In such cases, where the whole depth of the tank is not occupied by the material of which the bacteria bed is composed, the capacity is given only of that portion of the tank which is occupied by the material. The original water-capacity of the bed in the tank means the liquid capacity of the bed after the material of which it is formed has been thoroughly soaked. The original water-capacity therefore does not mean the quantity of liquid which could be poured into the bed in its dry condition, but rather the quantity which could be drained from the working bed during the specified time of emptying. Since the capacity of a bed alters considerably during a lengthened period of rest, the returns have usually included measurements which have been made after such rest periods. Such measurements have not always been made from the first filling after a rest period, and in such instances a draining period is generally recorded as well as the number of fillings since the rest period. Table 4 furnishes details concerning the septic tanks used at the various centres. Table 5 is a record of the working of the septic tanks. The information in these tables has been brought up to 30th April, 1902. 44 45 Table 1. Particulars of the Bacteria Beds. No. Name of town or district. Nature of installation. P.—Permanent, T.—Temporary. Number of beds. Distinctive number or name of each bed. Average or working area of the beds. Square feet. Measurement of the beds. Depth of the beds. Feet. Material and size of the material of which the beds are composed. Thickness of each layer of material, arranged in their order in the beds, from the top downwards. Method of under-draining the beds. Actual or estimated cost of making the beds. Actual or estimated cost per acre of making the beds. Cost of treating sewage per million gallons. At top. Feet. At bottom. Feet. 1 Accrington £ s. d. £ 8. d. £ s. d. p. 10 ... 3,019 62 feet in diameter each 8.5 and 9 Coke, 2 inch to 3 inch mesh ... Half 18 inch perforated earthenware pipes laid on concrete bottom 2 5 - 10,890 - - 4 6 per sq. yard. Including excavation, concreting bottom, underdraining, brickwork in cement and coke. (about) 4 1,944 49 feet 9 inches in diameter each 3 and 9 >) >> >> 2 Aldershot p. ... Top or primary 2,146 58x37 ... 4 Clinkers, 3/8 inch 15 inches Only by the packing of large material. No pipes are used 250 — — 5,000 — „ varying size 33 „ (about) Bottom or secondary 5,800 58x100 1.5 „ generally fine 220 — — 1,700 — — (about) 3 Acton T. ... ... ... ... ... 6.5 4 Aylesbury T. 4 ... 31,740 Varies from 5.0 Coarse burnt ballast 9 inch main drains (two mains to each large bed), with double junctions 2 feet apart and 3 inch agricultural pipes arranged in herring-bone fashion 3,200 — — 6,400 — — 15 — — 6 total area 50 x 30 to 116x30 3.25 Coke breeze (by contract) for coke breeze beds. 5 Barnsley T. 3 ... 32,400 120 x 90 ... 3 Broken clinker and ashes ¼ inch mesh... 9 inches By land tiles and square longitudinal 1,343 10 9 1,400 — — ½ „ 9 „ drains 18 inches by 12 inches (about) 1 „ 9 ,, including the open septic tank 1½ „ 9 „ 6 Birmingham T. 8 1 to 8 133,656 150x150 148J x148J 3 Coke, 1 inch to 1} inch Similar The whole bed is laid on a false bottom, in which there are channels 6 inches by 6 inches and 148 feet long 48,000 - - 12,000 — — 44,552 150x150 148Jxl48j 3 Destructor clinker, 1 i:icl> to If inch throughout ^ilUUUL ) (about) 7 Blackburn T. 1 ... 4,770 ... ... 5.5 Coke Similar 3 inch agricultural drain tiles laid herring-bone fashion in channels covered with 2 inch stone covers. There is a fall of 18 inches in each bed 1 ... 4,770 ... ... 5.5 Coke breeze throughout 8 Bloxwich district of T. 8 Primary ... ... ... 2.5 ½ inch to 1/16inch Land tiles 1,000 - - 5,000 - Walsall 8- Secondary ... ... ... 25 ½ inch to dust 9 Bristol— At Knowle T. 2 Knowle 132 each 22x6 22x6 6 Washed clinker from destructor which passed through a 2 inch ring ••• No pipes, floor inclined from centre to border At St. John's-lane T. 1 St. John's 396 22½ diameter 30 diameter 3 46 47 Table 2. Particulars as to the working of the Bacteria Beds. No. Name of town or district. Time during which the beds were in use. Name or number of the bed used. Character of the liquid supplied to the beds. Particulars of the settling and of the detritus tanks. Chemicals used for treating the sewage previous to bacterial treatment. Number of hours Average percentage purification effected on the crude sewage, as measured by the relative quantities of Occupied in fillings the beds. During which the beds remained full (contact period). Occupied in emptying the beds. During which the beds remained empty (aeration period). Number of filings per 24 hour?. Number of contacts in successive beds. Quantity of sewage treated in 24 hours, per acre of bed, one foot deep. Calculated for the purpose of comparison Oxygen absorbed by the crude sewage and by the final bacteria bed effluent. Albuminoid ammonia present in the crude sewage and in the final bacteria bed effluent. Capacity. Length. Bate of flow of sewage through the tanks. Name of chemical. Grains per gallon of sewage. Average percentage purification. Number of hours occupied in absorption. Temperature at which absorption took place ???. Gallons. Feet. Gallons per day. Gallons. 1 Accrington Aug., 1899 to date ... Sewage which has passed through a detritus chamber provided with a fixed screen, and which has afterwards passed through two sets of septic tanks, each set consisting of three tanks. The sewage is distributed on the beds by means of sprinklers All the detritus and sand is left either in the detritus chamber or two first septic tanks. Storm water is separate ... ... Continuously worked ... l 215,111 90.0 4 70 91.3 2 Aldershot ... ... Crude sewage after having passed through a small detritus chamber. No screening. Storm water is separate from sewage ... ... ... Nil ... ... ... ... ... 2½ 2 Primary beds deal with about 500,000 gallons per day 91.0 4 80 90.6 Second ary be ds wor ked on conti nuous flow pr inciple ... ... Secondary beds deal with about 130,000 gallons per day 3 Acfcon ... ... ... ... ... ... ... ... Contin uous m ethod About 372,300 ^ Wintt aker a nd Bry ant spr inklers are use d) 4 Aylesbury ... ... Sewage which has previously passed through a settling tank 40,000 50 x 30 250,000 ... ... Varies according to flow from the town 2 ½ and 1 2 ... ... A minimum quantity of 250,000 gallons to the six coke breeze beds (about ½ acre) per day (60 to 80 per cent. purification is effected.) 5 Barnsley During the last 12 months 1, 2 and 3 Only night water which has previously passed through a septic tank is treated, not sewage. Road detritus and sand are separated from the liquid 200,000 90 x 120 200,000 (about)' Lime Alumino ferric Depends upon the night flow and weather 1 1 6 Birmingham Less than six months ... Storm water and excess sewage from Reamain sewer 5,441,875 315 (average) 22,000,000 None ... 2 7 3 12 1 1 Varies 53.5 4 80 7 Blackburn 2 years ... Screened sewage which has been from 12 to 16 hours in the septic tank None V aried during the experiments ... 2 and 3 2 ... 75 to 80 4 80 971 8 Bloxwich district of Walsall ... ... Sewage which has passed through a septic tank ... ... ... ... ... 1 2 1 3 2½ 2 ... 96.3 4 ... 97.7 9 Bristol— ... • •• Continuous process ... ... 1 1,048,666 Stoddart distributor used 92 4 80 94 At Knowle Two years ... Sewage which has passed through a septic tank ... ... ... ... ii M ... 1 204,893 Candy-Caink distributor used 71 4 80 93 At St. John's-lane Two years ... Do. do. ' 48 49 Table 3. Particulars as to the Capacity of the Bacteria Beds and as to the loss of Capacity during working. No. Name of town or district. Name or number of bed. Capacity, when empty, of the tank containing the bed. Original water capacity of the bed in the tank. Water capacity ef the bed after use. Number of hours occupied in draining the bed. Number of days during which the bed had been resting previous to the measurement being made. Loss of capacity. Length of time during which the bed was in use. Number of fillings during the time. Date. Gallons. Percentage of the empty tank. Date. Gallons. Percentage of the empty tank. Gallons. Percentage of original water capacity of the bed. Gallons. l Accrington The beds are not ordinary contact beds, the sewage percolates through The same amount of sewage is being passed through the beds as when them. they were first constructed. 2 Aldershot No account is taken of the number of fillings. The system having gone beyond the experimental stage, the beds are brought into use as required. 3 Acton 4 Aylesbury 5 Barnsley It is expected that a reduction in capacity will occur. 6 Birmingham 7 Blackburn 8 Bloxwich district of Walsall 5,000 9 Bristol— At Knowle Continuous process. At St. John's-lane [7] 50 Table 4. Particulars of the Septic Tanks (if used). No. Name of town or district. Number of tanks. Distinctive name or number of each tank. Whether the tanks are open or closed. Dimensions of the tanks. Area. Depth. Capacity of the tanks. Feet. Feet. Gallons. 1 Accrington The whole of the tank capacity is a little over 1½ days' flow. 2 Aldershot No septic tanks used. 3 Acton ... ... Open 4 Aylesbury 5 Barnsley 1 ... Open 10,800 3 202,500 6 Birmingham 20 1 to 20 Open 189,000 (square feet) 605 7,143,500 7 Blackburn 2 in succession. Open 750,000 8 Bloxwich district o: Walsall ... Open Tank holds about 6 hours flow of sewage, 9 Bristol— At Knowle 2 Knowle Closed 275 and 360 6 26,000 (total) At St. John's-lane 1 St. John's Closed 200 6 8,125 51 Table 5. Particulars as to the working of the Septic Tanks. No. Name of town or district. Name or number of tank. Dates between which the tank was in use. Length of time during which the tank was used. Rate of flow of sewage through the tank. Quantity of sewage passed into the tank. Quantity of sludge left in the tank. Percentage of moisture in the eludge left in the tank. Percentage reduction in the amount of sludge effected by septic action. Weeks. Gallons per day. Gallons. Tons. 1 Accrington 6 Open 15 months' continuous use ... 1,250,000 (dry weather flow) ... ... 76.7 2 Aldershot 3 Acton 4 Aylesbury 5 Barnsley 6 Birmingham 1 to 20 In use constantly 104 22,000,000 ... None ... * 7 Blackburn 1 2 ... 104 240,000 ••• ... 90. 72. of the suspended solid matter. 8 Bloxwich district of Walsall 9 Bristol— At Knowle January, 1900 to March, 1902 ... 39,000 At St. John's-lane ... 1,600 * The sludge which hail to be disposed of before septic tanks were used amounted to double that which is now to be removed from the sedimentation tanks. 52 No. Name of town or district. Remarks. 1 Accrington The whole of the sewage is treated in a permanent manner, and the results are satisfactory to the Rivers Board. An attempt is being made to reduce the cost of treatment by dispensing with pumping; the coal bill is a very heavy item. 2 Aldershot 3 Acton The experiment was successful, and the effluent which was delivered into the tideway of the river at Chiswick Ait, was approved of by the Thames Conservancy. Arrangements are being made for open septic tanks and continuous filters for dealing with the whole of the sewage. 4 Aylesbury The result is considered satisfactory, and the installation is now permanent. 5 Barnsley This is a temporary experiment, and the result is considered satisfactory. The tanks and coke-beds have not been sufficiently long in use to afford opportunity for judging proper results. 6 Birmingham Sewage is applied to 1,828 acres of farm land. Within the last two years pre cipitation tanks have been converted into septic tanks, and the septicised sewage has been applied to the land. The results obtained from the experimental bacteria-beds, other than the large beds above referred to, were perfectly sufficient to show that the sewage could be efficiently treated in bacteria-beds. 7 Blackburn The temporary beds have been thrown out of use, and 24 beds 120 feet long by 60 feet wide and 3½ feet deep are now in course of construction. 8 Bloxwich district of Walsall The population of the area drained is 2,200. A large sceptic tank is in course of construction. First-class results have been obtained up to the present. 9 Bristol— At Knowle The effluent discharges into a brook which passes through a village; an application for an injunction to stop the works was dismissed, as the judge was satisfied as to the purity of the effluent. At St. John's-lane The works are surrounded by dwelling-houses, one being less than 50 feet distant. PARTICULARS OF THE BACTERIA BEDS, ETC., AT VARIOUS CENTRES. 54 55 Table 1. Particulars of the bacteria beds. No. Name of town or district. Nature of installation. Number of beds. Distinctive number or name of each bed. Average or working area of the beds. Measurement of the beds. Depth of the beds. Material and size of the material of which the beds are composed. Thickness of each layer of material, arranged in their order in the beds, from the top downwards. Method of under-draining the beds. Actual or estimated cost of making the beds. Actual or estimated cost per acre of making the beds. Cost of treating sewage per million gallons. At top. At bottom. P.—Permanent. T.—Temporary. Square feet. Feet. Feet. Feet. 10 £ S. d. £ s. d. Burnley— Duck pits (septic tanks) and Woodend works (beds) p. * l p 30,927 Furnace clinker above ½ inch mesh Coarse clinker 9 inches at bottom Socketed 12 inch earthenware pipes and 4 inch field tiles 1,200 – – 2 P 31,363 3P 27,878 4 P 28,134 5 P 28,314 6 P 54,540 11 P 14 S 26,136 Furnace clinker ½ inch to ½ inch mesh 9 inches at bottom 16 S 27,442 Coarse clinker 17 S 27,178 18 P 21,780 3 Engine ashes 19 S 21,780 * 3 Coke screened to 1½ inch mesh 22 S 20,909 Engine ashes 1/8 inch to ½ inch mesh 23 S 20,909 Engine ashes J inch to ½ inch mesh Altham works (septic tanks and beds) 1 P 5,227 2 P 13,068 3 P 12,632 4 P 12,632 5 S 4,792 6 S 13,504 7 S 12,632 8 S 12,632 * In this column, p indicates a Primary bed, S indicates a Secondary bed. 56 57 Table 2. Particulars as to the working of the Bacteria Beds. [###[No. Name of town or district. Time during which the beds were in use. Name or number of the bed used. Character of the liquid supplied to the beds. Particulars of the settling and of the detritus tanks. Chemicals used for treating the sewage previous to bacterial treatment. Number of hours Number of fillings per 24 hours. Number of contacts in successive beds. Quantity of 6ewage treated in 24 hours, per acre of bed, one foot deep. Calculated for the purpose of comparison Average percentage purification effected on the crude sewage, as measured by the relative quantities of Occupied in filling the beds. During which the beds remained full (contact period). Occupied in emptying the beds. During which the beds remained empty (aeration period). Oxygen absorbed by the crude sewage and by the final bacteria bed effluent. Albuminoid ammonia present in the crude sewage and in the final bacteria bed effluent. Capacity. Length. Rate of flow of sewage through the tanks. Name of chemical. Grains per gallon of sewage. Average percentage purification. Number of hours occupied in absorption. Temperature at which absorption took place Gallons. Feet. Gallons per day. Gallons. 10 Burnley— Duckpits (septic tanks) and Woodend works (beds) 1898-1901 Feb. to Mar. 18 Septic tank effluent ... ... ... Lime 0.42 ... 2 ... ... ... 1 56.8 4 80 52.5 1898 Apl. to Sep. 19 Septic tank effluent ... ... ... ... ... 2 ... ... ... l 43.1 4 80 43.9 1898-1901 July to Mar. 22 Coke-bed effluent from No. 18 bed ... ... ... ... ... ... ... ... ... 2 88.5 4 80 87.2 1899-1901 Oct. to Mar. 2 Septic tank effluent ... ... ... ... ... 2 ... ... ... 1 60.2 4 80 54.4 Oct. to Mar. 23 Coke-bed effluent from No. 2 bed ... ... ... ... ... ... ... ... ... 2 86.3 4 80 84.7 1899-1901 Dec. to Mar. 1 Septic tank effluent ... ... ... ... ... ... ... ... ... 1 56.3 4 80 53.5 1900 1901 Jan. to Mar. 19 Coke-bed effluent from No. 1 bed ... ... ... ... ... ... ... ... ... 2 85.6 4 80 85.1 1900-1901 June to Mar. 5 Septic tank effluent ... ... ... ... ... ... ... ... ... 1 57.9 4 80 54.8 1900-1901 July to Mar. 14 Coke-bed effluent from No. 5 bed ... ... ... ... ... ... ... ... ... 2 87.0 4 80 84.2 1901-1902 3 June to 31 March ... Septic tank effluent ... ... ... ... ... ... ... ... ... 1 58.6 4 80 50.1 1901-1902 14 Aug. to 31 March ... Coke-bed effluent ... ... ... ... ... ... ... ... 2 78.0 4 80 79.9 1902 10 Feb. to 31 March 6 Septic tank effluent ... ... ... ... ... ... ... ... ... 1 51.1 4 80 52.3 1902 17 to 31 March 15 Coke-bed effluent ... ... ... ... ... ... ... ... ... 2 73.8 4 80 83.8 Altham works (septic tanks and beds) 1900-1901 Feb. to Mar. 1 Septic tank effluent ... ... ... ... ... ... ... ... ... 1 68.0 4 80 59.6 Feb.toMar. 5 Coke-bed effluent from No. 1 bed ... ... ... ... ... ... ... ... 2 87.7 4 80 87.5 1900-1901 Oct. to Mar. 2 Septic tank effluent ... ... ... ... ... ... ... ... 1 76.0 4 80 64.6 Oct. to Mar. 6 Coke-bed effluent from No. 2 bed ... ... ... ... ... ... ... ... ... 2 89.4 4 80 85.9 1901-1902 25 April to 31 March 3 Septic tank effluent ... ... ... ... ... ... ... ... ... 1 60.4 4 80 57.1 1901-1902 ... 10 Feb. to 31 March 7 Coke-bed effluent from No. 3 bed ... ... ... ... ... ... ... ... ... 2 85.4 4 80 80.2 58 59 Table 3. Particulars as to the Capacity of the Bacteria Beds and as to the loss of Capacity during working. No. Name of town or district. Name or number of bed. Capacity, when empty, of the tank containing the bed. Original water capacity of the bed in the tank. Water capacity of the bed after use. Number of hours occupied in draining the bed. Number of days during which the bed had been resting previous to the measurement being made. Loss of capacity. Length of time during which the bed was in use. Number of fillings during the time. Date. Gallons. Percentage of the empty tank. Date. Gallons. Percentage of the empty tank. Gallons. Percentage of original water capacity of the bed. Gallons. 10 Burnley— Duck pits (septic tanks) and Woodend works (beds) Altham works (septic tanks and beds) 60 Table 4. Particulars of the Septic Tanks (if used). No. Name of town or district. Number of tanks. Distinctive name or number of each tank. Whether the tanks are open or closed. Dimensions of the tanks. Capacity of the tanks. Area. Depth. Feet. Feet. Gallons. 10 Burnley— Duck pits (septic tanks) and Wood-end works (beds) 12 1 Open 50 by 40 7.75 99,000 2 „ „ „ „ 3 „ „ „ „ 4 „ „ „ „ 9 „ „ „ „ 10 „ „ „ „ 11 „ „ „ 12 „ „ „ „ 5 „ 75 by 40 6.75 120,250 6 „ „ „ „ 7 „ „ „ „ 8 „ „ „ „ Altham works (septic tanks and beds) 4 1 Open 39 by 12 5.75 16,700 2 „ 23 in 14.33 37,200 diameter 3 „ „ „ „ 4 „ „ „ „ 61 Table 5. Particulars as to the working of the Septic Tanks. no. Name of town or district. Name or number of tank. Dates between which the tank was in use. Length of time during which the tank was used. Rate of flow of sewage through the tank. Quantity of sewage passed into the tank. Quantity of sludge left in the tank. Percentage of moisture in the sludge left in the tank. Percentage reduction in the amount of sludge effected by septic action. Weeks. Gallons per day. Gallons. Tons. 10 Burnley— Duck pits (septic tanks) and Wood-end works (beds) ... ... 17 weeks Altham works (septic tanks and beds) 62 63 Table 1. Particulars of the Bacteria Beds. No. Name of town or district. Nature of installation. Number of beds. Distinctive number or name of each bed. Average or working area of the beds. Measurement of the beds. Depth of the beds. Material and size of the material of which the beds are composed. Thickness of each layer of material, arranged in their order in the beds, from the top downwards. Method of under-drainirg the beds. Actual or estimated cost of making the beds. Actual or estimated cost per acre of making the beds. Cost of treating sewage per million gallons. At top. At bottom. P.—Permanent. T.—Temporary. Square feet. Feet. Feet. Feet. 11 Burslem T. P. 9 Primary 144,000 (total) ... ... 3 Pottery refuse, ½ inch to 1½ inch mesh £ s. d. £ s. d. £ s. d. Secondary ... ... ... 3 Tertiary ... ••• ... 3 Pottery refuse, ½ inch to 1 inch mesh 12 Bury P. 6 ... 8,100 45 x 30 45 x 30 3 Coke 5/8 inch to 1½ Covered channels in the concrete bottoms of the tanks packed around with coarser material 2,740 - - 6 ... 8,100 (totals) 45 x SO 45 x 30 3 Cinders inch mesh (Estimated cost of extensions now being made, exclusive of filling.) 13 Cambridge ... 2 ... 9,800 (total) ... (8,700 superficial feet) 10 Clinkers, 2 inch to 3/4 inch 6 feet „ 5/8 inch to 1/3 inch 2 feet „ above 2 inches 2 feet 14 Carlisle P. 4 1, 2, 3, 4 5,400 (each) 120 x 45 120 x 45 4 Sandstone, 5 inch to 1 inch mesh Not in layers Not underdrained. 2,550 - - 5,100 - - 15 Croydon P. 6 ... 5,140 Irregular 3.75 Coarse burnt clay ballast 1 inch to 3 inch mesh All the same size 3 inch agricultural drain pipes, 5 feet apart, leading to central drain 2,600 (about) - - 3,660 - - 16 Darwen P. 5 • •• ... 49 x 24 ... 3.5 Sand, 1/26 inch to 1/16 inch mesh 6 inch Channels in the concrete floors of the beds, covered with stone flags Hard vitrified clinker 3 feet 17 Epsom ... 6 Primary ... ... ... 3 1½ inch mesh Secondary ½ inch mesh 64 65 Table 2. Particulars as to the working of the Bacteria Beds. No. Name of town or district. Time during which the beds were in use. Name or number of the bed used. Character of the liquid supplied to the beds. Particulars of the settling and of the detritus tanks. Chemicals used for treating the sewage previous to bacterial treatment. Number of hours Number of fillings per 24 hours. Number of contacts in successive beds. Quantity of sewage treated in 24 hours, per acre of bed, one foot deep. Calculated for the purpose of comparison. Average percentage purification effected on the crude sewage, as measured by the relative quantities of Occupied in filling the beds During which the beds remained full (contact period). Occupied in emptying the beds. During which the beds remained empty (aeration period). Oxygen absorbed by the crude sewage and by the final bacteria bed effluent. Albuminoid ammonia present in the crude sewage and in the final bacteria bed effluent. Capacity. Length. Bate of flow of sewage through the tanks. Name of chemical. Grains per gallon of sewage. Average percentage purification Number of hours occupied in absorption Temperature at which absorption took place ???. Gallons. Feet. Gallons per day. Gallons. 11 Burslem ... ... Sewage which has been screened and passed through a septic tank ... ... ... ... ... l 2 l 4 3 3 242,000 12 Bury Since Mar., 1900 ... Sewage which has passed through a screening tank and been chemically treated and sedimented 50,000 (each) 6 circular precipitation tanks 2,000,000 Ferrozone or aluminoferric 6 to 7 1½ 1½ 1½ 1½ 4 ... 333,333 13 Cambridge ... ... Storm flow more especially ... ... • •• ... ... Streaming method of supply to beds 14 Carlisle 2 years Sewage which has been screened • ... ... ... ... ... 1½ 2 1½ 2 3 2 223,926 38 4 80 40 Nigh t sewage is treated contin uously in thes e beds (by coarse bed) 47 4 80 49 (by coarse bed and sand) 58 4 80 52 (by experimental bed, 1/8 in. mesh) 79 4 80 75 (by experimental bed, 1/32 in. mesh) 15 Croydon 2 years ... Sewage which has been screened 41,000 1,500 450,000 ... ... 11/3 2 11/3 2½ 2 1 169,500 63.8 4 ... 60.7 16 Darwen About 3 years 1 to 5 Sewage which has passed through a precipitation tank to remove as much solid matter as possible Capacity about one day's dry weather flow. Aluminoferric 7 8 hours 4 2 1 333,333 17 Epsom ... .... In one case sewage from a septic tank, and in the other case sewage from land ... ... ... ... ... ... 2 ... ... 3 66 67 Table 3. Particulars as to the Capacity of the Bacteria Beds and as to the loss of Capacity during working. No. Name of town or district. Name or number of bed. Capacity, when empty, of the tank containing the bed. Original water capacity of the bed in the tank. Water capacity of the bed after use. Number of hours occupied in draining the bed. Number of days during which the bed had been resting previous to the measurement being made. Loss of capacity. Length of time during which the bed was in use. Number of fillings during the time. Date. Gallons. Percentage of the empty tank. Date. Gallons. Percentage of the empty tank. Gallons. Percentage of original water capacity of the bed. Gallons. 11 Burslem 12 Bury A slight decrease in capacity has been noticed; probably due to overwork. 13 Cambridge 14 Carlisle 4 135,000 % Sept., 1900 54,319 40 Sept,1901 44,642 33 ... 7 9,677 17 15 Croydon Throughout the year the beds are in use for three weeks continuously, and then rest for one week. 16 Darwen The capacity of our bacteria beds was reduced by 1/3rd. 17 Epsom 68 Table 4. Particulars of the Septic Tanks (if used). No. Name of town or district. Number of tanks. Distinctive name or number of each tank. Whether the tanks are open or closed. Dimensions of the tanks. Area. Depth. Capacity of the tanks. Feet. Feet. Gallons. 11 Burslem ... ... Open 12 Bury None used. 13 Cambridge 14 Carlisle No septic tank 15 Croydon No septic tank 16 Darwen The septic experiments were not very successful. 17 Epsom ... ... ... ... ... 11,000 * 69 Table 5. Particulars as to the working of the Septic Tanks. No. Name of town or district. Name or number of tank. Dates between which the tank was in use. Length of tame during which the tank was used. Rate of flow of sewage through the tank. Quantity of sewage passed into the tank. Quantity of sludge left in the tank. Percentage of moisture in the sludge left in the tank. Percentage reduction in the amount of sludge effected by septic action. Weeks. Gallons per day. Gallons. Tons. 11 Burslem 12 Bury 13 Cambridge 14 Carlisle 15 Croydon 16 Darwen 17 Epsom 70 No. Name of town or district. Remarks. 11 Burslem The information respecting this centre has been obtained from particulars referring to a scheme in preparation, published by the Borough of Walsall. 12 Bury From the results obtained, the Corporation have decided to extend the works on similar lines. 13 Cambridge 14 Carlisle 15 Croydon About 450,000 gallons are dealt with daily. The effluent is passed over land once or twice by surface irrigation. 16 Darwen The sludge from the precipitation tanks is allowed to flow into a large lagoon formed in the deep bed of coarse gravel on which the sewage works are situated. A great deal of liquefaction takes place in this bed, thus causing the disappearance of the greater part of the sludge. The beds were originally of coke, but owing to the diminution caused by the breaking down of the coke, hard vitrified clinker has been substituted. 17 Epsom The information respecting this centre has been obtained from particulars published by the Borough of Walsall. PARTICULARS OF THE BACTERIA BEDS, ETC., AT VARIOUS CENTRES. 72 73 Table 1. Particulars of the Bacteria Beds. No. Name of town or district. Nature of installation. Number of beds. Distinctive number or name of each bed. Average or working area of the beds. Square feet. Measurement of the beds. Depth of the beds. Feet. Material and size of the material of which the beds are composed. Thickness of each layer of material, arranged in their order in the beds, from the top downwards. Method of under-draining the beds. Actual or estimated cost of making the beds. Actual or estimated cost per acre of making the beds. Cost of treating sewage per million gallons. P.—Permanent. T.—Temporary. At top. Feet. At bottom. Feet. 18 Evesham p. 4 1 to 4 20,000 ... ... 3.5 Slag ¼ inch to 1¼ inch. Mixed Perforated pipes £ s. d. £ s. d. £ s. d. 1,000 (filling only) 4,600 19 Glasgow 4 First contact beds 3,594 325 E ngine ashes, 1/4 inch mesh 9 in. Dry built brick drains, 9 inches by 9 inches in the centre of the bed and 4 inch field drain pipes laid diagonally from the centre to the sides The installation, which is merely experimental and on a very small scale cost £980. The original cost of the precipitation tanks which contain the beds is not taken into account. ^total) ,, ½ ,, 1 ft. 9 in. ,, ¾ ,, 9 in. 4 Second contact beds 3,582 • •• 3-25 ,, 1/8 ,, 2 ft. (total) ,,¼ ,, 7 in. ,, ½ ,, 8 in. 20 Haslingden, Rawtenstall and Bacup P. T. 16 ... ... 45 x 30 • • • 3 Fine clinker 6 in. 4 in. drain tiles surrounded with burnt ballast 5,800 - - Coarse and fine coke 14 in. Burnt ballast and aerating pipes 4 in. Coarse coke 8 in. Burnt ballast and 4 j,nch 4 in. drain pipes. 21 Hey wood • T. Afterwards the 6 inches of fine clinker were replaced by 1 foot of coarse clinker [10] 74 75 Table 2. Particulars as to the working of the Bacteria Beds. No. Name of town or district. Time during which the beds were in use. Name or number of the bed used. Character of the liquid supplied to the beds. Particulars of the settling and of the detritus tanks. Chemicals used foe treating the sewage previous to bacterial treatment. Number of hours Number of fillings per 24 hours. Number of contacts in successive beds. Quantity of sewage treated in 24 hours, per acre of bed, one foot deep. Calculated for the purpose of comparison Average percentage purification effected on the crude sewage, as measured by the relative quantities of Oxygen absorbed by the crude sewage and by the final bacteria bed effluent. Albuminoid ammonia present in the crude sewage and in the final bacteria bed effluent. Occupied in filling the beds. During which the beds remained full (contact period). Occupied in emptying the beds. During which the beds remained empty (aeration period). Capacity. Gallons. Length. Feet. Kate of flow of sewage through the tanks. Gallons per day. Name of chemical. Grains per gallon of sewage. Gallons. Average percentage purification. Number of hours occupied in absorption. Temperature at which absorption took place ° F. 18 Evesham Beds not yet completed 1/6 of daily flow None used 19 Glasgow ... Open septic tank effluent derived from crude sewage which contains a large quantity of trades' effluent of a variable nature ... ... ... None ... ½ 2 l 2 to 3 1 to 3 2 36,814 One filling daily 95 4 80 90.6 20 Haslingden, Rawtenstall and Bacup ... Sewage which had been screened and which had passed through a septic tank 1,825,000 (4 tank 180 s each 60 1,825,000 feet wide) ... ... 3 Partly meth 1 on the od l contin 14 uous 2 ... ... 86 79.6 (Both are cal on the tank e 4 4 figures culated septic ffluent) 80 80 90 871 21 Hey wood ... Sewage from septic tank Sewage which had been chemically precipitated 1 60 76 77 Table 3. Particulars as to the Capacity of the Bacteria Beds and as to the loss of Capacity during working. No. Name of town or district. Name or number of bed. Capacity, when empty, of the tank containing the bed. Original water capacity of the bed in the tank. Water capacity at the bed after use. Number of hours occupied in draining the bed. Number of days during which the bed had been resting previous to the measurement being made. Loss of capacity. Length of time during which the bed was in use. Number of fillings durimg the time. Date. Gallons. Percentage of the empty tank. Date. Gallons. Percentage of the empty tank. Gallons. Percentage of original water capacity of the bed. Gallons. 18 Evesham 19 Glasgow 4 1st contact beds 72,996 17 Sept., '00 36,498 32,617 50 (estimated) 44.6 (actual) wm Dec., '00 19,700 26.9 ... ... 12,917 39.6 101 days 167 Mar., '01 17,492 23.9 ... ... 2,208 6.8 83 „ 213 May, '01 21,412 29.3 ... 19 3,920 gain 12.0 44 „ 88 Aug., '01 20,321 27.8 ... ... 1,091 3.3 87 „ 174 Nov., '01 21,839 29.9 ... 25 1,518 gain 4.7 76 „ 152 Dec., '01 18,981 26.0 ... ... 2,858 8.8 22 „ 22 Jan., '02 19,046 26.0 ... ... 65 gain 0.2 42 „ 42 Mar., '02 17,997 24.6 ... ... 1,049 3.2 58 „ 88 20 Haslingden, Rawtenstall and Bacup 21 - Hey wood 78 Table 4. Particulars of the Septic Tanks (if used). No. Name of town or district. Number of tanks. Distinctive name or number of each tank. Whether the tanks are open or closed. Dimensions of the tanks. Capacity of the tanks. Gallons. Area. Feet. Depth. Feet. 18 Evesham 3 1 to 3 Open 1,780 4.5 150,000 19 Glasgow 1 ... Open 3,881 8.25 200,000 20 Haslingden, Rawtenstall and Bacup 4 ... Open 10,800 (each) 75 (average) 456,250 (each) 21 Heywood 79 Table 5. Particulars as to the working of the Septic Tanks. No. Name of town or district. Name or number of tank. Dates between which the tank was in use. Length of time during which the tank was used. Rate of flow of sewage through the tank. Quantity of sewage passed into the tank. Quantity of sludge left in the tank. Percentage of moisture in the sludge left in the tank. Percentage reduction in the amount of sludge effected by septic action. Weeks. Gallons per day. Gallons. Tons. 18 Evesham ... ... 25 150,000 19 Glasgow... 1 15 Sept., 1900, and 2 May, 1901 33 ... 44,526,128 818.5 92 54.25 20 Haslingden, Rawtenstall and Bacup ... Dec., 1899 to Dec., 1901. 104 456,250 47,000,000 Average depth of 3 feet in tank) 90 21 Heywood 80 No. Name of town or district. Remarks. 19 Glasgow 20 Haslingden, Rawtenstall and Bacup After two years' working it was found necessary to clean out the tanks on account of large upheavals of black sediment. The black sediment had a strong odour of sulphuretted hydrogen. It had a tendency to choke both the artificial and land filters. Periodical cleaning out has since been adopted. 21 Heywood The information respecting this centre has been obtained from particulars published by the Corporation of Manchester. PARTICULARS OF THE BACTERIA BEDS, ETC., AT VARIOUS CENTRES. [11] 82 83 Table 1. Particulars of the Bacteria Beds. So. Name of town or district. Nature of installation. Number of beds. Distinctive number or name of each bed. Average or working area of the beds. Measurement of the beds. Depth of the beds. Material and size of the material of which the beds are composed. Thickness of each layer of material, arranged in their order in the beds, from the top downwards. Method of under-draining the beds. Actual or estimated cost of making the beds. Actual or estimated cost per acre of making the beds. Cost of treating sewage per million gallons. At top. Feet. At bottom. Feet. P.—Permanent. T.—Temporary. Square feet. Feet. 22 Huddersfield T. 2 Coarse 1,600 40 x 40 40 x 40 3.5 Clinker, 5/8 inch to 5 inch mesh 3 feet 6 inches Land tiles £ s. d. £ s. d. £ s. d. Fine 1,800 ... ... 3.25 Clinker, ¼ inch to 5/8 inch mesh 9 inches „ „ Clinker, j inch to H inch mesh 1 foot 11 inches Clinker, rough ... 7 inches 24 No. 10 (One bed given as 1,800 a type) 48 x 38 48 x 38 3.25 Furnace clinker, \ inch to | inch mesh 10 inches 11 J> Furnace clinker, j inch to 1^ inch mesh 2 feet Rough clinker ... 5 inches 23 Hyde ... 2 Coarse bed 288 16.5 x 18.5 15.5 x l7.6 3.75 Destructor clinker, -j®,- inch to ^ inch mesh Destructor clinker, linch to 3 inch, mesh 3 inches (over part only) 11 11 Fine bed 288 16.5 x 18.5 15.5 x 17.5 3.75 Destructor clinker, 6 inches J? 11 -J3, inch to \ inch mesli Destructor clinker, 3 feet 3 inches 1 ... 45 (diameter) ... ... 9 j®, inch to 1 inch Coke rejected by 3 inch mesh 9 feet Half tiles on bricks, concrete floors 150 180 24 Keighley T. 2 Rough bed 100 10 x 10 10 x 10 3.25 Coke, 1 inch to 3 inch mesh Land tiles 4,500 Fine bed ... ... ... ... j inch to 1 inch mesh 5,000 - 3,540 25 Kettering T. 1 ... 210 21 x 10 21 x 10 3 Gravel pebbles 3 inches Land drain tiles, 2 inches indiameter laid herring-bone fashion to 3 inch central drain P. 2 ... 16,268 170 x 102 162 x 94 4 Coke ¼ inch to 1 inch mesh Coke breeze, 3/16 inch to 1½ inch mesh 2 feet 9 inches 4 feet Main drain with cemented joints up centre of each bed, 12 inches in diameter for one-half the length, 9 inches for the other. Side drains, land tiles 2 inches in diameter, butt jointed, 5 feet apart, laid herring-bone fashion. 1 16,268 170 x 102 162 x 94 4 Coke breeze, inch to 1½ inch mesh 2 feet (about) 1 ... 12,782 170 x 81 162 x 73 4 Burnt ballast, ½ inch to 2 inch mesh A layer of ircm furnace slag, 2 inches in thickness, was placed on the top of each bed. 2 inch mesh 2 feet 84 85 Table 2. Particulars as to the working of the Bacteria Beds. No. Name of town or district. Time during which the beds were in use. Name or number of the bed used. Character of the liquid supplied to the beds. Particulars of the settling and of the detritus tanks. Chemicals used for treating the sewage previous to bacterial treatment. Number of hours Number of fillings per 24 hours. Number of contacts in successive beds. Quantity of sewage treated in 24 hours, per acre of bed, one foot deep. Calculated for the purpose of comparison Gallons. Average percentage purification effected on the crude sewage, as measured by the relative quantities of Oxygen absorbed by the crude sewage and by the final bacteria bed effluent. Albuminoid ammonia present in the crude sewage and in the final bacteria oed effluent.[/##] Capacity. Gallons. Length. Feet. Rate of flow of sewage through the tanks. Gallons per day. Name of chemical. Grains per gallon of sewage. Occupied in filling: the beds. During which the beds remained full (contact period). Occupied in emptying the beds. During which the beds remained empty (aeration period). Average percentage purification. Number of hours occupied in absorption. Temperature at which absorption took place °F. 22 Huddersfield 10 Aug.,'98 to 23 Jan., '00 ... Sewage which had passed through a fine plate with inch perforations Effluent from coarse bed Detritus was settled in a trough and removed from time to time ... ... l 2 1 ... 2 ... 83,733 66 4 (1st contact) 80 66 2 2 ... 79 4 (2nd contact) 80 80 July,'98 to present time Sewage which had been chemically treated and sedimented 1,250,000 6,000,000 (Total of 24 tank s) Lime Sulphate of iron 3.5 l 2 l ... 3 ... 240,000 78 4 (1st contact) 80 79 2.9 3 2 ... 88 4 (2nd contact) 80 87 Aug.,'00 to present Sewage which had passed successively through a screen of 1 inch mesh, a small detritus tank and a septic tank Effluent from coarse bed Small detritus tank used ... ... l 2½ l ... 2 and 3 170,000 71 4 (1st contact) 80 71 time ... ... ... ... 2 and 3 2 ... 82 4 (2nd contact) 80 81 23 Hyde 3 years ... ... Crude sewage which had passed through the septic tank 75,000 90 75,000 None ... Continuous ... ... ... 2,178,000 85.7 4 ... 90 24 Keighley 18 months ... Sewage which had passed through detritus and sedimentation tanks 687 10 3,840 None ... Varied ... ... 2 126,000 ... 25 Kettering About 4 years Sewage which has passed through precipitation tanks Precipitation tanks are used, two of which are Dortmund tanks, each 25 feet in diameter and 40 feet deep to bottom of come. Capacity of each 80.000 None ... 3 (varies) 1 ) 2 to 3 l (varies) 2 or 3 1 31,250 50 4 80 35 ( Purification of tank effluent) 35,970 60 35,700 60 35,700 60 34,860 60 34,270 60 49,590 84 49,590 84 49,120 84 86 87 Table 3. Particulars as to the Capacity of the Bacteria Beds and as to the loss of Capacity during working. No. Name of town or district. Name or number of bed. Capacity, when empty, of the tank containing the bed. Gallons. Original water capacity of the bed in the tank. "Water capacity of the bed after use. Number of hours occupied in draining the bed. Number of days during which the bed had been resting previous to the measurement being made. Loss of capacity. Length of time during which the bed was in use. Number of fillings during the time. Date. Gallons. Percentage of the empty tank. Date. Gallons. Percentage of the empty tank. Gallons. Percentage of original water capacity of the bed. 22 Huddersfield Coarse bed 34,931 9 Aug., 1898 19,000 51-4 3 Mar., '99 9,000 25.8 ... 0 10,000 52.8 29 weeks 317 31 May, '99 7,300 * 20.9 ... 0 1,700 8.9 13 „ 148 11 July, '99 6,100 17.5 ... 0 1,200 6.3 6 „ 70 17 Oct., '99 5,600 16.0 ... 0 500 2.6 14 „ 156 24 Jan., '00 4,800 13.7 ... 0 800 4.2 14 „ 164 No. 10 Coarse bed (septic series) Fine bed (septic series) 36,392 25 July, 1898 19,940 54-8 10 Feb., '02 7,900 21.7 3 0 12,040 60.4 185 „ 2,881 6,738 22 Aug., 1900 3,990 59-2 13 Jan., '02 1,770 26.3 3 0 12,220 55.6 73 „ 6,738 22 Aug., 1900 3,900 57-9 13 Jan., '02 2,280 33.8 3 0 1,620 41.5 73 „ ' * 23 Hyde No loss of capa city so far as de termined. N ow working at higher speed | • than before. 24 Keighley • • • 1,980 ... 8 Mar., '02 660 33 ... None. 25 Kettering Fine sludge from the precipitation tanks clogs the surface of the beds, but in favourable weather the surface of the beds is loosened with a fork. This greatly improves the working of the beds. Road detritus appears to be retained in the Dortmund tanks, through which the sewage first flows. 3 beds 406,000 each June to Aug., 1898 170,000 418 130,000 (average) 320 2 to 3 ... 40,000 23-4 Since 1898 1 „ 320,000 Not me asured Each bed rests 1 week and works three weeks when practicable. Figures relating to ca parity are working averages. 88 Table 4. Particulars of the Septic Tanks (if used). No. Name of town or district. Number of tanks. Distinctive name or number of each tank. "Whether the tanks are open or closed. Dimensions of the tanks. Capacity of the tanks. Gallons .  Area. Feet. Depth. Feet. 22 Huddersfield l ... Open 1,590 5.5 50,000 23 Hyde l ... Open ... ... 75,000 24 Keighley ... ... Open 540 3.7 8,750 25 Kettering Septic action apparently occurs in the precipitation tanks. 89 Table 5. Particulars as to the working of the Septic Tanks. No. Name of town or district. Name or number of tank. Dates between which the tank was in use. Length of time during which the tank was used. "Weeks. Rate of flow of sewage through the tank. Gallons per day. Quantity of sewage passed into the tank. Gallons. Quantity of sludge left in the tank. Tons. Percentage of moisture in the sludge left in the tank. Percentage reduction in the amount of sludge effected by septio action 22 Huddersfield 22 July, 1900, to 29 May, 1901 44 50,000 (about) 15,232,000 107.88 91.3 38 23 Hyde ... l Jane, 1899 to 1902 3 years 75,000 ... 11 tons in 14 months 24 Keighley ... ... July, 1900 to April, 1902 91 Varies 25 Kettering • [12] 90 No. Name of town or district. Remarks. 22 Huddersfield That by no process can the formation of sludge be obviated. When the crude sewage is treated in contact beds, the rapid accumulation of matter in the beds renders the process impracticable. That by the use of a small quantity of lime and copperas (sulphate of iron), followed by contact bed treatment, a satisfactory effluent can be produced. That the contact beds used for the purification of the effluent after chemical precipitation will not retain their capacity indefinitely, and that in the course of a number of years it will be reduced to such an extent as to render necessary the washing or riddling of the material. That by the open septic process 38 per cent, of the sludge is destroyed. The septic effluent is not as amenable to subsequent contact bed treatment as the effluent from chemical precipitation. The capacity of the beds treating the septic effluent decreases more rapidly than that of the beds treating the effluent after chemical precipitation, owing to the excessive amount of suspended matter in the septic effluent. The septic effluent after double contact is frequently unsatisfactory. 23 Hyde A complete scheme of sewage treatment based upon these results has been submitted to the Local Government Board for approval. 24 Keighley The council does not intend installing bacteria beds so long as intermittent land filtration is satisfactory. 25 Kettering The bacteria beds have recently been examined and found to be quite clean inside and without any accumulation of sludge beyond some fine deposit on the surface. PARTICULARS OF THE BACTERIA BEDS, &c., AT VARIOUS CENTRES. 92 93 Table 1. • Particulars ok the Bacteria Beds. No. Name of town or district. Nature of installation. Number of beds. Distinctive number or name of each bed. Average or working area of the beds. Measurement of the beds. Depth of the beds. Material and size of the material of which the beds are composed. Thickness of each layer of material, arranged in their order in the beds, from the top downwards. Method of under-draining the beds. Actual or estimated cost of making the beds. Actual or estimated cost per acre of making the beds. Cost of treating sewage per million gallons. At top. Feet. At bottom. Feet. P.—Permanent. T.—Temporary. Square feet. Feet. 26 Leeds No. 1 coarse bed 5,580 90 x 65 88 x 63 5 Coke, 3 inch and larger mesh ... 3 inch agricultural drain pipes, surrounded by large coke £ s. d. £ s. d. £ s. d. 2 fine bed 5,580 100 x 61 99 x 51 6 Coke, 3/16 inch to 1½ inch mesh ... ,, 3 coarse bed 5,445 ... ... 3 Clinker, ½ inch to 1 inch mesh ... Partly drained by 3 inch pipes and coarse clinker 4 fine bed 5,445 ... ... 3 Clinker, 3/16 inch to ½ inch mesh ... „ „ 5 coarse bed 5,445 ... ... 3 Clinker, 1 inch to 2 inch mesh ... „ „ 6 fine bed 5,445 ... ... 3 Clinker, 3/16 inch to ½ inch mesh ... „ „ 7 fine bed 8,100 ... ... 3.5 Clinker, 5/8 inch to 1 inch mesh ... Not drained 8 fine bed 4,320 ... ... 3.5 Clinker, 5/8 inch to 1 inch mesh ... 3 inch agricultural drain pipes Whittaker No. 1 ... ... ... 10 Clinker, 1 inch to 3 inch mesh ... 9 inch drain pipe in concrete „ 2 ... ... ... 9.5 Coke above 1½ inch mesh 18 inch half-round drain pipes on concrete ,, 2 ,, ,, 1 foot 1 continuous 153 12 x 12 (about) ... 3.6 Coke, coarsest available • 2 „ ,, ... 2.6 Coke, 1 inch to 1½ inch mesh Afterwards" 1½ inch & upwards 9 inch drain pipes 3 „ JJ ,, ... 2.6 Coke, about 5/8 inch mesh Ducat 4356 ... ... 10 Clinker, 3/8 inch to 5/8 inch mesh 94 95 Table 2. Particulars as to the working ok the Bacteria Beds. No. Name of town or district. Time during which the bed were in use. Name or number of the bed used. Character of the liquid supplied to the beds. Particulars of the settling and of the detritus tanks. Chemicals used for treating the sewage previous to bacterial treatment. Number of hours Quantity of sewage treated in 24 hours, per acre of bed, one foot deep. Calculated for the purpose of comparison. Gallons. Average percentage purification effected on the crude sewage, as measured by the relative quantities of Occupied in filling the beds. During which the beds remained full (contact period). Occupied in emptying the beds. During srhich the beds remained empty aeration period). Number of fillings per 24 hours. Number of contacts in successive beds. Oxygen absorbed by the crude sewage and by the final bacteria bed effluent. Albuminoid ammonia present in the crude sewage and in the final bacteria oed effluent. Capacity. Gallons. Length. Feet. Rate of flow of sewage through the tanks. Gallons per day. Name of chemical. Grains per gallon of sewage. Average percentage purification. Number of hours occupied in absorption. Temperature at which absorption took place 26 Leeds 2 Oct., '97 to 2 Feb., '98 No. 1 coarse bed No. 2 fine bed Sewage screened by vertical bars one inch apart Not settled ... None ... 1 2 1 4 3 2 No. 12 precipitation tank used ... ... ... ... ... 1 2 1 4 3 2 No. 11 precipitation tank used 82.3 4 80 736 18 Feb., '98 to 3 Mar., '98 No. 1 coarse bed No. 2 fine bed Sewage which had been chemically treated and sedimented ... Lime 4 Mar., '98 to 8 Sept., '98 No. 1 coarse bed No. 2 fine bed Sewage which had passed through a fine screen with holes 1/8 inch diameter ... ... ... None 1 2 1 4* 3f 2 *Increased to average of 8 hours during the experimental period. ... ... ... ... 1 2 1 4* 3f 2 -(•Reduced to 2 fillings per day during the experimental period. 84 4 80 86 9 Sept., '98 to 18 Nov. '98 No. 1 coarse bed No. 2 fine bed Sewage which had been settled No. 1 settling tank ... None ... 1 2 1 8 average 2 2 ... 86.6 4 80 866 2 Dec., '98 to 6 Jan., '99 1, 2,3,4 Sewage which had been settled ... ... ... Lime 28 ... ... ... ... 3 2 ... 0 7 Jan., '99 to 1 June,' 00 1, 2, 3, 4, 5, 6 Sewage from which the grit had been settled ... ... ... None ... ... ... ... ... ... ... ... 92 4 80 87 8 Mar., '99 7 Sewage which had been chemically treated and sedimented ... ... ... Lime ... ... 2 ... ... 3 ... ... 77 4 80 62 20 Mar., '99 8 Sewage which had passed through a septic tank ... ... ... ... ... ... 2 ... 3 1 ... 74 4 80 63 22 Sept., '99 to 16 June, '00 1,2, 3, 4, 5, 6 Sewage which had passed through the closed septic tanks ... ... ... None ... ... ... ... ... 1 1/3 ... ... 90 4 80 86 9 Mar., '99 to 12 May, '00 Whittaker No. 1 Whit- taker No. 2 Sewage which had passed through No. 1 open septic tank ... ... ... ... ... Continuous met hod ... ... ... 83 4 80 73 (Purification of septic effluent) 2 Sept., '99 to 30 June, '00 Sewage which had passed through No. 1 open septic tank ... ... ... ... ... Continuous method ... ... ... 85 4 80 82 (Purification of septic effluent) 1, 2, & 3 continuous Sewage which had been screened (mesh, 37 per inch) ... ... ... ... ... Continuous method ... ... ... 78 4 80 71 29 Mar., '00 to 7 July, '00 Ducat Sewage which had been screened (3/16 inch screen) and which had passed through a small grit chamber ... ... ... ... ... Working alternate hours for 10 hours, rest 14 hours ... ... ... 91 to 97 4 80 88 to 96 'J 6 97 Table 3. Particulars as to the Capacity of the Bacteria beds and Ag T0 THE LOSg 0F Capacity during working. No. Name of town or di6triot. Name or number of bed. Capacity, when empty, of the tank containing the bed. Gallons. Original water capacity of the bed in the tank. "Water capacity of the bed after use. Number of hours occupied in draining the bed. Number of days during which the bed had been resting previous to the measurement being made. Loss of capacity. Length of time during which the bed was in use. Number ef fillings during the time. Date. Gallons. Percentage of the empty tank. Date. Gallons. Percentage of the empty tank. Gallons. Percentage of original water capacity of the bed. 26 Leeds No. 1 Coarse bed 174,800 83,300 47.7 2 Dec., '97 63,400 36.3 ... ... 19,900 23.9 9 weeks 284 16 „ '97 58,800 33.6 ... ... 4,600 5.5 2 ,, 30 „ '97 57,100 32.7 ... ... 1,700 2.0 2 ,, 13 Jan., '98 51,100 29.2 ... ... 6,000 7.2 2 ,, 27 „ '98 45,400 26.0 ... ... 5,700 6.8 2 weeks 2 Mar., '98 52,100 29.8 ... (increase) 6,700 8.0 ... 14 „ '98 52,300 29.9 ... (increase) 200 0.2 ... 315 26 „ '98 46,100 26.4 ... ... 6,200 7.4 ... 9 April,'98 42,900 24.5 ... ... 3,200 3.8 ... 23 „ '98 40,100 22.9 ... ... 2,800 3.4 ... 6 May, '98 45,800 26.2 ... 7(increase) 5,700 6.8 ... 20 „ '98 44.300 25.3 ... ... 1,500 1.8 ... 2 June, '98 44,600 25.5 ... (increase) 300 0.4 ... 16 „ '98 43,200 24.7 ... ... 1,400 1.7 ... 28 July, '98 56,500 32.3 ... 38 (increase) 13,300 16.0 ... 11 Aug., '98 45,800 26.2 ... ... 10,700 12.8 ... 25 „ '98 42,400 24.3 ... ... 3,400 4. 1 ... 8 Sept., '98 41,000 23.5 ... ... 1,400 1.7 ... 18 Nov., '98 42,200 24.1 ... (increase) 1,200 1.4 ... 135 7 Oct., '99 26,900 15.4 ... ... 15,300 18.1 No. 3 102,094 ... 51,800 50.7 1 July, '00 18,200 17.8 ... ... 33,600 64.9 5 102,094 ... 53,100 520 20 „ '00 16,600 16.3 ... ... 37,500 70.6 7 177,187 ... 55,700 31.4 5 „ '00 25,600 14.5 ... ... 30,100 54.0 8 94,500 ... 29,500 31.2 1 „ '00 11,000 11.6 ... ... 18,500 62.7 [13] 98 Table 4. Particulars of the Septic Tanks (if used). No. Name of town or district. Number of tanks. Distinctive name or number of each tank. Whether the tanks are open or closed. Dimensions of the tanks. Capacity of the tanks. Area. Depth. Feet. Feet. Gallons. 26 Leeds 7 l Open 6,000 7 7/12 250,000 2 Open 6,000 7 7/12 250,000 3 Open 6,000 7 7/12 250,000 4, 5, 6, 7 Open ... 2,000,000 2 Cameron or Exeter Closed 54 x 10 9 (total) 40,000 99 Table 5. Particulars as to the working of the Septic Tanks. No. Name of town or district. Name or number of tank. Dates between which the tank was in use. Length of time during which the tank was used. Rate of flow of sewage through the tank. Quantity of sewage passed into the tank. Quantity of sludge left in the tank. Percentage of moisture in the eludge left in the tank. Per rentage reduction in the amount of sludge effected by septie action. "Weeks. Gallons per day. Gallons. Tons. 1899 26 Leeds l 27 Feb. ... 250,000 134 807 82 28 15 Aug. ... 125,000 million 21 Sept. ... 250,000 gallons 1900 10 Dec. (End of experiment) 1889 2 28 April ... 125,000 ... 833 80 18 12 May ... 250,000 18 Dec. ... 125,000 1900 (End of experiment) Not. 1899 3 3 May ... 125,000 ... 586 82 23 12 May ... 250,000 18 Dec. ... 500,000 1900 ... Nov. (End of experiment) 1889 4, 5, 6, 7, 12 June • •• 2,000,000 j (Tanks working in series) 4 Aug. ... Closed tanks 6 June ... 40,000 100  No. Name of town or district. Remarks. 26 Leeds PARTICULARS OF THE BACTERIA BEDS, Etc., AT VARIOUS CENTRES. 102 103 Table 1. Particulars or the Bacteria Beds. No. Name of town or distriot. Nature of installation. Number of beds. Distinctive number or name of each bed. Average or working area of the beds. Measurement of the beds. Depth of the beds. Material and size of the material of which the beds are composed. Thickness of e«ch layer of material, arranged in their order in the beds, from the top downwards. Method of under-draining the beds. Actual or estimated cost of making the beds. Actual or estimated cost per acre of making the beds. Cost of treating sewage per million gallons. At top. At bottom. P.—Permanent. T.—Temporary. Square feet. Feet. Feet. Feet. 27 Leicester P. T. 4 £ s d. £ 8. d. £ s. d. 1 primary ... 37 x 30 ... Clinker, 1¼ inch to 2¼ inch mesh Two 6 inch layers of old flattened tins, 1 foot apart, were laid in the body of the beds \ 6 inch and 4 inch land tile drains ) 2 „ 37 x 30 ... 41 *2 Clinker, 1¼ inch to 2¼ inch mesh 3 „ 37 x 30 ... 4i Clinker, ¾ inch to 1¼ inch mesh 4 „ 37 x 30 ... 4i Clinker, ¾ inch to 1¼ inch mesh 1 secondary 675 ... ... 3 Clinker, 1/8 inch to ½ inch mesh ... 3 inch land tile drains 2 675 ... ... 3 Clinker, 1/16 inch to ½ inch mesh 6 inch 3 inch land tile drains Clinker, 1/16 inch to ½ inch mesh 19 inch mixed Clay ballast, ½ inch to 1 inch mesh Burnt ballast, inch to ½ inch mesh 11 inch 28 Lincoln ... P. 11 1 primary 3,255 71 x 50 4 10/12 Broken coke and clinker Primary beds, 1½ inch 1 mesh Secondary beds, ¾ inch mesh Same throughout Two and three inch pipes leading to each valve. In the largo beds there are 4 to 6 valves. The main pipes are provided with branches 5,000 - - -14- (labour on beds) -12 3 (precipitant) 2 secondary 8,586 159 x 54 ... 4 10/12 3 primary 3,600 72 x 50 ... 4 1/1 4 secondary 18,198 182 x 100 ... 5¼ 5 primary 3,303 82.5 x 40 ... 4 10/12 6 secondary 17,280 160 x 108 ... 5 7 primary 2,970 90 x 33 ... 4 10/12 9 „ 3,249 79.75 X 40.75 ... 4 1/3 11 „ 3,258 78.5 x 41.5 ... 41/3 13 „ 18,954 189 5 x 100 ... 5 15 „ 14,301 162.5 x 88 ... 5¼ 29 Liverpool (West Derby sewage farm) P. 6 1 primary ... 70.5 x 29.3 28 Burnt clay, 3 inch mesh Not graded 6 inch main with 3 inch collecting drains 1A secondary ... 80.6 x 28.3 ... 2.6 Coke, 3 inch mesh Ballast 14 inches 18 inches 2 primary ... 70.5 x 29.3 ... 3 Red sandstone, 3 inch mesh Not graded 2A secondary ... 80.6 x 28.3 3 Coke breeze, small size ,, 3 primary ... 70.5 x 29.3 ... 3 Ordinary gas coke, 2 inch mesh ,, | 3A secondary ... 80.6 x 28.3 ... 3 Sand and gravel ,, 104 105 Table 2. Particulars as to the working No. Name of town or district. Time during which the beds were in use. Name or number of the bed used. Character of the liquid supplied to the beds. Particulars of the settling and of the detritus tanks. Chemicals used for treating the sewage previous to bacterial treatment. Number of hours Number of fillings per 24 hours. Number of contacts in successive beds. Quantity of sewage treated in 24 hours, per acre of bed, one foot deep. Calculated for the purpose of comparison. Average percentage purificatiom effected on the crude 6ewage, as measured by the relative quantities of Oxygen absorbed by the crude sewage and by the final bacteria bed effluent. Albuminoid ammonia present in the crude sewage and in the final bacteria bed effluent. Occupied in filling the beds. During which the beds remained full (contact period). Occupied in emptying the beds. During which the beds remained empty (aeration period). Capacity. Gallons. Length. Feet. Rate of flow of sewage through the tanks. Gallons per day. Name of chemical. Grains per gallon of sewage. Average percentage purification. Number of hours occupied in absorption. Temperature at Which absorption took place Gallons. 3 1 72.7 4 80 72.6 27 Leicester 24 Oct. to 10 Nov., 1898 1 p Sewage which had passed through an open detritus tank 18,681 30 ... Q \ 68.9 4 80 74.8 11 Nov. to 26 Nov., 1898 l p Sewage which had passed through a closed detritus tank ... (15 feet wide, 7 feet d eep) o 1 s i 73.9 4 80 66.6 1 Sept. to 10 Nov., 1898 • •• Sewage which had passed through an open detritus tank and an open settling tank ... ... ... ... ... ... ... ... (1 filling daily for first 12 days only) a 1 72.6 4 80 81.1 11 Nov. to 6 Dec., 1898 • •• Sewage which had passed through a closed detritus tank and an open settling tank ... ••• ... 1 9. 2 3 3 1 71.2 4 80 71.0 7 Dec., 1898 to 22 July, 1899 • •• Sewage which had passed through a closed detritus tank ... ... ... a 1 76.2 4 80 65.0 24 July to 15 Sept., 1899 • • • Sewage which had passed through a closed detritus tank and a closed septic tank ... « • •• ... ... 4 1 73.5 4 80 73.6 19 Sept. to 13 Oct., 1899 • •• Sewage which had passed through a closed detritus tank ... ... ... ... ... ... 3 2 90.2 4 80 83.1 28 Nov., 1898 to 19 July, 1899 1p Sewage which had passed through a closed detritus tank ... ... ... ... ... 3 2 89.7 4 80 79.9 20 July to 2 Sept., 1899 • •• Sewage which had passed through a closed detritus tank and closed septic tank ... ... ... •. • 3 3 89.6 4 80 83.7 4 Sept. to 15 Sept., 1899 1 P, 1 and 2 S Sewage which had passed through a closed detritus tank and closed septic tank ••• ... ... ... ... 4 3 91.3 4 80 86.7 19 Sept. to 13 Oct., 1899 ... Sewage which had passed through a closed detritus tank ... • •• ... ... Alumino ferric 35 2 2 2 2 3 2 209,234 28 Lincoln ... ... Sewage which had been chemically treated and sedimented (12 hours' settlement) No detritus tank is used 29 Liverpool (West Derby Sewage Farm) June, 1899, to date All ... Crude sewage No settling tank. None ... 3 . 4 2 i Varies from 2 to 8 1 to 3 2 66,000 (average) [14] 106 107 Table 3. Particulars as to the Capacity of the Bacteria Beds and as to the loss of Capacity during working. No. Name of town or district. Name or number of bed. Capacity, when empty, of the tank containing the bed. Gallons. Original water capacity of the bed in the tank. "Water capacity of the bed after use. Number of hours occupied in draining the bed. Number of days during which the bed had been resting previous to the measurement being made. Loss of capacity. Length of time during which the bed was in use. Number of fillings during the time. Date. Gallons. Percentage of the empty tank. Date. Gallons. Percentage of the empty tank. Gallons. Percentage of original water capacity of the bed. 27 Leicester 1, 2, 3, 4 P 124,862 24 Sept., '98 61,865 49.5 . 15 Oct., '98 59,066 47.3 2,799 4.5 21 days (7th filling after rest) 21 Dec., '98 49,795 399 ... 9,271 150 67 „ 16 Feb., '99 43,211 34.6 6,584 106 57 „ 3 Mar., '99 45,432 364 3½ 2,221 36 15 „ (increase) 29 Mar., '99 43,051 34.5 ... 2,381 38 26 „ (2nd filling after rest) 10 April,'99 48,238 386 10 (increase) 5,187 8.4 12 „ 17 May, '99 41,859 335 . . * 6,379 10.3 37 „ 30 May, 99 48,572 38.9 12 (increase) 6,713 10.9 13 „ 4 Oct., '99 35,107 281 ... 13,465 21.8 128 „ 6 Nov., '99 44,232 354 24 (increase) 9,125 14.7 33 „ 6 Nov., '99 40,504 32.4 3,728. 60 0 „ 28 Lincoln 13 591,637 14 Feb., '01 12 May, '01 217,500 36-8 ... 11 ... ... 13 weeks ... ... ... ... 5 Oct., '01 150,000 25.4 7 67,500 ... 21 ,, ... ... ... ... 12 Oct., '01 168,750 28.5 7 (increase) 18,750 ... 1 ,, 1, 3, 5, 7 404,219 ... ... ... 12 May, '01 127,500 315 11 ... ... (total) ... ... ... 16 Sept.,'01 101,250 250 0 26,250 ... 18 „ ... ... ... ... ... 1 Oct., '01 120,000 29.7 7 ("increase) 18,750 ... 2 „ ... ... ... • • • ... 5 Oct., '01 101,250 25.0 0 18,750 ... 4 days 15 467,456 27 Nov., '01 193,750 41 3 Mar.,'02 160,000 342 0 33,750 174 14 weeks ... 5 May, '02 150,000 32.1 0 10,000 52 9 ,, 9 and 11 176,256 19 Aug., '01 70,000 39.7 0 (total) 21 Nov., '01 55,000 31.2 0 15,000 13 „ 7 Feb., '02 60,000 34'0 9 (increase) 5,000 ... 11 ,, 12 April,'02 60,000 34*0 5 ... ... 9 „ 5 May, '02 54,750 311 0 5,250 ... 3 „ 29 Liverpool (West Derby Sewage Farm) 1 34,594 28 June, '99 15,575 45.0 23 April,'00 9,375 271 ... 0 6,200 398 10 months 108 Table 4. Particulars of the Septic Tanks (if used). No. Name of town or district. Number of tanks. Distinctive Dame or number of each tank. Whether the tanks are open or closed. Dimensions of the tanks. Capacity of the tanks. Area. Depth. Feet. Feet. Gallons. 27 Leicester ... ... Closed 130 x 30 6 to 4¼ 125,962 28 Lincoln 4 C.D.E.F. Open 54 x 89 6 180,672 each 2 A.B. ,, 52 x 23 6.75 54,203 „ 1 G. ,, 78 x 89 7 303,712 1 I. ,, 139 x 46 7.25 313,048 1 II. ,, 168 x 39 6.5 281,024 29 Liverpool 109 Table 6. Particulars as to the working of the Septic Tanks. No. Name of town or district. Name or number of tank. Dates between which the tank was in use. Length of time during: which the tank was used. Rate of flow of sewage through the tank. Quantity of sewage passed into the tank. Quantity of sludge left in the tank. Percentage of moisture in the sludge left in the tank. Percentage reduction in the amount of sludge effected by septic actioon.[/##] Weeks. Gallons per day. Gallons. Tons. 27 Leicester 1899 5 June and 13 Oct. (125 working days) 156,503 149 90.77 28 Lincoln The tanks are filled and a allowed to stand 12 hours, the sewage is then drawn off and the sludge is run into low-lying lagoons and dug in. 29 Liverpool 110 No. Name of town or district. Remarks. 27 Leicester • 28 Lincoln By the end of 1903 it is expected that a sufficient number of bacteria beds will have been constructed to deal with all the sewage, i.e.,, an ordinary day's supply. There is already sufficient tank accommodation. 29 Liverpool PARTICULARS OF THE BACTERIA BEDS Etc., AT VARIOUS CENTRES. 112 113 Table 1. Particulars of the Bacteria Beds. No. Name of town or district. Nature of installation. Number of beds. Distinctive number or name of each bed. Average or working area of the beds. Measurement of the beds. Depth of the beds. Material and size of the material of which the beds are composed. Thickness of each layer of material, arranged in their order in the beds, from the top downwards. Method of under-draining the beds. Actual or estimated cost of making the beds. Actual or estimated cost per acre of making the beds. Cost of treating sewage per million gallons. At top. At bottom. P.—Permanent. T.—Temporary. Square feet. Feet. Feet. Feet. 30 Manchester P. T. 1 Roscoe coke 225 12.5 x 18 ... 3 Clean washed gravel 3 inches Open drain pipes and land drain tiles £ s. d. £ s. d. £ s. d. 1 Roscoe cinder 225 12.5 x 18 ... 3 Coke or cinder,1/8 inch to 3/8 inch mesh 6 inches Coke or cinder under f inch mesh 6 inches Coke or cinder under 1½inch mesh 9 inches Rough clinker 12 inches 1 Carbonaceous ... ... 2.5 Ironsand 24 inches ironsand Rubble 6 inches 1 Spent pyrites 225 ... ... 3 Burnt pyrites, 1/8 inch mesh 6 inches Burnt pyrites, 1 inch mesh 24 inches Burnt pyrites, large 6 inches 1 Fine cinder ... ... ... 2.5 Clinkers, 1/8 inch mesh 24 inches • Rubble 6 inches 1 Rough cinder 6048 ... ... 1¼ Boiler clinkers ... Grips in land filled with bricks The material of this bed was taken out. broken and re-screened in June, 1899. 1 A 571.6 33.5x33.5 17.5 4 Clinker, 1 inch to 3 inch mesh. Afterwards 1/8 inch to 1/8 inch mesh x 17.5 1 B 571.6 33.5 x 33.5 17.5 4 Clinker, ¼ inch to 1 inch mesh x 17.5 1 C 571.6 33.5 x 33.5 17.5 4 Clinker, ¼ inch to ¾ inch mesh 3,350 2 x ... 6 inch and 2 inch pipes in channels in bottom of tanks. Pipes surrounded by coarse material 17.5 1 D 571.6 33.5x33.5 17.5 4 Clinker, 1/8 inch to ½ inch mesh x 17.5 1 E 56.3 12x12 3x3 4 Clinker, 1/8 inch to ½ inch mesh 1 Stoddart's 144 ... ... 6 Coke, 3 inches x 2 inches 12 inches ... ... 17 11 2 (labour) Clinkers, 3inches x 2 inches 5 feet 32 3 4 (material) 1 1a ... 165 ... 31/3 Clinkers,3/16 inch mesh 28 inches x Clinkers, large 12 inches 12 inch pipes in groves in bottom of tanks 13425 1 2a ... 165 ... 31/3 x 134.25 6 Septic system 294 4 • 114 115 Table 2. Particulars as to the working of the Bacteria Beds. No. Name of town or district. Time during which the beds were in use. Name or number of the bed used. Character of the liquid supplied to the beds. Particulars of the settling and of the detritus tanks. ChemicaU used for treating the sewage previous to bacterial treatment. Number of hourt Number of | fillings per 24 hours Numbei of contact^ in successi\ beds. Quantity of sewage treated in 2-4 hours, per acre ot' ted, one foot deep. e Calculated for the- purpose of comparison Gallons. Arc-rage percentage purification effected on the crude sewage, as measured by the relative quantities of Occupied in filling the beds. During which th beds renin ine<. full (contact period). Occupied in. emptying the beds During which tnt beds remainid emptv (aeratior period;. Oxygen absorbed by the crude sewage and by the final bacteria bed effluent. Albuminoid ammonia present in the crude sewage and in the final bacteria bed effluent. Capacity. Gallons. Length. Feet. Rate of flow of sewage through the tanks. Gallons per day. Name of chemical. Graina per gallon of sewage. Average percentage purification Number of hours occupied in absorption. Temperature at which absorption took place o F. 1898 Lime Sulphate of iron 30 Manchester 1 Jan., 15 Dec. Roscoe "Chemical" effluent... ... ... ... 2.17 ½ 2 ½ 3 l 205,840 16 Dec. ,, ,, ,, ... ... ... 1.17 ... ... ... 4 l 208,120 1900 29 Mar, 30 May ,, ,, ,, ... ... ... ... ... ... ... 4 1900 1901 31 May 20 Feb. L901 ,, ,, ,, ... ... ... ... ... ... ... 3 1 58-7 4 58-1 (coke) 28 Feb., 27 Mar. ,, ,, ,, ... ... ... ... ... ... ... 2 l 1901 1902 68-3 4 67 1 27 Mar., 26 Mai. ,, ,, ,, ... ... ... ... ... ... ... 3 ... 157,000 (cinder 165,000 20 Nov., 1898, 6 septic Septic sewage ... ... ... ... ... ... ... 1 & 2 l 29 April, 1899 1898 beds 17-21 Sept. A and B Settled sewage ... ... ... ... ... ... ... ... 1 2 30 Sept., 26 Oct. ,, ,, ,, ... ... ... ... ... ... ... ... 2 2 28 Oct., 16 Nov. ,, ,, ,, ... ... ... ... ... ... ... ... 3 2 17 Nov., 3 Dec. ,, „ ,, (two filings) and raw sewage (one filling) ... ... ... ... ... ... ... ... 3 2 3 Dec., 14 Dec. A B and E Settled sewage (two fillings) and raw sewage (one filling) ... ... ... ... ... ... ... ... 3 3 16 Dec., 1898, ,, Raw sewage ... ... ... ... ... ... ... ... 3 3 7 Feb., 1899 1899 9 Feb., 1 May ,, ,, ... ... ... ... ... ... ... ... 4 3 13 April,31 May C and D Settled sewage and occasional fillings of storm water ... ... ... ... ... ... ... ... 2 2 1 June, 7 June ,, Open septic tank sewage ... ... ... ... ... ... ... ... 2 2 8 June, 5 July ,, ,, ,, ... 3 2 6 July, 17 Aug. ,, ,, ,, ... ... ... ... ... ... ... ... ... 4 2 18 Aug.,14Sept. C ,, ,, ... ... ... ... ... ... ... ... ... 8 2 B and D Effluent from primary bed C divided between these beds ... ... ... ... ... ... ... 4 2 ... ... ... ... ... ... ... ... 4 Oct., 7 Dec. A and C Open septic tank sewage ... ... ... ... ... ... ... ... ... 8 2 D Effluent from primary beds A and C run on to bed D ... ... ... ... ... ... ... ... ... 4 2 22 Aug., 31 Aug. A Open septic tank sewage ... ... ... ... ... ... ... ... ... 2 1 1 Sept., 15 Sept. ,, ,, ,, ... ... ... ... ... ... ... ... ... 3 1 16 Sept. ,, ,, ,, ... ... ... ... ... ... ... ... ... 4 1 1899 1900 7 Dec. 11 Apr. A and C ,, ,, ... ... ... ... ... conti nuous on D ... 1 D Effluent from primary beds A and C ... ... ... ... ... conti nuous on D ... 2 1900 3-30 May A and C Settled sewage ... ... ... ... ... ... ... ... ... 2 2 D Effluent from primary beds A and C ... ... ... ... ... ... ... ... ... 4 2 31 May, 1900 A and C Settled sewage ... ... ... ... ... ... ... ... ... 3 2 27 Mar., 1901 D Effluent from primary beds A and C ... ... ... ... ... ... ... ... ... 6 2 1899 1900 7 Dec. 22 Feb 1900 B Open septic tank sewage ... ... ... ... ... ... ... ... 4 1 2 Mar., 25 April ,, ,, ,, ... ... ... ... con tinuous equa l to 6 1 8 May, 7 June ,, ,, ,, ... ...' ... ... ... ... ... ... ... 2 1 1900 1902 ... ... ... ... ... 15 June 26 Mar. ,, ,, ,, ... ... ... ... ... ... ... ... ... 3 1 1900 1901 11 Jan. 17 July Iron sand " Chemical " effluent ... ... ... Lime 2.17 ... ... ... ... 3 I 90.1 4 845 bed 1.17 ... ... ... ... 1900 phate 22 March Fine ,, ,, ... ... ... of iron ... ... ... ... ... 3 1 166,496 85-3 4 826 1899 cinder 29 June Rough ,, ,, ... ... ... ... ... ... ... ... 1900 cinder 29 Mar., 30May ,, „ „ and storm water ... ... ... ... 4 1 591 4 53-5 1900 1902 • 13 June 26 Mar ,, ,, ,, ... ... ... ... conti nuous 1900 8 Aug. Stod- Open septic tank effluent ... ... ... ... ... ... conti nuous dart's 1900 1901 25 Aug.17 Jan. Burnt " Chemical" effluent ... ... ... ... ... ... 2 1 112,933 pyrites 1901 18 Jan. ,, ,, ,, ... ... ... ... ... ... 3 1 28 Jan., 17 Apr. la 2a Open septic tank effluent ... ... ... ... ... ... 1 1 116 117 Table 3. Particulars as to the Capacity of the Bacteria Beds and as to the loss of Capacity during No.; Name of town or district. Name or number of bed. capacity, when empty, of the tank containing the bed. Gallons. Original water capacity of the bed in the tank. Water capacity of the bed after use. Number of hours occupied in draining the bed. Number of days during: which the bed had been resting previous to the measurement being made. Loss of capacity. Length of time during which the bed was in use. Number of fillings during the time. Date. Gallons. Percentage of the empty tank. Date Gallons. Percentage of the empty tank. Gallons. Percentage of original water capacty of the bed. 30 Manchester Roscoe coke 15 Dec., '95 1,750 5 Jan., '98 1,260 ... 2 ... 490 28 2 years ... 7 Jan., '01 1,008 ... ... 1 258 15 3 ,, (Bed had be en washed) 17 Jan., '01 1,166 .. 2½ (increase) 158 9 10 days 26 Mar., '0'2 1,008 .. 10½ ... 258 15 15 months 15 Dec '95 1,750 5 Jan., '98 1,330 ... 2 ... 420 24 2 ,, ,, einder ... 7 Jan., '01 1,080 ... ... 1 250 14 5 ,, (Bed had be en washed) 25 Jan., '01 1,224 ... 2½ (increase) 164 9 5 ,, 26 Mar., '02 1,044 ... 10½ ... 180 10 ... A 10,580 27 Ort '98 4.800 45 15 Nov., '98 4,530 43 3 ... 270 6 19 days 20 April,'99 3,350 32 2½ 7 1,180 25 25 weeks 20 Sep., '99 3,930 37 4½ (increase) 580 12 47 „ 21 Sep., '99 3,520 33 1¼ ... 410 9 47 „ 22 Dec., '99 2,860 27 3 ... 660 14 60 ,, 5 July, '00 2,660 25 ... 7 200 4 98 „ 6 July, '00 2,280 22 7½ ... 380 8 98 „ 25 Feb., '01 2,440 23 ... 2(increase) 160 3 131 ,, 20 Mar., '02 2,210 21 10½ ... 230 5 ... B 10,580 10 Sept., '98 5,004 47 16 Nov., '98 4,530 43 3 ... 474 9 10 ,, 20 April,'99 4,350 41 2½ 7 180 4 32 „ 22 Sep., '99 4,470 42 3½ (increase) 120 2 54 „ 2 Aug., *00 2,980 28 1¼ ... 1,490 30 47 ,, 24 Jan.,'01 3,110 29 ... 7 (increase) 130 3 123 „ 22 Mar., '01 2,600 25 1¼ ... 510 10 133 ,, 8 April, '02 2,730 26 11 (increase) 130 3 ... C 10,580 11 April, '99 5,000 47 5 July, '99 3,690 35 4 ... 1,310 26 12 ,, 14 Sep., '99 1,965 19 l½ ... 1,725 34 23 „ 15 Sep., '99 2,220 21 3½ (increase) 255 5 23 „ 26 Sep, '99 3,520 33 ... 11(increase) 13,00 29 25 „ 1 June, '00 2,580 24 6 ... 940 19 59 „ 23 Aug.,'00 3,100 29 ... 7(increase) 520 10 71 „ 14 Mar., '01 2,580 24 ... 7 520 10 100 „ 15 Mar., '01 2,230 21 7 ... 350 7 100 ,, 3 April, '02 2,250 21 10½ (increase) 20 4 118 Table 4. Particulars of the Septic Tanks (if used). No. Name of town or district. Number of tanks. Distinctive name or number of each ttnk. "Whether the tanks are open or closed. Dimensions of the tanks. _ Capacity of the tanks. Area. Depth. Feet. Feet. Gallons. 30 Manchester 1 Closed 40 x 12 91/6 27,500 2 Open 300 x 100 6 1,125,000 The open septic tank s have been recently enlarged as follows— 300 x 100 7 1,300,000 119 Table 5. Particulars as to the working of the Septic Tanks. No. Name of town or district. Name or number of tank. Dates between which the tank was in use. Length of tunc during which the tank was used. Rate of flow of sewage through the tank. Quantity of sewage passed into the tank. Quantity of sludge left in the tank. Percentage of moisture in the sludge left in the tank. Percentage reduction in the amount of sludge effected by septic action. Weeks. Gallons per day. Gallons. Tons. 30 Manchester l 16 Feb., '99 to 26 April, '00 ... 4,200,000 ... 4,000 85 75 16 May, '00 to 14 Nov., '00 ... 2,500,000 425,000,000 ... • • • 21.6 14 Nov., '00 to 24 Jan., '01 ... 2,000,000 142,000,000 ... ... 33.5 • 50.0 (estimated) 120 No. Name of town or district. Remarks. 30 Manchester The sewage before treatment of any kind, is screened by a bar screen of 5 inch mesh, but since October, 1899, unscreened sewage has been supplied to the septic tanks. There are now at Manchester 12 half-acre beds in regular operation and many more are in course of construction. PARTICULARS OF THE BACTERIA BEDS, &c., AT VARIOUS CENTRES. [16] 122 123 Table 1. Particulars of the Bacteria Beds. No. Name of town or district. Nature of installation. Number of beds. Distinctive number or name of each bed. Average or working area of the beds. Measurement of the beds. Depth of the beds. Material and size of the material of which the beds are composed. Thickness of each layer of material, arranged in their order in the beds, from the top downwards. Method of under-draining the beds. Aotual or estimated cost of making the beds. Actual or estimated cost per acre of making the beds. Cost of treating sewage per million gallons. At top. At bottom. P.—Permanent, T.—Temporary. Square feet. Feet. Feet. Feet. £ s. d. £ s. d. £ s. d. 31 Middleton P. 2 1 and 2 22,230 62-5 5S-5 3 Clean riddled mill cinders ( 1 inch \ mesh 2 feet 6 inches 9-inch central drain and 4-incL unsocketed perforated drain pipes arranged herring bone^fashion 1,145 - - 2,290 - - 2 10 2¼ J 3 inch V. mesh 6 inches ) 32 Nelson P. 6 1 Primary 49,600 116 x 80 113x77 3 Coarse clinkers 2 „ (total) 93 x 80 90x80 •"> O 3 ,, 116 x 80 113x80 3 One grade only Earthenware pipes ... 3,000 — — 4 ,, 93 x 80 90x80 3 5 ,, 116 x 85 113X82 3 6 „ 86 x 85 83x82 3 33 Oldliam P. ... 1 ... 118 x89 2} Screened furnace ashes Material is not graded in the beds,butlargei pieces have been arranged round underdrains ... ... 1 16 11 2 ... 139 x 89 2f „ about j inch mesli 3 ... 139 x89 2$ 99 99 4 ... 139 x 89 21 99 99 5 ... 1571 x 93| 2j 99 99 6 ... 155|x 89| 2? 99 99 7 ... 155^ x 89i >> 99 8 ... 132' x 1011 2 91 99 9 ... 132 xlOOl 1{ 99 99 10 ... 161 x17 2} 11 ... 161 x 68 2 12 13,338 21 13 ... 145 x95 3 14 ... 136 x 951 3 99 99 15 ... 99 99 16 ... ... 3 Crushed and screened clinker from refuse destructor - ... ... 3 18 ... ... 3 34 Ormskirk P. 3 •** 2,400 (each) ... 35 Coke breeze Mains E.S.P. Wing dains 4 inch land tiles 60 - - 1,089 — — 35 Oswestry P. 9 Primary 60x60 51 x51 4½ Cinders,3/8 inch to 1½ inch mesh Not graded 3-inch agricultural drain pipes leadinto brick channels 2,100 - - 1,615 — — 1 12 6 Cost of permanent works (including sludge disposal) 9 Secondary ... 60x50 51x41 4½ Cinders, 3/8 inch to 1 inch mesh 30 Oldbury — 4 Primary 50,535 (total) ... ... 3.25 1¾ inch to 5/8 inch mesh 18 Secondary 29,943 (total) ... 3.25 11/8 inch to3/8 inch mesh 124 125 Table 2. Particulars as to the working of the Bacteria Beds. No. Name of town or district. Time during which the beds were in use. Name or number of the bed used. Character of the liquid supplied to the beds. Particulars of the settling and of the detritus tanks. Chemicals used for treating the sewage previous to bacterial treatment. Number of hours Number of fillings per 24 hours. Number of contacts in successive beds. Quantity of sewage treated in 24 hours, per acre of bed, one foot deep. Calculated for the purpose of comparison. Gallons. Average percentage purification effected on the crude sewage, as measured by the relative quantities of Occupied in filling the beds. During which the beds remained full (contact period). Occupied in emptying the beds. During which the beds remained empty (aeration period). Oxygen absorbed by the crude sewage and by the final bacteria bed effluent. Albuminoid ammonia present in the crude sewage and in the final bacteria bed effluent. Capacity. Gallons. Length. Feet. Rate of flow of sewage through the tanks. Gallons per dav. Name of chemical. Grains per gallon of sewage. Average percentage purification. Number of hours occupied in absorption. Temperature at which absorption took place 31 Middleton Commenced 29 Nov., '99 26 Jan., '00 1 Tank effluent from sewage which has passed through a grit chamber, and then beei treated with chemicals and sedimented 120,000 24 in diameter 1,000,000 Ferozone 6 ... 3 ,... 3 ... ... ... 90.0 2 32 Nelson 11 months 1 Tank effluent 1,050,000 10 each 100 x 30 600,000 (dry weather flow) Alumino ferric 9 ½ (about) 6 ... ... ... ... 71.4 3 years 2 2½ years 3 10 months 4 16 months 5 2½ weeks 6 33 Oldham 1897to end of 1898 Effluent from chemically treated and sedimented sewage 2,116,800 (total of 12 tanks) 128 ... Sulphate of iron Lime 1 ½to 2/3 2 to 3 2 2 (at least) 2 (Sundays included) ... 161,000 (about) 79.1 4 ... 82.1 ... 4 1899 to date ... Effluent from sewage after subsidence (Each of 2detritus tanks) 45 22,500 ... ... ... ... ... ... ... 84.1 4 ... 84.3 12 and 13 Settling tank liquid drawn off by floating arms previous to cleaning tank ... ... ... ... ... ... 1 to 24 34 Ormskirk ... ... Sewage after having gone through process of land filtration 83,000 (8 tanks total) ... ... ... ... ... ... ... ... ... 110.083 110,195 88.2 ... ... 89.7 35 Oswestry ... Primary Secondary Settling tank liquid 56,000 (total) 70 29,531 ... ½to 1¼ 1 to 2½ ¾ 2 to 5 2 to 5 ... 100,000 Effluent from primary beds. ... 1 to 1½ 3 to 4 1 3 to 4½ 2 2 ... 88.2 0.3 140 89.7 36 Oldbnry ... Primary Secondary Chemically treated and sedimented sewage ... ... ... ... ... ... 2 ... ... 2 2 3 126 127 Table 3. Particulars as to the Capacity of the Bactbkia Beds and as to the loss of Capacity during working. No. Name of town or district. Name or number of bed. Capacity, when empty, of the tank containing the bed. Gallons. Original water capacity of the bed in the tank. "Water capacity of the bed after use. Number of hours occupied in draining the bed. Number of days during which the bed had been resting previous to the measurement being made. Loss of capacity. Length of time during which the bed was in use. Number of fillings durimg the time. Date. Gallons. Percentage of the empty tank. Date. Gallons. Percentage of the empty tank. Gallons. Percentage of original water capacity of the bed. 31 Middleton 1 and 2 ... ... ... ... ... 1,700,000 One bed only 32 Nelson 1 168,188 10 Feb '02 33,870 20.1 ... ½ 11 months 2 138,000 11 ,, 21,540 15.6 3 years 3 172,500 12 ,, 22,170 12.9 , 2½ 4 138,000 13 ,, 35,920 26.0 10 months 5 181,125 25 ,, 37,330 20.6 16 „ 6 132,281 26 „ 59,170 44.7 2½weeks 33 Oldham 1 ... ... ... 40 per cent. 1900 60,121 2 ,, 70,138 3 ,, 57,382 4 ,, 63,762 5 ,, 73,361 6 ,, 69,520 7 ,, 69,520 8 ,, 58,183 9 ,, 58,038 10 ,, 53,000 11 ,, 54,740 13 ,, 71 ,150 14 ,, 70,550 34 Ormskirk 35 Oswestry ... ... ... ... ... (Primary beds) 30 to 40 3 to 4 years 36 Oldbury ... 315,844 (total) 187,144 (total) 128 Table 4. Particulars of the Septic Tanks (if used). No. Nacne of town or district. Number of tanks. Distinctive name or number of eaoh tank. Whether the tanks are open or closed. Dimensions of the tanks. Capacity of the tanks. Gallons. Area. Feet. Depth. Feet. 31 Middleton 32 Nelson Septic tank only just started. 33 Oldham 1 ... Open ... 7.5 175,400 34 Ormakirk 35 Owestry 36 Oldbury 129 Table 5. Particulars as to the working of the Septic Tanks. No. Name of town or district. Name or number of tank. Dates between which the tank was in use. Length of time during which the tank was used. Weeks. Rate of flow of sewage through the tank. Gallons per day. Quantity of sewage passed into the tank. Gallons. Quantity of sludge left in the tank. Tons. Percentage of moisture in the kludge left in the tank. Percentage reduction in the amount of sludge effected by septic acton 31 Middleton 32 Nelson 33 Oldham ... June, 1900 to June, 1901 52 weeks 350,000 127,750,000 (2 feet deep) 34 Ormskirk 35 Oswestry 36 Oldbury [17] 130 No. Nome of town or district. Remarks. 31 Middleton If sufficient area of beds is employed and they are properly managed the treatment is satisfactory. It is contemplated treating the whole of the sewage by the bacterial process. 32 Nelson Results obtained by experimental beds are quite satisfactory. 33 Oldham Average daily flow of sewage (1900) 4,000,000 gallons. Experiments show that bacteria beds should be supplied with a tank effluent of uniform strength. Chemicals are an unnecessary expense and rather hinder the work of the bacteria beds than assist it. It is intended to treat the Oldham sewage by subsidence followed by the action of bacteria beds. There is a greater uniformity in the strength of the effluent from the septic tank than in that from the sedimentation tanks, and the bacteria beds act better when an effluent of uniform strength is used, and the effluent from the septic tank and bacteria beds seldom putrifies on incubation. There is also a very considerable reduction in the quantity of sludge. 34 Ormskirk The results obtained at the farm of the Urban District Council of Ormskirk by passing the sewage through lagoons, into settling tanks, over the land and through the coke breeze filter beds successively, are very satisfactory and meet the requirements of the authorities (no chemicals are used). 35 Oswestry Small experimental beds were originally constructed. Later, beds for the treatment of the whole of the sewage. There is no doubt as to the success of the bacterial treatment, our results are continuously satisfactory and the effluents keep free from putrescence. Probably a small amount of septic action takes place in the settling tanks. 35 Oldbury PARTICULARS OF THE BACTERIA BEDS, Etc., AT VARIOUS CENTRES. 132 133 Table 1. Particulars of the Bacteria Beds. No. Name of town or district. Nature of installation. P.—Permanent. T.—Temporary. Number of beds. Distinctive number or name of each bed. Average or working area of the beds. Square feet. Measurement of the beds. Depth of the beds. Feet. Material and size of the material of which the beds are composed. Thickness of e ch layer of material, arranged in their order in the beds, from the top downwards. Method of under-draining the beds. Actual or estimated cost of making the beds. Actual or estimated cost per acre of making the beds. Cost of treating sewage per million gallons. At top. Feet. At bottom. Feet. 37 Reigate T. l Primary coarse 450 21 ft. 3 in. (square) ... 3.5 Broken bricks, coke and cinder, 3 inch to 1 inch mesh½ 1½ inch to ¾inch mesh ½ inch to 1/12inch mesh Broken bricks and coke ½ inch to 1/12 inch mesh ½ inch to 3/16 inch mesh Polarited clinkers,½ inch to 3/16 inch mesh Gas coke above 1½ inch mesh 1 foot 6 inches Agricultural tiles £ s. d. £ s. d. £ s. d. 1 „ 6 ,, 6 „ l Secondary fine 450 24 ft. dia. (circular) ... 3.5 9 „ Bricks laid as stretchers with headers above ½ inch open joints 9 „ 1 „ 6 „ 38 Rochdale T. 2 1,800 (each) 48 (in diameter) 9 Uniform throughout Perforated semi-circular 18 inch pipes laid on bricks on a concrete floor 5,000 - (about) for construction of beds and coke only 4 - - estimated 39 Salford P. ... Roughing beds ... ... ... 3 Gravel (fine) ... ... 7,000 - - - 16 (exclusive of chemical precipitation and pumping) T. 14 126 ... ... 5 and 8 Cinder, between 6 wire mesh and 2 wire mesh to inch 1, 2, 3 40 Sheffield T. 3 let contact 45,000 ... ... 5 Coke 1, 2, 3 (total of 3) 3 2nd contact 40,500 (total of 3) ... ... 31/3 Coke 41 Southport T. 2 Coarse 900 30x30 24 x 24 3 Coke,½| inch mesh Uniform By 6 inch open jointed earthenware pipes 250 ... - (approximately) ... ... 1 Fine (each) 900 30x30 24 x 24 3 Coke, ½ inch mesh 42 Swinton and Pentlebury P. 10 Primary ... 75x75 ... 3.25 Rough clinkers 12 inch 10 Secondary ... 75x75 ... Cinders above ½ inch mesh 9 inch Cinders above ¾ inch mesli 6 inch Cinders1/8 inch to 3/8 inch mesh 12 inch 43 Wolverhampton T. P. 2 1 810 ... ... 4.25 Slack Uniform 6 inch channels covered with perforated inverts ... 3,000 - - 2 4,500 4.25 Furnace ashes,3/16 in. to 1½ in. mesh 44 Wednesbury T. 1 Primary ... ... ... 3 Furnace clinkers, 2 inch 24 inch to 1 inch mesh Furnace clinkers, ¾ inch 6 inch to 5/8 inch mesh Furnace clinkers, ½ inch to 1/4 inch mesh 6 inch 1 Secondary ... ... ... 5 Coal, ¾ inch mesh 3 inch Coal, ½ inch mesh 3 inch Coal, ¾ inch to 1/4 in mesh 24 inch ... 1 Secondary 2,520 ... ... 5 Coal, 3/16 inch to 3/16 inch mesh Fine dust Granite, same size as 24 inch 6 inch 45 West Bromwich P. 1 Single contract 2,520 60 x 42 ... 3 coal bed Engine ashes, ½ inch to Not graded No under drains in any of the beds. Valves fixed at the side for emptying 400 - - 1 Primary 7,200 120 x 60 ... 35 2 inch mesh Engine ashes, ½ inch to 600 - - 1 Secondary 7,200 120 x 60 ... 3 2 inch mesh Engine ashes, 1/8 inch to 600 - - 46 Worcester ... 3 ... ... 80x3 ... 2 ½ inch mesh Furnace ashes, 1 inch to 1/20 inch No under drains 134 135 Table 2. - Particulars as to the working of the Bacteria Beds. No. Name of town or district. Time during which the beds were in use. Name or number of the bed used. Character of the liquid supplied to the beds. Particulars of the settling and of the detritus tanks. Chemicals used for treating the sewage previous to bacterial treatment. Number of hours Number of fillings per 24 hours. Number of contacts in successive beds. Quantity of sewage treated in 24 hours, per acre of bed, one foot deep. Calculated for the purpose of comparison. Gallons. Average percentage purification effected on the crude sewage, as measured by the relative quantities of Occupied in filling the beds. During which the beds remained full (contact period). Occupied in emptying the beds. During which the beds remained empty (aeration period). Oxygen absorbed by the crude sewage and by the final bacteria bed effluent. Albuminoid ammonia present in the crude sewage and in the final bacteria bed effluent. Capacity. Gallons. Length. Feet. Rate of flow of sewage through the tanks. Gallons per daw Name of chemical. Grains per gallon of 6ewage. Average percentage purification. Number of hours occupied in absorption. Temperature at which absorption took place o 37 Reigate 3 years 1 and 2 The sewage contains large quantities of brewery and tannery refuse ... (Two 8 3. x 4 18,000 X 8 feet) None used ... ... ... ... ... * • 2 ... 81 4 55 87 38 Rochdale 2½years 1 and 2 Sewage after passing through open septic tank 200,000 160 160,000 None ... conti nuous process ... ... 215,111 84.0 4 57 to 63 84.2 39 Salford ... ... Sewage from which road detritus etc., has been removed in "silt pits," and which has passed through precipitation tanks 5,250,000 (total of 12 tanks) 110 (each) 12,000,000 (average) Lime 13 contin uous m ethod by spr ay jets 2 ( 2,500,000 to 7,000,000 ) \ 5 to 8 feet deep j 40 Sheffield 3 years ... Sewage which has rapidly passed over two catch pits (the heavier detritus separates fairly readily, but finely divided mineral matter remains mixed with pntrescible solids) ... ... ... ... ... 1 i 2 4 3 2 200,000 (in first contact beds) 195,000 (in second contact beds) 87 to 90 4 Laboratory temperature 92.0 (about) 41 Southport ... ... Screened sewage ... ... ... ... ... 1 2 1 2 4 2 295,000 79.8 Average of 4 3 samples 80 June & J uly, 1900 42 Swinton and Pentlebury ... ... Screened and chemically treated and precipitated sewage ... ... ... Lime Sulphate of iron ... ... n ... ... 3 2 ... 43 Wolverhampton ... ... Tank effluent after lime treatment. It was possible to only partially separate out road detritus ... ... ... Lime ... 1½ 2 n 7 1& 2 ... 200,000 (Bed No. 1 two fillings) 123,000 (Bed No. 2 two fillings) 835 on tank effluent 44 Wednesbury Primary Secondary Secondary Septic tank effluent ... ... ... 2 3 2 ... ... ... ... ... conti nuous proces s ... ... ... 860 4 80 ... ... ... ... ... ... ... ... ... ... ... 87-7 4 80 45 West Bromwich 12 Sept.,'99 to 1 Nov., '00 Single contract Effluent from septic tank 50,000 40 ... ••• ... 1½ 2 1½ 3 3 1 ... 57 4 ... 54.7 8 Oct., '99 to 1 Nov,, '00 Primary Secondary Crude sewage ... ... ... None ... 1½ 2 1½ 3 3 2 ... 85-9 4 ... 78.6 46 Worcester ... ... Domestic sewage from isolation hospital ... ... ... None ... ... ... ... ... ... ... ... 97-7 4 ... 95.2 136 137 Table 3. Particulars as to the Capacity or the Bacteria Beds amd as to the loss of capacity during working No. Name of town or district. Name or number of bed. Capacity, when empty, of the tank containing the bed. Gallons. Original water capacity of the bed in the tank. Water capacity of the bed after use. Number of hours occupied in drain.ng the bed. Number of days during which the bed had been resting previous to the measurement being made. Loss of capacity. Length of time during which the bed was in use. Numbfr of fillings during the time. Date. Gallons. Percentage of the empty tank. Date. Gallons. Percentage of the empty tank. Gallons. Percentage of original water capacity of the bed. 37 Reigate 38 Rochdale No loss of capacity de tected. • 39 Salford 40 Sheffield 41 Southport Coarse and fine 16,875 ... 7,500 (each) 44-4 42 Swinton and Pentlebury 43 Wolverhampton 44 Wednesbury Primary Secondary ... 15,000 35 45 West Bromwich Single contact 47,250 ... 16,666 35.3 9,950 21.1 ... ... 6,716 40.2 ... 816 Primary 157,500 ... 45,000 28.6 29 455 18.7 ... ... 15,545 34.5 12 months ... Secondary 135,300 ... 45,000 33.3 ... 33,337 24.6 ... ... 11,663 25.9 12 months ... 46 Worcester No me asurements as to capacity have been made. 138 Table 4. Particulars of the Septic Tanks (if used). No. Name of town or district. Number of tanks. Distinctive name or number of each tank. "Whether the tanks are open or closed. Dimensions of the tanks. Capacity of the tanks. Gallons. Area. Feet. Depth. Feet. 37 Reigate 38 Rochdale 1 ... open 6,400 5 200,000 39 Salford ... 40 Sheffield 41 Southport 42 Swinton and Pentlebury 43 Wolverhampton l ... open 7,500 5.3 (mean) 249,000 44 Wednesbury l 2 ... ... covered open 45 West Bromwich 2 ... open 800 5 25,000 (each) 46 Worcester 139 Table 5. Particulars as to the working of the Septic Tanks. No. Name of town or district. Name or number of tank. Dates between which the tank was in use. Length of time during which the tank was used. "Weeks. Rate of flow of sewage through the tank. Gallons per day. Quantity of sewage passed into the tank. Gallons. Quantity of sludge left in the tank. Tons. Percentage of moisture in the sludge left in the tank. Percentage reduction in the amount of sludge effected by septic action. 37 Reigate 38 Rochdale 1 2 years 200,000 (3 months} 160,000 (afterwards) 130,000,000 200 ofpressed sludge of 60 per cent, moisture 89.8 26.5 (total solids) 62.0 (suspended solids) 39 Salford 40 Sheffield... 41 Southport 42 Swinton and Pentlebury 43 Wolverhampton l 31 May, '99, to 16 Oct., '00 68 250,000 (average) 50,000 to 500,000 ... ... ... 330 44 Wednesbury 45 West Bromwich 46 Worcester 140 No. Name of town or district. Remarks. 37 Reigate The sewage is distributed evenly over the surface of the bed by the automatic Candy-Caink sprinkler fed by intermittent valves. Two or three minutes flow of sewage is held up in a storage chamber and then discharged through the sprinkler in about one minute so that the bed is in this way both worked and rested in an intermittently continuous manner. There is no water logging of the bed and that continuous and frequent aeration is insured, is shown by the effluent being practically saturated with dissolved oxygen. 38 Rochdale The two beds are Whittaker and Bryant's thermal aerobic filters (as at Accrington). The sewage passes through a septic tank of a capacity of 1 j days flow. The sewage from the open septic tank flows into a small tank and is then pumped up and continuously and evenly distributed over the surface of the two beds by automatically revolving sprinklers, and passes directly through the bed. The septic tank was in use too long without the sludge being cleaned out. It will be cleaned out more frequently in future. 39 Salford Clarified sewage from the precipitation tanks which had passed through a roughing gravel filter was supplied to the bed by sprinkler jets making a spray or rainfall over the surface of the bed. Thus clarified sewage and air passed continuously through the filters while they were working. The roughing beds intercepted a good deal of fine mud and required cleaning out about every second day. We can fully depend upon the bacteria beds to give a satisfactory effluent even when working night and day almost without intermission. 40 Sheffield The degree of purification obtained has been uniformly satisfactory. The loss of capacity of the beds continues and experiments are being conducted with the object of reducing this as much as possible. Permanent works on bacterial principles are contemplated, but working details cannot be decided upon until further experiments are completed. 41 Southport Only a small proportion of the sewage is treated. The beds have always worked to entire satisfaction, and they have always produced a clear and non-putrescible effluent. 42 Swinton and Pentlebury The information inspecting this centre lias been obtained from the particulars published by the Borough of Walsall. 43 Wolverhampton The results from No. 1 bed were good, but, owing to the presence of iron salts in the sewage, a permanent installation is doubtful. It was necessary on account of the iron salts to add lime to the sewage before it passed into the septic tank. 44 Wednesbury 45 West Bromwich 46 Worcester These beds are in use only at the Isolation Hospital. They consist of trenches filled with furnace ashes along which the sewage flows. PARTICULARS OF THE BACTERIA BEDS, Etc., AT VARIOUS CENTRES. 142 143 Table 1. Particulars of the Bacteria Beds. No. Name of town or district. Nature of installation. P.—Permanent. T.—Temporary. Number of beds. Distinctive number or name of each bed. Average or working area of the beds. Square feet. Measurement of the beds. Depth of the beds. Feet. Material and size of the material of which the beds are composed. Thickness of euch layer of material, arranged in their order in the beds, from the top downwards. Method of under-drainirg the beds. Actual or estimated cost of making the bed'. Actual or estimated cost per acre of making the beds. Cost of treating sevage per million gailor. At top. Feet. At bottom. Feet. 47 York T 4 l 800 40 x 20 ... 3 Clinker, cinder and coke, ¾ inch to 1/4 inch mesh 3 layers, the largest material at the bottom. £ s. d. £ s. d. £ s. d. 2 800 40 x 20 ... 3 3 800 40 x 20 ... 3 4 800 40 x 20 ... 3 T 2 1a ... 90 x 30 ... 2.75 Clinker, cinder and coke, 1 ½ inch to 3 inch mesh Layers of coarser material at the top 2a ... 90 x 30 ... 2.75 Clinker, cinder and coke, T 1 Ladder filter composed 4 x 35/12 ... 2 3/8 inch to 3/8 inch mesh Clinker of 10 chambers T 1 York filter ... 67.5 in diameter ... 6.5 Clinker, ½ inch to 2½ inch mesh T 1 Gravel ... 19½ x 111/4 ... 3 Clean gravel, coarse 4½ inches „3/8 inch mesh 4½ inches „ ½ inch „ 9 inches „¾ inch „ 9 inches ,, ½ inch ,, 9 inches • ! 144 145 Table 3- Particulars as to the working of the Bacteria Beds. No. Name of town or district. Time during which the beds were in use. Name or number of the bed used. Character of the liquid supplied to the beds. Particulars of the settling and of the Chemicals used for detritus tanks. treating the sewage previous to bacterial treatment. Number of hours Number of fillings per 24 hours. Number of contacts in successire beds. Quantity of sewage treated in 24 hours, per acre of bed, one foot deep. Calculated for the purpose of comparison. Gallons. Average percentage purification effected on the crude sewage, as measured by the relative quantities of Occupied in filling the beds. During which the beds remained full (contact period). Occupied in emptying the beds. During which the beds remained empty (aeration period). Oxygen absorbed by the crude sewage and by the final bacteria bed effluent. Albuminoid ammonia present in the crude sewage and in the final bacteria bed effluent. Capacity. Gallons. Length. Feet. Rate of flow of sewage through the tanks. Gallons per day. Name of chemical. Grains per gallon of sewage. Average percentage purification. Number of hours occupied in absorption. Temperature at which absorption took place ° F. 47 York 21 April, 1899 to 31 Aug., 1901 1,2,3,4 Closed septic tank effluent ... ... ... ... 1½ to 2 2 variable 4 to 4½ 2 & 3 l 69,193 and 196,085 65.47 4 80 61.97 13 June, 1899 to 13 Oct., 1900 la, 2a Crude sewage which had been screened ... • • • ... ... var ied 3 2 55,569 80.0 4 80 72.0 8 June, 1899 to 15 Sept., 1900 Ladder filter (10 chambers in series later, 2 sets of 5 chambers in series) Raw sewage ... ... ... ... 175,368 44.3 4 80 36.6 5 July, 1900 to 12 Mar., 1900 York filter Open septic tank effluent ... ... ... ... continuo us process ... ... 327,631 84.5 4 80 90.0 23 Nov., 1900 to 1 J uly, 1901 la, 2a Open septic tank effluent ... ... ... ... ... 1½ 1½ 2 3 3 1 65,200 . 78.6 4 80 87.6 14 June, 1899 1,2, 3,4 Closed septic tank effluent (finally treated on land filters) ... ... ... ... Gravel Open septic tank effluent (not satisfactory) ... ... ... ... [19] 146 147 Table 3. Particulars as to the Capacity of the Bacteria Beds and as to the loss of Capacity during working. No. Name of town or district. Name or number of bed. Capacity, when empty, of the tank containing; the bed. Gallons. Original water capacity of the bed in the tank. Water capacity of the bed after use. Number of hours occupied in draining the bed. Number of days during which the bed had been resting previous to the measurement being made. Loss of capacity. Length of time during which the bed was in use. Number of fillings during the time. Date. Gallons. Percentage of the empty tank. Bate. Gallons. Percentage of the empty tank. Gallons. Percentage of original water capacity of the bed. 47 York 1a 46,406 13 June, '99 18,550 40 11 Sept., '99 9,300 20.2 ... ... 9,250 50 90 days 200 25 Sept., '99 13,650 29.7 ... 14 (increase) 4,350 23 14 „ 6 Nov., '99 9,600 20.9 ... ... 4,050 22 43 „ 2a No appreciable reduction of this bed was observed. 148 Table 4. Particulars of the Septic Tanks (if used). No. Name of town or district. Number of tanks. Distinctive name or number of each tank. "Whether the tanks are open or closed. Dimensions of the tanks. Capacity of the tanks. Gallons. Area. Feet. Depth. Feet. 47 York 1 ... Closed 800 8 40,000 1 ... Open 6,400 6.25 250,000 149 Table 5. Particulars as to the working of the Septic Tanks. No. Name of town or district. Name or number of tank. Dates between which the tank was in use. Length of time during which the tank was used. Rate of flow of sewage through the tank. Quantity of sewage passed into the tank. Quantity of sludge left in the tank. Percentage of moisture in the sludge left in the tank. Percentage reduction in the amount of sludge effected by septic action. Weeks. Gallons per day. Gallons. Tons. 47 York Closed 21 April, 1889 to 81 Aug., 1901 123 From 13,000 to 40,000 14,500,000 Open 26 June, 1900, to 12 Mar., 1901 89 182,000 to 318,000 106,000,000 390 cubic yards. 89.3 150 No. Name of town or district. Remarks. 47 York London County Council. ENTERIC FEVER IN LONDON. Report by the Medical Officer submitting a report by Dr. Hamer on certain localised prevalences of Enteric Fever in London in September, 1900. (Printed by order of the Public Health Committee, 6th December, 1900.) Public Health Department, 8, St. Martin's-place, W.G., January, 1901. 1.—In presenting to the Public Health Committee Dr. Hamer's report on outbreaks of enteric fever occurring in September, 1900, in Southwark, Lambeth and Kensal-town respectively, having regard to the conclusion at which Dr. Hamer has arrived, that an article of food not hitherto suspected of causing enteric fever has done so, I may refer to the method adopted in the inquiry into the circumstances of these outbreaks. 2.—Dr. Hamer has in each case selected a defined area in which the persons attacked with enteric fever resided, and has so far as practicable compared all the circumstances of those persons with those of other people living in the same area, but not infected with this disease. As the result of this comparison he has been able without any difficulty to negative the possibility that any of the agencies, commonly accepted as producing enteric fever, were concerned in the first two of these outbreaks, and the evidence he obtained has failed to show that any such agency was the cause of the third outbreak. It became obvious quite early in his inquiries in Southwark and Lambeth that the behaviour of the disease, its rapid appearance in a considerable number of persons, its multiple invasion of houses, and the peculiarities of the age distribution of the cases, were probably explicable on the hypothesis that infection had been received with a food supply. In his inquiry, one fact presented itself to him with overwhelming evidence, viz., that fried fish purchased at particular shops, one in Southwark the other in Lambeth, was the one and only article of food of common origin which had been partaken of by the sufferers as a whole in these areas. In the absence of any other adequate explanation of the phenomena he has intimately examined the possibility of this food being related to these outbreaks, and has come to the conclusion that the evidence on this question is so strong that this relation must be accepted. He has therefore stated all the circumstances bearing upon this hypothesis. In Lambeth, however, the connection between this article of food and the cases of enteric fever is perhaps less obvious than in Southwark, but there is much reason for thinking that this is due more to the smaller number of cases occurring and to conditions special to this area and which relate to peculiarities of topography and to distribution of persons of different social conditions and habits, than to any fundamental difference in the value of the evidence which is adduced. In the case of Kensal-town, the evidence which would tend to incriminate fish is in no way conclusive, but in the absence of other explanation of the attack of a number of persons with enteric fever, and in view of the evidence obtained in the investigation of the other outbreaks, it suggests the possibility that this food may have been the cause of a number of cases of enteric fever in that district. 3.—It needs to be stated at the outset that Dr. Hamer's inquiries have related to areas in which apart from the special cause under consideration, some amount of enteric fever may be expected, and especially in the month of September, when the natural autumnal prevalence is established. He has, therefore, in his examination of the circumstances of each case of this disease endeavoured to exclude such cases as would, without any special superadded cause, have occurred in the defined areas, and further, to separate from cases which he believes to have been directly due to the special cause those which may be presumed to be due to personal infection received from an antecedent ca8e. The result of so doing has left him with a large balance of cases which do not fall under either of the above headings and which he has described as the cases constituting in each area the " special outbreak." [5726 2 4.—If Dr. Hamer's explanation of the outbreaks in Southwark and Lambeth be correct it must obviously meet certain requirements. It necessitates that all the persons included in the special outbreak shall have eaten fried fish from a particular vendor at a time when they must have received infection, and it must be accepted that this requirement is substantially complied with. To those familiar with the difficulties attending such an inquiry it will be admitted that the cases concerning which Dr. Hamer speaks with less certainty on this point are exceedingly small in number. There are, indeed, only six cases in Southwark, among those in the special outbreak, which Dr. Hamer does not feel justified in definitely including among the consumers of fried fish from the particular vendor, at a time corresponding with the probable date of infection. Two of these may have done so, but the fact could not be ascertained from themselves. Of the remaining four, all were consumers of one fish or another from this vendor, who had two shops practically adjoining each other, one in which he sold wet fish, shell fish, &c., the other restricted to the sale of fried fish. Of these four, two may possibly have eaten fried fish purchased from this vendor. 5.—Dr. Hamer found that if he took a particular fried fish shop in Southwark for a centre and drew a circle of a quarter of a mile radius round it, he practically covered the ground in which the exceptional incidence of enteric fever was manifested in this locality. The cases of disease were found to be more thickly distributed near the centre than further away. In order to test the proportion of persons eating fried fish from this particular shop, two areas within the circle were taken for the purposes of detailed inquiry, and it was found that in these areas 42 per cent, of a total of 900 persons had eaten fried fish from this particular shop at a time when the Southwark population became infected. If we were to assume that these proportions obtained throughout the whole circle, which includes a population of about 25,000 persons, the incidence of disease upon the two classes of population, viz., those who purchased at this shop and those who did not, would be as shown in the following table. I have taken the facts relating to September for the statement of these proportions, so as to ensure inclusion of all cases possibly concerned with this cause. Total notified cases in two estimated populations in circle occurring in September* Persons eating fried fish from particular shop. Number infeoted. Persons not eating fried fish from particular shop. Number infected. 10,500 101 14,500 11 Total notified cases in tive estimated populations in circle occurring in September* after deduction of secondary cases. 10,500 97 14,500 8 Total notified cases in two estimated populations in circle occurring in September* after deduction of secondary cases and of cases not regarded as associated with special outbreak. 10,500 96 14,500 0 * Exclusive of two cases concerning which there is doubt as to whether fried fish was eaten, and inolusive of four cases concerning which it was ascertained that fish but not that fried fish was eaten. 6.—It is however probable that this division of population into two classes on the basis obtained by inquiry in two areas, both of which it should be stated are situated between about 100 and 200 yards from the centre, may not represent the actual proportions in the whole circle.† In areas nearer the centre the proportion of persons dealing at this fried fish shop would, caeteris paribus, be greater, in areas more remote would be smaller. The matter may be further tested by limiting consideration to the population resident in a ring between 110 and 220 yards from the centre in which these areas are situated. The figures then obtained are as follows — Total ratified cases in two estimated populations in ring between 110 and 220 yards from the centre and occurring in September.‡ Persons eating fried fish from particular shop. Number infected. Persons not eating fried fish from particular shop. Number infected. 1,969 39 2,718 4 Total notified cases in two estimated populations in ring occurring in September after deduction of secondary cases. ‡ 1,969 37 2,718 2 Total notified cases in two estimated populations in circle occurring in September after deduction of secondary cases and of cases not regarded as associated with special outbreak.‡ 1,969 36 2,718 0 † If we adopt the minimum percentage given by Dr. Hamer on page 12, namely, 25 per cent. instead of 42 per cent., the two populations would then be, respectively, 6,250 and 18,750. ‡ Exclusive of one case concerning which there is doubt as to whether fried fish was eaten and inclusive of one case concerning which it was ascertained that fish but not that fried fish was eaten. 3 7.—Dr. Hamer has, in the majority of instances, not experienced much difficulty in Southwark in deciding which cases should be regarded as primary and which should be treated as secondary. Cases occurring in the same house within a day or two of each other and not preceded by an earlier case in the same house are necessarily regarded as primary, cases occurring a number of days after an antecedent case in the same house have been classified as secondary. As matter of fact, however, the number of cases occurring in September in which doubt can be entertained is so small as not to affect the general result, and especially as the majority had eaten fried fish from the particular shop. Concerning the exclusion of primary cases not regarded as associated with the special outbreak (9 in number in the circle and 3 in number in the ring), the facts which led to such exclusion will be found in the appendix to Dr. Hamer's report. Two of the nine, although notified as cases of enteric fever, were not found after admission to hospital to be cases of that disease, two others, there was reason for assuming, had contracted their disease outside London, and the remainder are not in larger proportion than must often be found occurring during an autumn month in a population of 25,000 persons without any common cause being assignable as explanation of their origin. So far, therefore, Dr. Hamer's hypothesis meets the requirement that the whole of the increment of cases occurring at that time in this population should have been subject to the particular cause which he is associating with the outbreak. 8.—This hypothesis may, however, be examined in another way. The habit of consuming particular articles of food is not shared equally by the population at all ages. An outbreak of enteric fever, shown by Dr. George Turner to be due to the consumption of ice cream (Deptford, 1891), had, as might be expected, a much greater incidence upon the younger ages, including children under 5 years of age. The age incidence of an outbreak of enteric fever, shown by Dr. Theodore Thomson to be due to water (Newport, 1894), had an age incidence different from that of an outbreak of this disease shown by Dr. Davies to be due to milk (Plumstead, 1895). If Dr. Hamer's hypothesis be correct, the age incidence of the Southwark outbreak should be exceptional if fried fish is not consumed equally at all ages. This, indeed, is found to be the case, for, while inquiries by the Council's inspectors showed that boys and girls, young men and young women, have been the principal customers of the particular shop, it will be seen that infants and older persons have escaped disease, and young persons have been especially affected, the incidence on the ages 10-20 years being particularly marked. This peculiarity of the age incidence of the Southwark outbreak is not only conspicuous when comparison is made with that of certain outbreaks due to food, but becomes much greater when comparison is made with the age incidence of enteric fever in London generally, which must be regarded as the total result of all the causes operating within the county. 9.—In conclusion of this part of the subject it may be said (a) that the behaviour of the outbreak directly suggests that it was caused by the ingestion of an infected food; (b) that while all other food supplies commonly known to be capable of conveying infection can be excluded and many other foods also, fried fish cannot be thus excluded; that whether tested by the population in the circle or the ring taken for consideration, practically the whole incidence of the disease has been on the consumers of fried fish purchased at a particular shop, and that inquiries as to other articles of food pointed to no similar result; (c) that the age distribution of the disease in the outbreak is explicable on the hypothesis that infection was communicated by fried fish from the particular shop, having regard to the ages of purchasers and consumers of fried fish from this shop. After careful examination of Dr. Hamer's report, I am satisfied that these conclusions are well founded. 10.—While the positive evidence adduced by Dr. Hamer, that only fried fish eaters were attacked, points directly to the fact that this cause was operative, not less important is the exemption from attack of those who did not partake of this food, although the latter class constituted more than half the population in the area involved in the outbreak. This fact, moreover, obtains greater significance when the facts relating to particular families are considered, for Dr. Hamer found that, in numerous instances, the disease singled out the fried fish eaters for attack, and left unaffected the other members of the family who did not eat fried fish. 11.—It might be thought to be within the limits of possibility that explanation of the infection of purchasers at this fried fish shop could be found in some circumstances incidental to visiting the shop, but not necessarily including the consumption of the fried fish. Such hypothesis would, however, not afford explanation of the attack of persons who did not visit the shop themselves, but who received the fish in their own homes. 12.—In connection with the Lambeth outbreak it must be pointed out that the cases are less than half as numerous as those which occurred in Southwark, and do not therefore so well lend themselves to arithmetical statement. In the Lambeth outbreak, only one actual case of enteric fever occurred in September in which fried fish from the suspected source was not eaten, while in particular streets close to the shop, taken for the purposes of detailed inquiry, some 24 to 59 per cent. of the population had not obtained fried fish from this source. The topographical distribution of the cases was different from that of the Southwark cases, but Dr. Hamer's explanation of this circumstance is probably the true one (see p. 16). While the facts ascertained in Lambeth do not by themselves present the same amount of material for separate conclusion in their detail, they do not on any material point differ from those obtained in Southwark. 13.—The facts obtained in Kensal-town cannot be said to be in close agreement with those either of the Southwark or Lambeth outbreaks. A considerable proportion of the persons attacked had obtained wet fish or shell fish from a particular source, and a slightly smaller proportion had also obtained their milk from a common source. The proportion of cases which could not be associated with a common supply of any sort of food was much larger than in either of the two other districts. 4 14.—The question how fried fish should be capable of conveying the infection of enteric fever is one to which no answer can at present be given. If due to surface contamination before cooking it is probable that this process would destroy the infection; if due to infection within the fish it is improbable that the fish would be sterilized thereby. These points could be determined only by experiment. With respect to the question generally, as to how the fish acquired infective property, Dr. Hamer found no reason for thinking that specific contamination occurred on the Southwark premises, and if both the Southwark and Lambeth outbreaks were due to the consumption of fish, this fact would strongly militate against the view that such contamination had occurred in either of these districts, and points to some earlier period at which the fish became infected. 15.—It will be noted in connection with the four cases of enteric fever mentioned as possible exceptions in the Southwark outbreak, that the consumption of fish purchased as wet fish cannot be wholly excluded as a possible cause, and in this relation it may be stated that not infrequently fried fish shops are owned by the vendors of wet fish, and transference of fish from one to the other is, under these circumstances, of likely occurrence. Fish purchased as fried fish in Southwark comprises plaice, haddock and skate. The fish is fried in cotton-seed oil, and, beyond the batter in which it is cooked and the occasional addition of potatoes, no other foods are generally associated with the sale of fried fish. Shirley F. Murphy, Medical Officer of Health. 5 Dr. HAMER'S REPORT. On the 20th September, 1900, the medical officer of health received from Dr. Parkes, medical officer of health of Chelsea, a list of 15 cases of enteric fever which had been notified since the first day of the month in Kensal Town. Dr. Parkes wrote saying that he had made careful inquiry concerning this outbreak, but was unable to find anything definitely pointing to a particular cause. He discussed the question of milk supply in some detail, inasmuch as he had at that time found that 7 of the 15 cases had been obtaining milk from a particular local vendor; moreover, milk from one of the sources of supply of this vendor was traced to four other cases supplied th rough the agency of a second local vendor. On this day, September 20th, and the following day, more or less contradictory statements appeared in the press concerning prevalence of enteric fever in various parts of South London, and I was instructed to inquire into the question generally. The Council not being the authority receiving copies of certificates under the provisions relating to notification, some difficulty was at first experienced in following the matter up, but ultimately it was ascertained shortly before two o'clock on Saturday, the 22nd September, that upwards; of 20 cases had been notified within the past few days in St. George-the-Martyr, Southwark, while it was also observed that in London as a whole the cases notified during the week ending September 15th showed a marked increase as compared with the preceding week, the numbers notified in the two weeks being 74 and 128. As question was thus raised as to the possible distribution over widely-separated areas of some infected article of drink or food, further inquiry was obviously necessary. Here again difficulty was experienced, as Dr. Waldo, the medical officer of health of the district in which the larger outbreak had thus suddenly declared itself, had been ill, and was out of town. I was, however, afforded every assistance by the chief inspector and other officers of the authority of the district, and was able, having in view the facts already ascertained by them, to form a rough provisional conclusion that milk, which was especially the object of suspicion at the moment, was not at fault. On reporting the result of my inquiries to Mr. Shirley Murphy, he decided to himself prosecute further inquiry the same evening, at. certain hospitals to which the patients had been removed, and it was arranged that we should meet the following day (Sunday, 23rd September), and endeavour to learn certain additional particulars in the affected area. The age distribution of the cases in Southwark was from the first seen to be quite exceptional, the age groups 5-10 years, 10-15 years and 15-20 years being especially affected, and this, as well as certain other considerations, led to careful investigation being made concerning ice-cream. As the result of inquiry on September 23rd, it became, however, practically certain that neither milk nor ice-cream had caused the outbreak. The question of water supply was not, of course, lost sight of, but here again the facts as they came to light pointed to a negative conclusion. Exact knowledge as to the origin of the water supplied to all the houses in the area was not forthcoming until some days later, when it was obtained from the officers of the Lambeth Water Company. It was then quite clear that water had not been concerned in conveying infection. On conferring with Dr. Waldo on the morning of the 24th September, water, milk and icecream could be practically excluded from consideration as causes of the observed prevalence. The sudden appearance of the outbreak and the simultaneous attack in several instances of two or more members of one family were facts strongly suggestive of food as the medium of infection. We decided therefore to make thorough inquiry as to possible collections of persons—and more particularly, having regard to the age distribution of the cases, of young persons—at "parties" and "school treats," and in connection with "days in the country" and the like. The question of shell-fish also presented itself, and a suggestion was made by Dr. Waldo that the subject of public swimming-baths required to be considered. This last-named hypothesis seemed to somewhat closely fit the facts as to the age incidence of the disease in the light of such knowledge as in the first instance came to hand; when, however, more extended inquiry was made, it was found to altogether fail to explain the phenomena observed. Meantime it had become apparent, as the result of examination of the notification returns, that there was a third well-marked localised prevalence of enteric fever in London, affecting certain streets in Lambeth, and this third outbreak was found to present, though in much less marked degree, peculiarity of age incidence similar to that observed in the Southwark outbreak. The age and sex incidence in the three outbreaks is shown in diagram I., the age and sex distribution in London as a whole, in 1899, being given for purposes of comparison. In diagram II. the extent to which the prevalence of enteric fever, in the three sanitary districts concerned, affected the notifications (in the 37th, 38th and 39th weeks) for the whole of London, is shown. In Kensal Town the question of milk supply was still the subject of careful attention. As case after case was notified and inquired into, the judgment leaned now on the side of suspicion and now on that of complete acquittal of the milk. The problem was a very difficult one, inasmuch as though a large percentage of the persons attacked in Kensal Town had, it was ultimately found, been supplied with milk derived from one company, that company was ascertained to be supplying, through the agency of various retail vendors, at the very least, more than half the inhabitants of the streets attacked. Again matters were complicated by the fact that a group of cases occurred in St. Pancras, at about this time, and among the sufferers were eight consumers of milk supplied by a particular local vendor; question arose as to whether the source from which this vendor obtained his milk was identical with the source from which the Kensal Town supply was derived.* In North Kensington too a slightly increased prevalence * It transpired that the St. Pancras vendor, whose main supply was from his own cows, 14 in number, supplemented this to the extent of about two gallons daily, and from time to time obtained the additional milk from the company which was snpplying the Kensal-town vendor. This company conducted a very large business and. in the north-west of London more particularly, was supplying a great many local vendors with milk. 6 of enteric fever was noted, and here again a similar question arose.† Further inquiry was seen to be necessary in Southwark with a view to tracing in each instance the remote source from which local vendors were obtaining their milk, and, with a view to obtaining the same information as to the Lambeth cases, Dr. Priestley, the medical officer of health of Lambeth, was communicated with, and he made similar inquiries in his district. The result of these inquiries was to show that in Lambeth no milk from the source in question was distributed, in St. George-the-Martyr only a small percentage of those attacked was supplied from this source, and even in Kensal Town, where the incidence upon persons drinking milk supplied by the particular company was marked, a considerable percentage of the sufferers from enteric fever obtained milk from entirely different sources. It became, therefore, in the course of a very short time clear that, striking as was the incidence of enteric fever in Kensal Town upon consumers of milk obtained from the particular source, and curious as was the fact that in distantly remote parts of London, milk supplied by the same company had been in a few instances partaken of by persons who had developed enteric fever, these circumstances were really devoid of special significance, having regard to the extensive scale on which the supply in question was distributed. In St. Pancras the incidence upon consumers of the local vendor's milk was striking, eight cases of enteric fever, which developed symptoms" between August 24th and October 1st in a circumscribed area, all obtaining milk from this source. The local vendor's supply may, however, have been contaminated on his own premises.‡ There was in any case no reason for regarding the St. Pancras outbreak as possessing more than local significance. From the particulars to be presently given, it will be seen that milk could be definitely excluded from consideration as cause of the outbreaks in Southwark and Lambeth, and could almost certainly be excluded in the case of Kensal Town. Such time as could be found for the work was meanwhile devoted to house to house inquiry, with a view to recording any facts that were ascertainable in St. George-the-Martyr, where inquiry was then prosecuted. Questions of sewerage, drainage and refuse disposal were of course considered, but no indication of a source of infection was forthcoming under these heads. The manner of grouping of the dates of attack in time was seen to be suggestive of infection on a particular day or limited number of days, and this fact, taken in conjunction with facts already referred to, pointed strongly to infection by some kind of drink or food. The difficulty, so far as most of the possibilities passed in review were concerned, was felt to be the exceptional age incidence of the disease. All attempts to find explanation of the phenomena in some gathering together of persons attacked proved unavailing; the baths and ice-cream hypotheses, which would have to some extent met the requirements as to age incidence, failed to comply with other necessary conditions. The question of shell-fish had from the first been kept in mind, and indeed the extent to which the streets of the area were strewn with periwinkle shells made it impossible, in the light of recent discussion concerning shell-fish and enteric fever, to ignore the possibility of infection having been thus conveyed. But a shell-fish hypothesis proved quite untenable on closer examination. Oysters, it was found, had not been eaten by persons living in the affected area; only cooked shell-fish, generally speaking, appeared to be consumed there. But it was soon evident that even on grouping together the comparatively numerous consumers of periwinkles and the far less numerous consumers of mussels, cockles and whelks, and indeed, on further adding to these the persons who occasionally purchased shrimps, there would still remain, outside the group so constructed, a considerable percentage of the total number of those attacked by enteric fever. The question of age in relation to shell-fish consumption was never reached, inasmuch as this article of food did not fulfil the cardinal requirement of having been generally eaten by persons suffering from the disease. Many other articles of food and drink were made the subject of inquiry. The mother of one of the patients, on being asked to state, as far as she was able, what food and drink her boy was in the habit of consuming, remarked, "The only thing he ever did eat in this house (her son lived away from, and only visited in, the affected area) besides bread and butter was a bit of fried fish." This remark prompted more particular inquiry in subsequent cases concerning fried fish, and it then became speedily apparent that most of those who had been attacked, and who were questioned on this subject, had consumed this article of food, and, moreover, had obtained it from a particular shop. Again, on examination of the distribution of affected houses, it was evident that they were grouped about this shop as a centre, and further, that the intensity of incidence of house attacks rapidly diminished at increasing distances from the shop. This was not all; in several instances it was found, in particular families, that it was the fried-fish eaters who were attacked, to the exclusion of other persons not eating fried fish. Four principal difficulties stood in the way of seriously considering the hypothesis that infection had been conveyed by fried fish. In the first place the heat to which the fish was subjected in the process of frying would be not unlikely to destroy the typhoid bacillus. Secondly, question arose as to how it was possible for the fish to have been originally infected. Thirdly, there was the age incidence difficulty, and fourthly, it was of course conceivable, in the absence of precise knowledge of the customs of persons living in the area in regard to fried-fish eating, that almost everyone was in the habit of consuming fried fish from the particular shop, and that no special significance could therefore be attached to the observed fact that practically all the sufferers from enteric fever had eaten this fish. † In this district it was ultimately found that of the group of eleven cases which had to be dealt with, only three were obtaining their milk, at the time when infection presumably occurred, from the company already referred to. ‡ The first case of enteric fever, in the St. Pannras group of cases, occurred in a woman living on the milk vendor's premises who had recently returned from Wales, and this case may possibly have been the source of infection of the others. 7 Of these the first objection in itself might have been regarded as a fatal one, had it not been for the recollection of certain experiences in connection with cholera. In the report of the medical officer of health of the County of London on Cholera in London in 1893 (appendix II., annual report for 1893) there is noted the fact that two persons suspected to be suffering from cholera in Clerkenwell in that year had consumed fried fish said to have come from Grimsby (cases 8 and 9). Again, case 1, "the Westminster case," which proved, on bacteriological examination, to be a case of Asiatic cholera, had also a history of having eaten fried fish—for supper three days before the date of attack. In cases 8 and 9 the bacteriological examination gave a negative result, but these cases were included by Dr. Barry in his report to the Local Government Board as cholera cases; they seem to have been so included mainly on account of the existence of the thread of connection between them and Grimsby, afforded by the history of their having eaten fish from that port. With these cases in view it did not appear justifiable to altogether dismiss the fried fish hypothesis from consideration on mere a priori grounds. Moreover, a little observation made it clear that the ages of consumers of fish would have to be made the subject of study. Persons entering and leaving the fried-fish shop were seen to be for the most part young persons; inquiries made on this point as to fried-fish eaters in other parts of London corroborated this impression, and it was clearly, therefore, desirable to pursue the matter further and obtain precise information on this head. On September 27th inquiry was made as to the sources from which the particular fish shop was supplied. The origin of most of the fish could be traced, but certain supplies were purchased concerning which detailed information was not available. On the same day the suspicion entertained concerning fried fish, together with the information obtained with regard to sources of supply, was communicated both to Dr. Parkes and Dr. Priestley. From this date onwards much time was spent in studying the facts as to the Southwark cases, and this necessitated, since the large majority of the patients were removed to hospital, a number of visits to hospitals of the Metropolitan Asylums Board ; this work was much facilitated by the cordial aid given by the medical superintendents and assistant medical officers of these institutions. While this work proceeded careful observation was kept by the Council's inspectors under the direction of Mr. Jury, the chief inspector of common lodging-houses, upon the fried fish shop, and, for purposes of comparison, upon several other fried fish shops, and as the result of these inquiries it became clear that the ages specially attacked in the Southwark outbreak were the same as those observed by the inspectors to be represented in large proportion among the persons consuming fried fish. Age incidence, in place of being a difficulty, was, in so far as importance could be attached to it in the face of other difficulties, suggestive of fried fish as the cause of the outbreak. It was now clear that the fish hypothesis required to be carefully examined from the statistical side, and this was accordingly done. The particulars gradually accumulated in Southwark showed more and more clearly that while the question as to whether the observed relation between consumption of fried fish and enteric fever was one of cause and effect or of mere chance coincidence was a complicated one, there was good reason for deciding that the relation was one of cause and effect. It became important therefore to study the facts in regard to the outbreaks which had occurred practically simultaneously in other parts of London, in the light of the Southwark experience. In Lambeth Dr. Priestley had formed the opinion that the disease had been spread in the main by infection transmitted in the course of wringing and mangling operations. He caused inquiries to be made, however, with regard to fish, and pointed out certain difficulties in the way of accepting a fried-fish hypothesis as explanation of the Lambeth outbreak. These difficulties required to be carefully examined. In the outcome it appeared that the Lambeth case, considered by itself, did not do more than raise a suspicion, but it assumed larger importance when, it was borne in mind that its occurrence nearly coincided in point of time with the Southwark outbreak. Lastly, the question of Kensal Town had to be considered. Dr. Parkes had given directions for the facts to be ascertained, and Mr. Metzler, the sanitary inspector, readily gave me all the assistance I desired in this connection. The chief inspector of Kensington, Mr. Pettit, moreover, obtained for me particulars concerning cases occurring in North Kensington, in the near neighbourhood of Kensal Town. The facts as to Kensal Town were found to be in marked contrast in several respects with those of the other two prevalences; in themselves they afford little or no support to the hypothesis of distribution by fish, but they are perhaps deserving of study in connection with the other outbreaks. I therefore proceed to give a brief resume of the particulars ascertained in each of the three districts. Southwark. The locality affected in St. George-the-Martyr, Southwark, was of very limited extent, inasmuch as with three exceptions all the cases belonging to that parish, in which symptoms of enteric fever commenced between September 4th and September 24th, were notified from houses within an area of considerably less than a quarter of a square mile. A few cases occurred at about the same time in an adjoining portion of the parish of St. Saviour, Southwark, and it was found that these cases and the St. George-the-Martyr cases (with the exception of the three already referred to) could all be included within a circle having a radius of a quarter of a mile. The precise position of the limiting circle was determined by considerations to be afterwards specified; it will be sufficient here to say that the area as defined on the accompanying map includes all the cases above referred to, with the exceptions noted. The circle was found to cover, at its south-eastern border, a small strip of land in the parish of Newington. The area thus defined contains a group of large blocks of tenement dwellings six storeys high, with gloomy courtyards, dark staircases, and other sanitary defects; these dwellings afford accommodation 8 to about 3,000 persons, and were fully occupied at the time of inspection. The area also contains several streets of tenement houses, occupied to a large extent, by families apparently possessed of the very narrowest means, and some courts and alleys which have been officially represented as constituting an unhealthy area under the Housing of the Working Classes Act. It includes, moreover, large business premises, the fire brigade headquarters, and a limited number of houses, for the most part fronting upon main thoroughfares, occupied by tradespeople and others above the border line of poverty. The behaviour of enteric fever in this area may be best appreciated by reference to the table annexed. On the left-hand side of the page on this table are exhibited the cases of enteric fever developing within the circular area in Southwark on successive days between August 16th and October 10th.* The cases are numbered consecutively, and are grouped in three columns; the first and third columns contain "primary cases," the second column cases in which the sufferer was apparently infected by a person previously attacked and living (save in three instances specified in the appended notes) in the same house as that in which the presumed "secondary case" occurred. The reason for grouping the primary cases in two columns and for printing the numbers in different colours will presently appear, but for the purpose of indicating the time relations of the onset of attacks of enteric fever in the area, these distinctions may be disregarded. It will be seen for example that in the latter part of August enteric fever was of relatively rare occurrence in the area, only three cases developing between August 16th and the end of the month. Early in September, however, marked increase in prevalence of the disease manifested itself, and on September 6th two persons (Nos. 8 and 9), on September 7th three persons (Nos. 1(0 to 12), and on the 8th four persons (Nos. 13 to 16) were attacked on one and the same day. The number of persons attacked (and subsequently notified) reached a maximum on September 15th; the daily number then somewhat irregularly declined until, on September 24th (for the first time for nearly three weeks) only one patient was attacked in the twenty-four hours. From this time onwards the number of attacks did not exceed two in the day. Indeed, if secondary cases (in column 2) be excluded from consideration, it will be seen that the number of cases developing in the area had, at the end of September and in October, returned to what may be thought of as approaching normal limits; for though the cases are of somewhat more frequent occurrence in this post-epidemic period than they were in the pre-epidemic period, it must be remembered that seasonal influence has to be taken into account, and that the period to which the lower part of the table relates would, on this account, be expected to yield more cases than the period covered by the upper part. The dates to which cases have been allocated in the table just referred to are dates of onset of symptoms; these dates have been determined, in those cases in which patients were removed to hospital (and they form the large majority of the cases), after consideration of the hospital notes and temperature charts, and from information kindly furnished by the medical superintendents of the hospitals. The dates of notification of the cases are given in the appended notes. The two cases marked with an asterisk (*) proved not to be cases of enteric fever. The red dagger (t) which adjoins case 39 indicates another case, one which was not notified but was probably a case of enteric fever. Drainage and refuse removal.—Direct means of access of sewer air to the interior of houses was only quite exceptionally found to exist; sink wastes were disconnected, and water-closet appliances as a rule of a fairly satisfactory character. The drains themselves were in certain instances found to be faulty. Dr. Waldo, in reporting to the vestry on the drainage of the affected locality on October 18th, remarked that "several of the house drains—which are both separate and combined—are only imperfectly ventilated and are apparently not disconnected by any trap from the sewers. In 17 instances the house drain was found on examination with the chemical test (an imperfect one) in use by your authority to be defective. Steps have been taken to remedy these defects. The sewers into which the sewage drains are mostly imperfectly ventilated or not ventilated at all, and some of them (three particular sewers are specified) have been condemned by your surveyor." These conditions do not, of course, afford adequate explanation of the outbreak. As regards refuse disposal, it should be noted that there are dust shoots in the blocks of buildings referred to above, and serious nuisance was caused by these in several instances. Speaking generally, but few accumulations of dust were noted in the course of inspections made in the area. Water supply.—It was found that about half the houses in the area specially invaded were supplied by the Lambeth, and the other half by the Southwark and Vauxhall Water Company. The cases of enteric fever were distributed just about equally between the two companies—i.e., practically in the proportion in which they might a priori have been expected to be distributed. Complaints were made concerning pollution of water in storage cisterns in some of the blocks of dwellings above referred to; this question, however, while serious in itself, could not be regarded as of importance in connection with the outbreak of enteric fever. Milk supply.—The milk supply of infected houses was very varied. In about one-third of the houses involved in the outbreak condensed milk only was consumed. The brand of condensed milk used was ascertained in many instances, and it was found that at least four different brands were represented, though one brand attained a decided position of predominance. As regards the remaining two-thirds of the houses involved, in a few both condensed milk and ordinary milk were used, in the large majority cows' milk only was employed A particular local vendor, indicated by the letter B in the appended notes, supplied rather more than half these houses—i.e., about one-third of the total number of houses involved in the * This period includes rathpr more than a fortnight before, and after, the period of special prevalence in Southwark. Cases of Enteric Fever belonging to three areas and beginning on successive days from August 16th to October 10th, 1900. Date of onset of symptoms. Southwark. Lambeth. Kensal-town. Cases§ probably not associated with special outbreak. Secondary cases. Cases constituting "special outbreak." Cases§ probably not associated with special outbreak. Secondary cases. Cases constituting " special outbreak." Cases§ probably not associated with special outbreak. Secondary cases. Cases constituting "special outbreak." Aug. 16 1 „ 17 „ 18 „ 19 2 „ 20 1 „ 21 l „ 22 „ 23 2‡ „ 24 3 „ 25 2 „ 26 3 „ 27 3 „ 28 4 4 „ 29 † 5‡ „ 30 5 6 7 „ 31 6 † 8 9 10 Sept. 1 4* 7 8 9 11 „ 2 „ 3 5 10 11 12 12 „ 4 6 13 14 15 16 13 „ 5 7 „ 6 8 9 14 15 „ 7 10 11 12 17‡ 16 „ 8 13 14 15 16 18* 18a 17 „ 9 17 18 19 20 21 22 23† 19‡ „ 10 24 25 26 27 28 29 30 31 20 21 „ 11 32 33 34 35 36 37 38 39‡† 22 23 24 18 „ 12 40 41 42 43 44 25 19 20 „ 13 45 46 47 26 ,, 14 48 49 50 51 52 53 54 27 28‡ 21 „ 15 55 56 57 58 59 60 61 62 63† 29 30 31 „ 16 64 65 66 67 68 69 70† 71‡ 32 „ 17 72 73 74 75 76 77 78 79 33 34 22 „ 18 80 81 82 83 84 35 36‡ 23 „ 19 85 86 87 88 89 37 „ 20 90* 91 92 93 94 95 96 97 38 „ 21 98 99 100 101 39* 40 24‡ „ 22 102 103 104 105† 41 „ 23 106 107 108 109 42 25 „ 24 110 43 44 45 45A „ 25 111 112 46 26 27 „ 26 113 47* 28 29‡ „ 27 114 „ 28 115 30 „ 29 116 31‡ „ 30 117 32 Oct. 1 48 49 „ 2 50 33 34‡ „ 3 118 51 „ 4 52 „ 5 119 53 54 ,, 6 120 „ 7 121 122 55 „ 8 123 124 „ 9 125 56 „ 10 126 35 36‡ § The reasons for regarding some cases as contributing to the "special outbreak" and others as not will be seen later. The significance of the asterisks, &c., in the above table will also be shown. [5726 9 outbreak. No oilier local vendor supplied more than a very small number of houses. B's business was a considerable one, and his premises were situated not far from the centre of the area affected, so that it might be anticipated that a considerable percentage of persons attacked would be supplied with milk by him. B was the occupier of cowshed premises, with accommodation for 16 cows, and his milk was obtained almost exclusively from his own cows. The wholesale supplies of all the local vendors were made the subject of inquiry; the facts have now no special interest; in the early days of the outbreak it had been noted as remarkable that four of these local vendors Messrs. A, D, G, and I—were obtaining milk from the company supplying the vendor in Kensal Town, in connection with whose business the question of the relation of milk supply and enteric fever was at the time being carefully investigated.* Use of swimming baths.—In the early days of the outbreak importance was attached to the fact that a number of the sufferers had been in the habit of visiting a twopenny swimming bath in connection with some public baths situated a little to the north of the affected area. It was from the first obvious that considerable difficulty must be experienced in endeavouring to connect the use of a swimming bath, situated as this one was, with the outbreak of enteric fever, inasmuch as the bath was quite outside the locality invaded by the disease, and while it was largely used by residents in that locality, was also unquestionably used by many other persons, all of whom had escaped infection. The number of those attacked who had attended these baths led, however, to careful inquiry being made into the matter. On October 5th Dr. Waldo and I obtained, by the courtesy of the superintendent of the baths, full particulars concerning them. Most of the sufferers from enteric fever who made use of the twopenny swimming bath were school children, and it was found to be the practice for parties of such children to be taken to the baths for the purpose of being taught to swim. During the week ending August 25th 1,296 males used the twopenny swimming bath, and 67 boys, scholars at various schools, were also taken there. Thirty females and 42 girl scholars used the bath in that week. In the week ending September 1st the numbers were 792 males and 615 boy scholars; 18 females and 285 girl scholars. In the week ending September 8th, the corresponding numbers were 906 males and 727 boy scholars; 19 females and 248 girl scholars. Most of the swimmers (other than boy and girl scholars) were said to be under thirty years of age, so that prima facie the bath hypothesis afforded some promise of fitting in with the peculiar age incidence of the enteric fever, but, on the other hand, it appeared difficult to understand how it was that, whereas the scholars were only about half the total number of swimmers, the cases of enteric fever, in which a history of attendance at the baths was given, were, for the most part, confined to them. Again, the cases of enteric fever among scholars had principally affected those attending two particular schools, and there were some dozen schools sending scholars to the swimming baths; thus scholars attending the rest of these schools had almost entirely escaped. The facts were fully ascertained as regards use of the baths by scholars, and they may be summarised as follows— On Mondays boys from schools A, B, C and D attended the baths. On Tuesdays boys from schools B, E and F attended the baths. On Wednesday girls from schools A, C, D, F, G, I, J, L, M and two other institutions attended the baths. On Thursdays boys from schools G, H, F and I attended the baths. On Fridays boys from schools C, H, J, K, L and M attended the baths. All these children used the same swimming bath. This bath was cleansed and scrubbed on the following dates—August 14th, 16th, 18th, 21st, 25th and 28th; September 1st, 4th and 8th. The particulars as to attendance of individual sufferers at the baths are given in the appended notes, in which these particular baths are referred to as the "X" baths. Limiting consideration to the cases numbered 6 to 110 (i.e., to the cases occurring at the time of special prevalence) particulars as to attendance at the baths in question were ascertained in 83 instances. In 52 of these the patient never attended at the particular baths, and in some of the 31 instances in which such attendance was made, it is noted as having occurred some weeks before the onset of illness; again, in one or two cases it was the "first-class bath," and not the twopenny swimming bath which was visited. Most of the cases occurring among scholars who attended the baths were cases of boys and girls going to the school J (the girls from this school attended the baths on Wednesdays, the boys on Fridays). A few boys attending the school B, who attended on Mondays and Tuesdays, were also attacked. Girls from this school are not taken to the baths. These two schools, it may be noted, are the schools attended by the majority of children living on the area, but school J accommodates more children from the area than school B does. Lists of children who attended the baths on particular days were obtained by Dr. Waldo; they corroborate the particulars as to bath attendance obtained from the patients themselves. It was at first thought to be conceivable that infection of the water in the bath occurring, say, after the bath was cleansed on August 28th (Tuesday), might have led to infection of boys * The local vendor B on very rare occasions, "when he ran short," obtained a gallon extra, but could not specify whence such extra supply would be derived. He was sure he had not had any extra milk for about a month before the commencement of the outbreak. B's manager subsequently confirmed this last statement, and enumerated the sources from which extra milk had been obtained in the past summer; these sources did not include the company supplying milk in Kensal Town, and the manager on being asked said no milk had been obtained from that company. It may be noted that even supposing B to have received a gallon of milk from this company, the proportion of sufferers supplied with milk derived from the large company would still, under these circumstances, be less than half the total number of persons attacked. [ 2 ] 10 in school B who attended the baths 011 that day, of the girls from school J who went to the baths on the 29th (Wednesday), and of boys from school J who went on the 31st (Friday), and then have ceased to operate after the next cleansing of the baths on September 1st (Saturday). The escape, however, of scholars from other schools, who attended on the days in question, and f persons other than scholars who attended on those days, is not explained on tliis assumption. In the light of the fuller knowledge as to attendance at the baths which was ultimately obtained it was clear, having regard to the large number of sufferers from enteric fever who had never attended the baths at all, that the bath hypothesis was altogether untenable. The facts as to attendance at the baths were seen to be very much what might have been predicted, given an outbreak of enteric fever having an exceptional incidence upon young persons, in an area sending children mainly to the two schools J and B. Ice cream.—There were several premises in the area upon which ice-cream was manufactured. At one of these all the ice-cream was sold by barrow-men who disposed of their wares at a considerable distance from the area. At another several barrow-men were employed, most of whom sold their ice-cream away from the area, but two, the C and E of the appended notes, had as their standing places points in the area. At the establishment from which C and E came icecream was retailed, but this establishment, though within the area, does not appear to have been supplying directly any of the sufferers from enteric fever, though doing so intermediately through the agency of C and E. Neither of these men supplied any considerable number of the. enteric fever patients with ice-cream. The vendor A (see appended notes) was concerned with two barrows standing within the area; he took charge of one of these himself, while in connection with the other he employed an Italian barrow-man (called in the notes " A's man"). These two men between them appear to have supplied several of the enteric fever patients. The vendor B, it was found, had from time to time supplied nearly one-third of the sufferers from enteric fever with ice-cream. His shop was situated near the centre of the area, and his business was a large one, so that the incidence of disease upon his customers was, having regard to the habits of the population in regard to icecream, not greater than might have been expected. All the above vendors were Italians. One English vendor, 1), supplied, it will be seen, one or two infected households with ice-cream. More than one-third of those attacked by enteric fever either denied having ever eaten ice-cream, or said they had not partaken of it within at least a month of the onset of their illness. It was clear from consideration of these circumstances that ice-cream was not the cause of the outbreak. Inquiry was made concerning many other articles of food and drink. The bread consumed in infected households was obtained from very varied sources; watercress was rarely eaten in the area, several persons whom I questioned intimated that it was a luxury quite beyond their means. Fruit, lemonade, ginger-beer and other beverages sold on the area were found to be obtained from a variety of sources, and these articles were not very generally consumed by the inhabitants, who, indeed, could not, as a rule, afford to buy them. The question of possible influence of laundry operations was also carefully considered, and, early I'm the course of the outbreak, many circumstances were inquired into in connection with the schools already referred to as the .1 schools, inasmuch as many children attacked had attended those schools. As the history of the outbreak was more fully ascertained it became quite clear that these schools were not at fault, nor could any connection be established between school operations and the disease. Fish.—The only article of food or drink, emanating from one source, which had been generally consumed by persons attacked during the outbreak was fried fish. The circle of a quarter of a mile radius which has been already referred to as covering the area specially attacked has at its centre a fried fish shop. Moreover, if the circle in question, of a quarter-mile or 440 yards radius, be subdivided into four by three circles, 110 yards, 220 yards and 330 yards respectively in radius, and having the same centre, it will be found (limiting consideration to the cases occurring between September 4 and September 24$) that in the inner circle of 110 yards radius, described about the fried fish shop, 47 cases (involving 38 houses) occurred; in the' ring outside this circle, between it and the circle of 220 yards radius, 39 cases (involving 33 houses) occurred; in the next ring eight cases (involving eight houses) occurred, and in the outermost ring ten cases (involving eight houses) occurred. If the area of the innermost circle be taken as the unit, the areas of the three concentric rings outside it will be three, five and seven times this unit respectively. Hence, in order to compare the intensity of incidence of enteric fever, upon equal elements of area, in the four portions into which the affected area has been divided, the numbers 47, 39, 8 and 10, given above as pertaining to these portions, must, taking the outer zone as a standard, be multiplied by seven, 7-3rds, 7-5ths, and 7-7ths respectively, and there result the comparative numbers 329, 91, 11 and 10. These numbers give the relative intensity of incidence of enteric fever on equal elements of area, for the areas within 110, between 220 and 110, between 330 and 220, and between 440 and 330 yards from the fried fish shop. But another point must not be lost sight of; in an area in London of the size of the affected area an appreciable number of cases of enteric fever is likely to be met with, particularly at the time of year under consideration, apart from the existence of any cause of special prevalence. Roughly speaking, the affected area contains about 500^ °f ^le total population of the County of London, and in London during October the cases of enteric fever rose to nearly 200 per week; thus as a mere matter of chance, cases at the rate, approximately speaking, of very nearly one a week might be expected to occur in the affected area. As a matter of fact, during the period September $ These cases correspond to the cases 6 to 110 of the appended notes, excluding case 22, and they occurred in houses indicated on the accompanying map. On the map, however, the houses corresponding to cases 73 and 107, which were " secondary cases," are not represented, nor are the houses corresponding to case 90, which proved not to be typhoid, nor to case 22, as this girl lived outside the affected area. 11 4th to 24th there were seven eases to which particular attention may be directed in this connection. Five of these cases have been placed in column 1, as distinguished from the cases in column 3, of the diagram already referred to. In the remaining two cases infection was apparently traceable to previous cases which had occurred in the area; these two are placed in column 2. Of the former group of five cases one proved not to be a case of enteric fever. There remain four cases in column 1. Two of these patients were certainly, and a third probably, living away from the area at the date at which, having regard to the course of their disease, they were presumably infected. The fourth patient lived on the extreme boundary of the infected area. The question arises whether these cases should not be excluded from consideration in discussing the special cause of the outbreak. If they be so excluded, the numbers giving the intensity of incidence of enteric fever, upon equal elements of area, for the four portions of the affected area are 329, 84, 11, and 6, showing, in an even more striking manner than was the case before, the diminution in the intensity of incidence noticeable on proceeding outwards from the fried fish shop as a centre. Two cases occurred in houses altogether outside the quarter-mile radius to which reference may here be made. In one of these the girl attacked worked in the area, and her case has been referred to the place at which she worked, and she is thus included in the above summary. The facts concerning her are given in the appended notes, case 47. A second case, which is also included in the above summary, is that of a girl, case 22, who worked at premises only just outside the affected area.* The consumers of the fish of a particular vendor in each area have been indicated by red figures. Two of the cases in column 1, Southwark, Nos. 3 and 17, might perhaps more properly have been indicated in black, but all the cases in column 3, with the possible exception of six, undoubtedly ate fish from the particular fried fish shop at a time corresponding to the date of infection. As regards these six possible exceptions, in four there is a history of uncooked fish, obtained from a shop next door but one to the fried fish shop and in the same ownership, having been consumed, and two of the four may also have eaten fried fish, but this cannot be stated with certainty. These cases are marked thus—23†, 63†, 70† and 105†. As regards the other two cases—39‡ and 71‡—there is some likelihood that they ate fried fish from the particular shop, though the history is on the whole less conclusive as regards the former than as regards the latter case. Further, as regards case 71, it may be noted that the girl had been staying away from home for a few days at a time corresponding with a part of the period which may be looked upon as the probable period of infection. On the whole, therefore, after making a not unreasonable allowance for the sporadic cases which might have been expected to occur in an area of the size and character of the affected area, there is high probability that all the rest of the cases ate fried fish (in four cases fish from the same source, but not fried) at a time which must be regarded as corresponding with the date of infection. The particulars as to individual cases given in the appended notes show the extent to which wet fish, dry fish, fried fish, and shell fish from this shop were consumed by persons attacked. They may be summarised as follows so far as cases given in the third column (which were attacked between September 4th and 24th) are concerned— Fried fish.—All, with the possible exception of four, who bought their fish uncooked, (but from the same source as that from which the fried fish shop was supplied) and two others discussed above, in the case of whom the history is not conclusive. Uncooked fish.—In only 34 of the 105 cases was there a history of purchasing uncooked fish. Fish in this form was said by several of those questioned to be beyond their means. To these 34 cases should perhaps be added a few others who may haveexceptionally purchased a haddock or a bloater from the particular shop. It is quite clear, however, that uncooked fish from this shop was not eaten, during the period when infection must have occurred, by more than half the persons attacked. Shell fish.—In 65 cases shell fish or shrimps had been consumed. In several of these it was said to be a common thing to buy shell fish (usually winkles) or shrimps for tea on Sunday. In the majority it was only exceptionally that such luxuries were purchased. Apart from periwinkles very little shell fish was eaten in the area. Occasionally mussels were consumed; in only one instance was mention made of oysters. The question that now arises is what proportion of the whole population of the affected area was consuming fried fish obtained from the particular shop. This question has been made the subject of inquiry, the result of which it is nepessarv to state. Before doing so, however, it may be well to briefly indicate the distribution of fish shops (fried fish shops and others) in the neighbourhood of the affected area. This will be seen on reference to the map, on which fried fish shops and ordinary fishmongers' shops existing in the locality are indicated. The particular fried fish shop referred to above, and indicated in the appended notes as Mr. X's shop, is at the centre of the circle; next door but one to it is an ordinary fishmonger's shop, also in the occupation of Mr. X. It will be seen that the latter shop, which is practically at the centre of the circle, has no other fishmonger's shop within some distance of it. Just at the circumference of the circle, which is approximately a quarter of a mile—i.e., 440 yards—from this shop, are four fishmongers' shops which are indicated on the map. The fried fish shop, on the other hand, has other fried fish shops within a much smaller distance of it. At the nearest of these, which is situated a little to the north-west of the centre of the circle, a similar class of business to that at Mr. X's shop is carried on, but on a considerably smaller scale. At the shop situated to the east of Mr. X's shop a large business * A third case was heard of in the course of the inquiry, which might perhaps have properly been also included in the above summary. It was that of a man living at some distance from the area, who was employed for some davs, at about the time when he must have been infected, on premises in the near neighbourhood of the fried fish shop; he may have bought fried fish at the particular shop in the affected area, as he was often in the company of a young man who was certainly in the habit of doing so (see the case indicated by the red dagger adjoining case 39, and referred to in the appended notes), but the case was a fatal one, and the question could not be determined. 12 appears to be conducted, but it is of a different character from that at Mr. X's shop. It was explained by more than one inhabitant of the area that at the latter "a halfpenny bit'' could be procured, and it will be seen from the notes that it was common for children (presumably because they had no more than a halfpenny to spend) to patronise Mr. X's shop, when other members of the family were in the habit of going elsewhere. With a view to ascertaining what percentage of the inhabitants of the area purchased fish, fried fish, shell fish, etc., from Mr. X, a house to house inquiry was conducted in two portions of it by the Council's inspectors. The portions of the area dealt with are indicated by cross hatching on the map. Inquiry concerning persons attacked had shown that it was a not uncommon thing for the habits of different members of the same family to vary in respect of the articles purchased from a fish shop, and particularly in respect of fried fish eating. Hence the inspectors did not limit their inquiry to asking questions of tbe head of the family, but ascertained concerning each individual, making, if necessary, a second visit for the purpose, whether he or she was in the habit of obtaining fried fish, etc., and if so, whence it was obtained. It was of not infrequent occurrence to find, for example, that the elder members of a family did not consume fried fish, while the younger ones did so. In such cases the whole family has been classed as fried fish eating. In a very limited number of instances fried fish, shell fish, etc., were stated to have been procured from more than one source; in such instances, if one of the sources was Mr. X's shop, the case has been classed accordingly, the fact of there being an alternative source being neglected. In making their inquiry the inspectors were careful to ascertain the facts as to fish eating shortly before the outbreak of fever, that is at a time which must be regarded as the date of infection. The following results were obtained in the areas in which house to house inquiry was made— Number of families. Wet fish. Shell fish. Shrimps. Fried fish. Dry fish. From X. From other pources. None. From X. From other sources. None. From X. From other fourcea. None. From X. From other sources. None. From X. From other sources. None. Area A 77 41 9 27 35 9 33 32 9 36 37 17 23 41 19 17 Area B 100 60 25 15 40 6 54 37 10 53 49 22 29 57 26 17 Total 177 101 34 42 75 15 87 69 19 89 86 39 52 98 45 34 Percentage 57 19 24 42 9 49 39 10 51 49 22 29 56 26 18 57 43 42 58 39 61 49 51 56 44 X not X X not X X not X X not X X not X It will be seen that the results in the two areas closely correspond; so far as fried fish is concerned the percentages will be found to be identical. It thus appears that 49 per cent., or just about half the families, contained one or more members who ate fried fish from Mr. X's shop.* If, instead of dealing with families, the facts relating to individuals be considered, it transpires from the inspectors' inquiry that— 42 per cent. of the population did not eat fried fish. 16 per cent. ate fried fish not obtained from X's shop. 42 per cent. ate fried fish obtained from X's shop.† The areas A and B are of somewhat different character. Area B includes some of the blocks of tenement buildings already described. Area A consists of some houses, tenemented for the most part, fronting upon a main street, and a number of cottages in two alleys at the rear.‡ The facts as to fried fish are identical for the two small areas, and may, I think, be regarded as fairly typical of those of houses situated from 100 to 200 yards from the shop. The percentage of persons obtaining fried fish from Mr. X would probably somewhat exceed 42 per cent. in two of the streets close to the shop, which consist of the poorer class of tenement houses; on the other hand it would probably fall considerably short of 42 per cent. in the more outlying portions of the area. It may doubtless be stated with certainty that Mr. X's percentage for the area considered as a whole lies somewhere between 25 and 40 per cent. If the facts as to fried fish, shell fish, etc., for the entire area be compared with those ascertained for persons (Nos. 6-110 in the notes appended) attacked by enteric fever between September 4th and 24th, the contrasts are striking. Thus, while less than 40 per cent. of the * For the most part persons who obtained one of the five commodities referred to in the above table from X, obtained the others, if they purchased them at all, from the same source, Thus the 101 purchasers of wet fish from X in the above table include almost all the 75 purchasers of shell fish and the 69 purchasers of shrimps; they include, too, the majority of the 86 purchasers of fried fish and of the 98 purchasers of dry fish. If the families be grouped into those in which one or more members obtained food of any sort from X, and those in which no member did so, the former group contains about 70 per cent. of the whole number of families. † The number of persons not eating fried fish at all was 381, the number eating fried fish not obtained from X's shop 149, and the number obtaining fried fish from X 370; the total number thus amounts to 900. In the case of 12 of the 177 families, while it was ascertained that fried fish was consumed, particulars as to which members of the family were in the habit of consuming it were not recorded ; in tabulating these persons, it has been assumed that all the members, save those under 4 and over 60, were fried-fish eaters. As regards one other family, there is some doubt as to the way in which the particulars recorded should be tabulated. If all cases in which any kind of question arises were relegated to X, the number would only just exceed 42 per cent. of the total. ‡ This area has at its southern boundary a fried-fish shop already referred to as being a shop at which a similar class of business to that of Mr. X, but one on a considerably smaller scale, is carried on. . 13 habitants of the area ate Mr. X's fried fish, at least 88 per cent. of those attacked by enteric fever did so; indeed, excluding cases grouped in columns 1 and 2 for reasons already given, and including as consumers of Mr. X's fried fish the cases 23, 39, 63, 70, 71 and 105, for the reasons which have also been already specially discussed, the 88 per cent. becomes 100 per cent. In making their house to house inquiry the inspectors took a census of the inhabitants of the houses visited and ascertained particulars as to consumption of fried fish by each individual included in their census. From these particulars diagram III.* on the annexed page, which gives the facts as to fried fish consumption by males and females at different age periods, has been constructed. Two points are specially noticeable in this diagram— (a) The age distribution of the entire population is a somewhat unusual one, and particularly noteworthy is the smallness of the number of representatives of certain intermediate ages ; this is especially marked in the age group 25-35. (b) It is clear that there is an undue preponderance of persons eating fried fish at ages 5-20 years. This fact appears partially attributable to (a) and partially to manifestation of a greater tendency to consume fried fish at those ages than at the earlier or later age periods. In conjunction with this diagram, diagram IV. beneath it may also be referred to. This shows the result of observations kept upon the fried fish shop during those hours of the day when frying was proceeding.† It will be seen that the persons purchasing were divided according to whether they themselves ate or merely carried fried fish away with them; a third group comprises those concerning whom there is doubt as to which of the other groups they should be included in. The following points may be noted concerning diagram IV.— (a) Consumers at ages 5-20 predominate; indeed, the disproportion between consumers at those ages and those at other ages is now seen to be more marked than in the upper diagram, doubtless not merely because there is a greater proportion at 5-20 years of age of persons who eat fried fish, but because persons at the ages 5-20 years purchase fried fish more frequently than persons at other ages, and therefore form a larger proportion of the people found leaving the shop on any one day. (b) The proportion borne by persons who themselves ate to the total number of persons who purchased at different age groups is higher at the ages 5-20 than at other ages. The height of the red columns may perhaps be taken as the best indication available of fried fish consumption at different ages ; it certainly corresponds more closely to the actual facts as to such consumption than do the complete columns, which include persons who may have visited the shop merely to fetch fried fish for other persons. Two minor points may be here noted. In the upper diagram the total number of persons at ages 0-5 is seen to be less than at ages 5-10. This is probably accounted for by the fact that the inspectors in inquiring concerning age, did not distinguish between age last birthday and age next birthday. Any error arising on this account would tend to be more or less compensated for in later age groups, but in the 0-5 age group there would of course be under-statement of the number of persons in the group. Again, in the lower diagram the height of the columns for the ages 15-20 is excessive. From the nature of the observation kept it was impossible to do more than guess at the age of the persons leaving the shop. There has clearly been a tendency to over-estimate the ages of persons between 10 and 20; probably a few lads and girls at ages 13 and 14 have been transferred in this way to the group 15-20. It is further probable that this error has operated to a greater extent with young girls than with young lads, and this is borne out on comparing the heights of the columns for females between 10-15 and 15-20 respectively with those of males at the same ages, for if the excess of females over males at the latter age is accounted for by transference from the former age, this would explain the deficiency of females as compared with males in the earlier age group. Broadly the facts ascertained by the two methods, first of house to house inquiry, and second of keeping observation on the fish shop, confirm one another and indicate a considerable preponderance of fried fish eaters at the ages 5-20. It has been already noted that the incidence of the outbreak of enteric fever was especially upon these ages. The blackened columns at the lower part of diagram IV. give the age and sex distribution of the cases which may be regarded as constituting the special outbreak. The age and sex distribution of notified cases of enteric fever in London as a whole in the year 1899 has already been given (for the purposes of comparison with the age and sex distribution in the special outbreaks) in diagram I. The correspondence between the exceptional age incidence of the disease and the preponderance of persons at the ages specially attacked among the consumers of fried fish is a striking one. In the absence of accurate knowledge as to relative susceptibility to the disease at different ages under equal conditions of exposure, it is not of course possible to calculate exactly what proportion of cases should occur at each age if fried fish from the shop to which the above observations relate were the medium of infection, but it is interesting, in this connection, to contrast this outbreak with the water-borne outbreak at Newport which occurred in 1894, the milk-borne outbreak at Plumstead in 1895, and the outbreak in South-east London in 1891, attributed by Dr. Geo. Turner to ice-cream. It will be found that while in all four outbreaks there is markedly exceptional incidence upon ages under 25, in Southwark this incidence is particularly excessive at ages 10-20, while, in the other outbreaks, it is manifested to a relatively larger extent at younger ages. This fact is important in the light of the knowledge obtained as to the ages especially represented among fried-fish eaters. * See the second footnote on page 12. † The observations relate to the morning frying 12 to 2 of a Wednesday, and the evening frying 7 to 12 of a Friday. 14 A further point is made apparent on consideration of particular families in infected households. In many instances it was found that the sufferer or sufferers from enteric fever in a particular house were also eaters of fried fish obtained from Mr. X's shop, while other persons in the house either ate fried fish from that source only quite exceptionally, if they ate it at all, or were in the habit of procuring what they ate elsewhere. As instances in which the sufferer or sufferers ate Mr. X's fried fish, and other members of the same family did not, the following cases of which account is given in the appended notes may be referred to—Nos. 6, 7, 8, 15, 21, 29, 36, 37, 45, 46, 47, 54, 57, 58, 65, 83 and 89, and 87. See also in this connection Nos. 42, 49, 74, 85 and 110, 94 and 99 and 95. In these instances the fact of purchase by the individual attacked of something not eaten by the rest of the family was determined— (а) By the fact that the sufferer went to work and was thus led to obtain certain meals from sources not supplying the rest of the family. (b) By the fact that it was a not uncommon practice in the area for children to be given a penny or a halfpenny with which to purchase food for themselves, more especially on washing days or under other circumstances in which cooking at home was attended with difficulty. (c) By the fact that the individual attacked was specially fond of eating fried fish and usually devoted any pennies or halfpennies of which he or she became possessed to purchasing it. Such expressions as "a craving for fish," "a dreadful child for fish and taters," "terrible fond of fried fish," which I heard from mothers of patients attacked, in the course of my inquiry, indicate the extent to which the growing, and in many cases vigorous, hungry child appreciated its "halfpenny bit," and the extent to which repeated requests for halfpennies to spend had led the mother to look upon fried fish eating with concern and apprehension. I was told, moreover, that those children who were sent away for a slimmer holiday specially manifested this craving on their return from the country, and it was manifest that children described as particularly fond of fried fish were the more vigorous specimens and presumably those with the best appetites. In the affected area in Southwark it was not unusual to find that it 'was considered extravagant to spend money on watercress, lemonade, periwinkles, or ice-cream, but the "bit of fish and taters" was looked to by children and young people themselves, and by their parents for them, as the most suitable and economical means of supplementing, when the halfpenny or penny was available, such scant provision for satisfying hunger as could be made at home. The cases Nos. 40, 55 and 56, 59, 79, 103, 104 and 109 further illustrate some of the points above referred to. In these cases other members of a family as well as the actual sufferer or sufferers may have procured fried fish from the special source, but, inasmuch as the sufferer or sufferers consumed fried fish independently, and in most instances to a larger extent than did the other members, these cases may fittingly be referred to at this point. The cases 9, 11, 12, 22, 28, 35, 44, 53 and 100 present instances of sufferers from enteric fever obtaining their fried fish from the special source, while other members of the same family were in the habit of eating fried fish, but obtained it elsewhere. Finally certain cases, of which the particulars are given in the appended notes, may be referred to as containing information as to particular dates on which fried fish from the special shop was consumed. In the cases numbered 27, 36, 38, 62 and 97 the consumption of fried fish from the particular source can be fixed with high probability, in some instances with certainty, as having occurred either on August 31st or September 1st, and on no other day. The course of the outbreak is such as to suggest that infection occurred at about that time, and that it was not in operation for more than one or two days. Lambeth. The outbreak in Lambeth presents certain points of similarity, and, on the other hand, certain contrasts as compared with the Southwark outbreak. In the former, as in the latter, there was no reason for supposing that drainage defects, water, milk, shell fish or ice-cream were accountable for the spread of infection, while there was strong reason for suspecting fried fish. Particulars as to the four last-named articles are given in the appended notes. The age distribution of the Lambeth cases was unusual, and its departure from the ordinary distribution in ages was to some extent in the direction observed in the Southwark outbreak, though the abnormality of the distribution in ages was much less marked in the case of Lambeth. For convenience of comparison with Southwark, a circular area extending a quarter of a mile in all directions from a particular fried-fish shop has been taken, and this area is indicated on the accompanying map, on which are shown all the cases in which symptoms of enteric fever commenced between August 26th and September 24th. The dates of onset of the disease will be found indicated on the table facing page 8. It will be seen that the special prevalence commenced about a week earlier than the outbreak previously considered, and that it terminated at the same time. As in the case of Southwark, the cases have been arranged in three columns. Column 1 includes cases regarded for one reason or another as unconnected with the special outbreak; column 2 contains secondary cases, while the third column contains the cases which remain, the cases that is which constitute the outbreak. As regards column 1, which contains the sporadic cases probably unconnected with the special outbreak, it appears that these were somewhat less numerous than in Southwark. In the western portion of the Lambeth area was a considerable extent of ground unoccupied by houses, and, partly on this account, the population at risk of contracting enteric fever in the Lambeth circle was somewhat less than in the Southwark circle. As regards column 2, there is in one or two instances more difficulty in Lambeth than 15 there was in Southwark in distinguishing between a "secondary" case infected by a previous sufferer in a household, and a case which, though developing shortly after the occurrence of a first case in a house, might also itself be regarded as a primary case. This difficulty will be further discussed later. Of the cases occurirring at the time of special prevalence which have been allocated to column 1, three (Nos. 18, 39 and 47) were notified as enteric fever, but after removal to hospital it was found that the patients were not suffering from that disease. In the fourth case (No. 46), the patient was at the seaside at a time which would correspond with the date of infection, and he had eaten some oysters, to which he attributed his attack, while away from Lambeth at that time. As regards the cases in column 3, there was a clear history of consumption, of fried fish from a particular shop (referred to as Mr. Y's in the appended notes), at a time which would correspond with the date of infection, in all the notified cases with the exception of four (Nos. 17, 19, 28 and 36), and there was a similar history in two other cases indicated by a dagger, thus (†), which, although not notified, were probably cases of enteric fever. As regards the four exceptions particulars will be found in the notes; No. 17 was a fatal case, and, while it is certain that the man frequently purchased fried fish, it could not be ascertained where he obtained it; Nos. 19 and 28 almost certainly purchased fried fish at Y's shop at about the time when their illness must have been contracted, but the evidence was less conclusive with regard to them than with regard to the other cases in column 3; case 36 was that of a child (related to cases 6 and 16, who were frequent purchasers of Y's (fried fish) who was staying, at the time when she must have been infected, with an aunt who lived close to Y's shop. So far, the Lambeth outbreak presents much similarity to that in Southwark, though in the former, owing to the smaller number of attacks, the figures form a less reliable basis upon which to found conclusions. Two special difficulties, however, must now be mentioned as deserving of consideration in connection with the Lambeth outbreak. In the first place there is the difficulty of distinguishing between primary and secondary cases in dealing with certain members of households which had been already attacked. Thus— Cases 3, 21 and 25 were members of the same family. Case 8 was the sister of case 4. Cases 6, 16 and 36 belonged to one family. Cases 7 and 15 were brothers. Cases 12, 20, 43, 44 and 52 belonged to one family. Cases 29, 30, 33, 35, 49 and 54 belonged to one family. Cases 34 and 37 were sisters. Cases 41 and 51 were sisters; and case 42 was the child of a lodger living in the same house. Some of these cases were no doubt "secondary cases," but it is probable that several of them (in addition to the first case occurring in each house) were really primary cases, in which the date of onset of symptoms was later than it was in the 'case which first declared itself in the household. Thus—Case a sickened only 4 days atter case 4. 16 „ 4 „ „ 6. 15 „ 3 „ „ 7. 20 „ 7 „ „ 12. 33 „ 2 „ cases 29 and 30. 35 „3„„„„ 37 „ 2 „ case 34. 42 „ 1 day „ 41. There can be little doubt that in the above instances the second case (in the case of Nos. 33 and 35 the third and fourth cases) must really be regarded as a primary case, and not as a secondary" one. As regards cases 21 and 25, which occurred in the house in which case 3 occurred, the interval of time was longer, and the possibility of the later cases being infected by case 3 cannot be ignored. It is interesting, however, to note, as regards case 3, that the patient was in the habit of buying fried fish from Y's on his own account, and independently of the rest of the family, and it is of course conceivable that he and they were infected on distinct and separate occasions. The course of the outbreak in Lambeth is not, as in Southwark, such as to suggest limitation of infective agency to only one or two days. The agency, whatever it was, took effect in Lambeth about one week earlier than in Southwark. The falling off in the number of cases after September 4th, and the recrudescence on the 7th and succeeding days corresponding with the time of maximum prevalence in Southwark, rather lead to the suspicion that infective property may have been manifested in Lambeth on two separate occasions, one about a week earlier than the other, and the later one corresponding in date with the time of distribution of infective material in Southwark. If this supposition be correct it is easy to understand why the difficulty as regards distinguishing between secondary and primary cases should be more marked in Lambeth than in Southwark. The second difficulty arises from the fact that whereas in Southwark the cases showed a striking tendency to group themselves around the fried fish shop as a centre, and further to show diminishing intensity of incidence upon area as the distance from the fried fish shop was increased, in Lambeth the outbreak was especially manifested in three or four streets in the western half of the area, while the streets in the eastern half of the area almost entirely escaped. This difficulty was at once pointed out by Dr. Priestley when I first told him of the direction in which the 16 experience in Southwark seemed to point, and he later, as the result of further inquiry which he caused to be made, came to the conclusion that an average of SO per cent, of the houses in a non-infected street were supplied with fried fish from Y's, whereas only 33 per cent, of the 24 infected houses were so supplied. From investigation which I had already personally made, and which included inquiry addressed to the patients themselves while in hospital, it was clear that the large majority, if not all the infected persons, were supplied from Y's. In order to obtain further material on which to base an opinion as to the extent to which different parts of the area were supplied from the fried fish shop, house to house inquiry was again, made by ihe Council's inspectors. The result of this inquiiy was to show that— In the three streets mainly affected in the western half of the area 31 out of 36 families, or 161 out of 212 persons—i.e., 76 per cent, of the population—had been in the habit of obtaining fried fish from Y's. In four other streets in the western half of the area, adjoining the three streets already mentioned, 28 out of 46 families, or 99 out of 175 persons—i.e., 57 per cent, of the population—had been in this habit; and in three streets close to Y's shop, but situated in the eastern half of the area, only 38 out of 98 families, or 160 out of 390 persons—i.e., 41 per cent.—had been in this habit. This house to house inquiry showed a considerably larger percentage of purchasers of Y's fish among the persons living in the streets mainly affected than in those living in the other streets. But the amount of fish consumed by inhabitants of a particular street depends not only upon the number of purchasers, but also upon the frequency and extent of their purchases. Inquiry in the streets mainly affected showed that many of the inhabitants were in the habit of buying fried fish very frequently, while, on the other hand, one of the Council's inspectors who made inquiry in two streets in the eastern half of the area, but quite close to the fried fish shop, reports "if the statements of the occupiers are to be believed, they all partake very sparingly of fish." In this connection it is deserving of note that while the streets mainly affected to the west of the fish shop are occupied by a very poor class of persons, the corresponding streets just to the east of the shop appear to be occupied by a class a little less poor. Another point which must be borne in mind is that two of the affected streets form practically a cul de sac, and people who live in them and in two adjoining affected streets are from the topography of the locality necessarily compelled to go eastwards to do their shopping. To the west are extensive premises occupied by a railway company; to the north and south houses are occupied as residences and not for business purposes, so that the only available shops are in the main road to the east of the specially-affected streets. In this road, close to the opening of the cul de sac already referred to, and immediately opposite one of the streets mainly affected, is the fried fish shop. On the other hand, inhabitants of the streets in the eastern half of the area, while they no doubt largely make use of the shops in the main road, in which the fried fish shop is situated, are not necessarily constrained to go westwards; there are shops on all sides of them, and that they go to the shops on their east and north and south, as well as to those on their west, is shown by the results of the house to house inquiry made by the Council's inspectors. The attempt was made to gauge the extent to which the inhabitants of different streets frequented the fried fish shop, by keeping observation on the shop, and noting the streets to which purchasers of fried fish returned. It was found, however, that purchasers of fish, after leaving the shop, did not, in a large number of instances, go straight home, but that they either proceeded to make other purchases, or in some instances went into a place of entertainment situated near the shop, and in one way or another many persons were lost sight of and could not be traced. As the outcome of the observations made, it transpired that 101 persons out of a total of 481 who came out of the fish shop returned to the three streets mainly affected in the outbreak. While it may be inferred that most of the 101 persons lived in the three streets to which they returned, it is probable that a number of the other persons making up the total of 481 also did so. Apart, however, from the difficulty of allocating persons leaving the shop to the houses in which they lived, it became clear in the course of the inquiry that no estimate based upon observations made subsequent to the outbreak could be precisely accurate, as several of the families, particularly those living in the streets mainly affected, were found to have then ceased to purchase fried fish at Y's shop. A fact of some interest in connection with the observations made with regard to persons leaving the fish shop was that the proportion of persons returning to the three mainly affected streets showed considerable variation at different times: thus, on a particular Tuesday morning, it was only 13 per cent, of the total number leaving the shop, while on the following Friday morning it was 30 per cent. On Saturday evening it was 19 per cent., but at this time in particular it was clear that only a comparatively small number of those visiting the shop returned, on leaving it, straight to their homes. Having regard to the facts ascertained in Southwark as to the connection between fish eating and modifications of ordinary domestic routine (occasioned, for instance, by washing days), it may well have happened, in view of what has just been said, that on a particular day or days a very considerable percentage of the persons visiting the shop came from the three streets mainly affected. The marked incidence on these three streets is none the less in contrast with the greater uniformity of distribution of cases around the Southwark fried fish shop, and the facts stated in the latter instance as to marked diminution of intensity of incidence, on proceeding outwards from the particular shop, have not a parallel in Lambeth. In connection with these circumstances the smaller magnitude of the Lambeth outbreak must not be lost sight of as being likely to yield a less symmetrical distribution of cases, and the peculiar topography of the area taken in conjunction with differences in the character of the populations to the east and west of the fried fish shop are certainly considerations to which weight may Be attached, as possibly affording explanation of the greater incidence of disease upon the streets which were mainly affected. 17 In water epidemics of cholera and typhoid fever the question of the escape of particular communities has repeatedly been urged as a difficulty; it is only necessary to refer to the escape of the East London Industrial School and other institutions in the cholera outbreak of 1866, and to the escape of the village of California and certain groups of houses in the Tees Yalley outbreak of enteric fever. Having in view the smallness of the total number of cases in Lambeth, it might be anticipated that in some streets three or four households would be attacked, while other streets would altogether escape, even if the matter were one of pure chance ; having regard to the certainty that inhabitants of the streets specially affected purchased to a greater extent than inhabitants of other streets, and to the possibility of their having purchased on a particular occasion or occasions to an altogether disproportionate extent, the fact that in certain streets to the west of the shop there were six, seven and eight infected households, while in other streets there was only one infected household, or there were none at all, cannot be regarded as a serious difficulty. In Lambeth, as in Southwark, it is noteworthy that in several instances there is a history of the person attacked by enteric fever obtaining fried fish from the particular shop, while other members of the household who escaped probably did not. Cases 7, 12, 14, 15, 19, 20, 45 and 45a afford instances of this. In the family to which case 12 belonged the facts were particularly striking. This child and her two sisters, cases 20 and 43, were stated to be the only customers of Y in the family, which is a large one. Cases 12 and 20 were both attacked by enteric fever. Case 43 and the baby of the family, case 44, did not sicken until quite towards the end of the outbreak, and these cases may have been really secondary cases. As regards the baby she is not definitely known to have eaten fried fish, but her three sisters, who were frequently left in charge of her, all did so, and as it is a not uncommon practice of purchasers of fried fish in the neighbourhood, if they take a baby into the shop, to give it a bite, it is probable that this particular baby did have some. The evidence afforded by the history of cases 12, 13, 19, 22 and 28 is of interest, as showing that in all instances in which fried fish was definitely stated to have been consumed on a particular day, that day was either Friday or Saturday. In case 41 the usual day for purchasing fish was Friday, but just about the time when infection must have occurred there was a birth in the family, and the children, cases 41, 42 and 51, were, by reason of this circumstance, given money each day to buy their food out of doors, and the mother of case 41 stated that they purchased fried fish from Y daily at that time. Kensal Town. The facts as to Kensal Town need be only very briefly referred to. In this locality there was no marked incidence upon consumers of fried fish from any particular shop. There was, however, a somewhat striking incidence upon persons purchasing fish or shell fish at a general fishmonger's shop, and also upon persons ultimately obtaining their milk fron\l a milk company doing a very large business. For purposes of comparison with the other areas, an area within a one-quarter mile radius of the fishmonger's shop, referred to in the appended notes as the shop of Mr. Z, has been taken. The distribution of the disease in point of time is indicated on the table facing page 8.* The total number of cases occurring in the area was considerably smaller than 'in Lambeth and much smaller than in Southwark. The cases in which no connection with Z's shop was definitely traceable are indicated by the numbers in black in the first column of the table. In some of these there was reason for concluding that infection had been contracted altogether away from the district. The cases in the first column of the table are actually less numerous in Kensal Town than in the other districts, but the proportion they bear to the total number of cases is far greater, the outbreak in Kensal Town not attaining the magnitude reached in the other districts. All the other cases, those numbered in red, had made purchases at Z's shop, though, as regards the cases marked‡, it should be noted that the fact of such purchase was only stated by case 29, a secondary case; the member of the household first attacked, case 5, being a girl who was unable to recollect from what source she had obtained fish or shell fish. Of the 21 cases which occurred within a quarter of a mile radius of the shop between August 25th and September 17th, 16 (if case 5 just referred to be included) certainly obtained fish or shell fish at Z's shop. There may be some question as to whether two of the remaining 5 cases did not also do so; one of these two, and a third case, lived at the extreme boundary of the quarter-mile circle; with such a small total number of cases the fact of the inclusion or exclusion of a case living at the limits of the area considerably affects the numerical result. The incidence upon purchasers of fish or shell fish from Z can, however, only be regarded as assuming some importance by reason of the phenomena coincidently manifested in Southwark and Lambeth. As regards milk, the supplies of the local vendors, A, B, C, H, I, and on occasion that of F, were in part derived from one large company. It will be seen therefore that of the 21 cases referred to above, and occurring between August 25th and September 17th, 14 almost certainly, and possibly one other case, were obtaining milk supplied by this company. The incidence upon persons supplied through one or another agency by the milk company was therefore nearly as great as upon persons who purchased fish at Z's shop. Having regard to the extent to which milk derived from this company was being distributed in the neighbourhood of the area affected in Kensal Town, the former incidence cannot be regarded as specially remarkable. It is interesting to note that a fried fish shop is situated close to the centre of the area of one quarter-mile radius already defined, but in only one of the families affected by enteric fever was fried fish from this shop consumed. On the other hand seven of the 21 cases mentioned above ate *The facts ascertained concerning one of the cases indicate that in all probability in this case infection occurred on August 23rd. The child (case 7 in appended notes) had been away from home for three months, and returned to Kensal-town on the 23rd of August. She and other members of the same family (cases 3, 4, and 9) were attacked between August 27th and August 31st. If the child who had been away was infected in Kensaltown, it is probable she was infected immediately on her return. [3] 18 fried fish obtained from a shop in the south-western quadrant of the circle of one-quarter-mile radius. This shop is referred to in the appended notes as that of Mr. z. The attempt was made in each instance to learn the source from which the fish sold by Messrs. X, Y and Z was obtained. It was not, however, found possible to pursue this matter. The three vendors obtained their fish from Billingsgate. Mr. X also obtained considerable quantities of fish direct from Grimsby.† It was said to be impossible to trace for each day the source from which the consignments purchased came; so many different middlemen were dealt with by Messrs. X, Y, and Z, and complete records of purchases effected were not kept. Inquiry was, moreover, made as to the existence of cases of illness, just before the time of the outbreak, among the persons living at the fish shop premises, or employed by Mr. X, with a negative result. The conclusion to which the facts which have been summarised appears to me to point is that the local prevalence of enteric fever observed in Southwark during September, 1899, must be attributed to the consumption by the sufferers of fish, purchased from a particular vendor, and almost entirely in the form of fried fish. In the light of this conclusion the outbreaks of enteric fever occurring at about the same time in Lambeth and in Kensal Town must, in the absence of any adequate explanation of their cause, and in view of the fact that so considerable a percentage of sufferers in the one case consumed fried fish from a particular fried fish shop, and in the other were in the habit of making purchases at a general fishmonger's shop, be regarded as possibly, and, in the case of Lambeth, probably admitting of similar explanation. W. H. Hamer, Assistant Medical Officer of Health. APPENDIX. Notes as to cases of Enteric Fever in Southwark, Lambeth and Kensal-town. The inquiries as to milk, fish, &c.. were of course directed to ascertaining from what source those articles of food were obtained, at a time which would correspond with the period when infection must have oocurred. Local milk vendors are indicated by letters A, B, C, &c., and ice-cream vendors by the same series of letters, but the two sets of letters must not be in any way connected with one another ; again there is no connection between the letter3 A, B, &c., used to designate vendors in the three districts Southwark, Lambeth and Kensal Town. Southwark. (The cases which may be regarded as constituting the special outbreak are those numbered 6 to 110.) No. Date of onset of illness. Date of notification. Sex and age. Milk supply. Ice-cream. As to consumption of fish, fried fish, shell fish, &c. As to use of swimming baths. Remarks. 1 Aug. 16 Sept. 22 M. 21 Head brand Never Obtained from three sources, which he names. Never from X Never ... 2 Aug. 19 Sept. 6 F. 20 ... ... Was living away from the district at the time when her illness must have been contracted ... ... 3 Aug. 24 Sept. 7 F. 34 Condensed Never Sometimes buys winkles from X, but never obtains fish or fried fish there Never ... 4 Sept. 1 Sept. 14 M. 3 A Never Obtained from a source named. Never from X Never Proved not to be enteric fever. 5 Sept. 3 Sept. 21 M. 35 B Never Never from X. Was much away from affected area. Never See case 73. 6 Sept. 4 Sept. 23 M. 11 Condensed Never Mother buys winkles, skate and plaice from X. The boy himself, just before his illness, was in the habit of buying fried fish there, but other members of the family do not have fried fish Goes to the X baths Eats watercress sometimes. 7 Sept. 5 Oct. 3 F. 18 Condensed Yes, but source not ascertained Fond of fried fish, which she obtains from X. Other members of family do not have it. She often purchases it for her mid-day meal, which she eats away from home Also obtains winkles from X Never ... †The supply for Mr. Y's shop and for two other fried-fish shops at some distance from it but in the same management was, according to the statement of the manager, purchased at Billingsgate-market by the same individual, and as a rule came from market to the three shops in the same cart. There had been no marked prevalence of enteric fever in the neighbourhood of these other shops. 19 No. Date of onset of illness. Date of notification. Sex and age. Milk supply. Ice-cream. As to consumption of fish, fried fish, shell fish, &c. As to use of swimming baths. Remarks. 8 Sept. 6 Sept. 17 F. 14 Condensed A Fish and shell fish practically never consumed at home, but the girl herself often buys fried fish and winkles from X Never ... 9 Sept. 6 Sept. 18 M. 12 C Frequently from A's man, also from B The lad, who is very fond of fried fish, buys it from X; he also buys winkles there. Other members of family obtain fried fish from another source To X baths on Mondays ... 10 Sept. 6 Sept. 17 F. 10 D Frequently from B Frequently obtained fried and other fish, shrimps and winkles from X ... 11 Sept. 7 Sept. 22 F. 23 ... Never This patient and her brother used often to buy fried fish for supper from X, the rest of the family not obtaining it. Occasionally fish was eaten at home, source then uncertain Never ... 12 Sept. 7 Sept. 22 M. 13 ... From B To X baths ... 13 Sept. 8 Oct. 13 M. 17 Condensed. Head brand ... No fried fish ; wet and dry fish from a source named. Not from X To X baths "Hopping" from Aug. 25 to Sept. 3; probably infected then. 14 Sept. 8 Sept. 16 M. 14 ... Probably, if so from B The family deal at X's shop. Three of the children, according to the mother, viz., this boy, an elder brother and a younger brother (case 66) often obtain fried fish there on their own account for supper Never 15 Sept. 8 Oct. 5 M. 8 Condensed. Cup brand Occasionally, but source not ascertained Fish and shell fish from X. The boy often has fried fish obtained from same source Never, an elder brother goes Drinks ginger-beer and lemonade occasionally, obtained from a shop named. 16 Sept. 8 Sept. 16 M. 15 None C Fried fish, shrimps and winkles obtained from X. The first-named often To X baths "on a Saturday night" Lemonade occasionally from a shop named. 17 Sept. 9 Sept. 18 F. 17 B Also condensed milk Never Family deals at X's, but the patient rarely eats fish and does not care for fried fish Never At Southsea for 14 days, returned at end of Aug. Probably infected there. 18 Sept. 9 Sept. 21 F. 6 E B Sister of cases 14 and 66. Her mother does not think she would have money to buy fried fish on her own account, as her brothers did, but they might have given her some and she would in any case have obtained it at home. Never There is some doubt as to the diagnosis in this case. 19 Sept. 9 Sept. 14 F. 14 Various sources On one occasion from a source some distance away from the area Plaice and shell fish and fried fish on Fridays from X ... ... 20 Sept. 9 Sept. 17 F. 12 B F. sometimes A's man Fish generally from a source named, not X; but often obtains fried fish from X and occasionally winkles and shrimps also To X baths, but only rarely ... 21 Sept. 9 Sept. 22 M. 16 B Never Had a penny piece of fried fish almost every night from X. The others would not have this. Also shrimps occasionally from X To X baths, but not for a month prior to beginning of illness Never eats watercress or drinks mineral waters, ginger-beer, &c. 22 Sept. 9 Sept. 21 F. 18 ... Probably not Used to obtain fried fish for supper at X's and almost certainly did so on night of Friday, Aug. 31st. Other members of the family did not buy from X To X baths on Friday, Aug. 31st A fatal case. Lived at some distance from affected area, but/passed through it on her way to work. 20 No. Date of onset of illness. Date of notification. Sex and age. Milk supply. Ice-cream. As to consumption of fish, fried fish, shell fish, &c. As to use of swimming baths. Remarks. 23 Sept. 9 Sept. 27 M. 10 A Very rarely The family usually deal at a fish shop named, not X's, but occasionally a piece of fish is procured from X Never Sometimes drinks lemonade. 24 Sept. 10 Sept, 16 M. 15 D Very seldom Fish and fried fish obtained from X To X baths occasionally No ginger-beer, &c. 25 Sept. 10 M. 11 B A's man Fried fish from X, also from another source. Occasionally winkles and shrimps from X To X baths A doubtful case of enteric. 26 Sept. 10 Sept. 16 F. 10 G A's man Fried fish and winkles habitually obtained from X Never Occasionally gingerbeer. 27 Sept. 10 Sept. 23 F. 12 B Never Bought "fried fish and taters" at X's shop on a Saturday night, about 5 weeks before the 8th Oct. (i.e., probably Sep. 1st). Sometimes obtains winkles from X ... 28 Sept. 10 Sept. 20 F. 13 H B Mother does not deal at X's shop and the fried fish consumed by the family is not obtained there. The girl herself, who is very fond of fried fish, bought from X occasionally just before her illness To X baths Ginger-beer frequently. 29 Sept. 10 Sept. 15 F. 11 Condensed Possibly, but not certainly Fried fish from Xon Saturday nights. The patient was a "dreadful child for fish and taters." The others, father, mother and five children, rarely had any. Never shell fish or shrimps Never Watercress on Saturdays. Never lemonade, gingerbeer or kaola. 30 Sept. 10 Sept. 19 F. 13 B Fried fish from X frequently. Never shell fish or shrimps ... Lemonade, sometimes. 31 Sept. 10 Sept. 23 M. 5 B B Very fond of "fried fish and taters" from X's shop. Never buys winkles To X baths Very fond of fruit. 32 Sept. 11 Sept. 22 F. 14 B B or C Fried fish, wet fish, and winkles from X See cases 91, 32 and 126. 33 Sept. 11 Sept. 27 M. 14 Goat brand Occasionally, probably from A Fried fish and winkles habitually obtained from X Not to X baths, but swims occasionally Drinks kaola. 34 Sept. 11 Sept. 17 F. 24 G B Frequently obtained fried fish and winkles from X ... ... 35 Sept. 11 Sept. 20 F. 12 Head and goat brands B The family obtain fried fish from a particular source, not X's shop. The girl herself has been in the habit of buying from X. All eat winkles and eels from Xoccasionally To X baths Ginger-beer and lemonade frequently. 36 Sept. 11 Sept. 26 F. 9 B D or C "On a Friday, about a fortnight before she began to be ill" (probably August 31st), bought a bit of fried fish at X's. She remarked at the time how nasty it was, and indeed it gave her "a shuddering against fish." None of the other members of the family had any. They buy winkles, mussels and shrimps from X occasionally Never Never eats watercress. Drinks kaola. 37 Sept. 11 Sept. 24 M. 16 I B The family do not eat fish. The boy and a friend (case 42) obtained "fried fish and taters" from X on night of September 1st To X baths, the "first-class swim" on September 1st No ginger-beer, lemonade, &c. 21 No. Date of onset of illness. Date of notification. Sex and age. Milk sapply. Ice-cream. As to consumption of fish, fried fish, shell fish, &c. As to use of swimming baths. Remarks. 38 Sept. 11 Sept. 21 M. 16 Head brand Never His mother says the only thing she had ever seen him eat at home, except bread and butter, was a bit of fried fish from X's. This he had on a Sunday, probably September 2nd. He himself corroborates this and says the bit of fish was bought by his sister on Saturday night, i.e., probably September 1st To X baths, but some time before his illness Lived away from home, but visited there on Wednesday afternoons and on Sundays. 39 Sept. 11 Oct. 2 M. ll Head Brand Never The family does not obtain its fish from X, but the patient, who runs errands, and thus gets pennies, may have done this. His mother thinks it likely, as he is a friend of a boy (case 42) who is in the habit of obtaining his supper there. Occasionally has winkles from X Never Drinks ginger-beer and kaola. † Sept. 11 ... M. ... ... Obtained fried fish and other fish from X frequently for his mid-day meal. A friend of the man referred to in footnote on p. 11 ... Illness said to be "double pneumonia," it proved fatal on Sept. 19. 40 Sept. 12 Sept. 17 F. 12 ... Probably not Mother deals at X's, and often buys fried fish there. Child may have also bought independently; she spends her pennies in the street. She would not have bought shell fish Never ... 41 Sept. 12 Oct. 2 M. 7 B. Also Cup Brand A and B The family obtain fish and fried fish from X's Never See cases 48 and 113. 42 Sept. 12 Sept. 29 M. 16 B. B Occasionally purchases winkles, and habitually buys fried fish at X's. On Saturday, Sept. 1, he and the boy case 37, went to the baths and then ate a number of things, including "fried fish and taters" at X's. He was upset next day To the X baths, "first class," on Sept. 1 Fond of ginger-beer, also of fruit. 43 Sept. 12 Sept. 20 M. 13 Nestle Yes. From a shop away from the infected area Obtains fried fish from X's shop quite frequently To X baths, but not to the swimming bath ... 44 Sept. 12 ... F. 13 Condensed B., or elsewhere Mother did not deal at X's. The children, particularly this child, were "terribly fond of fried fish, and they went for the half-penny bit at X's" ... Case notified in Camberwell. Family lived, however, in infected area up to Sept. 11. 45 Sept. 13 Sept. 17 M. 14 Head brand "Not lately" The family obtain winkles and occasionally a haddock from X. The boy often bought "fried fish and taters" from X on bis own account Nut for more than a month before illness Never watercress. Occasionally ginger-beer. 46 Sept. 13 Sept. 25 M. 20 Cup brand Never Patient often used to buy "fried fish and taters" from X, but about the end of August, during the hot weather, he took a dislike to the fish. The family rarely or never bought fried fish; they still buy "taters" and occasionally wet fish Never Never watercress. Mineral water and ginger-beer occasionally. 47 Sept. 13 Oct. 8 F. 19 Squirrel brand Possibly Lives at some distance from infected area, but works at premises within it, and was in the habit of bnying fried fish at X's. Other members of the family did not do this ... ... 48 Sept. 14 Sept. 22 F. 13 Cup brand A and B The family obtain fish and fried fish at X's Never A sister of case 41. 22 No. Date of onset of illness. Date of notification. Sex and age. Milk supply. Ice-cream. As to consumption of fish, fried fish, shell fish, &c. As to use of swimming baths. Remarks. 49 Sept. 14 Sept. 25 F. 13 B B Family buys skate, haddock and shrimps, and occasionally winkles for Sunday from X. The girl herself was in the habit of buying "fried fish and taters" there. The other members of the family very rarely have fried fish Never ... 50 Sept. 14 Sept. 22 M. 5 ... A The family obtain fried fish from X's Never ... 51 Sept. 14 Sept. 17 F. 11 Condensed Fond of ice cream; source not ascertained Fried fish, also winkles and shrimps occasionally from X's ... Never ginger-beer or mineral waters 52 Sept. 14 Sept. 20 M. 12 Head brand B "Fried fish and taters" from X frequently. A bloater occasionally To X baths Fond of ginger beer. 53 Sept. 14 Sept. 22 M. 15 Head brand Never The family obtain "fried fish and taters" from another source, not from X, but the patient is a friend of the boy, case 52, and would buy with him from X To X baths on August 22nd; not since Never buys mineral waters of any kind. 54 Sept. 14 Sept, 28 F. 15 J Rarely, and then from a source quite away from the area Family do not buy fish from X. The gill bought "fish and taters" from X for supper very frequently Never Occasionally gingerbeer. 55 Sept. 15 Sept. 22 F. 13 Condensed Never Family obtain fish and shrimps from X. These two children bought "fried fish and taters" for themselves for supper on Saturdays, and sometimes on other nights too ... Sec cases 116 and 120. 56 Sept. 15 Sept. 22 M. 10 Condensed Never 57 Sept. 15 Sept. 17 F. 17 Condensed Occasionally Whole family used to eat fried fish from X. Latterly the father had stopped their having it and none was brought home. The girl continued up to the time of her attack to buy on her own account, usually elsewhere, but on occasion still from X. Shell fish also from X ... Fond of watercress. Never mineral waters. 58 Sept. 15 Sept. 18 M. 14 K C Also ate some at King's-cross on Sept. 15 Family buy winkles and shrimps from X. The boy is very fond of getting "fried fish and taters" there. None of the others do this To X baths on Saturdays and Mondays A very mild case. No lemonade or ginger-beer. 59 Sept. 15 Oct. 3 M. 7½ Head brand A "Gets his bit of fried fish at X's, never anywhere else." Is fond of fried fish ... "Hopping" from September 5th to 28th. Drinks ginger-beer and lemonade. 60 Sept. 15 Sept. 24 M. 8 B B Occasionally Fond of fried fish from X's Never Drinks mineral waters. 61 Sept. 15 Sept. 21 M. 17 E E Buys fried fish at X's frequently ... Ginger-beer occasionally. 62 Sept. 15 Sept. 18 M. 10 B and I Never "About six weeks ago" (from date October 6th) "had a piece of fried fish from X's" To X baths ... 63 Sept. 15 Oct. 1 F. 17 B B The family have a piece of wet fish from X's frequently, but not fried fish, shell fish or shrimps Never Fond of ginger-beer and lemonade. 64 Sept. 16 Sept. 28 M. 12 B A's man Fried fish from X; a haddock or kipper from same source occasionally To X baths No watercress. Drinks ginger-beer and lemonade. 23 No. Date of onset of illness. Date of notification. Sex and age. Milk supply. Ice-cream. As to consumption of fish, fried fish, shell fish, &c. As to use of swimming baths. Remarks. 65 Sept. 16 Sept. 26 M. 13 Condensed Never Wet fish and shrimps from X. The boys, the patient and his brother, buy fried fish there To X baths Drinks mineral water. Does not eat watercress. 66 Sept. 16 Sept. 21 M. 11 E B Fried fish from X frequently (see cases 14 and 18) Never ... 67 Sept. 16 Sept. 21 M. 15 G; also goat brand A's man Fried fish, and sometimes winkles from X To X baths at end of August ... 68 Sept. 16 Sept. 25 F. 7 ... Never Fried fish and winkles habitually obtained from X Never A very mild case. 69 Sept. 16 Sept. 24 M. 14 Condensed Never Fried fish for supper, obtained from X. Never winkles or shrimps Never ... 70 Sept. 16 Sept. 21 M. 7 Head brand Never A haddock bought from X on Saturday 1st or 8th of September, and some eaten by patient. Fish usually obtained by family elsewhere, but childmay have obtained fried fish on his own account ... ... 71 Sept. 16 Sept. 30 F. 17 L Never Shell fish from X, but fish for family obtained from another source. The girl, however, buys on her own account, and may have bought fried fish at X's, the nearest shop. The girl was away from home Sept. 1—4 and may have been infected then ... Family used to live close to X's shop, but removed to some little distance from it about Sept. 16th. 72 Sept. 17 Sept. 23 M. 15 None None Never bought anything at X's shop so far as he can remember ... Lived on extreme boundary of infected area. 73 Sept. 17 Sept. 24 F. 30 B Never This patient is the wife of No. 5 Never Drank mineral waters. 74 Sept. 17 Sept. 19 M. 12 I Occasionally Mother buys winkles but rarely buys fish from X. The children buy "fried fish and taters" for themselves from X Never Brother of girl, case 85. See also case 110. 75 Sept. 17 Sept. 25 M.8 B B Mother deals at X's. "The children are very fond of fried fish and taters, but they always procure it at X's, the shop they know." Another case (108) in this family To X baths Never ginger beer or mineral waters. 76 Sept. 17 Sept. 25 F. 12 B B Not to baths Never ginger beer or mineral waters. 77 Sept. 17 Sept. 25 M. 16 F Never Fond of fried fish. Obtains this and also haddock, bloaters and shrimps from X To X baths on Wednesdays Drinks ginger beer. 78 Sept. 17 Oct. 13 M. 19 ••• Never Fish of all kinds from X's shop frequently ... A relapse on Oct. 1st, and this 2nd attack was diagnosed as enteric. 79 Sept. 17 Sept. 26 F. 11 Condensed Various sources Used to deal at X's, but changed early in Sept., because they had "some they did not fancy." Child often bought fried fish there Never No mineral waters. 80 Sept. 18 Sept. 25 F. 8 B Never The family deal at X's; they buy most of their fish uncooked, but sometimes have fried fish ... Not removed to hospital. A very mild case. 81 Sept. 18 Sept. 25 F. 13 Condensed C Fried and wet fish from X Never ... 82 Sept. 18 Sept. 27 F. 14 ... Never Fried fish from X frequently To X baths Sister of case 96 24 No. Date of onset of illness. Date of notification. Sex and age. Milk supply. Ice-cream. As to consumption of fish, fried fish, shell fish, &c. As to use of swimming baths. Remarks. 83 Sept. 18 Sept. 29 M. 12 Cup brand Never Family rarely have fish, if they do they do not buy it from X. The two boys, however, very frequently purchase "fish and taters" from X's shop To swimming baths but never to X baths Brother of case 89. Never has gingerbeer or mineral waters. 84 Sept. 18 Sept. 25 M. 3 M Never The family frequently consumes X's fried fish. The child eats it often, also the mother, the father is not so fond of it Never No ginger-beer or mineral waters. Case 96 is this child's mother. 85 Sept. 19 Sept. 19 F. 8 I Occasionally See case 74 ... Children at Ramsgate from Sept. 10-17. 86 Sept. 19 Oct. 8 M. 13 G Probably Fried fish and shrimps from X To X baths ... 87 Sept. 19 Sept. 25 F. 13 Condensed. Never Winkles and shrimps occasionally from X. The girl "if ever she had a halfpenny to spend would go to X's for a bit of fish and taters." Probably did so on night of Sept. 1st Never Drinks kaola. Left for Kent on night of Sept. 1. 88 Sept. 19 Oct. 1 M. 16 B A Bought fried fish from X until quite recently, i.e., a few days before his illness commenced To swimming baths, but not to X baths Drinks lemonade and kaola. 89 Sept. 19 Sept. 29 M. 5 Cup brand Never See case 83 (the brother of this boy) To swimming baths but never to X baths. Brother of case 83. 90 Sept. 20 Sept. 29 M. 4 ... ... This case proved to be one of pleural effusion and not enteric fever ... ... 91 Sept. 20 Oct. 3 F. 4 B B or C Fried fish, wet fish and winkles from X Never Sister of cases 32 and 126. Daughter of case 92. 92 Sept. 20 Oct. 8 F. 36 B Never See above. In addition to fish has had cockles and oysters from X Never See case 91. 93 Sept. 20 Oct. 1 M. 11 B Never Family often have fried fish and sometimes winkles and shrimps from X To X baths on Monday mornings Drinks ginger-beer. See cases No. 125. 94 Sept. 20 Sept. 27 F. 15 Condensed Yes, but source not known Family deal at X's. This girl and her sister (case 99), often buy fried fish there. The others (father mother and baby, set. 2), do not, eat fried fish as a rule To swimming baths but never to X baths Eats watercress. Drinks mineral waters. A very mild case. See case 99. 95 Sept. 20 Sept. 29 M. 4 B A's man Often buys fried fish for supper from X. Other members of family rarely do so, but occasionally buy winkles there Never Drinks kaola. 96 Sept. 20 Sept. 28 F. 30 M Never See case 84 (the child of 96) Never Lemonade occasionally. 97 Sept. 20 ... F. 18 Condensed ... Fried fish and other fish from X. Probably had former on Sept. 1st, but not after that until commencement of illness ... Went hopping on Sept. 1st. May have been infected while away. 98 Sept. 21 Oct. 8 F. 30 N Lives at an ice cream shop Fried fish, wet fish, and shell fish from X Never A very mild case. 99 Sept. 21 Oct. 12 F. 10 Condensed ... See case 94. Very fond of "fish and taters" Never A mild case, but gave marked Widal's reaction. 100 Sept. 21 Sept. 28 F. 12 Head brand B Family buy winkles from X, fried fish elsewhere. The child, however, gets "fried fish and taters" from X regularly on Saturdays Never Very rarely has lemonadeorgingerbeer. 25 No. Date of onset of illness. Date of notification. Sex and Milk supply. Ice-cream. As to consumption of fish, fried fish, shell fish, &c. As to use of swimming baths. Remarks. 101 Sept. 21 Oct, 1 F. 10 B Never Fried fish, winkles i nd shrimps from X. The former usually on Wednesdays (washing day) for dinner. Sometimes on other days Never Eats watercress. 102 Sept. 22 Sept. 27 F. 8 B B Mother dealt at X's before child was ill. Child was fond of fried fish Never No mineral waters. 103 Sept. 22 Sept. 25 M. 12 ... B Family occasionally eat fried fish from X. The boy "mostly spends his own half-pennies, when he does spend them, at X's, on fish and taters, but he is a saving boy." Never eats winkles Never A fatal case. Peritonitis. 104 Sept. 22 Oct. 6 F. 10 Head brand also from B D Family occasionally has fried fish. Child often buys "fish and taters" at X's on her own account Never Eats watercress. No mineral waters. 105 Sept. 22 Oct. 2 M. 16 Head brand A and elsewhere Mother does not deal at X's. Boy buys winkles and fish there but is not sure about fried fish. He often buys fried fish on his own account but usually elsewhere To X baths Often buys fruit and ginger beer for himself. 100 Sept. 23 Sept. 27 F. 9 ... ... Stayed from 21st to 23rd September with an aunt living in the infected area. Had also stayed with her on September 9th and possibly on September 2nd. Lived some distance away. The family of the aunt obtained milk from B and fish (when they have it, they do not like fish) from a source named, not X Fried fish from source named, not X. This lad is the cousin of case 42. ... ... 107 Sept. 23 Oct. 1 M. 12 B Never Never A doubtful case, not removed to hospital. 108 Sept. 23 Sept. 28 M. 5 B B See cases 75 and 76; his brother and sister Never ... 109 Sept. 23 Oct. 7 M. 14 E also head brand B Often buys fried fish at X's for his supper. Family eat it occasionally and also obtain mussels from X Never Eats wateroress. 110 Sept. 24 Sept. 28 M. 61 ... ... Brother of cases 74 and 85 ... ... 111 Sept. 25 Oct. 1 M. 17 L Sometimes has "16 dips at a time" Fish from source named, not X Not to X baths Drinks mineral waters. 112 Sept. 25 Oct. 9 F. 12 Condensed ... Mother does not buy from X. Child is a great friend of case 115, and "may have bought things" when out with her. Used to go to a house where cases of enteric fever had occurred (see case 115) To X baths. Has won prizes for swimming Fond of fruit and watercress. 113 Sept. 26 Sept. 27 F. 4 B also cup brand A and B See cases 41 and 48; child belongs to same family. Another case was notified from this family on September 29th, a child, female, æt. 4 ... ... 114 Sept. 27 Oct. 2 M. 22 B B Family deal at X's. This patient is the brother of case 46, he washed this brother when he wa3 lying ill of "influenza" on September 16th ... ... 115 Sept. 28 Oct. 3 F. 8 Head brand Never Fried fish, fish and winkles from X. This child and the child, 112 above, were in the habit of visiting a house in which cases of enteric fever were under treatment at home ... Never lemonade or ginger-beer. [4] 26 No. Date of onset of illness. Date of notification. Sex and age. Milk supply. Ice-cream. As to consumption of fish, fried fish, shell fish, &c. As to use of swimming baths. Remarks. 116 Sept. 29 Oct. 5 M. 17 ... ... Brother of cases 55 and 56 ... See case 120. 117 Sept. 30 Oct. 7 M. 18 B Never Eats very little fish Never Drinks ginger-beer. 118 Oct. 3 Oct. 28 F. 13 ... Various places Fried fish from source named, not X ... ... 119 Oct. 5 F. ... ... Sister of case 44 ... ... 120 Oct. 6 Oct. 15 F. 39 ... ... Belongs to same family as cases 55, 56 and 116 ... ... 121 Oct. 7 Oct. 18 M. 20 Goat brand Never Buys fish at X's, not shell fish Never ... 122 Oct. 7 M. ... ... Father of case 44 ... ... 123 Oct. 8 Oct. 14 M. ... ... Removed from a common lodginghouse, only there a few hours. Had come on October 8th from Dover, where he had been 7 months ... ... 124 Oct. 8 Oct. 10 M. 6 ... ... Brother of case 29 ... ... 125 Oct. 9 Oct. 20 F. 35 ... ... The mother and younger brother of case 93 ... ... Oct. 9 Oct. 20 M. 3 126 Oct. 10 Oct. 18 F. 12 ... ... Belongs to same family as cases 32, 91 and 92 ... ... Lambeth. (The cases which may be regarded as constituting the special outbreak are those numbered 3 to 45a.) No. Date of onset of illness Date of notification. Sex and age. Milk supply Ice-cream. As to consumption of fried fish. As to consumption of other kinds of fish and shell-fish. Remarks. 1 Aug. 20 Aug. 27 F 22 ... Never Often bought fried fish from Y Winkles from B See case 2. 2 Aug. 23 Sept. 18 M. 50 ... Never Usually bought fried fish elsewhere, but may have eaten some purchased by his daughter from Y ... Father of case 1. 3 Aug. 26 Sept. 12 M. 21 Condensed Never Often bought fried fish from Y on his own account and independently of rest of family Never winkles or shrimps See cases 21 and 25. 4 Aug. 28 Sept. 12 M. 17 Various sources ... Family often had fried fish from Y up to the time the children became ill ... Brother of case 8. t Aug. 29 ... M. 10 ... ... Habitually bought fish from Y, other people living in same house did not do so ... Supposed at time of illness to be influenza, Case 50 a playmate of his, lived in same honse 5 Aug. 30 Sept. 7 M. 35 A Never Fried fish from Y frequently Shell fish from A Never watercress; fond of mineral waters. 6 Aug. 31 Sept. 20 M. 7 ... Never All members of family frequently ate fried fish obtained from Y ... See cases 16 18 and 36. 27 No. Date of onset of illness. Date of notification. Sex and age. Milk supply. Ice-cream. As to consumption of fried fish. As to consumption of other kinds of fish and skell-fi'h. Remarks. † Aug. 31 M. adult Condensed ... Frequently ate fried fish obtained from Y Other fish from A This man was supposed to have "congestion of the lungs and bronchitis." He lived in the same house as case 27. 7 Sept. 1 Sept. 21 M. 16 B Never Often bought fried fish from Y, as did also his brother, case 15, other members of the family rarely did so Shell fish from A See case 15. 8 Sept. 1 S ep t. 10 F. 11 Various sources See case 4 ... Sister of case 4. 9 Sept. 1 Oct. 4 F. 24 C Never Early in September was staying at a friend's house where she frequently had fried fish from Y's shop ... ... 10 Sept. 3 Sept. 15 F. 5 ... Never Family obtained fried fish from Y frequently Winkles from various sources ... 11 Sept. 3 Sept. 21 F. 50 D ... Family obtain fried fish from Y Winkles occasionally Eats watercress. 12 Sept. 3 Sept. 17 F. 11 ... ... Mother does not buy fried fish. This girl and her two sisters, cases 20 and 43, often buy "fish and taters" at Y's, more often on a Friday than any other day Winkles and shrimps from various sources ... 13 Sept. 4 Sept. 14 M. 25 E Never Has eaten some 6 pieces of fried fish since February last. Two of these he remembers buying from Y on two Saturday evenings, probably in 2nd and 3rd weeks of August. He bought l½d. pieces A, but very rarely. No shell fish ... 14 Sept. 4 Sept. 14 F. 8 Condensed ... The child used to buy fried fish from Y ; her mother very rarely did so B Drinks kaola and lemonade. 15 Sept. 4 Sept. 21 M. 18 B Never See case 7 Shell fish from A ... 16 Sept. 4 Sept. 14 F. 34 ... ... Often ate fried fish obtained from Y ... Mother of ease 6. 17 Sept. 7 M. ... ... Fond of fried fish but it is not known where he obtained it ... A fatal case, his relatives cannot be traced. 18 Sept. 8 Sept. 15 F. 32 ... ... Says she did not eat fried fish. This case was found, at the hospital to which she went, not to be one of enteric fever ... A lodger in the house where cases 6 and 16 lived. 18a Sept. 8 F. 2 ... ... This child stayed during the daytime when her mother was at work with her grandmother who lived in the affected area. She played in front of Y's shop, and almost certainly ate fried fish purchased there B Played frequently with the boy, case 28. 19 Sept. 9 Sept. 19 F. 28 Nestle At a shop close by Used to buy fried fish from Y on a Saturday night but does not remember doing so for some few weeks before Sept. 19. Other members of family never bought from Y. A, but very rarely 20 Sept. 10 Sept. 17 F. 4 ... ... See ease No. 12 See above Sister of cases 12, 43, 44 and 52. 28 No. Date of onset of illness Date of notification. Sex and age. Milk supply Ice-cream. As to consumption of fried fish. As to consumption of other kinds of fish and shell-fish. Remarks. 21 Sept. 10 Sept. 16 F. 18 Condensed ... Frequently ate fried fish from Y's shop Never winkles or shrimps Sister of case 3. See also case 25. 22 Sept. 11 Sept. 17 F. 10 Very little Never Fried fish from Y every Saturday night Winkles from A ... 23 Sept. 11 Sept. 20 F. 19 ... Occasionally Fried fish from Y frequently No other fish. No shell fish A fatal case. 24 Sept. 11 Sept. 20 M. 19 F Very fond of ice cream Bought fried fish from Y occasionally No other fish. No shell fish ... 25 Sept. 12 Oct. 18 F. 55 Condensed Never Mother of cases 3 and 21. Frequently ate fried fish from Y's Never winkles or shrimps A fatal case. 26 Sept. 13 Sept. 22 M. 6 Condensed ... Fried fish from Y frequently No shell fish or other fish ... 27 Sept. 14 Sept. 20 F. 26 Condensed ... Fried fish from Y frequently No other fish or shell fish Notified as "continued fever." 28 Sept. 14 Sept. 18 M. 9 ... ... Fond of fried fish and fruit. Had 1d. on a Saturday which he spent, as a rale, on one or the other. Would probably buy his fried fish at Y's; moreover, his mother says he used to frequent the front of Y's shop on the chance of being given a bite of fish by his friends who purchased there ... ... 29 Sept. 15 Oct. 1 M. ]i ... ... All the family fond of fried fish, which they buy at Y's Shell fish and shrimps from A See cases 33, 35, 49 and 54. 30 Sept. 15 Oct. 1 M. 3 ... ... 31 Sept. 15 Sept. 22 F. 8 Nestle No ice cream Fried fish from Y's Winkles from B ... 32 Sept. 16 Sept. 21 M. 18 G ... Fried fish from Y frequently No other fish Watercress occasionally. 33 Sept. 17 Oct. 4 F. 14 ... ... See cases 29 and 30 Shell fish and shrimps from A Sister of cases 29 and 30. 34 Sept. 17 Sept. 21 F. 10 Condensed ... Often bought fried fish from Y A Sister of case 37. 35 Sept. 18 M. adult ... ... See cases 29 and 30 See cases 29 and 30 Father of cases 29, 30, 33, 49 and 54. 36 Sept. 18 Sept. 25 F. 9 ... ... Lived some distance from Y's shop, but stayed shortly before her illness with an aunt, who lived close by it. A cousin of the boy, case 6 ... See also cases 16 and 18. 37 Sept. 19 Sept. 26 F. 12 Condensed ... Often bought fried fish from Y A Sister of case 34. 38 Sept. 20 Oct. 7 F. 8 Name of shop not known ... All the family fond of fried fish. They buy it at Y's Winkles and shrimps very rarely; from A's ... 39 ... Sept. 22 M. 9 ... ... Not a case of enteric; notified in error ... ... 40 Sept. 21 Sept. 28 M. 4 Condensed Fond of ice cream Frequently obtained fried fish from Y A and B for mussels ... 41 Sept. 22 Sept. 27 F. 4 Condensed ... Once a week, usually on Fridays, children have fried fish from Y. At the end of August they had it more frequently Winkles and fish occasionally from A Sister of case 51. 29 No. Date of onset of illness. Date of notification. Sex and age. Milk supply. Ice-cream. As to consumption of fried fish. As to consumption of other kinds of fish and shell-fish. Remarks. 42 Sept. 23 Sept. 25 M. 4 ... ... Lived in same house as case 41. Obtained fried fish from Y ... A fatal case. 43 Sept. 24 Oct. 2 F. 6 ... ... Sisters of cases 12, 20 and 52 ... A fatal case. 44 Sept. 24 Oct. 9 P. 2 ... ... ... ... 45 Sept. 24 Sept. 25 M. 12 Condensed ... Family dealt at Y's, but these two patients also bought fried fish there "on their own" A Very mild case. 45a Sept. 24 Sept. 26 F. 18 Condensed ... A Said not to be enteric. 46 Sept. 25 Oct. 7 M. 19 G ... Never fried fish. At Margate first week in September, and while there ate some oysters, to which he attributes his illness ... ... 47 Sept. 26 Sept. 26 F. 40 Cup brand ... Not a case of enteric. Discharged a few days after admission to hospital ... ... 48 Oct. 1 Oct. 9 F, 17 ... ... Does not care for fried fish Various sources ... 49 Oct. 1 Oct. 3 M. 11 ... ... Belonged to same family as cases 29, 30, 33, 35 and 54 Case apparently secondary to the case marked † between eases 4 and 5 above. The child (50) played with the boy† during his illness, which was at first thought to be influenza, but was afterwards, on the two children being taken to hospital (after the second child sickened), suspected to have been enteric fever ... ... 50 Oct. 2 Oct. 16 F. 5 ... ... ... ... 51 Oct. 3 Oct. 9 F. 6 Condensed ... See case 41 ... Sister of case 41. 52 Oct. 4 Oct. 9 F. baby ... ... Belonged to same family as cases 12, 20, 43 and 44 ... ... 53 Oct. 5 Oct. 14 F. 33 H Never Used to obtain fried fish from Y A ... 54 Oct. 5 Oct. 13 F. 8 ... ... Belonged to same family as cases 29, 30, 33, 35 and 49 ... ... 5'5 Oct. 7 Oct. 14 M. 17 Head brand Never Bought fried fish, but not from Y B ... 56 ... Oct. 18 M. 9 Bought fried fish from Y ... ... Kensal-town. (The primary cases occurring at the time of the special outbreaks in the other districts are those numbered 2 to 22.) No. Date of onset of illness. Date of notification. Sex and age. Source from which milk wm supplied* As to consumption of fried fish. As to purchase of shell fish and fish other than fried fish. Remarks. 1 Aug. 21 Sept. 10 ... ... ... ... Only came to live in area three days before she was taken ill. 2 Aug. 25 Sept. 4 M. 26 A No fried fish Dry and wet fish from Z Fatal case. 3 Aug. 27 Sept. 15 M. 36 B Fried fish from z Dry and wet fish from Z Fatal case. 4 Aug. 28 Sept. 1 F. 16 B *The supply of seven of the local vendors lettered A to K was in large or small part derived from one large dairy company. A second dairy company supplied milk to a few of these vendors, and there were one or two other sources of supply in the case of individual vendors. The firstmentioned company supplied directly or indirectly A, B, C, F, H, I and J. 30 No. Date of onset ot illness. Date of notification. Sex and age. Source from which milk was supplied. As to consumption of fried fish. As to purchase of shell fish and fish ether than fried fish. Remarks. 5 Aug. 29 Sept. 26 F. 16 Condensed No fried fish Does not remember where fish is bought(see case 29) See cases 24, 29, 31, 34, and 36. 6 Aug. 30 Sept. 8 M. 19 A ... Does not buy fish from Z At Yarmouth from Aug. 4th to 7th; did not eat shell fish but had shrimps there. 7 Aug. 30 Sept. L F. 8 B Fried fish from z Dry and wet fish from Z Same family as cases 3, 4 and 9. 8 Ang. 31 Sept. 11 F. 18 Not known Ate no fried fish so far as is known when in affected area Ate fish while on one of her visits, but it was not obtained from Z Only visited in affected area; did not live there. 9 Aug. 31 Sept. 4 M. 10 B Fried fish from z Dry and wet fish and possibly shell fish from Z Same family as cases 3, 4 and 7. 10 Aug. 31 Sept. 9 F. 25 A Fried fish not from z Dry and wet fish and possibly shell fish from Z ... 11 Sept. 1 Sept. 10 M. 44 C Fried fish not from z Dry and wet fish and possibly shell fish from Z A fatal case. 12 Sept. 3 Sept. 12 F. 9 Various† No fried fish Dry and wet fish and possibly shell fish from Z, and also from another source ... 13 Sept. 4 Sept. 15 F. 19 A Fried fish from z, bnt very rarely Dry and wet fish and possibly shell fish from Z ... 14 Sept. 6 Sept. 11 M. 20 H and. I ... Dry and wet fish and possibly shell fish from Z ... 15 Sept. 6 Sept. 12 M. 16 C Fried fish, not from z Dry and wet fish and possibly shell fish from Z ... 16 Sept. 7 Sept. 23 F. 18 D and G Fried fish from z Wet and dry fish and possibly shell fish from Z ... 17 Sept. 8 Sept. 14 F. 14 D and E Fried fish from z Wet and dry fish and possibly shell fish from Z ... 18 Sept. 11 Sept. 20 M. 25 J No fried fish Passes close to Z's shop on his way to work, but said not to buy wet fish Out of town for three days at beginning of September. A fatal case. 19 Sept. 12 Oct. 17 F. 25 K Fried fish, but not from z Passes close to Z's shop on her way to work, but said not to buy wet fish Not notified until her sister, case 32, was attacked. 20 Sept. 12 Oct. 18 F. 10 No milk No fried fish Dry fish from Z ... 21 Sept. 14 Oct. 3 M. 50 Condensed Often ate fried fish; not from z Does not eat wet fish as a rule Lived just on boundary of area. 22 Sept. 17 Sept. 24 F. B ... Buys from Z occasionally ... .23 Sept. 18 Sept. 29 F. 11 H and I Not from z Dry and wet fish from Z A sister of case 14. 24 Sept. 21 Sept. 26 M. 4 Condensed No fried fish They buy from Z at times Same family as case 5. 25 Sept. 23 Sept, 27 M. 9 H and I Not from z Dry and wet fish from Z Brother of case 14. 26 Sept, 25 Sept. 27 M. 5 H and I Not from z Dry and wet fish from Z Brother of case 14. 27 Sept. 25 Oct. 2 M. 14 A From z but very rarely Dry and wet fish from Z Brother of case 13. 28 Sept. 26 Sept. 29 F. 13 C Not from z Dry and wet fish from Z Visited at house in which case 14 lived. 29 Sept. 26 Sept. 26 F. 10 Condensed See case 5 This child remembers having some winkles which were bought from Z. They usually obtain wet fish from a shop further away Same family as case 5. †May on occasion have purchased from a local vendor F, supplied by the first of the two companies above referred to. 31 No. Date of outset of illness. Date of modification. Sex and age. Source from which milk was supplied. As to consumption of fried fish. As to purchase of shell fish and fish other than fried fish. Remarks. 30 Sept. 28 Oct. 3 M. 21 A No fish No fish Visited at house in which case 2 resided. 31 Sept. 29 Oct. 9 F. 2 Condensed See case 5 See case 5 Same family as case 5. 32 Sept. 30 Oct. 17 F. 25 K Fried fish occasionally, not from z Never wet fish Sister of case 19. A fatal case. 33 Oct. 2 Oct. 16 M. 15 Condensed Fond of fried fish, not from z Rarely have any other kind of fish A fatal case. 34 Oct. 2 Oct. 9 M. 12 Condensed See case 5 See case 5 Same family as case 5. 35 Oct. 21 P. 30 D and E See case L 7 See case 17 Sister of case 17, whom she nursed up to within a few weeks of being herself attacked. 36 Oct, 10 Oct. 15 F. 14 Condensed See case 5 See case 5 Same family as case 5. Three more members of this family were subsequently taken ill— F. 37, notified Oct. 21, attacked Oct. 17. M. 38, notified Oct. 21, attacked Oct. 20. M. 8/12, notified Oct. 21, attacked Oct. 20. The mother of case 3, and grandmother of cases 4, 7 and 9 was attacked on Oct. 20, and notified on Oct. 26. An aunt of the child, case 5, was notified on Nov. 20, she had then been ill some time. Condon County Council. SANITARY CONDITION OF CEMETERIES AND BURIAL GROUNDS. Report by the Medical Officer of Health presenting a report by Dr. C. W. F. Young, Assistant Medical Officer of Health, as to the condition of the Cemeteries and Burial Grounds chiefly used by the population of the County of London, as to whether further provision for burial is required, and whether further regulation is necessary in the interest of public health and decency. (Printed by order of the Public Health Committee, 22nd Jane, 1899.) Public Health Department, 8, St. Martin's-place, W.C. (1.) With a view to obtaining information necessary for a report to the Council, Dr. Young has visited the burial grounds in use in London and the burial grounds situated beyond the limits of the county, but in which the London dead are largety buried. Letters of inquiry have, moreover, been addressed to cemetery companies and burial boards, and every effort made to ascertain the circumstances of all such burial grounds. These efforts have been in great part successful, and a large amount of information has been obtained which is incorporated in Dr. Young's report. (2.) It will be well to state briefly the difficulties which attend any effort to form an estimate of the duration of time in which the existing grounds will be available for burial. Apart from the fact that the use of the burial grounds visited by Dr. Young is not limited to the London population, further difficulty results from these burial grounds containing two classes of graves, the one private, the other common graves. Private graves may each receive only one, or more than one body, the fact whether a private grave is used for subsequent interments after the first burial depending on family circumstances, which must differ very greatly. Hence, there are rights of burial in numerous private graves which may or may not be exercised, and nothing but the lapse of time can determine whether these rights will be exercised. Again the number of bodies which are interred in common, graves differs very much in the several burial grounds. There is no regulation which limits the depth of a grave, and the practice of the owners of burial grounds in this respect varies. In some of the cemeteries as many as 12 or 15 bodies are interred in the same grave one above the other ; in other cemeteries only four or five bodies are thus interred. In the Woking Cemetery, with few exceptions, no unpurchased grave is used for the burial of members of more than one family. In the Jewish Burial Grounds not more than one body is interred in any grave. And again, the superficial area of a grave in the several burial grounds is not the same, and thus the number of graves per acre differs. Apart from these considerations, increase in the adoption of the practice of cremation may possibly affect the results. (3.) These circumstances make very hazardous any attempt to estimate the length of time during which the existing provision will suffice. The following statement may, however, be of interest in this connection. There are in the burial grounds, as a whole, about 41 burials in common graves to every burial in a private grave, and if we assume that every common grave will receive on the average six bodies and every private grave three bodies, it follows that a burial ground will require four private graves to nine common graves. Now there are in the burial grounds included in Dr. Young's report about 1,300 acres of land purchased for burial purposes and not yet utilised, and it is possible to ascertain on such assumption how long this ground will be available for interment of the number of bodies supplied by the population of the administrative county of London and of Greater London with death-rates of 16, 18, and 20 per 1,000 living. Thus— (4.) Table showing the number of years for which 1,300 acres is sufficient provision assuming (a) 1,000 graves per acre, (b) 750 graves per acre, (c) 500 graves per acre, and death rates of (1) 16 per 1,000, (2) 18 per 1,000, and (3) 20 per 1,000 per annum, and assuming also that the population of the administrative county of London is uniformly increasing throughout the whole period at the same rate as between 1891 and 1896, and that of Greater London at the same rate as between 1881 and 1891— Assuming death rates of Administrative County of London. Greater London. (a) (b) (c) (a) (b) (c) 1,000 graves per acre. 750 graves per acre. 500 graves per acre. 1,000 graves per acre. 750 graves per acre. 500 graven per acre. years. years. years. years. years. years. (1) 16 per 1,000 65.4 52.4 37.6 43.2 34.9 25.4 (2) 18 „ 59.8 47.6 34.0 39.6 31.9 23.0 (3) 20 „ 55.1 43.7 31.0 36.7 29.4 21.1 [2334 2 (5.) In view of the fact that within Greater London are burial grounds not included among those containing the 1300 acres of ground referred to, the periods of time in the table headed Greater London are too small; while for the reason that this ground will doubtless receive the bodies of many persons not resident in the Administrative County of London, the periods of time stated in the table under the heading Administrative County are too large. It is probable also that the longest period of time in each table more nearly approaches accuracy than the shortest period of time for the reasons that an acre could contain 1,200 graves measuring 9 feet by 4 feet, or 36 square feet, and that 1,000 graves per acre is a more accurate estimate of the extent to which burial grounds will eventually be used than is 500 graves per acre. The above figures, moreover, do not include the numerous existing graves which will for many years be used for interment. (6.) In considering whether it is expedient that any further regulations should be made in respect to burial grounds in the interest of health and decency it is obvious that it would be well, so far as this is practicable by regulations, to promote the adoption of practices that will ensure the speedy dissolution of the body. Thus every encouragement should be given to the use of perishable coffins in earth graves. The time has, moreover, come when advance should be made upon the system of interment in vaults and brick graves. The intention of their use is obviously to preserve the body for as long a time as possible; the interest of the community is to ensure the dissolution of the body in as short a time as possible. The requirement that bodies interred in vaults and brick graves shall be enclosed in lead coffins has no doubt the object of retaining the gases of decomposition as well as of preserving the remains. I have been told, however, that it is a common experience that these efforts are often futile, and that lead coffins from time to time burst from the pressure of accumulated gases. I have myself known of a lead coffin being punctured by an undertaker to obviate this risk. It is assuredly not an unreasonable demand that the provision of new brick graves and vaults in burial grounds in London should cease. (7.) For similar reasons the burial of bodies in clay is highly objectionable. Burial in a clay soil tends, as Dr. Young says, to the preservation of the body or "the products of decomposition pass into a liquid form which may be retained within the limits of the grave for an indefinite period, if no means of drainage of the grave exist." I do not believe that public sentiment would be satisfied with burial in clay if its unsuitability for this purpose were better understood. (8.) Beyond this the present system of interment in common graves is not calculated to meet the requirements of a reasonable sentiment. I refer to the "open grave" which is not closed until it has been filled with the numerous bodies it has been dug to receive. (9.) It is seen, however, from Dr. Young's report that custom in respect to method of interment is changing, that brick graves are less frequently demanded than before, that, although yet in small proportions, perishable coffins are preferred to coffins of oak and elm, and that the practice of cremation has made a distinct beginning and is increasing year by year. The public is learning by degrees that the thought of preserving the remains must be abandoned, and that the speedy dissolution of the body into its constituent elements must be facilitated and not retarded. (10.) The experience of Sir Seymour Haden and Dr. Vivian Poore of the burial of the bodies of animals near the surface shows the rapidity with which dissolution of the body is effected when thus buried,and undoubtedly it would be well to learn how far it would be practicable to adopt this method as a means of disposing of the dead, for what may be done with isolated bodies in a country district might not perhaps be found possible with numerous bodies in a London burial ground. (11.) Dr. Young has made an estimate of the amount of suitable land which would be required for the dead of the London population if surface burial were adopted, and he finds that fifty-five acres, or, with land for paths and an unburied-in belt, some seventy acres would be required annually, and the land could be again utilised after the necessary interval of time, which Sir Seymour Haden shows to be proportionate to the depth below the surface at which interment takes place. Similar estimate for Greater London shows that about eighty acres would be required for the number of deaths which now occur in a year, with an increase of about 1.7 per cent, per annum to allow for increase of population. (12.) If it were intended to encourage the adoption of methods of interment under natural conditions, which aim at the speedy dissolution of the body, much no doubt could be done if a representative body in each county were authorised to make regulations which put limitations upon the continuance of practices aiming at or leading to the preservation of the body. Such regulations would tend to guide public opinion, and might, as this grows in the proper direction, be strengthened from time to time. (13.) More speedy results would no doubt be attained if the ownership of all burial grounds were vested in public authorities who would not be influenced, as trading companies might be, in the retention of customs which it is desirable should cease. Especially, if it were determined to give facilities for surface interment, would it be desirable that ground so utilized should be in public ownership. Shirley F. Murphy, Medical Officer oj Health. 3 Dr. C.W.F Young's Report. (1.) The instruction of the Committee is to inquire into the condition of cemeteries* within the metropolitan area with a view to ascertaining whether any further provision for the purpose of burial is necessary, and whether it is expedient that any regulation should be made in respect to such places in the interest of public health and decency. (2.) It will be well in the first place to refer to the fact that a Royal Commission reported on the question of burial, more especially with regard to intra-mural burial, in 1850, and to state briefly the results of the Commissioners' report, so far as relates to the scope of the instruction of the Committee. (3.) Previous to 1850, however, namely, in 1834, the late Sir Edwin Chadwick had been requested to inquire into the subject of burial, and he presented a report dealing comprehensively with the whole question of the disposal of the dead, and containing recommendations with a view to effecting improvement in the conditions of funerals and of burial. This report does not appear to have been followed by action until the year 1850, when the above Commission—consisting of Lord Carlisle, the Earl of Shaftesbury, Sir Edwin Chadwick, and Dr. Southwood Smith—was appointed, and shortly afterwards presented a report on a " General scheme for extra-mural sepulture." (4.) The information which was obtained by the Commission shows that as regards the first part of the above instruction the accommodation existing at that time—practically the churchyards in the metropolis—had been exhausted, and that burial could only be effected in these places by disturbing the remains of bodies in existing graves within a period of time which, even if the soil had been virgin soil, was insufficient for allowing the process of decay to proceed to a stage at which nothing was left of the body, whereas in the case of these burial grounds the soil was already so saturated with the products of incomplete decomposition that it not only was illadapted to promote decomposition but was also the cause of nuisance in the immediate neighbourhood. (5.) As regards the second part of the instruction, the evidence obtained for the Commission showed that owing to this crowding of churchyards and to the increased demand for burial brought about by the increase of population, the interment of the dead could not be carried out with due regard to sanitary conditions and to feelings of sentiment, and indicated the need that in future interments should be specially regulated. (6.) The result of the report of the Commissioners was the passing of an Act which constituted the then existing General Board of Health—a Government department—the burial authority for the metropolis, with a view to closing the churchyards, the provision of new places for interment, and the taking over by the Board of Health of existing cemeteries which had been provided by private companies; for previous to 1850 the need which existed for further accommodation for the burial of the dead had been felt and had found expression, in the formation of cemeteries, that is places of burial provided under special Act of Parliament or under the Cemeteries Clauses Act, 1847, by private enterprise for the use of residents in London. Without entering into details, it is sufficient to state that this Act failed in its purpose, and was followed by further legislation in 1852, a new Act, the first of the Burial Acts (15 and 16 Vic. cap. 85), being passed. This Act (1) provided for the closure of existing places of burial by order in Council, with the exception that such order was not to extend to burial places belonging to Quakers or Jews unless they were specially mentioned in the order, and further by a special section (sect. 54) the cemeteries provided by private companies referred to above were exempted from the Act; (2) gave power to parish authorities to establish burial boards with a view to the provision of burial grounds for their districts; and (3) gave power to a Secretary of State to make regulations in regard to burial grounds with a view to the proper supervision and management of such places. This Act further provided that no new burial ground was to be laid out in the metropolis or within two miles of it without the authority of a Secretary of State. Several Acts amending the Act of 1852 have since been passed, the chief effects of which have been to make it applicable to the whole country, to extend the powers of the Secretary of State, to authorise the inspection of burial grounds, and to make the regulations so far as they relate to common graves applicable to the cemeteries belonging to private companies enumerated in a schedule to the Burial Act, 1852, or to any cemeteries established under a local Act. (7.) The powers given by the Act to establish burial grounds have been made use of by many *In this report the word cemetery is frequently used as a convenient and generally understood term signifying a place provided for the interment of the dead. In legal phraseology the term has a more restricted meaning. Thus a cemetery is either— (1) A place provided for the interment of the dead as a commercial undertaking, under special Act of Parliament or under the Cemeteries Clauses Act, 1847; or (2) A place provided for the interment of the dead by local authorities, under the Public Health (Interments) Act, 1879, by which the provisions of the Cemeteries Clauses Act are incorporated into the Public Health Act, 1875. This Act is not applicable to London. Local authorities in London are able to provide places of interment under the Burials Acts, which apply to the country generally. These places are known as burial grounds. The difference between a cemetery and a burial ground is not solely one of nomenclature, since in the case of a burial ground under the Burials Acts "a "portion of it must be tendered to the bishop of the diocese for consecrntion; whereas it is not necesary that "any portion of a cemetery should be consecrated at all. "Further, while" no part of a cemetery may be laid "out within 200 yards of a dwelling-house, in the case of a burial ground all that the Burials Acts require is that "no one shall be buried within 100 yards of any dwelling-house without the consent of its owner or occupiers; "and in neither case apparently is there any provision which forbids the subsequent erection of dwelling-houses " in closer proximity to the graves."—(Local G-overnment—Blake Odgers.) In addition to these two classes of places for interment there is a third, namely, the parish churchyard. For the most part these are now closed in London, but a few situated in the outlying and less populated parts of the county are still in use. 4 parishes in London at different times since 1852, and it thus conies about that the provision for burial at the present time consists mainly of burial grounds provided under the Burial Acts by local authorities, and of cemeteries provided under special Acts by private companies. There are also a few smaller places, namely, two parish churchyards in the outer part of the metropolis still in use, and some private places belonging to religious bodies. Since the passing of the Burial Act in 1852 the number of cemeteries belonging to companies has been increased by the formation of others which have been opened with the approval of the Home Secretary, while one of those included in the schedule of the Act has been closed. As regards the burial grounds provided under the Act by the parish authorities two have already been filled, so far as new graves are concerned, and new grounds have had to be obtained, and in the case of several others the area of ground originally laid out has had to be extended owing to the filling up of space. (8.) The regulations made under the Burial Acts have undergone revision at different dates since 1852, and each burial ground of a local authority is subject to the set of regulations in force at the date of its approval. The regulations, it has already been said, do not apply to those private cemeteries which existed in 1852, except so far as relates to common interments, but a private cemetery which has been opened since 1852, and hence requiring the approval of a Secretary of State, would be subject at the time of its approval to conditions similar to those contained in the regulations. (9.) With a view to carrying out the instruction of the Committee, I have made visits to all the cemeteries at present in general use situated within the county, and also to a considerable number situated without the county boundary, but in such proximity as to be largely available for the use of residents within the county. The latter include all cemeteries provided outside the county by London parochial authorities as well as the Necropolis cemetery at Woking, which, although at a considerable distance, is, owing to the special railway facilities which exist for the conveyance of corpses from London, largely used for the burial of persons who die in the county. The following account regarding these cemeteries and the subject of burial is based upon these inspections, and upon the information obtained in conversation with the secretaries, superintendents, clerks of burial boards or burial committees of vestries, and others intimately connected with the places of burial. (10.) In addition to these places of interment, there are others in which burial occasionally takes place either under certain restrictions from the Home Office or because graves belonging to certain families have not yet been completely filled. These include a few churchyards, and some burial places provided by burial boards, closed except for members of families possessing graves not yet filled; and a few private places of interment for the use of members of certain religious institutions. These places have not been regarded as forming part of the general provision for the disposal of the dead, and have not been taken into consideration in the following account. (11.) As has been already stated at the commencement of the report, the instruction of the Committee is "to inquire into the condition of the cemeteries and burial grounds within the metropolitan area, and to report whether any further provision for such purpose is necessary, and also whether it is expedient that any regulation should be laid down in respect of such places in the interest of public health and decency." (12.) This instruction has been interpreted as one to inquire into the disposal of the dead by means of burial, and has not been regarded as including a consideration of cremation as a method of dealing with the dead. Incidentally reference has been made in the report to cremation (which must now be regarded as a recognised practical proceeding) with a view to forming some idea as to the influence which it possibly may have in the future upon burial. Beyond such mention the subject of cremation has not been dealt with. As regards burial in the earth, it has been found necessary to consider not only the method which is universally practised at the present time; that is one in which the bodies are buried at considerable depths from the surface, in which several bodies are placed in the same grave, one above the other, and in which, as final result, as soon as all the ground has been used the burial place is closed and never used again, but also another method,—which has been advocated chiefly by Sir Seymour Haden—the principles of which are burial near the surface, the use of perishable coffins, and the restriction of one body to a grave, with a view to the proper and complete decay of the corpse and the possible use of the ground again, after a sufficient interval of time has elapsed to ensure complete decay and to avoid any objection on grounds of sentiment. The latter method appears to present so many advantages as regards the conditions most suitable for insuring decay of organic matter, in comparison with the method now in vogue that considerable prominence has been given to it in the following report. (13.) The subject has been dealt with in the following way—A general account, based upon the information obtained during visits to cemeteries, is given as regards (A) the availability of the existing places for burial, (B) the expediency of making further regulations in regard to them, and this is followed by (C) the conclusions which are indicated by this information. A detailed account is then given regarding each burial ground and cemeteiy. Finally in the form of an appendix, information obtained partly in 1897 by means of a circular letter from the Council to the various authorities concerned, and partly during this inquiry, is given, showing the provision made by poor law guardians for the burial of paupers, with the charges in each case, and the parochial bodies (and the sanitary authorities to which they correspond) which have provided burial grounds, under the powers conferred on them by the Burial Acts, in place of the old churchyards. General Statement. (A.)—The availability of existing cemeteries and burial places. (14.) The information which has been obtained as to the amount of ground unused at the present time in existing cemeteries is not such as to enable more than an approximate estimate 5 to be made of the area available for interment. The reason for this is that, in most cases, only a general knowledge appears to be in the possession of those who are concerned with the different cemeteries, no recent surveys having been made and no systematic record apparently being generally kept with the object of knowing the area of the ground which has actually been used. Ordinary inspection of a burial place does not enable any one to give an opinion of much weight as to the extent to which the ground is occupied, if the judgment is to be made upon the standard of the area of grave spaces which was approved at the time the cemetery was opened. An attempt to form such an opinion would easily lead to error, since at some cemeteries it has been the custom to use the ground either by burying in alternate grave spaces, or in no systematic manner, with the result that headstones and monuments being as a consequence erected over the cemetery generally the ground has the appearance of being entirely used up, although really there may be intervening spaces which are still unused. The amounts of unused ground given in the following statement were obtained during the inquiry from officials connected with each cemetery, and may be regarded as approximating to the actual amounts sufficiently accurately to enable an idea to be formed as to the area of ground which is still available for burial. It is desirable to emphasise the fact that this does not include the space occupied by private graves which have already been buried in, but which are still available for further burial for the use of those who own them. (15.) Under the present mode of use the availability of existing places for interment depends partly upon the accommodation which is still left in graves (either earth graves, brick graves, or family vaults) in regard to which the exclusive right of burial for a certain number of bodies has been purchased at some previous date, and which have not yet been filled, and partly upon the amount of ground which, so far, has not been buried in at all. As regard? the former, it has not been possible to obtain information showing to what extent there is still accommodation for further burial in these private graves. It could doubtless be obtained by a careful examination of the register of the burial place since its opening, and by noting all the private graves not yet filled, and the number of bodies which can still be buried in them. It is doubtful, however, to what extent, if at all, this accommodation could be taken into account in forming an estimate as to the availability of the existing provision, since the use of such graves, being limited to members of those families by whom they were originally purchased, it is possible that owing to the family having become dispersed, or having left the neighbourhood, the graves may never be completely filled, or the time taken in filling them may be spread over an indefinite period lasting perhaps beyond the actual life of the burial ground or cemetery. This information as regards private graves not being forthcoming, estimate as to the availability of the ground now in use for the disposal of the dead is restricted to the area of ground which has not yet been buried in. (16.) The information which it has been possible to obtain as to the extent of such ground is as follows— Cemetery. Total area. Area not yet buried in. (Estimated by officers of burial boards and cemeteries.) i. Cemeteries with clay soil. [London clay.] Within the County— Acres. Acres. Private—Norwood 40 20 Nunhead 54 26 Abney-park (some gravel) 33 10 S. Mary's Roman Catholic 23 10 Kensal -green 70 20 Jewish, Islington 2 70 spaces. These have already been purchased. Parochial—Camberwell 32 16 Lambeth (a small amount of river gravel) 41½ 10 Putney (new) 13 12 Hampstead 20 10 Greenwich 16 No information. Lee 10 7½ Outside the county— Private—Chingford-mount 60 55 Elmer's-end 35 29 Jewish, Hendon 8 only 27 bodies buried so far „ Willesden 9 6 Parochial—Battersea 130 126 Paddington 25 7 Willesden, Old 26½ 20 „ New 4½ eighty spaces Total 652½acres about 392 acres (and 150 spaces and unknown area in Greenwich cemetery ) 6 Cemetery. Total area. Area not yet buried in. (Estimated by officers of burial boards and cemeteries.) ii. Cemeteries having soils which consist party of clay. [London clay, boulder clay, sand and gravel of higher grounds, Thanet and Woolwich beds, and valley gravel and sand.] Within county— Private—Highgate (clay and Bagsliot sand) 38 8 Parochial—Wandsworth (clay and river gravel and sand) 34 30 Deptford (clay only to slight extent on surface, chiefly Woolwich and Thanet beds) 20 8 Lewisham „ „ „ 15 6 Outside county— Private—Great Northern (clay and gravel) 70 56 Parochial—St. Pancras (boulder clay and gravel) 105 70 Islington „ „ „ 79 49 St. Marylebone „ „ 40 20 Total 401 acres about 247 acres iii. Cemeteries having sails of gravel and sand. [Valley gravel, Bagshot sand and loam, Thanet, Woolwich and Blackheath beds.] Within county— Private—City and Tower Hamlets (river gravel) 40 No estimate. A small area only probably under 10 acres Jewish, Mile-end (rivergravel] 4 ½ Government—Brompton (river gravel) 40 2 Parochial—Fulham (river gravel and sand) 14 2 Hammersmith „ „ 18 8 Streatham „ „ 26 25 Plumstead (Thanet, Woolwich andBlackheath beds) 32 27 Charlton ,, „ „ 8 4 Woolwich „ „ „ 32* 19* Putney, Old (river gravel) 2J None Tooting Churchyard(gravel) A small area Eltham Churchyard (sand) 2| ¾ Outside the county— Private—Manor-park (river gravel) 45 20 East London „ 30 22 Woodgrange „ No information. Woking (Bagshot sand) 500 400 Parochial—Kensington (river gravel) 15 6 St. George, Hanover-square (river gravel) 24 14 City of London (river gravel) 168 100 Total 1,001 acres (and unknown area in Woodgrange cemetery and Tooting-churchyard) about 660 acres (and unknown area in Woodgrange cemetery and Tooting-churchyard) (17.) Summarising the above into those within and without the administrative county and those in which the soil consists of clay, partly of clay and partly of gravel or sand, or of gravel and sand, it appears that there are, so far as information is available— Within county. No. of cemeteries. Total area. Area unused. Acres. Acres. Clay 12 354 141 Partly clay 4 107 52 Gravel and sand 12 219 98 Total 28 680 291 *From Parliamentary Return No. 412, July 26th, 1897. 7 Without the county. No. of cemeteries. Total area. Area unused. Acres Acres. Clay 8 298 251 Partly clay 4 294 195 Gravel and sand 7 782 562 Total 19 1,374 1,008 (18.) The above may be taken as fairly representing the amount of virgin ground available for interment in cemeteries and burial grounds in and near the county of London, that is to say, ground which has been approved under special Acts of Parliament or under the various regulations applicable to burial grounds established since the passing of the first Burial Act in 1852, as being suitable for the purpose of burying the dead. (19.) An estimate of the probable duration of each cemetery under the existing recognised modes of use of the ground for burial might be formed by taking into consideration the number of burials per annum, the proportion of private to common graves per annum, and the area of grave spaces, and by allowing an average number of bodies to each grave. This would give the amount of ground which would be used each year, and from this the life of the burial place, so far as new graves are concerned, could be calculated. (20.) The information obtainable as to .each of the above factors, and especially as regards the proportion of common to private graves, and the average number to each grave, is not sufficiently precise to justify an expectation that such an estimate would be so near the truth as to enable a satisfactory opinion being formed as to whether it is necessary to make other provision for the burial of persons dying in London. (2l.) This is the less important, however, since there appears to be reason for thinking that such an estimate would not, for practical purposes, be of any great utility owing to the fact that it would be largely based on the assumption that the past mode of use of the ground will necessarily continue in the future. (22.) Now the regulations made under the Burial Acts of 1852, and the revision of them at present in force, are so framed as to recognise two distinct modes of burial, namely, entombment or the placing of the body in a brick grave, or vault, or mausoleum in a hermetically-sealed coffin with a view to its preservation, and inhumation or burial in the earth with a view to its decay. (23.) During the early periods of the existing cemeteries it was largely the custom to adopt the former of these methods of interment, but it is stated that during recent years a change has taken place in the views of the community and earthen graves are much more often chosen than brick graves, or their equivalents, namely, vaults, mausoleums above ground, or catacombs. The statements made regarding this point during the inquiry were practically unanimous, and it does not appear that the change of opinion is based upon the possible less expense involved by burial in an earth grave, but is due to an appreciation by the public that the proper object of burial is the decay of the body, and that the result of attempt at preservation by means of entombment is only a temporary delay in the process of decomposition. (24.) The change in opinion on the part of the community may reasonably be regarded as opening up the possibility of abandoning, in part, if not entirely, the present mode of use of ground set aside for interment, the essence of which is the filling up of graves both private and common with a certain number of bodies and never again disturbing them, and adopting a system which will allow, after a given interval, the use of the same ground over again for purposes of burial. Such a system would minimise if it did not entirely overcome the difficulty which threatens of continually increasing appropriation of land to provide for the burial of an increasing population. It may be added that the continued re-use of the same grave, after sufficient intervals of time between successive interments to permit complete decay, seems to be implied in the regulations made under the Burial Acts in which it is laid down that a grave shall not be used a second time—except for a member of the same family, that is practically private graves—until after an interval of 14 years, though the context, that a foot of earth shall be left over the last interred coffin, appears to indicate that the number of bodies for which any one common grave space is to be used is limited. (25.) If the present desire for burial in the earth, in place of entombment with the object of preservation of the remains, be regarded as sufficient to justify the consideration of making some alteration in the use of the land on the lines set out above, an estimate of the availability of the existing cemeteries and burial grounds can be made much more readily than under existing methods, and with a considerably greater degree of preciseness. As use of the ground in the manner suggested above has many advantages in comparison with the present mode, the estimate given in the following has been made in this way. (26.) Before proceeding to give such estimate it is desirable here to digress in order to see whether the object which, as far as can be gathered, underlies the change in opinion of the community—namely burial in such a manner as shall ensure a complete decay of the corpse within a reasonably short period—is or is not attained under the conditions of burial which prevail at the present time. (27.) The evidence which has been obtained in regard to this point leaves little reason for doubt, 8 short of actual examination of graves, that under the present conditions the desire on the part of the community is not orten attained. In fact there seems little doubt that so-called earth burial is often little else than a form of entombment. (28.) Now the splitting up or decomposition of organic matter, in whatever form, is dependent upon the action of micro-organisms, which for the effectual fulfilment of their work need the aid of a sufficiency of air, a certain amount of moisture, and an appropriate degree of temperature. Interference with one or more of these conditions will result in retardation or alteration in the ordinary process of decomposition. Entire absence of air would prevent the oxidation needed in the breaking up of the complex organic matter into simpler compounds, and of these into their ultimate constituent elements, while excess of air, as by exposing the body to a continuous current of air, by promoting desiccation dries up the tissues and checks decomposition. The human body contains a large amount of water— in an average body weighing 154 pounds the proportion is about 96 pounds—and if desiccation be avoided this would probably be sufficient for the process of decay, but under ordinary circumstances the presence of moisture to a certain degree appears to favour decomposition. Excess of moisture, as for instance total submersion in water or burying in a soil constantly damp or waterlogged on the other hand interferes with decomposition and brings about a change of the soft parts of the body into adipocere, a compound of considerable permanency, consisting of a fatty acid in combination usually with ammonium. The temperature most favourable for inducing decomposition appears to be between 63°—70° F. A high degree of temperature tends to cause mummification, while a very low one practically stops any changes taking place in the corpse. (29.) The facts which are now about to be set out will show that under existing methods the body is buried in a manner which interferes with the most favourable combination of the agencies needed for its proper decomposition, and that it is possible, if alterations were made in regard to this method of disposal of the dead, to improve to a considerable extent the conditions under which it is placed. (30.) The causes which, under the present methods, lessen the value of burial in the earth will, for convenience, be considered under the three following headings. It must be borne in mind, however, that in practice these three causes, each of which by itself has influence upon the process of decay of the body, act together and it would be difficult to say as regards the result in any special case, to what extent one cause had had effect rather than another. It would appear, however, that taking them in order of importance as regards the influence which they play in interfering with the natural process of decomposition they may be considered as follows— (i) The depth at which bodies are buried. (ii) The character of the coffins in general use. (iii) The character of the soil of ground available for burial. (31.) (i) The depth at which bodies are buried.—In the first place it is necessary to point out that under the regulations no body must be buried within less than 4 feet from the surface in the case of an adult, or within less than 3 feet in the case of a child under 12 years of age. (32.) So far as private graves—that is, graves which have been purchased for the burial of members of one family—are concerned, it appears that the depth to which they are dug is less than it used to be in former years. A depth between 9 and 12 feet is usually now required. In the case of graves for common interments, however, considerably greater depths are dug, from 12 to 18 feet being not an uncommon practice, and in one or two cases the graves are 20 or 25 feet deep. (33.) The influence exerted by the depth at which a body is buried appears to have considerable effect on the process of decay. Experiments bearing on this point have been carried out with the bodies of animals by Sir Seymour Haden,, and the following quotation taken from a letter which appeared in the Times in 1897, describes the results which he has obtained by buiying bodies at superficial depths— (34.) "For eleven years— since 1886 in fact—I have been burying in the grounds attached to this "house animals of every kind and size—calves, swine, cats, dogs, geese &c.—with the object of "ascertaining not only the depth at which interment may be safely made, but the time at which "complete resolution of the buried body may with certainty be looked for. Beginning with a depth "of 4 feet—the depth prescribed by the Local Government Board—for instance, I have found that a "period of something more than four years (depending mainly on the size of the animal buried) was "necessary for complete resolution, and, speaking roundly, that for every foot of depth below the "surface a year or thereabouts was necessary ; for a depth of 3 feet three years ; of 2 feet two years ; "and of 1 foot one year ; in a word, that resolution was rapid in proportion as the grave was shallow "and the soil porous. (35.)"Nor is this all. For the last two years I have not been burying the body at all, but—simply "laying it on the ground and covering it in every direction with a single foot of earth—have "found that at the end of a year every trace of animal tissue had disappeared, the bones alone being "left. (36.) "Any one disposed to make a pilgrimage to this place may see one or more of these surface "parallelograms a foot thick in every direction, and, if a year have elapsed since the interment, remove "if he will, and break up the whole of it. He will find, as I have said, nothing but the bones, which "as an integral part of the earth's substance of course remain ; and moreover, that the whole process "has been effected without the slightest appreciable effect either on the small portion of soil employed "or on the purity of the earth beneath or on the sweetness and freshness of the air around." (37.) Dr. Vivian Poore has also had similar results indicating that the more superficially a body be buried the more rapidly and thoroughly is decay found to have taken place after a given period. (38.) These results are what might be expected if consideration be given to the factors needful for the decomposition of organic matter, and more especially to conditions of temperature and the presence 9 of micro-organisms. As regards the former it may be said that the nearer to the surface the greater the influence of daily and seasonal changes in temperature ; while as regards the latter examinations which have been made of soils show that there is considerable difference in the number of bacteria found in the soil according to the depth from the surface at which it has been obtained. Sternberg, writing on the subject of bacteria in soil (Text Book of Bacteriology), states as follows— (39.) "In some experiments made in 1881, Koch ascertained that in soil which had not been "disturbed but few bacteria were to be found at the depth of a metre, and this fact has since been "established by the extended researches of Friinkel. (40.) "Friinkel has given special attention to the examination of undisturbed soil not in the " immediate vicinity of dwellings. (41.) "The greatest number was not immediately upon the surface, but at from one-quarter to "one-half metre below the surface. (42.) "At a depth of three-quarters of a metre to a metre-and-a-half from the surface there was a "very great and abrupt diminution in the number of germs. (43.) "The most important fact developed by Fränkel's researches is that in virgin soil there is a "dividing line at a depth of from three-quarters to one-and-a-half metres, below which very few "bacteria are found." (44.) In the case of ground which has been subject to disturbance, such as the digging of excavations which are then filled in again by the soil which has been excavated, as is the case in burial places, it is to be expected that examination of the soil might give different results owing to this cause alone, while the placing at some depth in it of a body carrying bacteria, as must be the case with a human corpse, would further tend to cause a difference. In a paper by Dr. J. Buchanan Young, published in vol. 37 of the Transactions of the Royal Society of Edinburgh, on an examination of soil, at different depths, it is shown that" the soil of graveyards contains as a rule more bacteria than virgin soil, the difference "being most marked in the deeper layers, although the number of bacteria is not so great as "one would expect." Dr. Young refers in his paper to a research by Reimers on soil in churchyards, which demonstrated the fact, confirmed by his own examinations—that the number of micro-organisms is not greatest immediately under the coffin, but at a short distance above, although the number in the vicinity of the coffin was comparatively great, and further, that the number of bacteria diminishes rapidly in the soil under the coffin. Thus in two experiments the following results were obtained— (1) In the superficial layers of the soil 320,100 bacteria per c.c. At a depth within 1.2 metre of the coffin 844,500 ,, ,, At a depth 1.6 metre just under coffin 142,300 „ „ (2) No coffin found but many bones at a depth of ].5 metre from the surface. At a depth of 1 metre 985,000 bacteria. „ „ 1.8 „ 244,600 „ 2 „ 15,600 „ (45.) It is difficult to say to what extent the increase in the number of bacteria in soil at a depth from the surface is due to bacteria carried by the body itself, but increase caused in this way must vary considerably according to the condition of the body, the nature of the disease which has proved fatal and perhaps the time which has elapsed between death and burial. Excluding diseases which are due to the invasion of the organs and fluids of the body by pathogenic organisms, the internal tissues of a body are at the time of death free from the presence of bacteria, except in the case of the alimentary tract. The organisms naturally present in this part of the body as soon as the person is dead initiate the process of decomposition. By causing softening of the tissues they are gradually able to spread from within outwards, and so prepare the body for the action of micro-organisms from without. In all probability the organisms which exist naturally within the human body are not able completely to effect the whole cycle of decay, and the action of external microbes is necessary. Brouardel, in one of a series of lectures on "Death and Sudden Death," translated by Benham, states that the first phase in the process of decay of all organic matter depends on the action of aerobic organisms, that is those requiring the presence of oxygen. This is followed by a second phase, during which the work is carried on by organisms which can act either in the presence of oxygen or not, and this is followed by the final stage in which anaerobic organisms, or those which do not require oxygen for their action, complete the process of decay. (46.) While, therefore, the number of bacteria at a depth from the surface is increased by disturbing the soil and interring the body in it, this increase is not likely to be so great as to place the body, so far as the presence of these needful agents is concerned, in a position as favourable for complete decay as if it were placed nearer the surface, and such evidence as {here is of the results of superficial as compared with deep burial confirms this opinion. (47.) (ii.) Character of the coffins in general use.—The use of coffins made of material—usually elm or oak—which, when placed in the earth, does not tend to be destroyed, is another factor which plays a part in frustrating the object of burial in earth graves. That this form of coffin does not decay is shown by the fact that wooden piles driven into the bed of rivers for the purposes of bridges, last for indefinite periods, and that the old wooden water mains which are at times excavated in different parts of London are found in a sound state of preservation. In the case of coffins the same thing applies, and instances are not wanting where a grave has been reopened down to the last interred coffin for a second interment after a considerable period, and the coffin found to be as intact as at the time of its burial. It is only when the coffin is of a character so fragile as to give way to the superincumbent weight of earth, or where, owing to moisture, the screws have undergone rusting and swelling and so caused bursting of the wood that opportunity arises for any contact between the corpse and the surrounding earth. In any case, the use of such coffins is to approximate the conditions of this socalled earth burial to that of entombment with this difference that the absence of a hermetically-sealed coffin, such as one of lead, affords opportunity for the gaseous and liquid products of decomposition [2] 10 to pass into the surrounding soil, which, if of an impervious nature like clay will retain them more or less within the limits of the original excavation, for an indefinite period. This latter point will be referred to later. (48.) A marked instance of the effect of an indestructible encasement of the body in retarding decay is given by Sir Seymour Haden, in a paper entitled "The Disposal of the Dead," dated October, 1888. After referring to the conditions which existed in the past, and which led to action on the part of the Government and the closure of the old churchyards or intramural places of burial which were overcrowded, and after pointing out that the provision then made for the future— namely, the opening of new places for interment "outside the town, to become in no long time as much inside the town" as those which had been abandoned—can only result in the creation of the original difficulty of "overcrowding" to be again remedied by the repeated opening of new cemeteries, he proceeds as follows— "It was under these circumstances that in 1875—impatient of a position at once so "helpless and so little creditable to us as a practical people, and scarcely less so of certain "fanciful proposals which were just then being put forward for its correction—I ventured to "advance the alternative recommendation of a simple reliance on the provisions and prescrip"tions of nature, and to promise as a return for such reliance a speedy extrication from all "our difficulties. Fortified by the well-defined cosmical law, which provides for a return to "the earth of all organized bodies that had lived and died upon its surface, I pointed out "that by enclosing the bodies of the dead in hermetically-sealed coffins, we were vainly "seeking to make them an exception to that law, and by preventing their dissolution, were "ourselves the cause of their embarrassing accumulation. Further, I showed that by the "simple expedient of enclosing them in coffins which would not prevent the resolvent action "of the earth—in coffins, that is to say, as perishable as themselves—we had it in our power "at any moment we pleased, if not wholly to undo the mischief we had done, at least "to stay its progress and to avert its ultimate consequences. Finally, I declared that if the "dead were only thus properly buried in from three to five, or at most seven, years from "the time of such proper burial, not a single dead body would remain to infect the soil, "and a quantity of land of incalculable value, now hopelessly alienated, would be liberated " for purposes of hygiene or of utility.* "Nor had I long to wait for a striking confirmation of the soundness of these propositions. About that time it leaked out that the Prussian Government were issuing a secret com"mission to enquire into the condition of the dead in the battlefields of the Vosges. A year "and nine months or thereabouts had elapsed since those battles were fought, and it was "feared, as many dead bodies were known to have been only very superficially buried, that "epidemic disease might result. What the commissioners found, however, entirely put an "end to any such fears. In cases in which as many as 800 dead bodies, in the hurry incident "to rapid military movements, had been thrust into one shallow excavation, these bodies it "was found had already disappeared, their bones and accoutrements alone being left. But "to this unexpected disappearance there was a remarkable exception. The bodies of officers "buried in macintoshes, and which thus represented more or less the condition of bodies "buried in coffins, had not so disappeared. I was not at the time allowed by the rules of "our Intelligence Department to make any use of the information which, through its "instrumentality and the courtesy of our ambassador at Berlin, I had thus obtained. There "can be no harm in my using it now, though I do not know that it adds anything very "material to the previous knowledge which 1 had acquired by experiments conducted on a "small scale in my own garden, and on a larger during the removal of the Holborn burial"ground, in which latter case it was found, as I have stated elsewhere, that the only bodies "which had wholly disappeared were those which had been thrown without covering into "the plague-pit. And here I may as well mention other plague-pits which I have seen "opened—since we shall presently hear of the danger which attends the disturbance of all "such ground—that I never heard of any harm whatever having arisen from such disturbance "or from the exposure and removal of the bony residuum which constituted their sole "contents. No harm, indeed, resulted from the removal of the whole of the Holborn "burial-ground, though the operation, if I remember rightly, was carried out in the middle "of summer." (49.) To remove the obstacle placed in the way of the process of decay by solid wooden coffins, the use of coffins which are of a readily perishable nature when placed in the earth has been proposed. Coffins of different material have been introduced and made use of, but the one which, so far as can be gathered, best meets the requirements is that known as the earth-to-earth coffin. This coffin was introduced by Mr. Larkman, at one time secretary of the London Necropolis Company, and was patented by the company, but the patent has now lapsed. It is made of paper pulp or millboard about 1/8th inch in thickness on a framework of wood, and with a wooden bottom, so as to give it the stability necessary for the weight of the body, and is lined internally with an imnervious waterproof lining (such as is used in the packing of articles which are being sent abroad), in order to prevent any leakage from the coffin up to the time of interment. Externally it is covered with cloth and has the usual fittings. When placed in the earth it disintegrates within a space of two or three weeks, and allows the earth to come into free contact with the body. This form of coffin is not used to any large extent however, indeed there appears to be a marked preference on the part of the community to use coffins of polished wood rather than those covered with cloth. Such use as is made of it is almost entirely restricted to the wealthier classes. Compared with wooden coffins the cost to the ordinary public of an earth-to-earth coffin is * Haden, Francis Seymour, F.R.C.S., three letters to the Times, January 12th, March 13th and June 16th, 1875. Reprinted tiy MacMillan. 11 probably much the same, the charge varying between £2 to £20, according to the degree of elaboration, but in its simplest possible form, such as might be used by the guardians of the poor for the burial of paupers, the cost of its construction would be £1, or a few shillings more than the cost now paid for the simple elm coffin which is used in these cases. (50.) (iii.) Character of the soil.—A large extent of the ground still unburied in the cemeteries available for residents in London consists of a dense and tenacious clay, in some places low-lying or of a flat surface, and liable to be moist in character. There appears to be no doubt, from the statements made to me during this inquiry by persons connected with cemeteries, that the best soil for bringing about the decay of the dead is one of a dry and porous nature, such as sand or gravel, through which air, necessary for the oxidation of organic matter, can circulate without difficulty, and from which water falling on the surface and percolating into the soil can readily pass away.* A clay soil possesses neither of these advantages. An excavation in it is to all intents and purposes a water-tight receptacle, and if such an excavation be again filled in with the disturbed earth—as is the case when a body is buried—this disturbed earth, however well rammed down, remains more pervious than that forming the sides and bottom of the excavation and allows water to soak in at a rate greater than that with which it can pass away. It thus becomes damp, or even waterlogged, if efficient means are not resorted to for draining. Even with artificial aid to improvement such soil can never be as satisfac tory as one porous and naturally drained ; and it would appear that the influence exerted upon the process of decomposition which sets in after death is one of retardation, the result depending upon the interaction of the various conditions brought to play, namely, the condition of the body, the interval which elapses between burial and death, the condition of the soil, as well as the conditions which have already been referred to, of depth of burial and character of coffin. Even in the case of a soil naturally porous, such as gravel or sand, it is essential that burial be not effected below the level of the subsoil water, and if this level be near the surface, drainage of the land is requisite before using it for burial in order that decay of the body be not retarded. The regulations of the Home Office provide for this by requiring that burial places shall be, if necessary, underdrained to such a depth as will prevent water remaining in any grave or vault. (51.) The final result of burial in a clay soil seems to be one of two, either (1.) the body remains without much apparent external change, or (2.) the products of decomposition pass into a liquid form which may be retained within the limits of the grave for an indefinite period, if no means of drainage of the grave exist. (52.) As regards the first of these, the following experience of a superintendent of a cemetery may be related. In the cemetery in question, the soil of which consists of low-lying London clay, a body was exhumed for transportation abroad, eight years after death, from a grave twelve feet deep. The coffin was found to have undergone a sort of dry rot, and during removal it partly gave way, exposing the upper part of the corpse. The face had the appearance of a recently deceased person, and had apparently undergone but little change. This, it was thought, was due to the fact that the grave, although not separately drained, was situated between two drained brick graves and immediately above the level of a cemetery drain, so that the ground was constantly very dry. In the case of an undrained clay grave, which has become waterlogged, it is probable that the tissues of the body would undergo a change into adipocere, or saponification, and that the body would retain its external form without marked change, as in the case of bodies which have been exposed to continual conditions of dampness for a long period, in other situations. (53.) Regarding the second of the above-mentioned results, which is probably of more frequent occurrence, if no means of drainage to the grave exist it sometimes comes about that when at a later date another grave is dug adjoining it, the existence of a layer of claystone, or other cause giving rise to a fissure in the ground separating the two graves, allows leakage of the foul contents with consequent inconvenience if not actual harmful effects to the workmen. An instance illustrating the above was heard of during the inquiry. One of the cemeteries visited, and which was opened within the last few years, is situated on a clay soil towards the bottom of a small valley. The ground when laid out was deep drained, but it was not considered necessary to connect the earth graves, as they were dug, with the drains. After burial had been taking place for a few years it was found that the earth graves showed signs of containing much water, and it was decided to tap them from a trench dug parallel to the row of graves, and to connect them with the drains. On tapping the graves liquid so foul escaped as to render the work difficult of execution. Another instance is given in a paper by Mr. C. H. Cooper, published in the transactions of the Sanitary Institute, vol. xv. In this case a trench was being dug close to a cemetery situated in a low-lying clay soil. The portion of the cemetery adjoining had not been buried in for 25 years, but so foul were the oozings from this ground into the trench as to compel the workmen to cease work at times. (54.) The following experience, related by a superintendent, appears to be an exception to the above remarks as regards the processes taking place in an earthen grave in a clay soil. In a cemetery with a clay soil a body was, with the approval of the Home Secretary, and at the request of the friends, removed from one private grave to another, after an interval of 12 years. The screws in this coffin had rusted, and the coffin was so dilapidated as to expose the remains. These * A similar opinion as to the soil best adapted for cemeteries is given in the report of the Commission of 1850 on a general scheme for extra-mural burial. Thus, in describing a site near London which had been chosen as being suitable for a proposed new cemetery, the following statements are made—"It rises by a gradual ascent from the river bank to the height of 80 feet above high-water mark. The surface is moderately irregular, being here and there a good deal broken, but consisting for the most part of gentle undulations and slopes. It comprises an ample extent of land, in a tract of gravelly and firm soil over chalk. Immediately below the gravel is a bed of sand 70 to 80 feet in depth." " Below the sand is the chalk, which is nearly on a level with low water, but water is not arrived at for the depth of from 270 to 300 feet. There are no streams or rivulets crossing the surface of the land in any direction and no springs whatever. These conditions secure the dryness of the soil, and are conducive to the natural process of decomposition." 12 sisted of the skeleton and hair only. In this case the grave was situated in the higher ground near the boundary of the cemetery, and was in the neighbourhood of trees, and this probably accounts for the conditions found, since it appears that the influence of trees in the neighbourhood of graves is to cause alternations in the conditions of moisture and dryness, producing rotting of the coffin as well as rusting of the screws, and so allows more intimate relation between the body and the soil. The presence of roots of trees would also tend to the draining away of the contents of the grave. (55.) Recognition of the result of burial in clay soil has led to the deep drainage of the land, and in many cases all or as many as practicable of the earth graves are directly connected with the drains, and burnt ballast or other loose material is placed at the bottom of the grave, and even used to fill up the grave at one end in order to allow the products of decomposition and of water passing into the graves to pass readily away. In those cases where the system of drainage is thoroughly carried out and is freely provided with ventilation by means of ventilation pipes and air inlets, the disadvantages of clay appear to be somewhat lessened For the most part, however, the drain connection of every earth grave in a clay soil is not effected. Common graves usually are connected, since in each cemetery they are dug more or less to the same depth, generally just above the level of the drains, and in the same part of the ground, so that there is little difficulty under these conditions in connecting the first grave in a row to the adjacent drain, and then laying a pipe between one grave and another throughout the row as each grave is dug. In the case of private graves, however, the depth chosen may be at some distance above the level of the drains, and the spot chosen for the grave may be at some distance from the nearest drain, and connection with a drain would involve a greater amount of labour and time than can probably be given to it at the time. (56.) Further, in graves in clay soil gases of decomposition appear to be retained for a long period, so that when a grave is re-opened a second time, upon reaching the depth of the last interr ed body, the effluvium may be so great as to interfere with the work of the labourers. In such cases it may be necessary during the process of excavating to bore an opening through the intervening soil to allow a freer exit to the gases, so that the work may be proceeded with with as little delay as possible. In the case of graves in porous soils, such as gravel or sand, it appears that the reopening of graves is not attended by this drawback. (57.) At a cemetery which was visited during this inquiry, it was found that a condition had been imposed at the date of its approval which indicates that an opinion similar to that expressed above as regards the unsuitability of clay may have had influence at the time. The condition referred to is that at this cemetery the coffin when placed in the grave is to be embedded in concrete. This is done by first of all pouring in concrete in liquid form so as to cover the bottom of the grave, and then after the coffin has been placed in position pouring in more concrete so as to surround the whole coffin. The concrete is then allowed to set and the grave filled in. Action of the earth is thus entirely interfered with, and in fact burial in the earth is practically converted into entombment. It is true that a like condition of approval was met with at one other cemetery where the soil is not clay but river gravel, and one probably well suited for earth burial. The imposition of the condition in this case would not therefore be based on unsuitability of soil, but indicates rather an entertainment of the view that even in a suitable soil burial in the coffins now used, and at the depths customary, so far interferes with the object of earth burial, as to render the application of conditions of entombment desirable in the case of all earth graves. (58.) The disadvantages possessed by a clay soil are absent in the case of those of a gravelly or sandy nature. In such soil, owing to greater permeability, a freer movement of air and of water is able to take place naturally, and there is no need for draining graves or even the ground except primarily with a view to lowering the level of the subsoil water where it is proposed to bury at depths lower than this level. Further, the experience of those connected with cemeteries having soils of this character tends to show that the changes which go on are more rapid than in the case of an impervious soil, and that the reopening of a grave for a second interment, if not within a short period of the last interment, or the digging of a new grave in proximity to another already occupied, is seldom if ever accompanied by effluvium nuisance. The following experience has bearing on this subject of the advantage of a pervious loose soil—The soil of a cemetery consists of fine, dry sand, which is for the most part capped by a layer of clay varying from about 8 feet to 16 feet in depth. When the ground was laid out the surface, it is stated, was swampy and the ground was systematically drained at a depth of 9 feet, thus enabling graves 8 feet deep to be dug, or in other words allowed burial within the layer of clay. Some years afterwards the ground was redrained at a depth of 20 feet, and graves could after this be excavated into the sand. It is found in the reopening of graves, that those in the clay—the older graves in the cemetery—are generally very offensive, and the soil is much stained, whereas this is not so in the case of more recent graves in the sand. It was also stated that the coffins appear to disintegrate in the latter to an extent which does not take place in the clay. In the case of the grave of a child 6 feet deep in a cemetery with sandy soil, which was reopened after four years for a second interment, nothing appeared to be left but the skeleton. (59.) The above account of what takes place after burial of the human body by the existing methods is sufficient—so far as it is possible to form any conclusion without actual examination of graves definitely for this purpose—to show that the decay of the body is to a large extent interfered with by the conditions of its burial. To place the body under the most favourable possible conditions, it is essential— (i.) That it be not buried at a considerable depth. This requirement would carry with it another requirement, namely, that only one body be buried in the same grave. (ii.) That only coffins of readily destructible material be used. (iii.) That the soil used be of a suitable character. (60.) With these conditions it appears possible that after a certain period the body will have undergone decay to an extent that the ground may be regarded as being no longer occupied by 13 corpses, and as being therefore available for use over again for the burial of other bodies. If this be so, it would be possible to provide once for all the total amount of ground which is needed for the disposal of the dead by burial of a given population, the area of ground needed being subject only to alterations in the annual number of deaths. (61.) Before adopting means of burial with this object in view, however, farther information is required, so far as the human corpse is concerned, (a) as to whether its more superficial burial is liable to give rise to objection, and (b) as to the period which should elapse before the ground could be used again. (62.) In regard to the former it has to be pointed out that one of the results of the inquiry of the Royal Commission in 1850 was the framing of regulations which prohibited burial within a given depth of the surface, this being evidently with the object of preventing nuisance such as is shown by the evidence given before the Commission used to arise from the churchyards then in use. It must be remembered, however, that these churchyards had become so overcrowded with corpses that the soil bad become impregnated with the incomplete results of decomposition, and it is probable that if the ground had been used in such a way as to avoid this, such objection would not have arisen. In connection with this matter reference may be made to a report by Dr. Brouardel, published in the Annales d' Hygiene Publique, torn: xvi., 1886, on a proposal to lay out a cemetery at Boulogne-surSeine. In this report he refers to chemical and microscopical examinations made by Schutzenberger and Miquel respectively of the air of cemeteries in Paris, the results of which show that the decay of bodies under normal conditions of inhumation gives rise neither to the escape of gases of a deleterious nature into, nor to an increase in the number of bacteria in the atmosphere. Thus samples of air collected at a cemetery showed no difference bacteriologically, from those collected in a public park in the suburbs of Paris. In the case of samples examined chemically only the ordinary constituent gases of the atmosphere, namely, nitrogen, oxygen and carbonic acid gas were found, the last mentioned being (in samples collected at the surface of the ground) slightly in excess of the normal. It follows, therefore, that other gases which may be produced in the process of decay of the body are absorbed and split up before leaving the ground. These analyses and researches seem to show that there is no cause to fear that the air from a cemetery need be of an injurious nature. Clay soil, with its liability to fissure to a considerable depth during hot weather, would, however, be subject to the risk of allowing offensive emanations to pass into the air without being subject to the influence of the earth. (63.) In the second place the possibility of disturbance of the remains by animals, which may be thought of as likely to arise from burial nearer the surface, needs to be mentioned. This, however, is a question of management of burial places, which could no doubt be provided for, so as to avoid any risk of its occurrence. (64.) Regarding the point as to the period during which a grave should remain undisturbed, the data for fixing this cannot be said to have been determined in regard to the human corpse in a manner sufficiently accurately to enable an opinion to be given. The existing regulations, in a qualified sense, imply that an interval of 14 years may be sufficient. The experiments with the bodies of animals which have been made by individual observers, and which have already been referred to, indicate that a period less than this is adequate for the disappearance of the body if the animal be buried superficially in a suitable soil, and without any covering which can retard the process of decay. Brouardel states in the report just referred to, that Schutzenberger has shown that in a soil of average permeability decay of organic matter is complete in five years. Further, the experience of the Prussian Commission, related by Sir Seymour Haden, shows that in the case of the human body the period necessary under the conditions of burial of the special case is well within 14 years. (65.) Before, however, any definite period could be given for guidance in the mode of use of ground in cemeteries, it is desirable to obtain further information by careful experiments as to actual results in the case of soils, which are available in the neighbourhood of London, and which appear to be of a suitable character. It is possible that conditions now exist in some cemeteries by which light might be thrown on this matter. In some of the parochial cemeteries when first opened, and when the number of burials was not so great as at present, bodies were buried in common graves at relatively shallow depths of five and six feet, and the grave then closed after a single burial. At Woking Cemetery similar graves exist. Some of these have not since been used, though an interval of 10 years having elapsed and the graves not having been purchased, the ground is now available for further use. A careful examination of this ground would possibly afford information bearing on the point. (66.) With the adoption of burial under the above conditions and on the assumption that the ground could be utilised over again after a known period, it is possible to form an estimate, with a certain degree of definiteness indicating the availability of the ground in existing cemeteries for a given number for all time. (67.) The total area of virgin ground in the list of cemeteries given in this report is some 1,300 acres. This includes ground the soil of which is London clay and is unsuitable. A deduction of this would leave roughly about 880 acres. This amount includes all the ground as yet unburied in in burial places included in groups ii. and iii. in the table given earlier in the report, and doubtless errs on the side of excess as regards soil suitable for earth burial, since some of it—though how much it is not possible to state definitely—is of a clayey nature, and therefore not well suited for the purpose of burial. Now the total number of deaths in the County of London in 1897 was 79,209. The present regulations of the Home Office require that each grave space shall be, in the case of adults 9 by 4 feet, or 4 square yards, and in the case of children under twelve years of age 6 by 3 feet, or 4½ by 4 feet, or 2 square yards. Under a special set of regulations no definition is given of the grave space, but it is required that each grave must be separated from graves by an interval of one foot, which in practice means that the space to each adult grave is on an average 7 feet by 3 feet. It will be better, however, in estimating the amount of ground necessary, to take into consideration the larger space of 9 feet by 4 feet, which cannot be regarded as excessive for the purpose in the case of adults, and 6 14 feet by 3 feet for children under 12 years. The proportion of deaths of children under 12 years is somewhat more than a third of the total number, but for the purpose of this computation it may be taken as one-third. (68.) The deaths in 1897 therefore would be made up of 52,806 adults and 26,403 children under 12 years, and allowing the above spaces to each of these they would require the following amount of ground, namely— Adults 211,224 square yards. Children 52,806 „ „ Total 264,030 square yards. In other words 55 acres per annum would be required tor the dead of the bounty of London, increase of population, with a larger number of deaths, would necessitate a yearly provision of space greater than this, but in connection with this the following figures as to the yearly number of deaths in the administrative County of London are of interest— Year. Deaths. Population. 1891 89,017 4,232,188 (census) 1892 86,650 — 1893 90,364 — 1894 75,705 — 1895 85,416 — 1896 81,963 4,433,018 (census) 1897 79,209 — 1898 82,312 — (69.) the area given above does not include provision tor paths, or tor a belt of unused ground around the boundary of the cemetery. For these purposes it is computed, in a memorandum of the Local Government Board in regard to cemeteries, that 1/6th of the total area should be allowed for paths and buildings, and ¼th to 1/3th according to the configuration of the site, for a neutral belt separating the actual burial ground from adjoining property. (70.) From this estimate as to the area required for one year, it would be possible, with a knowledge of the period which must elapse before ground can again be used a second time for purposes of burial, to give an estimate as to the area which would serve for all time. (71.) There are three factors which to some extent qualify an estimate formed as above, and it would be necessary to make allowance for the influence which they would have upon the rate of use of the available ground. Two of these factors tend to increase, while the other tends to lessen the amount of ground which would be required in the future. So that in practice they would probably more or less cancel each other. The factors referred to are— (i.) The increase in the adoption of cremation of the dead body. (ii.) The persistence of the skeleton in the grave. (iii.) The custom of allotting graves for private or family use in perpetuity. (72.) (i.) The influence of cremation—In a speech recently delivered before the Cremation Society, Sir Henry Thompson, the chairman, reviewed the progress of cremation since the society was established in 1874. Prior to 1883 the society had given an assurance to the Home Secretary that no cremation would be carried out without previous leave from him, and cremation cannot be said to have come into recognised use before this year. In 1883 Sir James Stephens gave judgment in regard to a case of cremation which occurred in Wales, and which was the subject of legal proceedings, that cremation was a legal proceeding if no nuisance were caused. In 1885 the first cremation of a human body at the society's premises at St. John's, Woking, took place. Since that date the numbers in each year have shown a slow increase. Thus in 1885 the number of bodies cremated was 3 1895 „ „ „ 150 1898 „ „ „ 240 (73.) Further, during this interval crematoria have been erected in other parts of the country as follows— At Manchester, opened in 1892. At Glasgow, opened in 1894. At Liverpool, opened in 1896. At Hull, in course of erection. (74.) The Vestry of Camberwell in 1897 appointed a sub-committee to consider and report on the subject of cremation as a possible alternative to burial. This sub-committee recommended in favour of powers being obtained to enable a crematorium to be erected by the local authority, and this was adopted by the vestry. The City of London has also decided to seek for power to erect a crematorium at its cemetery at Ilford. (75.) Other metropolitan authorities have also considered the question, and have adopted a similar recommendation, and it appears from information obtained by the sub-committee of the Camberwell Vestry that a large number of local authorities throughout the country have expressed approval of such amendments in the Acts relating to the disposal of the dead as may enable them to provide and maintain crematoria. (76.) The Council also has had under consideration the question of obtaining powers for the erection and maintenance of a crematorium. (77.) In a recent number of the Medical News, published in New York, the following figures are given as to cremation on the Continent of Europe during 1898— Gotha 179 bodies. Heidelberg 105 „ Hamburg 98 „ Jena 21 „ 15 (78.) The following facts as to cremation in the United States are given in the British Medical Journal, July 8th, 1899—The first organised attempt at cremation in the United States was in New York, in 1874, and the first crematorium was erected privately at Washington, Pa., in 1876. It was not till 1885 that New York finally erected a crematorium. From that time till 1897 others were erected in different parts of the country until the total number reached twenty-five, of which one in Middleton, Conn., has not been put to use, and one in Washington, Pa., has gone out of use. More than half of these crematoria are connected with cemeteries. Undertakers control three. From 1884-1898 the number of bodies which had been cremated was 8,883, of which total 1,699 were cremated last year. There has been a slow, but steady increase. (79.) The extent to which cremation is at present in adoption as a means of disposal of the dead is relatively small, but it would appear from the above figures that objection to it on sentimental grounds is lessening, and it probably would be more widely made use of by individuals if the facilities for adopting it were greater and the cost less. A greater number of cremations would no doubt materially tend to lower the cost. The cost of the process at the present time at the crematorium at Woking is given in a pamphlet (1898) issued by the Cremation Society of England, at £5. This includes the charge for cremation, services of attendants at crematorium, use of chapel and waiting-room, as well as a simple urn for the ashes. In the case of a person dying in London it is stated, the total cost, inclusive of all charges, need not exceed £15. The ashes can be buried in ground attached to the chapel for the fee of one guinea. This would compare adversely with the minimum charge for burial in a private earth grave. But this expenditure is probably capable of being lessened. The Vestry of Camberwell obtained—for the purpose of the report referred to above—information as to cost of cremation at the Cimetèire de 1'Est, in Paris, and it appears from this that the cost varies according to the class of funeral, the minimum charge for persons dying in Paris being 50 francs. (80.) In the future, therefore, cremation is likely to have appreciable effect on the question of the amount of ground needed for the disposal of the dead. (81.) (ii.) The persistence of the skeleton in the earth—The persistence of the skeleton, that is, the inorganic portion of the body—which is insusceptible of decomposition—in its complete form is undoubtedly of considerably greater duration than that of the body itself, and disturbance of this would, on grounds of sentiment, be an objection to the use of ground over again, or at least would necessitate a prolongation of the period within which this could be done. It is possible, however, that in some soils, by a process of disintegration and crumbling, even much of the skeleton may lose its form, and under such conditions there should be no reasonable objection to the use of the ground again for the purpose of another interment, indeed, sentimentally, there appears to me to be less objection to this course than to the present custom of burial in what are, known as "common" graves, that is unpurchased graves. These graves are dug of a, depth sufficient for six or eight bodies, and are filled up forthwith with the bodies of persons who are in no way connected with each other, but who have died about the same time. The privilege is usually accorded to relatives to erect small headstones, with the result that several of these are frequently noticed on the surface of the same grave. (82.) (iii.) The custom of allotting graves for private or family use in perpetuity—The prevalent custom of purchasing graves offers probably a greater obstacle to the provision of burial places on the principle of again being able to utilise for burial the whole of the ground. This purchase of graves is not a purchase of the freehold of the piece of ground, but a purchase of the right of burial, which can only be exercised by the person who is the recognised owner of the grave, the limit to the use of the grave being whether it is full or not. Carrying with it the right to erect a monument over the piece of ground an additonal difficulty is introduced, and it appears likely therefore that a part of a burial place would always have to be reserved for the use of persons wishing to have the privilege of obtaining a grave the ground of which could not be disturbed without the sanction of themselves or members of their families. (83.) The adoption of burial under the conditions most favourable for promoting decomposition as set out above, is not, except as regards the kind of coffin, and to a certain extent the depth of burial, a matter within the control of the individual. The character of the coffin used is to a great extent under the control of members of the community individually, but although it appears to be their desire to be buried directly in the earth, owing either to a lack of appreciation of the effects of such coffins as are generally in use, or to the force of custom and the paramount influence of undertakers, or both combined, the methods which are adopted are such as to frustrate or at least to delay the object with which an earth grave is often chosen rather than a brick grave or vault. (84.) To ensure a combination of the most favourable circumstances, it would appear that action on the part of the legislature is necessary. (Ii).—The expediency of making further regulations in regard to places of burial. (85.) The second part of the instruction of the Committee is as to whether there is need for making any further regulation in the interest of public health. (86.) It will be necessary in this connection to refer to the methods of burial of the dead at present in use, and to the question whether there is evidence that these methods lead to nuisance. (87.) The methods in vogue in the various burial places in the metropolis are based upon and subject to regulations made by the Secretary of State under the powers conferred by the Burial Acts, except as regards private cemeteries already in existence in 1852, which were formed under special Acts of Parliament, and which are only subject to the regulation as to common interments, The first set of regulations was made in 1853, and since that date there have been several revisions. In addition, there is a special set of regulations differing slightly from the others, which is used in special cases. In a memorandum forwarded from the Home Office, with a complete set of the regulations, it is 16 stated that "the regulations have no general application per se. They are brought into force in "individual cases by the following process: Whenever the Secretary of State is asked to approve "a new burial ground, he gives his approval conditionally on the observance of the regulations "—in London all new burial grounds require his approval, and it may therefore be taken for "granted that most, if not all, the burial grounds opened in the metropolis, as defined by "schedule B of the Act, are subject to some regulations of the Secretary of State—which of the "six different sets of regulations they are subject to would depend on which of them was the one "in use at the date when the particular burial ground was opened." (88.) The following is an abstract in a tabular form of the regulations as revised at different dates since 1853. One or other of these indicate the conditions of approval of the cemeteries established since that date— Regulations. Year when regulations were made. Area of grave space required. Least depth of coffin from surface. Interval which shall elapse between interments.* Is foot of earth to be left between coffins? Is there a regulation prohibiting more than one burial in a grave at one time?* 1. 1853 If 17 yrs. of age or over. ft. ft. 9 x 4 If between 7—17 yrs. of age. ft. ft. 7 x 3 If between 0—7 yrs. of age. ft. in. ft. in. 59 x 29 3ft.—4ft. If 16 yrs. of age or over. 14 yrs. If between 7—16 yrs. of age. 10 yrs. If between 0—7 yrs. of age. 7 yrs. No. If corpse be undecayed, remains not to be disturbed, and grave not to be used. Eighteen inches of soil to be left over last coffin in private graves. Whenever a burial has taken place grave to be forthwith filled up with earth. 2. 1857-1863 If 12 yrs. of age or over. ft. ft. 9 x 4 If between 0—12 yrs. of age. ft. ft. 6 x 3 3ft.—4ft. If 12 yrs. of age or over. 14 yrs. If between 0—12 yrs. of age. 8 yrs. One foot to be left undisturbed, and, if offensive, soil not to be touched. No remains to be removed. One body only shall be buried in a grave at one time. 3. 1863 If 12 yrs. of age or over. ft. ft. 9 x 4 If between 0—12 yrs. of age. ft. ft. 6 x 3 or 4½ X 4 Ditto. Ditto. Ditto One body only to be buried in a common earth grave at one time. 4.-1882-1893 Ditto Ditto Ditto Ditto One body only to be buried in a grave at one time. 5.—1893 Ditto Ditto Ditto Ditto One body only shall be buried in an unwalled grave at one time. 6.—Present date. Form B—For general use. Ditto Ditto Ditto Ditto One body only shall be buried in any common earthen grave at one time. Form A—For use in special cases. No earthen grave to be dug within 1 foot of any other Ditto Ditto Ditto One body only shall be buried in any common earthen grave on same day unless every coffin be forthwith covered with earth at least 1 foot thick, closely rammed and never to be disturbed. All the regulations require cemeteries to be kept drained, so as to prevent any water remaining in any grave or vault. Since the first framing of regulations in 1853 the requirements have been the same as regards (excluding consideration of requirements as to family graves) spare of grave, least depth of coffin from surface, and interval of time which is to elapse before a grave can be used a second time, except that between 1853 and 1863 a slight and not important revision was made as to space required for graves of children. As regards private or family graves the only difference in the regulations is that those of 1853 required in the case of wall-graves or vaults an air-tight metallic coffin, whereas the subsequent regulations require that each body be entombed separately in an air-tight manner, i.e., properly cemented stone or brickwork, which shall never be disturbed. In each earth grave burial can take place at any time on request of relatives. Since 1857 the regulations have required that one foot of earth shall be left undisturbed over last buried coffin when a second interment takes place. This evidently applies either to a private earth grave or to one which has not been purchased. In the set of regulations previous to this date, viz., 1853, the requirement was 18 inches in the case of private graves, and if in any grave the body was found to be undecayed the grave was not to be used. Since 1857 there has been a regulation prohibiting more than one burial at a time in a grave, but the wording is not always the same, thus, in the regulations of 1857 and 1882 the requirement refers to "a grave"; in those of 1863, to"a common earthen grave"; in those of 1893, to " an unwalled grave" ; and in those of the present date, to "any common earthen grave." * Excluding private graves. 17 A special set of regulations exists now which differs from all the above—(1) in not defining the area of grave, but each must be one foot from another; (2) more than one body can be buried in a grave on same day if one foot of earth be put in and rammed down never to be disturbed, and if bodies be those of members of the same family. (89.) The method of burial in the cemeteries which have been visited (excluding those belonging to the Jewish community) may conveniently be considered as regards private or ■purchased graves and common or unpurchased graves. (90.) In the case of the former, when an interment is to be made for the first time the grave is dug upon the site selected to a depth varying according to the number of bodies which the purchaser anticipates it will be used for, and when an interment has been made the grave is forthwith filled up to the level of the ground, and afterwards, if the relatives so desire, they are allowed to place a headstone or other form of monument over the grave. When the grave is needed for a second or third interment, it is re-opened to within a short distance of the last interred coffin, with the object of leaving undisturbed the interval of earth prescribed by the regulations. It appears, however, from statements made during the inquiry, that at some cemeteries, owing to the demand of relatives, it is necessary to expose either the entire coffin last interred or the coffin plate, otherwise complaint is made that the wrong grave has been opened, or that some other person has been buried in it during the interval which has elapsed since the last interment. (91.) For the purpose of common interments, the practice now in vogue in most cemeteries is to have ready for use a number of graves varying in depth from 10 to 20 feet. These are generally dug in a row side by side or end to end in a special part of the burial ground, or cemetery, and it is generally found that all the open graves are in use at the same period so as to avoid the necessity of keeping one burial waiting until another has been completed when there is more than one on the same day and at the same time. In such cases a common interment service may be held over two or more bodies in the chapel and at the grave side, if the graves be close to one another. Arrangements, however, exist at those cemeteries where many common interments take place, to have burial services at fixed intervals—about every ½ to 1 hour—during the afternoon (no burials taking place in the morning except when special fees are paid), and by this arrangement the same grave may be used more than once on the same day, the previously interred coffin being covered with earth before another is buried. As regards two cemeteries, however, it was stated that more than one burial in the same grave on the same day was prohibited by special regulation. Common graves are similar in size and shape to ordinary private graves. No such thing as an excavation sufficiently large in area to admit more than one adult coffin at the same level was met during the inquiry. They only differ in appearance from private graves, in that the latter are usually solitary openings, whereas the common grave forms one of a number in a part of the ground specially set apart for the purpose, but each grave is separated from the other by an interval of earth. This collection in one spot of a number of graves leads often to an untidy appearance of the immediate surroundings—which is absent in the case of the private grave—owing to presence of the bank of earth which has been excavated. (92.) In use, common graves differ from private graves in that a number of persons, in no way connected, are interred in each, and that the grave is not finally closed until it has received its full complement of bodies. (93.) The use of a common grave in this way—that is, delaying the final closure till it is filled with coffins—is common in all the cemeteries. Originally when parochial cemeteries were first provided in place of the old churchyards, it appears to have been the custom in many of them to fill up a common grave at once after one interment, each body being given what is termed a " churchyard grave." The present practice of using common graves as a recognised method appears to have arisen upon an application to the Home Secretary by a parochial burial board in 1858. As a result of this application an inquiry was made on behalf of the Home Secretary into the local circumstances, with the result that the regulation, that only one body shall be buried in the same grave at one time, was relaxed, subject, however, to the following condition, which was set out in the letter from the Home Secretary to the local authority, namely, "provided that every coffin is immediately covered with soil one foot in thickness, and the soil closely rammed down, and that no common grave in which several bodies have been buried is ever again reopened." Precedent apparently being thus established, the custom has been adopted in other cemeteries, as the population of the district for which the cemetery provides, and as the number of interments have increased, the objects being the economical use of the ground, and saving in the labour and time necessitated by the frequent opening of the ground. (94.) As regards economy of space, if burial in the earth, carried out as has been suggested earlier in the report, allows the ground to be used over and over again after a given interval, the above method—that is, one which prevents any further use at any time of the ground occupied by common graves—is not the most economical. During the inquiry, ground was seen which, originally used for the burial of one body only in a common grave, was now again available for burial, an interval of 14 years, as required by the regulations, having elapsed since its previous use, and in some cases such ground was again being utilised. If burial had been effected in the manner suggested, i.e., one body in a grave, within a few feet of the surface, and with perishable coffins, a shorter interval of time would probably have sufficed. (95.) As regards economy of labour and time there is much probability that this is effected by the present custom, since the digging of a separate grave for each body would involve, in order to comply with the regulation requiring 4 feet of earth to be left between the surface and the coffin, a minimum excavation for each interment of 6 feet or so. (96.) This, however, appears to be the only thing which can be said in favour [3] 18 of the present practice of burial in common graves. On the other hand, there are several disadvantages. Practically there is the objection that a common grave, as at present used, remains unclosed generally for several days, the interval between the first and last interment varying, in different cemeteries and at different times of the year, from two or three days to ten days or a fortnight. During this interval the coffins already interred lie in a partially-filled excavation covered by a thin layer of earth, while the top of the grave is covered over by boards. In cases where a long interval elapses between two interments the grave is often filled in up to the surface temporarily with loose earth. From the point of view of sentiment there are the objections (1) that a number of persons in no way connected are placed in one grave, and (2) that relatives in some cases do not like a deep grave. The former objection is one which, it may perhaps be said, would apply in the case of a separate grave if, after an interval of years, it is to be again used for a common interment, but the objection would only exist in a modified degree, since the ground would not be used again till the remains of the previous occupant had undergone complete decay, and during the interval the immediate relatives may have left the neighbourhood, or have given up visiting the grave. As regards the latter, it was stated at one cemetery that it had been found necessary to reduce the depth to which common graves were dug owing to this objection, and at others application is at times made for a shallow grave, that is to say, for burial in a grave which has nearly received its full complement—and at one cemetery I was informed that the desire to have a shallow grave has led to unpleasant scenes at the grave side when more than one interment was taking place. In such cases the intense expression of feeling appears to have been connected with religious sentiment, but in most the explanation given to account for the preference for a shallow grave is the belief commonly held that the relatives of the last interred body possess a greater right to the surface of the grave than the relatives of more deeply interred bodies. It may also be that a desire to purchase a grave at some future date, and to remove the body to it may have some influence, since permission for such removal can no doubt be more readily obtained in a case where the disturbance of other bodies is not involved. (97.) In several cemeteries it is the custom to use the upper part of adult common graves for the bodies of children, two or three coffins being placed on the same level. In others, however, children are buried in separate common graves of a smaller size and shallower depth than the adult grave. The reason for this is that there is an objection on the part of relatives to burying children at a great depth. (98.) Cemeteries belonging to Jews do not come within the above remarks. In these it is the custom not to bury more than one body in a grave. The depth of burial is not more than 6 feet from the surface, and the coffin must be in contact with the soil. Brickwork is at times used at the sides of graves, but this is rather with a view to forming a support for a monument, and the space between the brickwork and the coffin is filled in with earth. In no case is there brickwork on the bottom of the grave. Coffins are similar in character to those used by other persons. (99.) So far as the present practice of common interments is concerned, the existing regulations if applied, would appear to be sufficient to prevent the practice. If, however, more superficial burial is to be regarded as the proper mode of interment the regulation as to minimum depth from the surface would perhaps need revision. (100.) During the course of my inquiry I did not myself experience any nuisance. It would appear possible, however, that the custom of interment in common graves, which frequently are not filled and finally closed for an interval of several days, the coffins being covered with only a small amount of earth, may lead to the passage into the atmosphere of foul gases which are being disengaged from bodies in different stages of decomposition enclosed in coffins which, while not being hermetically closed, are yet sufficient to prevent the contact of the surrounding earth with the corpse, and to lessen the deodorising action which this contact would probably have. Further, as regards cemeteries where clay exists there is no doubt, from the statements made, that in dry weather fissures occur in the soil over graves to a much greater depth than in a clay soil which has not been disturbed. In one cemetery I was informed a fissure was searched and followed to a depth of 8½ feet, and in another instance it appears that during the dry summer of 1898 unusually deep cracks occurred, and one was followed with a probe till the underlying coffin was reached. The occurrence of such fissures gives rise to the liability of the direct passage into the atmosphere of gases which have previously been pent up by the impermeability of the clay soil. The re-opening of graves may also cause nuisance in the immediate vicinity, and if the soil be of clay this would occur even after a long period since the previous interment. (C.) Conclusion. (101.) The conclusion indicated by the facts set out in the foregoing part of this report is that there would be advantage if alterations could be made in the conditions under which the burial of the human body in the earth is at present effected. The recognition by the community of the true object of burial, which is indicated by the preference for earthen graves rather than vaults or brick graves, lends hope to the idea that eventually there would not be any objection to an acceptance of the view that tenure of the ground by a corpse is, under such conditions, of a temporary nature only. (102.) With a view to bringing about alteration in the present conditions, the following steps might be taken— (103.) That power be obtained to bury bodies at superficial depths with a view to the examination of the ground at a future date. (104.) That, if no contra-indications were forthcoming, the existing regulations should be relaxed, with a view to allowing burial within two or three feet of the surface, provided that the nature of the soil be suitable, and that bodies be buried in coffins made of perishable material. 19 (105.) That, if in any special case there be no reason to the contrary, permission should be given, in regard to existing burial places, to utilise the upper layer of ground which has been already used for common interments, and which is no longer, under existing conditions, of further use; provided that the body be buried in a coffin of perishable material. (106.) That perishable coffins be used in the case of all paupers or the bodies of hospital cases buried at the expense of the guardians. (107.) The adoption of burial under the altered conditions would do away with the present undesirable method of common interments, and each body of adult and of child would have its separate grave. (108.) Secondly, it would to a large extent, if not entirely, overcome the difficulty which exists under present conditions of having at periodical intervals to extend existing, or to provide new cemeteries, by enabling the ground to be utilised over again after a sufficient interval has been allowed to elapse since previous interments. It is this difficulty which, with a view to the economy of space, has led to the present undesirable mode of interment in common graves. The persistence of desire to erect monuments over the actual site of interment would possibly necessitate the reservation of part of the ground for graves to be held in perpetuity, and to this extent would restrict the use of the whole area of ground over again. Details as to each Cemetery. (109.) The information contained in the following account has been obtained by inspection of the cemeteries and by personal inquiry of clerks to burial boards, superintendents of cemeteries, and secretaries to cemetery companies. The statements made as to the amount of ground still available for use should be regarded as approximate estimates based upon the intimate knowledge possessed by those who have had, for the most part, to do with these places of burial for a number of years. (110.) In the case of Paddington, the clerk of the burial committee of the vestry has been good enough to obtain, by going through the registers since the date of opening of the cemetery, the number of graves already used which are still available for further burial, and the total number of interments which can still be made in them. (111.) In the following account the cemeteries have been arranged in alphabetical order, and are given in two classes, namely, those situated— (a) Within the administrative County of London. (b) Without the administrative County of London. (112.) The administrative county differs from the metropolis as defined in the Burials Act, 1852, in that the latter includes the parish of Willesden, but excludes the parishes of Lee, El'.ham, Kidbrook, Lewisham, and the hamlet of Penge. A.—Cemeteries situated within the County of London. (113.) Abney-park cemetery—Opened 1839. Situated at Stoke Newington, the cemetery is surrounded on all sides by houses in proximity to its boundaries. The soil for the greater part consists of London clay, but over a small extent sandy soil, varying in depth from 2 feet to 2½ feet lies over the clay. In some parts a running sand is met with at a depth of about 12 feet. The cemetery is drained at depths of 8 to 15 feet by brick drains, which discharge into the metropolitan sewers. All these drains are laid underneath pathways; they drain the ground and surface water. The total area is between 32 and 33 acres. Of this there are, it is stated, about 10 acres not yet buried in, consisting of small plots and single spaces, the largest plot being about 3/4 acre in area. This distribution of what is regarded as virgin soil is owing to the fact that in the past it has been customary to sell only every alternate space. This ground will, it is estimated, probably avail for 50,000 interments. As regards the ground already used, about 15 acres of private graves can still be buried in, and will, it is expected, provide for 25,000 burials, if all is used. The area of space generally purchased in the case of private graves is 8 feet 6 inches by 3 feet, 9 feet by 4 feet, or 10 feet by 4 feet. Common graves are all 25½ square feet. The usual depth required by purchasers of private graves is 12 feet. A greater depth than 14 to 15 feet is discouraged by prohibitive charge for excavation. Common graves are from 14 to 20 feet deep, and usually 8 to 10 bodies are interred. It takes from a week to ten days to fill a common grave, but during the summer time they are not kept open so long, so as to prevent any risk of nuisance. The catacombs at this cemetery are never used now. The use of brick graves has alfo much diminished. The total number of interments in 1897 was— Private 557 Common 1,014 Total 1,571 (114.) Brompton cemetery—Opened 1840. Situated at West Brompton, the cemetery is bounded on the south-west by the West London Junction Railway, immediately beyond which are two athletic grounds, and one of the 20 hospitals of the Metropolitan Asylums Board. On the remaining three sides there are houses in close proximity to the cemetery. The ground is flat, and the soil consists of river sand and gravel, which extends to a greater depth than it is ever necessary to excavate for a grave. The cemetery is not deep drained. Sub-soil water is reached at a depth of 7 or 8 feet at the northern part, but at other parts the ground is dry to a depth of 17 feet. The total area is 40 acres, and all this, except 1 to 2 acres of ground comprising the margins at either side of the central avenue, and plots of small extent between graves, has been buried in. Allowing an average of 4 bodies to a grave the virgin ground will, it is estimated, avail for the interment of some 7,200 bodies. As regards the area already used for graves, about 12 acres is entirely filled up. In the remaining 25 acres the graves are still available for re-opening. No grave is re-opened unless a depth of 5 feet can be dug after allowing one foot of soil over the last interred coffin. The area of grave space is mostly 7 feet by 3 feet; a few are 8 feet by 3 feet or 9 feet by 4 feet. There arc no common graves in use now. The depth varies from 7 feet to 17 feet. At this cemetery there are many mausoleums, one was in course of erection at date of visit. There are also catacombs and brick graves and vaults. The use of the former is not now allowed, and demand for the latter has much diminished of late years. About six brick graves were sold during 1897. The total number of interments in 1897 was 738. All these, except 98, were burials in graves already used. (115.) Camberwell cemetery—Opened 1850. Situated at East Dulwich, near Honor Oak station on the London, Chatham, and Dover Railway, which bounds the cemetery on the east. On the south and south-east there are houses close to the cemetery. The ground is for the most part on a slope, and the soil consists of stiff London clay, barely needing timbers to stage up the sides of graves as they are dug. Clay stone is occasionally met with. The cemetery is deep-drained. The total area is 32 acres, of which it is stated 16 acres are still unburied in. It is estimated that about 100,000 bodies can be buried in the cemetery if all private graves are used for the number of bodies for which they were originally dug. In a report to the Vestry of Camberwell by the superintendent of the cemetery, dated November, 1897, an estimate is given that if burial be continued as at present the ground will last between 30 and 40 years. The area of grave space is, for private graves 6 ft. 6 in. by 2 ft. 6 in. „ ,, ,, common graves 6 ft. 6 in. by 2 ft. 6 in. The depth usually required for private graves is 12 feet. Common graves are 12 to 15 feet deep, mostly 12 feet. On an average 8 bodies are interred in each common grave, the upper part being used for children's bodies, two or even three coffins being placed on the same level. This allows the grave to be filled to within 3 feet of the surface. Brick graves are occasionally wanted. The interments in 1897 were— Private 477 Common 3,121 Total 3,598 (116.) Charlton cemetery—Opened 1855. The situation of this cemetery is on high ground to the south-east of Old Cbarlton. The soil consists of a dry sand or gravel in the older portion, and of gravel in a recent extension of the cemetery. The soil forms part of the Woolwich and Reading and Thanet geological beds which come to the surface in the south-east of London. Drainage is not needed except for carrying away surface water. The total area is 8 acres, and of this quite 4 acres, it is estimated, are yet unburied in. Most of the ground already used is occupied by purchased graves which are still available for re-opening. The area of all grave spaces is 9 feet by 4 feet, except as regards graves in one portion which was originally plotted out in spaces of 7 feet by 3 feet. Private graves vary in depth from 6 to 12 feet, the greater number being 12 feet deep, and a few are 15 feet deep. Common graves were formerly only dug 6 feet, and only two bodies were interred in each; now it is the custom to dig to a depth of 12 feet for the larger and 9 feet for the smaller size grave spaces. Children are always buried in separate graves, 7 feet by 3 feet in area and 12 feet in depth. Common graves remain open for a period of 1 to 2 weeks before being filled; if longer than this they are temporarily filled in during the interval. Three to four bodies are interred in each common grave. Very few brick graves are required. The number of interments during 1897 was— Private 104 Common 121 Total 225 21 (117.) City and Tower Hamlets cemetery—Opened 1841. Situated a little to the south of Bow-road, the cemetery is surrounded by houses in close proximity on all sides, except for a short extent at the south-east corner where a railway forms the boundary. The houses are separated from the cemetery boundary by public roadways except at the eastern limit, where houses on one side of Wellington-street have small yard spaces extending to the margin of the cemetery. The surface of the ground is level, and the soil consists of gravel and sand, except near the railway, where clay is met with in parts. The ground is drained at a minimum depth of 20 feet, the drains discharging into the local sewers. The ground is said to be very dry. No graves are connected with the drains. The total area of the cemetery is 40 acres. There appears to be no knowledge as to what amount of ground has not yet been buried in, but it is stated that at the present rate of burial the ground is estimated to last for about 14 years. There is no plot of ground of large extent unburied in. Such vacant ground as is available is made up of small plots in different parts judging from the appearance of the cemetery. In the ground already used a large number of private graves are, it is stated, still available for re-opening. The area of ground usually purchased in the case of private graves is 6 feet 6 inches by 2 feet 6 inches, intervals of 1 foot laterally and 2 feet between rows being allowed between graves. Common graves are of the same area, with lateral intervals of 1 foot and 2 to 3 feet alternately, and intervals of 9 inches to 1 foot between rows. The most usual depth in the case of private graves is 10 to 12 feet. Common graves are dug 18 to 20 feet deep, and 7 or 8 adults are interred in each. Children are buried in separate graves, each grave containing about 14 coffins. The use of brick graves has much decreased. The number of interments in 1897 was— Private 370 Common 2,465 Total 2,835 (118.) Deptford cemetery—Opened 1852. Situated at Brockley, adjoining Lewisham parochial cemetery, which forms the western boundary of Deptford cemetery. On the north and north-east Ivy-lane and Brockley-road, having houses on the opposite side, form the boundary, while on the south-east and south there are houses and some open land. The sub-soil, made up of the Woolwich and Reading beds, consists of fine sand capped, over the greater part of the cemetery, by loamy clay, varying in thickness from 8 feet to 16 feet. The ground is drained at a depth of 20 feet, the drains discharging into the local sewer in Ivy-lane. When the cemetery was laid out, the ground, which was very damp in character, was drained at a depth of 9 feet. This only allowed graves to be dug to a little over 8 feet—that is within the limits of the clay portion of the soil. In 1875 the cemetery was redrained at 20 feet, thus allowing use to be made of the sandy soil underlying the clay. It is found that on reopening private graves in the clay the soil is generally offensive, even after a number of years, whereas those which have been dug into the sand are not so. In the latter case also it has been found that destruction of the coffin takes place much more readily than in the more superficial clay layer. The total area is 20 acres (including 4 in reserve, which have been acquired since the cemetery was opened). Of the total it is estimated that there are about 12 acres of virgin soil available for burial. This ground—apart from the 4 acres in reserve—is made up mostly of small plots, and spaces between graves, owing to the fact that it has been the custom to bury in all parts of the ground since the cemetery was opened. As regards private graves, most of them are still unfilled. The area of grave spaces in the case of both private and common graves is 9 feet by 4 feet for adults, and 9 feet by 3 feet for children. A frequent depth for private graves is 12 feet. Common graves are mostly 20 feet deep. The length of time which it takes to fill a common grave varies; it may be two cr three weeks if it is a deep grave. When the cemetery was first opened it was the custom to give a "churchyard" grave in the case of common interments—that is, each body had a separate grave, which was filled in forthwith. The use of brick graves now is quite infrequent. With a view to using up some which were formerly built, a small commission is given to undertakers when one of them is used for burial. The number of interments in 1897 (March, 1897-1898) was— Private 109 Common 1,739 Total 1,848 (119.) Fulham cemetery—Opened 1865. The cemtery is situated on the east side of Fulham Palace-road. Houses are gradually being built on the land surrounding the cemetery. The cemetery has been enlarged twice since it was first opened. The ground is flat, and the soil consists of fine river sand and gravel extending to a greater 22 depth than that required for any grave. Originally the level of the subsoil water was reached at a depth of 9 to 11 feet, but now it is not reached till 17 feet, this probably being due to the construction of sewers in the neighbourhood owing to the erection of houses. The cemetery is not deep drained. The total area of the cemetery is 14 acres. Of this about 2 acres only are virgin ground. But a large extent of the ground has in the past been used for common graves, in each of which one body only has been buried. It was the custom at first when the number of burials was not great to give each body a "churchyard" grave, and to fill it up at once. This ground is now available for use again, and it is estimated will provide for some 6,000 bodies. The area of each grave space is 7 feet by 3 feet. When the cemetery was first opened 9 feet by 4 feet was required for each grave, but about 1884 application was made to the Home Office, and the adoption of the smaller area allowed. The depth of private graves varies, but if no special depth is fixed on by relatives 7 feet are excavated. Common graves are dug 17 feet, and usually six bodies are placed in a grave. Children are buried in separate graves. There are brick graves and vaults here, but they are mostly family graves, first buried in years ago. Brick graves are only occasionally required nowadays. The total number of burials in 1897 was— Private 483 Common 1,429 Total 1,912 (120.) Greenwich cemetery—Opened 1857. Situated to the south of Shooter's-hill, not far distant from the Herbert Military Hospital and the new hospital of the Metropolitan Asylums Board. There are no houses in the immediate neighbourhood. The greater part of the cemetery is situated on sloping ground, and the soil is made up of clay, which in parts is very damp. The ground is drained by means of main brick drains, and lateral drains across the burial plots. Only brick graves are connected with the drains. The depth of the lateral drains varies; the main drain is 12 feet from the surface at the receiving points. Brick graves are seldom required. If a vault space be purchased it is often used as an earth grave. The total area of the cemetery is 16 acres. No further information has been obtained regarding this cemetery. (121.) Hammersmith cemetery—Opened 1869. The cemetery is situated at Margravine-road, Fulham. Houses have now been erected in its immediate neighbourhood. The soil consists of river gravel and sand, the subsoil water being generally reached at a depth of 12 feet from the surface. It is not deep drained. The total area is 18 acres, of which about 8 acres are still virgin soil, but no definite information was obtainable on this point. The area of all grave spaces, both private and common, is 9 feet by 4 feet for adults, and 4 feet by 3 feet in the case of children. The depth of private graves is usually 10 feet. Common graves are dug to 12 feet, that is to the level of the subsoil water. During some years past no common graves have been dug in new ground owing to the fact that when the cemetery was first opened it was the custom to give, in the case of each common interment, a separate grave which was then closed. Much of the ground was therefore occupied by bodies each in a separate grave, but at such a depth as to allow sufficient interval between it and the surface for more bodies. The period of 14 years laid down in the regulations having elapsed, this ground is now being used over again. The number of bodies buried in each common grave depends upon the depth to which these graves can be reopened. Brick graves are seldom made use of now. The number in this cemetery is not large. The number of interments in 1897 was 1,441 (about 130 private interments on an average in each year). (122.) Hampstead cemetery—Opened 1876. Situated at Fortune-green, Hampstead. There are no houses in proximity except towards the south-east corner of the cemetery. The soil consists of London clay, and the cemetery is drained at depths varying from 8 feet to 30 feet from the surface, the drains discharging into the metropolitan sewers. All common graves and brick graves are connected with the drains. A layer of burnt ballast is placed in the bottom of each earth grave, and one end of each grave is filled in with ballast up to the surface with the object of ensuring free drainage of water passing into the grave. The total area is nearly 20 acres, and of this about 10 acres have not yet been buried in. There were some 15,000 grave spaces still available in 1897. The area of private graves is 6 feet 6 inches by 2 feet 6 inches, with an interval of 1 foot on all sides. If a greater amount of space is required a second space of the same size must be purchased. Common graves are the same area. Vault and brick graves are 9 feet by 6 feet 6 inches, or 9 feet by 4 feet. Private graves are usually dug to 11 feet; common graves vary in depth 23 according to the level of drain; at date of inquiry they were being dug 15 feet. The number of bodies in each common grave varies, the upper part of the grave being used for the bodies of children. In all cases one foot of earth is left between coffins. Common graves remain open for a week or more in consecrated ground; longer in the unconsecrated portion, as the burials are not so frequent. The demand for brick graves and vaults is decreasing. A few are generally kept ready for use if required. The number of interments in 1897 was 821. (123.) Highgate cemetery. This cemetery consists of two portions separated from each other by a roadway. Waterlow-park adjoins on the north-east. On the south-east there are houses and Highgate Infirmary, and on the remaining sides there are but few houses at all close to the cemetery. The cemetery is mostly situated on a considerable slope, but at the south-east and lower part the surface of the ground tends to become flat. The soil consists of sand extending for a depth of 35 feet in the higher and middle part of the ground; the lowest part is tenacious clay, which cracks deeply in dry weather. A fissure has been traced for 8 feet 6 inches. Between the clay and the sandy portion the soil is a marl. The ground is deep drained, and brick graves are connected with the drains, which empty into the metropolitan sewers. Common graves are also connected with the drains. The total area is 38 acres. It is stated that about 8 acres of ground are still unburied in. In the older and higher portion no large plot of ground remains unused, and common graves are being dug wherever there are any available strips of ground. Only a small number of private graves have as yet been filled. It is not possible to say what area of ground has been used for common graves, as these are widely dispersed over the cemetery. The area of private graves is 6 feet 6 inches by 2 feet 6 inches, 6 feet 6 inches by 2 feet 10 inches, 9 feet by 4 feet, or 9 feet by 6 feet (a double grave). Common graves are dug 7 feet by 3 feet. Private graves are generally required to be 12 feet deep. Common graves are dug 16 to 20 feet deep, and 6 inches of earth are, it is stated, left between each coffin. There are here mausoleums, catacombs, and brick graves, but none of these are now made use of to the extent which formerly prevailed. The total number of interments during 1897 was— Private 1,254 Common 414 Total 1,668 (124.) Jews' cemetery, Islington. This is a small burial ground of about 2 acres in extent, having houses and a factory in close proximity. The soil is gravel. The ground is now practically closed, no interments taking place except in spaces which have already been purchased. There are probably about 70 spaces still available, each of which is approximately about 9 feet by 4 feet in area. No more than one body is placed in a grave, and the grave is never again disturbed. The depth of graves is 6 feet. Brickwork is never used except sometimes at the sides of the graves to serve as a support to a monument. The coffin rests on the soil, and the interval between the sides of the grave and the coffin is filled in with earth. (125.) Jews' cemetery, Mile-end-road. This cemetery is situated on the north side of Mile-end-road, and close to the workhouse. The soil consists of river gravel, and the area of ground is 4 acres, which has all been used except some 500 spaces, which are still available for use. The area for each grave varies according to the size of the coffin, intervals of one foot being left between rows of graves and halfa-foot between the graves in each row. There is no distinction of graves. Graves for adults are dug never less than 5 feet (usually about 6 feet) deep, and for children a foot less. A grave is never used again, and not more than one body is interred. The coffin must always rest on the soil. Occasionally brickwork is placed at the sides for the purpose of forming a better support for the grave stone. The number of interments at this cemetery is on an average about 60 in each year. (126.) Kensal-green cemetery—Opened 1833. This cemetery is situated on the south side of the Harrow-road, in Kensal-green, and immediately north of the Grand Junction Canal. St. Mary's Roman Catholic cemetery adjoins on the west. The surface of the ground has a considerable fall in most parts, but becomes flat at the western end. The soil is made up of London clay. It is drained at depths varying from 7 to 14 feet from the surface, and brick graves are connected with the drains which discharge into the metropolitan sewers. The total area of the cemetery is 70 acres. The area which has not yet been buried in is as follows—There is a large piece of ground at the west end of the cemetery 24 which, it is estimated, is approximately about 20 acres, in which there are as yet only a few graves dotted about here and there, and some common graves at the boundary margin. In addition there is a good deal of ground consisting of small plots, and single spaces amongst the existing graves which would probably be equal to 15 acres in all. There has not, however, been any recent survey of the ground. The ground already buried in is said to be chiefly occupied by private graves, and the majority of these are still available for further interment. The area of private graves is usually one of the following, namely, 6 feet 6 inches, by 2 feet 6 inches, 8 feet by 3 feet, or 9 feet by 4 feet, with lateral intervals of one foot and intervals between rows of 2 feet. Common graves are 6 feet 6 inches by 2 feet 6 inches, an intervening space being left in between, this ground being sold for use as cheap purchase graves. When the intervening ground is so used, there would be an interval of 6 or 7 inches between each grave. The depth most frequently required in the case of private graves is 10 or 11 feet; this is sufficient for four bodies. Common graves are now mostly dug to a depth of 16 feet. In these six to seven adults and two to three children in the upper part are interred. A grave takes about eight or nine days to fill. There are many mausoleums here, also brick graves, but the demand for them has much decreased of late vears. The total burials in 1897 was— Private 1,089 Common 960 Total 2,049 (127.) Lambeth cemetery—Opened, 1854. The cemetery is situated at Lower Tooting, near Garratt-lane. At present on two sides there is open land, that on one side being land belonging to the Yestry of Lambeth, and on the other land used for agricultural purposes. On the third side a railway forms the boundary, while on the fourth is a public road. Houses are now being built on the land on the opposite side of this road, and will, eventually, extend close up to the cemetery. The ground is low-lying and flat, and the soil consists of a dense clay, with layers of clay stone in places, necessitating the use of a pick-axe when excavating graves. A quantity of water is generally found in the neighbourhood of these bands of stone. In some parts of the cemetery there is a superficial layer of river sand and gravel. The cemetery is drained at a depth of 11 feet, the drain pipes being laid in all parts underneath the footpaths. Vaults and brick graves are, where possible, connected with the drains. "Where this is not possible a pipe is brought up near to the surface, so that when necessary—e.g., after heavy rain, or just before the grave is to be re-opened—it may be pumped dry. The total area of the cemetery is 41½ acres. Of this about 10 acres have not yet been buried in, while some 13 acres already used are possibly still available for other interments. It is estimated that the virgin ground will provide for 40,000 bodies. The area of grave space is, for private graves 8x5 feet (brick graves, 9 x 4). „ „ for common ,, 8 x 4 „ The depth of graves is, for private graves various. ,, „ common ,, 12 feet. As a rule four or five bodies are interred in each common grave. Children are buried in separate graves. There are but few brick graves in the cemetery, and they are seldom required now in the case of new graves. The total number of burials in 1897 was 3,750. (128.) Lee cemetery. This cemetery, situated on the east side of Hither-green-lane, is at present at a considerable distance from houses. The surface of the ground has a considerable declivity. The soil consists for the most part of London clay, but a small portion on the higher ground is gravelly and very hard in character. The cemetery is drained by a main brick drain 12 feet deep, which was constructed when the ground was originally laid out for burial purposes; lateral drains were put in in 1874 at the same depth. Only brick graves are connected with the drains. The total area is 10 acres (4 in reserve), of which 7½ acres about are still unburied in. All grave spaces are 9 feet by 4 feet in area. Private graves are usually 8 feet in depth. Common graves vary from 15 to 18 feet, and in them are interred four or five adults, and children in the upper part of the grave. They remain open for periods of two or three weeks. The number of brick graves required each year is small. The total number interred in 1897 was 183. (121).) Lewisham cemetery—Opened 1858. Situated on high ground at Ladywell, adjoining Deptford cemetery on the west. To the south there is open land, but on the north-east boundary houses are in close proximity to the cemetery. The soil is loamy clay and sand, part of the Woolwich and Reading geological beds 25 which come to the surface in this neighbourhood, and is of a very dry character. Sand is reached at 7 feet at the south end, and at a depth of 14 feet at the north-east portion. The land is deep drained at a depth of 32 feet, the drains discharging into the metropolitan sewers. No grave is connected with the drains. The total area of the cemetery is 15 acres, including a recent addition of 6 acres. Of this there are 6 acres, and some spaces in between graves in the used portion of ground, which have not been buried in yet. It is estimated that there is room for about 3,900 graves, which in all probability will be mostly private. Allowing an average of five bodies to a grave this will provide for 19,500 bodies. In the ground already used very few of the private graves are yet filled. There are 3,184 private graves, each 6 feet 6 inches by 3 feet 6 inches, or about 5 acres of ground. The area of grave spaces now for both private and common graves is 9 feet by 4 feet. The usual depth dug for private graves is 12 feet, for common graves 20 to 22 feet. Originally the latter were only dug 8 feet, and were closed after the interment of one body. These are now being filled up with more bodies. There are still several hundred such graves in the cemetery not filled. The usual number interred in new common graves is 10 or 11 bodies, a grave taking from a week to sixteen days to fill. Burial in the earth is preferred to burial in brick graves. The use of the latter has decreased considerably in recent years, not more than one a year on an average being required here. The total number of interments in 1897 was— Private 260 Common 717 Total 977 (130.) Nunhead cemetery—Opened 1840. This cemetery is situated in the parish of Camberwell, and houses have now been built in close proximity to it on the north-east and north-west. The cemetery is on high ground, and the surface has a considerable fall in parts. The soil consists of dense London clay, but in one part a small belt of running sand is at times met when excavating graves. The total area of the cemetery is 54 acres. About two years before the date of inquiry a survey was made, and it was then found that there were 28 acres of virgin ground, including spaces between existing graves. Since the date of this survey it is estimated that about two acres more had been used, leaving about 26 acres available for new graves. It was estimated that if the rate of burial remained the same as up to the date of survey the cemetery would last for another fifty years. The area of private grave spaces is 6 feet 6 inches by 2 feet 6 inches, 8 feet by 3 feet, or 9 feet by 4 feet, according to the position in the cemetery in which the grave is chosen, the larger areas being in the more desirable situations. Common grave spaces are 6 feet 6 inches by 2 feet G inches. The depth usually required in the case of private graves is 12 or 13 feet—that is a grave for six bodies—but any depth may be required, and exceptionally a depth of 30 feet has been dug. Common graves are dug 18 feet, 20 feet, or 24 feet deep, and in these respectively 7, 9, and 12 bodies of adults, together with one or two rows of children's coffins in the upper part are buried. In all cases 5 feet of soil are left between the top coffin and the surface of the ground. The catacombs at this cemetery are extensive, but they are seldom used for burial now. The use of brick graves and vaults is also decreasing. The total number of burials in 1897 was— Private 931 Common 4,403 Total 5,334 (131.) Plumstead cemetery—Opened 1890. Situated in Wickham-lane, close to the boundary of the county. The ground is on an elevated situation, and the surface has a good slope. The soil consists of sand and gravel of the Woolwich and Reading geological series. In some parts chalk has been reached at a depth of 13 feet, but it is in most parts not nearer than 20 feet from the surface. The ground is not drained except for surface water. The total area available for the purpose of the cemetery is 32 acres, but only 10 acres have so far been appropriated for use. Probably not more than 5 acres have yet been buried in, and this area mostly contains private graves still available for further interment. About half-an-acre contains common graves, and is no longer available for further use. All grave spaces for adults are 9 feet by 4 feet, and 6 feet by 3 feet for children. The majority of private graves are dug 10 feet; that is a depth sufficient for three interments. Common graves are dug to 20 feet and 8 bodies are interred. Children are not buried in adult common graves but have separate graves 12 feet deep, or sufficient for six children. When the cemetery was first opened common graves were not dug deeper than 10 feet, but the ground was thus being rapidly used up, and as on inquiry it was found that at other cemeteries a greater [4] 26 number of bodies was buried in a grave, the Burial Board decided to do so likewise. A common grave takes from 6 to 7 days to fill. Brick graves are seldom required. The number of interments in 1897 was 6.57. (132.) Putney cemetery (new)—Opened 1891. Situated on the south-east side of Kingston-vale, towards the bottom of a small valley. There are no houses in the immediate vicinity. The soil consists of a dense clay. It is drained at a depth of 14 feet by open jointed pipes laid at intervals of 50 feet in trenches which are filled up to within 6 inches of the surface with ballast. When first opened earth graves were not connected with the drains, but it was afterwards found necessary to do so, and it is now the practice to drain each row of graves by a drain passing from one grave to another till that nearest a drain is reached; this one is connected by a pipe passing into the ballast surrounding the drain. The bottom of each grave is filled in with a layer of ballast in which the drain lies. The total area of the cemetery is 13 acres, but only 6¼ are in use. Of the total, 12 acres are yet unburied in. The amount of ground so far used for common graves is small in extent. It is estimated that 40,000 interments can still take place in the cemetery. The area of grave space is, for private and common graves, 9 feet by 4 feet. The depth usually required in the case of private graves is 10 feet. This is also the minimum depth dug, while a maximum of 13 feet is never exceeded. Common graves are usually dug 13 feet deep, and generally provide for 6 coffins. Brick graves are only occasionally constructed, burial in the earth being preferred. There are probably not more than 20 brick graves in the cemetery, though it is stated this is a cemetery used by persons who are well off and residing in the west-end of London. About four is the average in each year. The interments m 1897 were— Private 97 Common 101 Total 198 (133.) Putney cemetery (old). , Situated at Putney Lower-common. There are no houses in close proximity. The soil consists of river gravel. The cemetery is now full as regards new graves, but is still used for the burial of those who own private graves. The total area is 2f acres. There is probably provision here for the further burial of 1,500 bodies, if all the graves are used. (134.) St. Mary's (Roman Catholic) cemetery, Kensal-green—Opened 1858. Situated to the west of and adjoining Kensal-green cemetery, it is bounded to the south by the Grand Junction Canal, and on the north by a railway. The surface of the ground has a slight fall to the west. The soil consists of tenacious London clay, which gets harder and drier the deeper it is excavated. The ground is drained at a depth of 12 feet. The drains discharge into the metropolitan sewer in Scrub-lane at a depth of 35 feet. All the drains are laid underneath paths. No graves are connected with them except brick graves. Earthen graves in proximity to brick graves are really drained by the latter. The total area of the cemetery in use is between 22 and 23 acres. In addition there are between 4 and 5 acres of land in reserve. The amount of virgin ground now available is approximately about 10 acres. In the ground already used there are probably some 9,000 private graves, and most of these are still available for re-opening. It has been estimated that at the rate of burial in the past the cemetery will last for 60 years. The area of each private grave is 9 feet by 4 feet. The space allowed to each common grave is 8 feet by 3 feet 6 inches. Formerly and till about the year 1863 the space was 9 feet by 4 feet, and only one body was buried in a grave. The reduced space was then allowed by the Home Secretary, but until 1869 it remained the custom not to bury more than one body in a grave. This ground is now again available for use under the conditions laid down in the regulations. The depth of most private graves is 12 feet, but a depth of 25 feet has been required. Common graves vary as to their depth from 7 feet to 16 feet—that is, sufficient for from two bodies to nine bodies. The difference in depth depends upon the requirements at different times of the year. Children are buried in separate common graves, 6 feet by 3 feet in area, and never more than 7 feet deep. There are catacombs here, and also a few mausoleums and brick graves. The catacombs are still used to a fair extent, but chiefly for the corpses of foreigners who have died in England, the corpse being placed here temporarily with a view to transportation to the native country of the deceased. The number of burials in 1897 was— Private 332 Common 1,469 Total 1,801 27 (135.) Streatham cemetery—Opened about four years ago. The cemetery is situated at the western limit of the parish, near Garratt-lane. At present there is open land around it. The surface of the ground has a slight fall towards the west in the direction of the river Wandle. The soil consists of a fine white and dry river sand down to a depth of 10 to 12 feet where clay is reached. The ground is drained at a depth of 25 feet, the drainage being lifted by pumping into the neighbouring sewers. Earthen graves are connected with the drains. The total area of the cemetery is 23 acres in use, and 3 acres in reserve. Of this about 25 acres have not yet been buried in. There are only 3 rows of graves which have been used for common interments, and which therefore cannot be again disturbed. The remainder of the graves are private, and available for reopening. The area of grave spaces is, private and common, 9 feet by 4 feet 6 inches. The depth of graves is as follows—In the case of private graves a greater depth than 9 to 10 feet is seldom required. This is sufficient for three interments. A greater depth than 12 feet is never dug. In the case of common graves 20 feet is the depth. The number buried in each common grave is 7 to 8 adults, and children in the upper part of each adult grave. This allows the grave to be filled within 3 feet of the surface. Common graves are sometimes not filled for three weeks. In such case the grave is temporarily filled in with loose earth over a plank bottom. An interval of 9 inches to a foot of soil is left between each coffin. Brick graves or vaults are seldom required. Number of interments in 1897 — Private 91 Common 292 Total 383 (137.) South Metropolitan or Norwood cemetery—Opened 1838. Situated at Lower Norwood, the cemetery is surrounded on all sides by houses. The surface of the ground is hilly, and has a good fall in a northerly direction. The soil consists of London clay. The cemetery is not deep drained, but there are superficial drains for carrying off the surface water. The total area is 40 acres 28 perches, of which it is stated that some 20 acres are still unburied in. This area of 20 acres will, it is estimated, provide for 150,000 interments. The ground already used is mostly filled with private graves, the proportion of common interments being small. Probably 12 acres of the occupied ground is still available for further interments, and will provide, it is estimated, for about 70,000 bodies if all graves are used. The area of private graves is 6 feet 6 inches by 2 feet 6 inches, or as much more as may be purchased. For common graves an area of 7 feet 6 inches by 3 feet 6 inches is allowed. The usual depth required in the case of private graves is 10 feet; the minimum depth of any grave is 7 feet. Common graves are 18 feet deep, and provide for 8 to 10 coffins, an interval of one foot of earth between each being left as near as possible. In the case of private graves, the desire on the part of relatives to see the last interred coffin does not always permit an interval to be left between coffins, and it is stated that in practice a private grave 15 feet deep is found to provide for as many interments as a common grave of 18 feet. There are at this cemetery— (1) Catacombs, under the Episcopal chapel. (2) Mausoleums. (3) Vaults and brick graves. (4) Earth graves. Catacombs are seldom used now. The mausoleums are chiefly erected by members of the Greek community in London, who use this cemetery. There are many of these buildings here. Vaults and brick graves, it is stated, are much less frequently wanted than formerly, probably one to forty or fifty earth graves, but there are a considerable number in the cemetery which were constructed in former vears. The number of interments in 1897 (including still-born children) was— Private 1,214 Common 802 Total 2,016 (136.) Tooting Churchyard. This is the burial ground for those dying in the parish of Tooting, except those persons in public institutions which exist in the parish—e.g., Chelsea Union and a fever hospital. It is situated at St. Nicholas Church, in Lower Tooting, and has open land to the south and east. The soil consists for the most part of gravel, with bands of clay here and there. Common interments, or interments of paupers, do not take place here. In the case of all graves the right of burial is purchased, except in the case of children, and most are family graves. The usual depth of graves is 9 feet. 28 Brick graves are still buried in to a small extent—about four a year on an average at this churchyard. The number of interments in 1897 was 123. (138.) Wandsworth cemetery—Opened 1878. Situated on rising ground in the parish of Wandsworth, to the east of Garratt-lane, and just south of the South-Western Railway main line. Some distance to the north-east is Wandsworth Prison. There are no houses in proximity to the cemetery. The surface of the ground has a good slope. The soil consists partly of clay and partly of river gravel, and a new piece of ground, lately acquired with a view to extension, is of a sandy nature. The cemetery is drained at a depth of 13 feet, and brick graves are connected with these drains. The total area is 34 acres; of this 12 acres are enclosed and 9 laid out for cemetery purposes. The remainder is used for nursery or agricultural purposes. Of the total, 30 acres have not been buried in, while of the 4 acres already used about 1 acre is occupied by common graves, and is therefore not again available for interments. The area of grave spaces is, for private and common graves, 9 feet by 4 feet. The depth of private graves is variable, but the tendency, it is stated, is to have graves for single bodies. Common graves are dug 17 feet usually, four adults and three children being interred in a grave. The bodies of _paupers are interred at Woking cemetery. There are only a small number of brick graves or vaults here. They are seldom required now. The number of interments in 1897 was— Private 160 Common 765 Total 925 (139.) Woolwich cemetery. I am unable to report on this cemetery. The local authority has failed to supply information regarding it. 13.—Cemeteries situated outside the boundary of the County of London. (140.) Battersea cemetery {new)—Opened 1891. Situated at Morden, in Surrey, the cemetery is surrounded by open country on all sides. The ground is low-lying, and for the most part flat and has a small brook running through part of the land purchased for use as a burial place. The soil consists of London clay, and is drained at a depth of 11 feet from the surface, the effluent being pumped from a well into the Croydon sewerage system. The total area of the ground is 130 acres. Part of this is let for grazing; 62 acres are in use for burial purposes. Some 4¼ acres of ground have now been buried in, about 3 of which are occupied by common graves which cannot again be disturbed. Probably one-sixth of the private graves are also full. The area of all grave spaces is 9 feet by 4 feet. Children are, as a rule, buried in separate common graves, for which the same space is allowed. Private graves are mostly 7 feet deep. Common graves are dug to 10½ or 11 feet, and, as a rule, the corpses of five adults are interred in each. They are usually filled within two days. There is no demand for brick graves, and none have yet been constructed in this cemetery. The number of interments during 1897 was— Private 149 Common 1,932 Total 2,081 (141.) Battersea (???) cemetery—Opened 1860. (Situated within the county.) This cemetery is now only used for burials in private graves which have not yet been filled. Chingford Mount cemetery—Opened 1884. This is owned by the proprietors of Abney-park cemetery. The soil consists of clay. The ground is drained for surface water by means of drains laid underneath the pathways. The area of the cemetery is 60 acres, in only 5 acres of which have burials taken place, and in at least 2 acres of the latter graves are still available for further burial. The area of grave spaces is as follows—For purchased graves, 8 feet 6 inches by 3 feet, 9 feet by 4 feet, 10 feet by 4 feet; for common graves, 25½ square feet, or 8 feet 6 inches by 3 feet. Private graves are usually required to be of a depth of 12 feet. Common graves vary from 14 to 20 feet, and 8 to 10 adult bodies are in most instances buried in each grave. The use of brick graves and vaults is dying out. 29 The number of interments in 1897 was— Private 395 Common 3,218 Total 3,613 (142.) City of London cemetery—Opened 1856. This cemetery is situated at Little Ilford, Essex, adjoining Wanstead-flats. There are but few houses in the immediate vicinity of the ground. It is close to Manor-park cemetery. The ground is for the most part of fairly level surface, and the soil is made up of river gravol, with clay in parts. The gravel extends to a depth of 15 feet or less. The land is deep drained, and all common graves are connected with the main drains by drains passing from one grave to another, and then to the main drain. The effluent discharges to the river Roding. The cemetery comprises 168 acres, of which 118 are enclosed for burial purposes, and 50 acres are in reserve. In 1892, of this area 56 acres 2 roods had been buried in or devoted to graves. On an average it is found that each acre contains 1,010 graves, and allowing four bodies to each grave, the total number of interments up to date would require between 65 and 66 acres. Approximately, therefore, 100 acres of virgin soil still exist, or sufficient for 404,000 bodies. A large number of the graves already used are private, and still available for further interments. The area of private graves is 6 feet 6 inches by 2 feet 6 inches, 6 feet 6 inches by 2 feet 10 inches, 9 feet by 4 feet, and 9 feet by 6 feet 6 inches, with intervals of one foot laterally and of 11 feet 6 inches between rows of graves. Common graves are 7 feet 6 inches by 2 feet 6 inches, and intervals of one foot are left between graves and rows of graves. The depth of private graves is usually 10 to 12 feet, and of common graves 12 feet. Six inches of earth are placed between each coffin, and five bodies are buried in each grave. Children are buried in separate common graves. The total number of interments in 1897 was— Private 749 Common 4,010 Total 4,759 (143.) Crystal Palace district, or Elmer's-end, cemetery—Opened 1876. This cemetery is situated at Beckenham, and is bounded on the north-west by a railway, on the north-east by a roadway, on the south-east by a sewage farm, while on the fourth side there are a few houses, but in this part of the ground no interments have taken place. The cemetery is on sloping ground. The soil consists of London clay, which in parts is loamy in character and very hard. There are superficially-laid drains for carrying off surface water, and one drain at a depth of 11 feet from the surface of the ground which is connected with brick graves. This discharges to a ditch at the lower boundary of the cemetery between it and the land used for a sewage farm. The ground approved for use as a burial place is 35 acres in extent; of this 7 acres are occupied by paths and roads. About 29 acres are yet unburied in. In the ground already used there are more private than common graves, and very few of the former have been filled. The area of private graves is 6 feet 6 inches by 2 feet 6 inches, 7 feet by 3 feet, or 9 feet by 4 feet and 9 feet by 6 feet 6 inches, with intervals of 6 inches laterally between graves and 1 foot or 14 inches between rows of graves. The first mentioned is the most usual size. Common graves are 6 feet 6 inches by 2 feet 6 inches with intervals of 9 inches laterally and 1½ feet between rows. The depth of common graves varies between 12 and 16 feet, according to the position. One of the conditions of approval in regard to this cemetery is that between and around each coffin a layer of concrete, 4 inches or more in thickness, shall be placed. This is made by mixing ballast with lias lime. It is also used in private graves. Children are buried in adult common graves. A good many spaces, of an area sufficient for brick graves or vaults, are purchased, but they are used as earth graves. The use of brick graves is decreasing. (144.) East London cemetery—Opened 1872. This cemetery is situated at Plaistow, E. There are no houses near the ground except on the south-east. On the north it is bounded by the embankment of the northern outfall metropolitan sewer, and on the west by land which is unbuilt on. The ground lies low and is flat, and the soil consists of river gravel varying from 10 to 24 feet in depth. The ground is drained at depths of 16 to 20 feet with pipe drains, which are perforated at the upper part. No graves are connected with the drains. The total area of the cemetery is 30 acres, in about 22 acres of which it is stated no burials have yet taken place; while in 3 acres of ground already used graves are still available for further interments. The space of private graves varies, according to position in the cemetery, from 8 feet by 3 feet to 10 feet by 6 feet 6 inches. Common graves are 7 feet by 3 feet in area. Private graves are dug from 8 feet to 14 feet, according to the wishes of the owners, but a greater depth than 9 feet is seldom required. 30 Common graves are dug to the available depth, having regard to the nature of the soil— that is to say, they vary between 10 and 24 feet. The number of bodies buried in each differs in almost every case, being dependent on whether a grave is used principally for adults or children. The latter are usually buried in adult common graves which are nearly full. A large number of common graves is kept open at the same time, and it takes from 3 to 5 weeks as a rule to fill a grave. One of the conditions of approval in this cemetery is that in all graves each coffin shall be entombed in concrete. This is made by mixing gravel and Portland cement with water, which is then poured into the grave so as to secure a layer of concrete four inches thick between each coffin. Brick graves are but little used. The total number of interments in 1897 was— Private 224 Common 4,454 Total 4,678 (145.) Great Northern cemetery—Opened 1861, under special Act of Parliament. Situated at New Southgate on land adjoining a sewage farm. There are no houses in proximity to the cemetery. The ground is elevated, and the surface has a considerable fall. The soil consists of gravel for a distance of some fifty yards on all sides of the chapel. The remainder of the ground is either loam, clay, sand or stoney. The cemetery is drained at a depth of 16 feet by pipe drains perforated on the upper part, and surrounded by ballast. They are laid underneath the pathways, and discharge to Pymm's brook, which flows at the line of the boundary of lower part of the ground. No graves are connected with the drains, except brick graves when the owners desire it. The total area of the cemetery is 70 acres, and of this about 56 acres are yet unburied in. It is estimated, that on an average of four bodies to a grave, there is space sufficient for 500,000 interments. The 14 acres already used are largely occupied by private graves, most of which are available for re-opening. The number of common interments at this cemetery is decreasing, while interments in purchased graves are increasing. The area of all graves is 9 feet by 4 feet, and private graves are usually required of a depth of 11 feet. Common graves are 12 to 14 feet deep. It takes, on an average, three days to fill a common grave. One foot of earth is left between each coffin. Children are usually buried in .the upper part of adult common graves. The number of brick graves required is small. The total interments in 1897 was— Common (including paupers from Shoreditch) 1,009 Private 300 Total 1,309 (146.) Islington cemetery—Opened 1854. This cemetery adjoins, and was opened at the same date as, the St. Pancras cemetery, the ' St. Pancras Burial Board having sold part of the property which was purchased for a burial place for the district of St. Pancras to the parish of St. Mary, Islington. The character of the ground and of the soil is similar to that of the St. Pancras cemetery. A portion of the ground is drained (the chapel portion) at a depth of 18 feet, the drains joining the main drain common to the two cemeteries. The total area is 79 acres. This includes about 39 acres in reserve. The ground which has not yet been buried in, together with that in reserve, amounts approximately to 49 acres. The former consists mostly of areas small in extent, varying from 4 acres downwards. The above total does not include single grave spaces or small plots of ground of two or more grave spaces between graves which have been buried in. These probably would make up 5 acres. In the ground already used there are, it is estimated, some 6,000 private graves of which probably not more than 600 have been filled. At the present rate of interment is is estimated by the superintendent that the cemetery will last for 50 years. The area of private graves is 9 feet by 4 feet, 7 feet 6 inches by 3 feet, or 6 feet 6 inches by 2 feet 6 inches, with intervals of 1 foot between rows of graves and 3 inches latterly between graves. Common grave spaces are 9 feet by 4 feet. The depth of most private graves is 11 feet. Common graves are dug between 15 to 18 feet. A layer of three inches of earth is placed between each coffin, and children are buried in the upper portion of adult graves. This allows burial within 3 feet of the surface. Brick graves are only infrequently required. The number of interments in 1897 was— Private 336 (graves sold) Common 3,906 Total 4,243 31 (147.) Jews' cemetery, Hendon. This cemetery has only recently been approved and opened for use. Only 27 bodies have so far been buried here. It is situated at Golder's-hill, and is surrounded by fields on all sides. The soil is clay, and it is drained at a depth of 7 feet from the surface, the drain discharging into a filter bed. The total area is 8 acres, but only 4 acres have been enclosed as yet for the purpose of interments. All grave spaces are 6 feet 6 inches by 3 feet 6 inches, intervals of 2 feet laterally and 12 feet between rows of graves being left. The depth of graves is 6 feet, and never more than one body is interred in a grave, which is never again disturbed. (148.) Jews' cemetery, Willesdon—Opened 1873. This cemetery is situated at Church-end, Willesden, adjoining the cemetery provided by the Urban District Council for the use of residents in the parish of Willesden. The surface of the ground is flat, and the soil consists of London clay. It is drained at a depth from the surface of 7 feet 6 inches. No graves are connected with the drains except brick graves. As in other Jewish cemeteries where bricks are used in a grave, none are placed on the bottom, and the interval between the coffin and the brickwork is filled in with earth. The drains discharge into the local sewers. The area of ground enclosed for burial purposes is 9 acres. There are also 3 acres in reserve which were not approved for use at the date of application owing to the proximity of houses. Of the enclosed portion, about 6 acres are yet unburied in. The ground already buried in is never again used, as in the case of other Jewish burial places. The area of all graves is 6 feet 6 inches by 3 feet 6 inches, with intervals of 1 foot 6 inches between rows of graves. The depth of graves is 6 feet. The number of interments in 1897 was 141. (149.) Kensington cemetery. Situated at Hanwell, on the north side of the main road leading to Uxbridge. There are houses at no great distance. The ground is flat, and the soil consists of gravel which extends to the greatest depth to which a grave is ever dug. The cemetery is drained at a depth of 12 feet from the surface, the drp'ns being chiefly intended for carrying off surface water. No graves are connected with the drains. The total area of the cemetery is now about 15 acres. It has been enlarged twice since the ground was first opened. Of this total, about 6 acres, made up of good-size areas, have not yet been used. In addition there are spaces between existing graves, and strips of ground along the sides of the entrance avenue and paths which are unburied in. When the cemetery was first opened only one body was buried in each common grave, and this ground, probably about 1½ acres in extent, is now available for use over again. The area of all grave spaces is 7 feet 6 inches by 3 feet 6 inches or 4 feet. Private graves are usually required to be dug to a depth of 9 feet. Common graves are never dug deeper than 12 feet; below this level sub-soil water is reached. The usual number interred in a common grave is 6 adults. Children are either buried in separate graves or at the upper part of adult common graves. The greater number of interments are in common graves. The number of brick graves required is small. The number of burials in 1897 was— Common 650 Private 81 Total 731 (150.) Manor-park cemetery—Opened 1874. Situated at Manor-park, E., the cemetery is bounded on the south by the Great Eastern Railway, and on the north by Wanstead-flats, a row of houses intervening. On the west and east the adjoining land is occupied by houses. The soil consists of river gravel and sand, varying from 10 to 20 feet and upwards in depth. Drains are laid at a depth of 11 to 16 feet from the surface of the ground. The total area of the cemetery is 45 acres, of which about 20 acres are as yet not buried in and 5 acres are only partly used. In the remainder, 15 acres have been used for the purpose of common interments, and are now of no further use for burial. The area of private graves may be one of the following, namely, 6 feet 6 inches by 2 feet G inches, 7 feet by 3 feet, 9 feet by 4 feet, or 9 feet by 6 feet 6 inches. The last two are spaces for brick graves and vaults. Common graves are 8 feet by 3 feet. In the case of private graves the depth usually required varies from 12 to 14 feet. Common graves are from 14 to 20 feet deep. Children are sometimes buried in adult common graves, sometimes in separate graves. The period which elapses between the first interment in and the closure of a common grave varies with the depth, but under a special regulation in force as regards this cemetery not more than one interment is to take place in the same common grave on one day. A considerable number of common graves has therefore to be kept ready for use. 32 The demand for brick graves is small. The total interments during 1897 was— Private 200 Common 5,500 Total 5,700 (151.) Marylebone cemetery. The cemetery is situated in East-end-road, East Finchley, on elevated ground, having a cousiderable slope towards the south-west. The soil consists at the upper part of very dry and hard clay, chalky in character and containing many flints (boulder clay), and at the lower part of gravel and sand. The cemetery is drained at depths varying from 12 to 25 feet. Each grave is connected with the system of drains, which is provided with a flushing tank at the higher level, and is freelv ventilated by means of man-holes and of ventilators brought to the surface of the ground. The contents of the drains, after precipitation and filtration through specially-prepared filter bads, discharge into a brook tributary of the river Brent. The total area of the cemetery is 40 acres, and there are quite 20 acres of virgin ground, consisting of separate plots of fair size. The area of all grave spaces is 9 feet by 4 feet. The depths of private graves vary from 10 to 16 feet. Common graves are 15 to 20 feet in depth, eight bodies being buried in a grave of the maximum depth. Children are buried in the upper portion of adult common graves. The number of brick graves required has decreased. The number of interments in 1897 was— Private 186 Common 1,666 Total 1,852 (152.) Paddington cemetery—Opened 1855. This cemetery is situated at Kilburn, on the south-west side of Willesden-lane. The land around the cemetery is now, for the most part, occupied by houses, except towards the west. The surface of the ground has a fair fall. The soil consists entirely of London clay. Drains are laid at depths varying from 10 feet at the lower and 25 feet at the higher part of the cemetery. Each brick grave and all common graves are connected with the drains, which join the local sewers. The total area of the cemetery is 25 acres. In this there are 10,370 grave spaces still unused (7,470 in consecrated, 2,900 in unconsecrated ground), in which a total of 61,450 interments may be made. In the ground already used there is still space in the private graves for the interment of 27,621 bodies. The area of private and of common graves is 6 feet 6 inches by 2 feet 6 inches, with intervals of 6 inches laterally and 1 foot between the head and foot of adjoining graves in the case of common graves, and intervals of 6 inches laterally and l½ to 2 feet between the head and foot of each in the case of private graves. Private graves are mostly dug 10 feet deep. Common graves are 14 feet and 17 feet deep in alternate rows. The number interred in a common grave is 12 adults in a grave 17 feet deep, and 12 adults and children in the shallower common graves. A special regulation in regard to this cemetery prohibits the use of a common grave more than once on the same day. Brick graves are only a small proportion of the whole number of graves in each year. The number of interments in 1897 was— Private 539 Common 1,416 Total 1,955 (153.) St. George's, Hanover-square, cemetery. This is situated at Hanwell, on the south side of the Uxbridge-road, and almost opposite Kensington cemetery. The surface of the ground is flat, and the soil consists of river gravel. It is drained by a main brick drain 14 to 15 feet from the surface, and by lateral drains joining it. Brick graves are connected with the drains. The area of the cemetery is nearly 24 acres. It has been enlarged once since it was first opened. About 14 acres have not yet been buried in. The virgin ground available will probably allow 150,000 interments of adults and children. A fair proportion of the ground already used is occupied by private graves, of which very few have yet been filled. It has always been the custom here to fill common graves, and the ground so used has thus been rendered unavailable for further use. The area of all graves is 6 feet 6 inches by 2 feet 6 inches, with an interval of 1 foot between all adjoining graves. In the case of private graves a larger area than this may be purchased. Private graves are mostly 10 to 12 feet in depth. Common graves are dug 15 feet, and 33 six adults are interred in each. Children usually are buried in separate graves, but in most adult common graves children are also buried on the top. Children's graves are 5 feet by 2 feet in area. T he demand tor brick graves is small. The number of interments in 1897 was— Common 1,605 Private 181 Total 1,786 (154.) St. Pancras cemetery—Opened 1854. The cemetery is situated at East Einchley on the east side of the road leading to Barnet, and has no houses in its immediate proximity. Islington cemetery adjoins. The surface of the ground is irregular, and has a considerable fall in different parts. The soil consists of a hard, chalky clay (boulder clay), of gravel extending in parts to a depth of 10 feet, and of sand. The cemetery is not systematically drained. There is one main drain which serves for both Islington and St. Pancras cemeteries, and which discharges into Strawberry-vale brook. Joining this drain are others from different plots of the cemetery which it has been considered necessary to drain. These are laid at a depth of 20 feet, and some of the earth graves are connected with them. In the case of those graves which require draining, ballast and clinker is placed at the bottom, and is also used in filling in each grave. The total area of the cemetery is 105 acres. In addition the vestry possess 3 to 4 acres not enclosed, and about TO acres which are at present sublet. Of the enclosed land about 70 acres have not yet been buried in. In the ground already used the number of private graves (February, 1899) was 5,418, many of which are still available for re-opening; while in the portion, about 5 acres in extent, where common graves were dug when the cemetery was first opened, only every alternate grave space has been used. There are therefore about 2½ acres of this ground still available. The space of private graves varies. The area of ground sold for enclosure is either 9 feet by 4 feet, 7 feet by 3 feet, or 6 feet 6 inches by 2 feet 6 inches. Between each of these areas intervals are left of 1 foot laterally and 1½ to 2 feet at head and foot of grave. In the case of common graves an area of 6 feet 8 inches by 2 feet 4 inches is usually excavated, with the following intervals between graves, namely—1 foot at head, 2 feet at each side, and 2 feet at foot of grave. The depth most frequently required in the case of private graves is 10 feet. Common graves are dug 18 feet. The number of bodies interred in each common grave varies with the number of children's coffins which can be interred in the upper part of adult graves. In the Roman Catholic portion of the ground children have separate graves. It is the custom to leave an interval of 6 inches of soil between each coffin, and a layer of 4 feet in all graves between the top coffin and the surface. The demand for brick graves is small. A large number of non-parishioners are buried in this cemetery, especially Roman Catholics. number of interments in 1897 was— Private 300 Common 5,272 Total 5,572 (155.) Willesden (Urban District Council) cemetery—Opened 1890. This cemetery is situated at Church-end, Willesden, and adjoins a Jewish cemetery. There are no houses at present in the immediate vicinity, but the district is increasing at a considerable rate. The soil consists of London clay, and is drained to a depth of 14 feet. Brick graves are connected with the drains. The total area of the cemetery is 26½ acres, 20 acres of which, at least, are still unburied in. In the portion already used only a small proportion has been used for common graves. All grave spaces are 9 feet by 4 feet. Common graves are dug 16 feet, and seven or eight bodies are interred in each grave, a layer of earth 6 inches deep being placed between each coffin. Children are buried in separate graves. These graves are dug 11 feet deep. T he total interments in 1897 were— Private 170 Common 859 Total 1,029 Old Cemetery.—This was an extension of the old churchyard. It is now used up except for some 80 spaces still available for new graves, and private graves which are not yet filled. The soil is clay, and the ground is drained into the local sewers at a depth of 10 feet 6 inches. The area of grave spaces is 9 feet by 4 feet. The number of interments for year ending March, 1898, was 80. [5] 34 (156.) Woking cemetery—Established under special Act of Parliament, 1852. The cemetery is situated at Brookwood, Surrey, some distance to the west of Woking. It adjoins the South-Western railway station at Brookwood, and there is a special railway siding into the ground. The company have made arrangement with the railway company for the conveyance of the dead from London to the cemetery, and possess a private station with suitable waiting rooms for the use of mourners in Westminster-bridge-road. In connection with the station there is also mortuary accommodation, the provision of which enables relatives to have the removal of the body from the dwelling effected at night previous to the day of interment, when friends attending the funeral assemble at the station. By this means the disadvantages attendant on the ordinary funeral procession are removed. The cemetery is situated on high ground, and is surrounded by open country. The soil consists of fine sand, forming part of the upper Bagshot beds which extend over a considerable area in this part of Surrey. On excavation it is found to be quite dry for a considerable depth, but it is stated that in parts of the cemetery, before they are drained, moisture is reached at a depth of 6 to 7 feet from the surface. This may extend for a few feet downwards when the ground again becomes dry. The ground is drained at varying depths. At the date of visit a main drain was being laid in a trench excavated to a depth of 10 to 12 feet. The drains discharge into a brook, which eventually joins the river Wey. The total area of the cemetery is as follows—300 acres have been enclosed for use as a cemetery, and there are 200 acres in reserve. In addition the land adjoining, which comprises several hundred acres, is the property of the company, and this could be utilised for burial purposes if required. Of the 500 acres, it is estimated that fully 400 are yet unburied in, while 50 acres of the ground already used are still available for further interments. The area of ground allowed for each grave is in all cases 9 feet by 4 feet. The custom of interring a number of bodies of persons not belonging to the same family in a common grave before it is closed does not exist at this cemetery ; in other words, there are no common graves. The different classes of grave may be divided into those in regard to which the exclusive right of burial in perpetuity is purchased and those in regard to which this right is not purchased, the latter including graves for the burial of paupers. In the case of the former the grave may be any depth which the relatives require. The deepest is 20 feet, and this is quite exceptional; the majority are 8 to 10 feet, but it is stated that the tendency amongst that portion of the community purchasing graves at this cemetery is to purchase plots of ground of an area sufficiently large to allow a separate grave to each person rather than to have a single grave excavated to a depth sufficient for the same number. These private graves, if intended for more than one body, may be re-opened at any date for a second interment. The graves which are not purchased are usually dug to a depth of 6 to 8 feet. In this case also, if a relative desires to bury another member of the same family in the grave, and there be sufficient depth to allow compliance with the requirements of the Act that no coffin is to be within 54 inches of the surface, the grave would be reopened, but this only infrequently occurs, and usually not more than one body is interred in each grave. The company have power under their Act to use this ground again after an interval of 10 years. Up to the present, however, no ground already buried in has been disturbed within 20 years of the last interment. The number of interments during 1897 was 3,534. (157.) Woodgrange cemetery—Opened about 11 years ago. Situated on the south side of Romford-road, near to the point where it is crossed by the Tilbury and Southend Railway. This cemetery, Manor-park and the City of London cemeteries are all in close proximity to each other. The ground is flat, and the soil consists of river gravel and sand. It is stated that it is not drained. Information has not been received as to the area of the ground nor as to what amount is still unbunied in. There is a good proportion of the total area which appears not to have yet been used, but the rate of burial is said to be increasing, and the ground is filling up rapidly. A large n umber of persons from Upton-park, Leyton, East Ham, and the East-end of London is said to be buried here. The area of private graves is said to be 6 feet 6 inches by 2 feet 6 inches, with lateral intervals of 1 to 1½ feet and 1½ to 2 feet between rows. Common graves are 7 feet by 3 feet, with 1½ feet intervals between. The depth of private graves is usually 10 feet, and of common graves 15 feet. It is stated that under the regulations applying to this cemetery the burial of more than six adult bodies in one grave is not allowed. 35 APPENDIX. Information as to the provision for burial which has been made by local authorities for residents in the various sanitary districts, as to the cost of interment, and as to the provision made by the poor law unions for the burial of paupers. (1.) Under the Burial Acts, parish authorities, namely, the vestries, except in the case of parishes within the City of London for which the Commissioners of Sewers are the authority, have the power of determining whether or not a burial ground shall be provided for the use of the parish. Having resolved to do so, the vestries prior to 1894, appointed a burial board for the purpose. Under the Local Government Act, 1894, power is given for the transference to the vestries of the duties and liabilities of the Burial Board, and in several instances in the county this transference has taken place. (2.) The provision of places for the burial of the dead is a matter which is intimately connected with public health administration, and the following account shows the extent to which the powers conferred by the Burial Acts have been made use of by local authorities. (3.) The authority for sanitary purposes is not in all cases the same as the vestry, in several instances two or more vestries being joined for the purpose of sanitary administration, and forming a district board which is the sanitary authority for the whole district. Taking the sanitary authority as the unit, it appears that— (4.) As regards 19 sanitary authorities (including three district boards) within the county, there are 25 places for burial provided by the vestries for the parishes which are comprised in the areas under the jurisdiction of these sanitary authorities. Of these, there are— (a) Situated within the county, 17 burial places. (b) Situated without the county, 8 burial places. (a) 1. Hammersmith. 2. Fulham. 3. Hampstead. 4. Lambeth. 5. Camberwell. 6. Lewisham. 7. Plumstead. „ Forming Wandsworth 8. Wandsworth. sanitary district with 9. Tooting. Clapham, which con- 11.Putney tracts with a private cemetery. 12. Eltham. 13. Charlton. Lee sanitary district. 14. Lee. ) 15. Greenwich. Greenwich sanitary dis- 16. Deptford. trict. 17. Woolwich. (b). 1. Paddington. 2. Kensington. 3. St. George, Hanover-square. 4. Marylebone. 5. St. Pancras. 6. Islington. 7. Battersea. 8. City of London. Note.—Battersea has two cemeteries— (1) In the county, but now filled and only used for re-opening of private graves. (2) Outside the county. Putney has two cemeteries— (1) Only used for the re-opening of private graves. (2) New cemetery at Kingston Yale. (5.) As regards 24 sanitary districts, burial places have not been provided by the parishes which they comprise. They are the following:— (a) Vestries— 1. Chelsea. 2. Westminster. 3. St. James. 4. Stoke Newington. 5. Hackney. 6. St. Martin-in-the-Fields. 7. Clerkenwell. 8. St. Luke. 9. Shoreditch. 10. Bethnal-green. 11. St. George-in-the-East. 12. Mile-end Old-town. 13. St. George-the-Martyr. 14. Newington. 15. Bermondsey. 16. Rotherhithe. (b) District Boards— 1. St. Giles. 2. Strand. 3. Holborn. 4. Whitechapel. 5. Limehouse. 6. Poplar. 7. St. Saviour. 8. St. Olave. (6.) The absence of provision of a burial place by a local authority appears to be a disadvantage to persons residing in the district, inasmuch as they must bury their dead either in a 36 cemetery belonging to a private company or in one provided by some other authority, and in this case the charge for interment for non-parishioners is usually higher than for parishioners. Now, there is probably little doubt that the choice as to a place of burial by the relatives of a deceased person is in a large number of cases much influenced by considerations of proximity—that is to say, a cemetery supplies the neighbourhood in which it is situated, and consequently if a burial place provided by an authority is at a distance, and there should be another nearer, it is possible that many would choose the latter, even though having to pay a higher fee. But whether this be so or not, the residents in a district for which a burial place has been provided have the advantage of using a burial place at a smaller charge than those living in a district for which no provision has been made. Certainly the former may be considered as being justified in having to pay less, since there may be a burial rate levied in the district, although, as a matter of fact, it appears from information supplied to the Council in 1897 as to what was the amount of the burial rate, if any, raised in the different parishes, that out of 22 parishes or local authorities which have provided cemeteries, in 9 only was there a rate for the purposes of the cemetery. (7.) Information obtained for the same year, namely, 1897, as to the burial of paupers shows that in those cases where burial grounds are provided, the various boards of guardians of the unions representing the parishes avail themselves of the provision for the purpose, except in the case of Kensington and St. George, Hanover-square, the paupers from which poor law unions are interred at the Necropolis Cemetery, Woking. With one exception—viz., Marylebone—a fee is paid by the guardians to the burial boards. These fees vary from 3s. 6d. at Paddington cemetery to 21s. at Wandsworth cemetery. Where burial grounds have not been provided, the guardians make use either of the provision made by other parochial bodies or of private cemeteries, thus— 4 boards of guardians avail themselves of the ground provided by the City of London at fees of 12s. 6d. and 13s. 6d. per burial, the fees being in each case bigger than the fees paid by the Board of Guardians of the City itself, viz., 9s. 6d. 8 boards of guardians (including Kensington and St. George, Hanover-square, which have parochial cemeteries) make use of the Necropolis at Woking, at fees varying from 15s. to 30s. Gd.—chiefly 15s. 2 boards of guardians make use of the East London cemetery, Plaistow, Essex, at fees of 13s. and 13s. 6d., and of the Roman Catholic cemetery, Leytonstone. 1 board of guardians avails itself of the Manor-park cemetery at a fee of 13s. 6d. 1 board of guardians makes use of the Great Northern cemetery, Colney-hatch, at, a fee of 14s. (8.) In the following table (1) information obtained partly by circular letters addressed by the Council during 1897 to the various burial authorities and boards of guardians, and partly during the present inquiry, is set out showing the actual charges for interment, the position of the cemetery, if one has been provided, and the provision made for burial of paupers. The charges for interment refer only to common graves. Private graves are purchased at varying sums over and above these. In another table (2) information is set out as regards the private cemeteries in the neighbourhood of London which have been visited. C. W. F. Young, Assistant Medical Officer of Health. 37 TABLE 1—PROVISION FOR BURIAL MADE BY LOCAL AUTHORITIES. TABLE 2—PRIVATE CEMETERIES. 38 39 Table 1. Provision for burial made by local authorities. Sanitary district. Population 1896. Situation of burial place provided by local authority. Area in acres. Deaths, 1897, in district. BurialB, 1897, in cemetery. Charges for common interments. Amount of Burial rate, if any. raised in parish. Poor Law Union corresponding to sanitary district. Paupers buried at Fee for adults. Other cemeteries which are in use and which are situated in district. (Does not include burial places still available for occasional use under special conditions.) Parishioners. Non-parishioners. Private. Common. Total. Within county. Without county. Unconsecrated ground. Consecrated ground. Unconsecrated ground. Consecrated ground. West. Vestry of Paddington 124,506 Willesden-lane 25 1,823 539 1,416 1,955 s. d. s. d. £ s. d. £ s. d. None. Paddington Paddington s. d. Brompton Cemetery Kensal-green Cemetery 11 6 15 - 1 2 6 2 - - 3 6 „ Kensington 170,465 Hanwell 15 2,692 81 650 731 17 6 17 6 Double fees Included with poor rate of which it equals from 0 to a fraction of a penny,but usually cemetery is self-supporting ⅓d. Kensington tery Necropolis Cemetery 15 - „ Hammersmith 104,199 Margravine-road, Fulham ... 18 1,763 ... ... 1,441 12 6 17 6 2 2 - 2 9 6 Fulham Hammersmith Cemetery 9 - St. Mary's Roman Catholic Cemetery „ Fulham 113,781 None. Bishop's Palaceroad, Fulham ... 14 2,039 483 1,429 1,912 12 - 17 6 Non-parish loners cannot be buried in common groun d. Fulham Cemetery 9 - ... „ Chelsea 96,646 None. None. ... 1,713 ... ... ... ... ... ... ... Chelsea Necropolis Cemetery, Woking 10 - ... „ St. George, Hanoversquare 79,967 ... Hanwell 24 1,064 181 1,605 1,786 14 - 14 — 1 5 — 1 5 — None. St. George, Hanover- square ) Do. 15 - ... „ Westminster 53,234 ... 8 acres of Woking cemetery is reserved by arrangement with cemetery company. ... 1,025 ... ... ... Charges are the same as those of Cemetery Company None. „ St. James 23,050 None. None. ... 391 ... ... ... ... ... None. Westminster (also includes St. Anne, Soho, part of Strand district) Do. 27 6 ... North. Vestry of Marylebone 141,188 ... East Finchley 40 2,564 186 1,666 1,852 ... ... Included in poor rate and equal to jd. in the £ Marylebone Marylebone Cemetery None. ... „ Hampstead 75,449 Fortune-green ... 20 914 ... ... 821 ... Non-parish ioners cannot be bn ried here. None. Hampstead Hampstead Cemetery 10 6 ... „ St. Pancras 240,764 ... East Finchley 105 4,528 300 5,272 5,572 10 15 - 15 1 3 6 None. Cemetery is self-supporting St. Pancras St. Pancras Cemetery 5 - Highgate Cemetery „ Islington 336,764 East Finchley 79 5,393 336 (graves sold) 3,906 4,242 8 6 12 2 None. Islington Islington Cemetery 12 2 Jews' Cemetery „ Stoke Newington 33,485 None. None. ... 488 ... ... ... ... ... None. Hackney Manor-park Cemetery 13 6 Abney-park Cemetery „ Hackney 213,044 None. None. ... 3,586 ... ... ... ... ... ... None. Central. ... ... ... ... ... District Board of St. Giles 38,237 None. None. ... 698 ... ... ... ... ... None. St. Giles and St. George Necropolis Cemetery, Woking 20 - ... Vestry of St. Martin-in-the-Fields 13,077 None. None. 207 ... ... ... ... Strand this does not include St. Anne, Soho, a part of the Strand sanitary district.) Do. 27 6 & ... 30 6 District Board of the Strand 23,782 None. None. ... 499 ... ... ... ... ••• ... • if from work house at Edmonton „ Holborn 31,208 None. None. ... 706 ... ... ... ... ... ... None. Holborn Vestry of Clerkenwell 66,202 None. None. ... 1,461 ... ... 1 ... ... ... None. City of London Cemetery, Ilford 13 6 ... ... „ St. Luke 41,527 None. None. ... 1,053 ... ... ... ... ... None. City of London 30,970 ... Ilford 168 641 749 4,010 4,759 17 6 17 6 1 5 — 1 5 _ None. City of London Do. 9 6 • 1st Class 1st Class, plus Incumbent's fees plus Incumbent's fees East. Vestry of Shoreditch 122,348 None. None. ... 2,624 ... ... 8 6 8 6 1 _ _ 1 mm — ... 2nd Class 2nd Class, plus Incumbent's fees plus Incumbent's fees ... ... ... ... Shoreditch Great Northern Cemetery, New Southgate 14 - ... ... Bethnal-green 129,162 None. None. ... 2,761 ... ... ... ... None. Bethnal-green E. London Cemetery, Plaistow, Essex 13 - ... 40 41 Table Provision for burial made by local authorities-(continued). Sanitary district. Population, 1896. Situation of burial place provided by local authority. Area in acres. Deaths, 1897, in district. Burials, 1897, in cemetery. Charges for common interments. a mount of Burial rate, if any, raised in parish. Poor Law Union corresponding to sanitary district. Paupers buried at Fee for adults. Other cemeteries which are in use and which are situated in district. (Does not include burial places still available for occasional use under special conditions.) Private. Common. Total. Parishioners. Non-parishioners. Within county. Without county. Unconsecrated ground. Consecrated ground. Unconsecrated ground. Consecrated ground. East—(continued). District Board of Whitechapel 77,717 None. None. ... 1,631 ... s. d. s. d. £ s. d. £ s. d. ... Whitechapel City of London Cemetery, Ilford s. d. ... ... ... ... ... 13 6 ... Vestry of St. George-in-the-East 47,506 None. None. ... 1,259 ... ... ... ... ... ... ... ... St. George-inthe-East E. London Cemetery 13 — ... ... Roman Catholic Cemetery, Leyton stone 21 — ... District Board of Limehouse 58,305 None. None. ... 1,464 ... ... ... ... ... ... ... Stepney City of London Cemetery 12 6 ... Vestry of Mile-end 111,060 None. None. ... 2,091 ... ... ... ... ... ... ... Mile-end City of London Cemetery 13 6 Jews' Cemetery Roman Catholic Cemetery, Leytonstone 21 — City and Tower Hamlets Cemetery (partly in Mile-end, partly in Poplar district). District Board of Poplar 169,267 None. None. ... 3,367 ... ... ... ... ... ... Poplar E. London Cemetery 13 — ... South. District Board of St. Saviour, Southwark 25,365 None. None. ... 612 ... ... ... ... ... ... ... ... St. Saviour Necropolis Cemetery, Woking 15 — ... Vestry of St. George-the-Martyr 60,278 None. None. ... 1,435 ... ... ... ... ... ... ... ... „ Newington 120,939 None. None. ... 2,590 ... ... ... ... ... ... ... ... District Board of St. Olave 11,731 None. None. ... 252 ... ... ... ... ... ... ... ... St. Olave Do 15 -— ... Vestry of Bermondsey 85,475 None. None. ... 1,884 ... ... ... ... ... ... ... ... „ Rotherhithe 40,379 None. None. ... 770 ... ... ... ... ... ... ... ... „ Lambeth 295,033 Tooting ... 41½ 5,272 ... ... 3,750 13s. 6d. ... ... None. Lambeth Lambeth Cemetery 9 6 Norwood Cemetery „ Battersea 165,115 Battersea (closed except for re-openings) Morden 130 2,742 149 1,932 2,081 14s 17 s. Raised with poor rate Wandsworth and Clapham. Battersea Cemetery 11 — ... District Board of Wandsworth 1. Wandsworth parish 187,264 Earlsfield ... 34 2,620 160 765 925 £1 1s. ... ... Included in poor rate, equal to ½d l½d. Wandsworth Cemetery 21 — ... 2. Putney „ ... (a) Kingston-vale ... 13 97 101 198 10 The fee for non-parishioners is treble that for parishioners. Putney Cemetery 9 10 ... (b) Lower Common (now closed except for re-openings). ... 2¾ 3. Streatham „ ... Garratt-lane ... 26 91 292 383 9s. 6d. ... ... Included in poor rate. Streatham Cemetery 16 — ... 4. Tooting* „ ... *Tooting-church ... ... ... 123 ... 15 - ... 3 15 - None. Tooting Cemetery 15 — ... 5. Clapham „ ... yard Contract with Norwood cemetery ... ... ... ... 14s. 14 s. 2/5d. Necropolis Cemetery, Woking 15 — ... Vestry of Camberwell 253,076 East Dulwich ... 32 4,279 477 3,121 3,598 ... 12 6 ... 2 1 6 None. Camberwell Camberwell Cemetery 9 6 Nunhead Cemetery District Board of Greenwich 1. Greenwich parish 175,774 Shooter's-hill ... 16 3,052 ... ... ... ... ... ... ... ... Greenwich Greenwich 13 — ... 2. Deptford (St. Paul and St. Nicholas parishes) ... Ladywell ... 20 109 1,739 1,848 ... ... ... ... ... tery DeptfordCemetery 13 — ... Vestry of Plumstead 59,252 Wickham-lane ... 32 836 ... ... 657 9 - 1 5 6 1 7 - 3 16 6 Included in poor rate, equal to 1¼d Woolwich Plumstead Cemetery 14 — ... Local Board of Woolwich 41,314 Plumstead ... ... 738 ... ... ... ... ... ... ... ... Woolwich Cemetery 12 — ... District Board of Lee 38,588 Charlton ... 8 519 104 121 225 7 6 10 6 ... ... None. L Charlton parish ... Charlton Cemetery 10 — ... 2. Lee „ ... Hither-green ... 10 ... ... 183 13 - 18 - 1 19 - 2 14 - 2d. Lewisham Lee Cemetery 18 — ... 3. Eltham* „ ... *Eltham ... ... ... ... 9 6 12 6 1 18 - 2 4 - None. Eltham Cemetery 11 2 ... District Board of Lewisham 104,521 yard Ladywell ... 15 1,362 260 717 977 12s. 6d. (This includes 3s. for minister's fee.) £2 4s -d. (This in eludes 6s. for nister's £2 None. Lewisham Cemetery 9 6 ... * In the ease of the parishes of Eltham and Tooting the burial places available are not burial grounds which have been provided by the parish authorities under the powers conferred by the Burial Acts. The churchyards in these parishes which were in existence at the date of the passing of the Act are still available for use, though in each case extension of the area of ground has taken place. At the present time these parishes are semi-rural in character and their population is small. 42 Table 2. Private Cemeteries. Cemetery. Situation. Area in acres. Burials in 1897. Charges for common interments. — Adults. Within county. Without county. Private Common. Total. Bromptcn (belonging to the Government) Kensington ... 40 738 none 738 No common interments allowed now. Kensal-green Kensington ... 70 1,089 960 2,049 ... St. Mary's, Roman Catholic Hammersmith ... 23 nearly 332 1,469 1,801 ... Highgate St. Pancras ... 38 1,254 414 1,668 £2 2s. City of London and Tower Hamlets Mile - end Oldtown ... 40 370 2,465 2,835 First class, £1 10s. Second class, £1 5s. Abney-park Stoke Newington ... 33 557 1,014 1,571 £2 Nunhead Camberwell ... 54 931 4,403 5,334 £1 10s. Norwood Lambeth ... 40 1,214 802 2,016 ... Great Northern ... New Southgate 70 300 685 and 324 paupers 1,309 Third class,,£2 7s. Fourth class, £1 5s. Fifth class, 18s. Chingford Mount ... Chingford 60 395 3,218 3,613 15s. Manor-park ... Manor-park, Ilford 45 200 5,500 5,700 Ordinary, £1. First class, £1 10s. East London ... Plaistow, Essex 30 224 4,454 4,678 ... Necropolis ... Woking 500 ... ... 3,534 No common interments as at other cemeteries. Fee for interment in unpurchased grave, including conveyance by train from London, £1. Woodgrange ... Ilford ... No information. No information. Elmer's-end or Crystal Palace district ... Elmer's-end 35 175 270 445 No information. ... 4 ... ... Jewish (Spanish and Portuguese Jews) Mile - end Oldtown about 60 a year No common interments as at other cemeteries take place in Jewish burial places. Jewish Islington ... 2 ... ... ... This ground is filled, except for a small number of graves which have all been purchased. Jewish ... Hendon 8 ... ... ... Only 27 bodies buried here up to present time. Jewish ... Willesden 9 ... ... 141 ... London County Council EXPERIMENTS ON DISINFECTION. Report by the Medical Officer presenting joint report by Drs. Klein, Houston and Gordon on the result of their experiments in connection with the subject of disinfection. (Ordered to be printed by the Public Health Committee, 16th January, 1902.) In accordance with the resolution of the Council of 31st July, 1900, experiments have been conducted by Drs. Klein, Houston, and Gordon with the object of ascertaining the value of various disinfectants under the ordinary conditions of their use in dwelling houses. A room in an unoccupied house in the possession of the Council was in the first instance utilised for the purpose of testing methods of gaseous disinfection, and later a room of about the same size in the shelter of the Finsbury Borough Council. Among fluid disinfectants carbolic acid, permanganate of soda bleaching powder, and corrosive sublimate have been tested. Among gaseous disinfectants formalin and sulphurous acid gas have been made the subject of experiment, the disinfection in this branch of the inquiry being supervised by Dr. Newman, medical officer of health of Finsbury, who has kindly facilitated the carrying out of the work. Seven microbes have been experimented with, organisms representative of highly resistant and less resistant pathogenic forms being chosen. Consideration was necessarily given, in making the selection, to the question of the ease with which the particular microbes employed could be subsequently identified, but the list includes, it may be noted, the organisms of enteric fever, diphtheria, cholera, and tuberculosis. Four different sorts of material, in ordinary practice requiring to be disinfected, namely, cloth, unvarnished or unpainted wood, linen, and wall paper, were chosen. To them, microbes distributed in broth, in milk, or in melted gelatine, were liberally applied, and the charged materials were then exposed to the various disinfectants. As regards gaseous disinfectants it was found that both formalin and sulphurous acid failed in the case of wood and cloth charged with spores. The contrast observed between wood and thick cloth on the one hand, and linen and paper on the other, may probably be explained by the fact that the microbe-containing mixtures soaked into the materials first named ; the microorganisms were thus not limited to the surface, whereas, in the case of linen and paper, the organisms were so limited, and therefore were more exposed. In one experiment even the little-resistant bacillus typhosus, exposed on wood or cloth, was not destroyed by formalin, but the reporters raise question as to whether the result was due to some fault in the experiment. This organism was, however, destroyed under like circumstances bv sulphurous acid. Formalin vapour, on the other hand, showed to greater advantage than sulphurous acid in the case of tubercular sputum dried on linen and paper. As regards fluid disinfectants, corrosive sublimate, 1 in 1,000, with 24 hours' exposure, destroyed all microbes, including the spores of anthrax and the tubercle bacilli ; carbolic acid in 5 per cent. solution, with 24 hours' exposure, failed to destroy anthrax spores, but was efficacious for all others. In the case of Condy's fluid, one teaspoonful to a pint with 24 hours' exposure gave a negative result; when used in five times that strength it was still practically of negative value; bleaching powder, generally speaking, only destroyed the less-resistant forms of microbes, though in the case of anthrax spores on paper and on linen, this material proved more effective than carbolic acid. In summary it may be stated that the typhoid bacillus was killed by all the disinfectants except Condy's fluid and bleaching powder. Condy's fluid gave a negative result in each experiment and bleaching powder for the disinfection of wood and cloth infected with this organism failed with 1 hour's exposure but was efficacious on 24 hours' exposure. The bacillus diphtherite was killed by formalin and sulphur dioxide. The vibrio of cholera was in each experiment destroyed by all the disinfectants except Condy's fluid and bleaching powder. Condy's fluid was practically of negative value, and bleaching powder was not always efficacious on 1 hour's exposure, but was successful with 24 hours. Bacillus pyocyaneus was acted upon in much the same way. It was killed in each experiment by all except Condy's fluid and bleaching powder. Staphylococcus aureus was also killed in each experiment by all except Condy's fluid and bleaching powder. Anthrax spores were only destroyed with certainty by perchloride of mercury, the other disinfectants either failing on each occasion or being uncertain, and almost invariably failing when wood and cloth were the materials to be disinfected. For tubercle bacilli, carbolic acid and perchloride of mercury were the only disinfectants efficacious on each occasion. Condy's fluid and sulphur dioxide were of negative value and the other disinfectants unreliable. It is deserving of notice that neither formalin nor sulphur dioxide were efficacious for the wood or cloth infected with this bacillus. Shirley F. Murphy, Medical Officer of Health. Public Health Department, 8, St. Martin's-place, W.C., 10th February, 1902. [1568 EXPERIMENTS ON DISINFECTION. Report by Drs. Klein, Houston and Gordon. In the following pages we beg to report on the experiments which we have carried out, in conformity with the arranged plan, in order to test various disinfectants, commonly used, on a variety of microbes, such as would be occurring in practice, and under conditions as nearly as possible similar to those generally met with. The disinfectants tested were—(1) carbolic acid, (2) permanganate of soda, (3) bleaching powder, and (4) corrosive sublimate; these were used in the fluid state as appropriate solutions to be fully described later. In addition to these, two substances were used in the gaseous state, viz., (5) formaldehyde, or formalin, and (6) sulphurous acid gas. For the opportunity and facility of using these two substances we are indebted to Dr. Newman, medical officer of health of Finsbury, who has been most willing throughout to help us, and who on several occasions himself superintended the process of disinfection. Dr. Newman has kindly furnished us with all the details, to be presently mentioned, concerning the amount of the gases used, cubic space of room, etc. For his help and great interest in the experiments we beg to tender him our very best thanks. The microbes that we experimented with were— (a) Spores of bacillus anthracis, representing one of the most resistant forms of pathogenic microbes. (b) The staphylococcus pyogenes aureus, representing one of the most resistant forms of non-sporing pathogenic microbes. (c) The bacillus of typhoid fever. Non-sporing forms of pathogenic bacilli. (d) The bacillus of diphtheria. Non-sporing forms of pathogenic bacilli. (e) The bacillus pyocyaneus. Non-sporing forms of pathogenic bacilli. (f) The vibrio of cholera; and (g) The bacillus of human tuberculosis. From this list it will be seen that most of the microbes chosen, in the first place include such as would in common practice be required to be disinfected, and in the second place are readily identified in the course of the experiment by their colour (staphylococcus aureus, bacillus pyocyaneus) or by their cultural characters (vibrio choleras, bacillus typhosus, bacillus anthracis) or by their specific action oil the animal (bacillus anthracis, bacillus diphtheriæ, bacillus tuberculosis). These are advantages which are not to be under-rated, considering that the materials subjected to disinfection are not themselves sterile, and are for hours exposed to mixture with saprophytic bacteria, conditions which naturally increase the difficulties of subsequent identification of the particular microbes subjected to disinfection. The microbes enumerated above were in all instances (except the spores of bacillus anthracis and the bacillus tuberculosis) 'taken from a recent actively-growing culture (agar culture grown for 24 to 48 hours at 37° C.) so as to ensure the active and vigorous state of the microbe to be disinfected. This is a point to be borne in mind, being of importance in all disinfection experiments. It must be obvious that in all cultures of non-sporing microbes, many of the individual microbes become less vigorous, and others even die off with the age of the culture; thus, for example, in the case of bacillus diphtheriæ, the virulence of the microbe becomes, in agar culture grown at 37° C., rapidly attenuated after the first two or three days; bacillus typhosus taken from a 24 to 48 hours' agar culture shows all bacilli actively motile; later, the number of such acting motile forms rapidly diminishes, indicating that the bacilli with age of the culture undergo distinct changes, whereby some of their important characters are for the time lost. As regards the spores of anthrax, these, as is known, are formed in the course of several days to a few weeks on the surface of the agar growth. The spores used in our experiments were ascertained to be fully virulent on the animal. The bacillus tuberculosis was used as it occurs in human pulmonary sputum, this being not only the form in which this microbe would be dealt with in actual practice, but also the form known to be virulent, and therefore suitable to be subjected to disinfection. The experiments having been undertaken to ascertain which of the substances commonly in use are best for the object of disinfection under conditions such as exist in actual practice, it was of course necessary so to arrange our experiments that they would, as far as possible, imitate the conditions commonly obtaining. For this purpose we distributed the microbes on various materials, such as wall-paper, linen, cloth and wood, these being the chief materials which in ordinary practice are subjected to the process of disinfection in rooms, tenements and inhabited spaces. The modus procedendi was this— (a) Virulent spores of anthrax taken from the surface of agar cultures were distributed in separated milk, or in melted gelatine, so as to form a turbid emulsion. This emulsion was applied liberally on the above materials and allowed to dry in the air of the laboratory. 3 (b) From a recent culture on agar of the bacillus typhosus, bacillus pyocyaneus, bacillus diphtherias, staphylococcus aureus and vibrio cholera) respectively a turbid emulsion was made in broth or in separated milk; this was then applied liberally to the above materials and allowed to dry in the air of the laboratory. In the later experiments we made our cultures, not on agar, but direct on gelatine, and incubated the culture tubes for 24 hours at 37° C., whereby the gelatine became, of course, melted, and turbid from the growth. For the object of carrying out the experiment we applied the turbid (melted) gelatine culture liberally on the above materials. On cooling, the gelatine set. In all these proceedings, therefore, the microbes used were emulsified, not in water, but in menstrua somewhat thicker, e.g., milk and melted gelatine. In choosing these menstrua we were guided by the fact that under the conditions obtaining in practice the virus to be disinfected is not suspended in water but in thicker menstrua, e.g., fluid typhoid stool, pus, blood, fluid cholera stool, diphtheritic throat secretions, and the same applies to the tubercle bacillus, for this as a rule is voided by the infected persons in the expectoration, which is muco-purulent. As was mentioned above, in all our experiments with tubercle we used pulmonary sputum, containing the tubercle bacilli; this was liberally applied on the materials and allowed to dry in the air of the laboratory. The materials, paper, linen, cloth, wood, charged with the above microbes, were then exposed to the various disinfectants in the following manner— (A.) In the case of the gaseous disinfectants, i.e., formalin, or sulphurous acid gas, the materials charged with the microbes were carried in large glass cylinders (plugged) from the laboratory to the room where the disinfection was to be carried out, and here, having been taken out, were placed and fixed on a table. Next day they were replaced again in the glass cylinders and carried to the laboratory. Here the materials separately were placed in a tube of sterile broth—except the cholera-charged materials, which were placed in peptone salt solution —in this they were slightly washed, and then transferred to a fresh tube of broth (or peptone salt solution respectively) and both tubes incubated at 37° C. The first washing was made for the sake of removing any excess of the disinfectant left in the materials. The resulting growth was examined microscopically, culturally, and by animal, experiment, in order to identify the microbe with which the material had been charged. It must be obvious that the materials, not having been sterile, and moreover, having been exposed after the disinfection, for some hours at least, to the air, would harbour a variety of microbes deposited on them from the air, and therefore the above broth tube, by incubation, would, and as a matter of fact did, in some instances, produce growths additional to, or other than, the microbes with which the materials had been intentionally charged. It was, therefore, a matter of no small importance to diminish the difficulties of identification by plate cultures or otherwise, of the original microbe, and this was done by our choosing the more easily identifiable microbes. In the case of the spores of bacillus anthracis, of staphylococcus aureus, of vibrio of cholera and of bacillus pyocyaneus the identification by one or another method (microscopically, culturally, animal experiment) is comparatively simple on account of the marked characteristics of the microbe. But in the case of the typhoid bacillus and the bacillus diphtheriae the identification was considerably more difficult; the difficulties, as will be stated further below, were in great part due to a possible confusion with similar microbes (bacillus coli or bacillus xerosis, respectively) widely diffused in Nature and particularly in town air and dust. In the case of tubercular sputum, the materials charged with it were, after the gaseous disinfection, treated in a different way, viz., the surface layers (dried sputum) were scraped off and distributed in salt solution, and this was injected in considerable amounts subcutaneously into the groin of a guinea pig and the result watched. Cultural experiments, owing to the well-known enormous difficulties connected with the culture of the tubercle bacilli from sputum were not attempted, injection into the guinea pig being far the easiest and most reliable method of discovering whether or not the injected materials contained the tubercle bacillus in a living state. If the injection into the subcutaneous tissue of the guinea pig is, after several weeks (6—8), not associated with and not followed by tubercular enlargement of the inguinal lymph glands of the injected side, and if on a post mortem examination no tubercles or tubercular changes are found in the viscera (liver, spleen, lung), then we may take it for certain that the injected matter did not contain living tubercle bacilli, and therefore the disinfection was successful and positive. But if in these and other experiments (carbolic acid, Condy's fluid, etc.) the inguinal glands and viscera did show the tubercular changes (anatomically, and after staining for tubercle bacilli), typical of inoculation tuberculosis, then the conclusion was drawn that the matter injected did contain tubercle bacilli in a living state, and therefore that the disinfection was unsuccessful and negative. (B.) Disinfection with the fluid substances: carbolic acid, perchloride of mercury, Condy's fluid, bleaching powder, was carried out as follows:—The different materials, wood, cloth, linen and paper having been charged with the recent and active culture (melted gelatine) of the microbes (bacillus typhosus, bacillus pyocyaneus, bacillus diphtheriae, vibrio cholera, spores of bacillus anthracis, staphylococcus aureus) were, after setting of the gelatine in the air of the laboratory, exposed for the required time in a large test tube to the disinfectant solution; after that the materials were taken out from these solutions and placed in a tube of broth (or peptone salt in the case of vibrio cholera), and from here transferred to a new tube of the same culture medium and then incubated at 37° C., and treated in the same way as was mentioned in the case of testing gaseous disinfectants. 4 The same plan that was described above in the case of gaseous disinfectants with regard to the tubercular sputum, was also followed in the case of the fluid disinfectants, viz., the materials, wood, linen, paper, cloth, were charged with the sputum, and when dry, exposed to the disinfectant solution. After the exposure they were well washed in sterile water to remove the disinfectant, and then the scrapings from the surface of the materials (the dried sputum) were injected into the subcutaneous tissue of the groin of guinea pigs and the result watched. We now proceed to describe the results of our experiments, and commence with those carried out with the gaseous disinfectants, formalin, and sulphurous acid gas. A. Gaseous Disinfectants. Series I.—Formalin. The first experiments were carried out in a room which Dr. Newman had kindly measured and found to be of cubic capacity of 1344 cubic feet. 30 formalin tablets* were used, this being in Dr. Newman's opinion, a full allowance for a room this size. The time allowed was exactly 5 hours. Before lighting the lamp, the window and fireplace were sealed up with stickfast paper. The lamp was then lit, and the door was sealed up on the outside with similar stickfast paper. After 5 hours the room was opened, the lamp extinguished, and the window and door were left partially open all night. The materials exposed to the disinfection were fetched in the morning and treated in the manner already described. 1.—Bacillus typhosus. Experiment A.—The materials, wood, paper, linen, cloth were liberally charged with bouillon emulsion of bacillus typhosus from a 24 hours' old agar culture. The emulsion was strongly turbid, that is to say, it contained an abundance of the typhoid bacilli. After drying the materials, they were exposed to formalin, except one sample of paper which was to serve as control. After the disinfection (see above), the materials were placed in phenol broth and incubated at 37° C. After 24 hours the wood, linen, and cloth phenol broths showed much turbidity, while the paper phenol broth was only faintly turbid, but the control paper showed strong turbidity. From each phenol broth tube, one phenol agar surface plate was made and incubated at 37° C. for 24 hours. The phenol agar plate of wood typhoid showed abundance of colonies which looked, in all respects, like those of typhoid, the phenol agar plate of cloth typhoid had amongst numerous colonies some which looked like those of typhoid. The phenol agar plates of linen and paper typhoid showed no typhoid-like colonies. The phenol agar plate of the control paper broth was practically a pure culture of typhoid. Sub-cultures were made of the typhoid-like colonies of the wood and cloth typhoid and they corresponded in every morphological and cultural respect with those of the true typhoid bacilli. Further, they were tested with blood serum of a guinea pig immunised by previous injection with typhoid culture and kept in the laboratory for the general purpose of agglutination (Widal) test. The blood serum was used in the dilution of 1 to 40, i.e., one blood serum to forty emulsion of the microbe to be tested; agglutination of the bacilli of the emulsion was distinct in 15 minutes, and complete within half an hour. From this experiment it appears that while the typhoid bacilli on the paper and on the linen were killed by the formalin vapour, those on wood and cloth had not been disinfected. The reason for this difference in the two sets is obvious, viz., the bouillon emulsion rich in the typhoid bacilli readily soaked into the wood and the thick cloth, whereas the thin linen and the thin paper contained the typhoid bacilli not only in smaller numbers but more exposed. Therefore, the formalin vapour in this experiment apparently did not reach the bacilli in the depth of the wood or cloth, while in the thin linen and paper the formalin could more easily and more readily accomplish the disinfection. Control experiments were made which showed that the typhoid bacilli are not killed by drying on paper in the air of the laboratory for 24 hours. It must, however, be at once added that this unfavourable result is not the rule, for we shall presently see a different result in further experiments. Whether or not the negative result qua disinfection on wood and cloth in experiment A was due to some fault in the actual experiment, remains open. As a matter of fact, it was the very first experiment of the whole series. Experiment B.—In this experiment the emulsion of the typhoid bacilli (agar surface growth, incubated 24 hours at 37° C.) was made in separated milk, the amount of growth added to, and shaken up with the milk was considerable, and the emulsion was liberally applied to the surface of the materials, viz., wood, cloth, linen and paper. The exposure to formalin (5 hours) was carried out in the same place and with exactly the same amounts, and in all respects in the same way as in experiment A. The materials next day were placed as in experiment A in phenol broth, which was then incubated at 37° C. No growth of any kind took place in any of the broth tubes. Experiment C.—In this experiment the culture of typhoid bacilli was made in gelatine and incubated for 24 hours at 37° C. After this time the (liquefied) gelatine showed great turbidity, and in this liquid form was liberally applied to the surface of the materials: wood, cloth, linen and paper. On cooling, the gelatine set, and in this form was kept a few hours and then exposed to formalin in exactly the same manner, duration and amount as in experiment A. Here also the result was complete disinfection of the typhoid bacilli. The following table I. summarises the above three experiments— A tablet weighs .034 oz. 5 Table I.—Showing the remit of exposure of the bacillus typhosus to formalin vapour. Nature of emulsion in which the typhoid bacillus was exposed. Nature of the material on which the emulsion had been placed. Result of culture after exposure. Broth emulsion Wood + „ Cloth + „ Linen — ,, Paper — (Separated) milk emulsion Wood — „ „ Cloth — ,, „ Linen — „ ,, Paper — Melted gelatine culture allowed to set Wood — „ „ „ Cloth — „ „ „ Linen — „ „ „ Paper — 2.—Bacillus diphtheriœ. Experiment A.—Emulsion of bacillus diplitheriæ from a 24 bour old agar culture in separated milk was liberally applied to wood, linen, cloth and paper, and, after drying, exposed to formalin in the same place and under exactly the same conditions as in previous experiments. One control diphtheria paper was kept (24 hours) till the exposed materials were ready, after disinfection, to be used for culture. All these materials were placed in broth in test tubes and incubated at 37° C. After this time only the broth inoculated with the control diphtheria paper and from the disinfected diphtheria wood, were found turbid. Agar surface plates were made and these were kept for 24 hours at 37° C. The agar plate of the diphtheria wood was covered with a film of bacillus mesentericus, the agar plate of the control diphtheria paper showed numerous diphtheria-like colonies. These were tested by microscopic specimens, by Neisser's stain, and by injection in guinea pigs, and found to be typical virulent diphtheria, the same as was applied originally to the paper. This experiment proves, therefore, that while the diphtheria bacilli, dried on paper in the laboratory for 24 hours, remain living, those exposed on wood, cloth, linen and paper to formalin for 5 hours became completely disinfected and killed. Experiment B.—This experiment was of the same nature as the former, except that the diphtheria bacilli were applied to the materials as a (liquefied) gelatine culture incubated for 24 hours at 37° C. The result was also negative, inasmuch as none of the materials after exposure to the formalin yielded diphtheria growth The following table II. gives a summary of the results— Nature of the emulsion. Nature of the materials. Result of culture after exposure. Separated milk emulsion Wood — „ „ Cloth — „ „ Linen — „ „ Paper — (Melted) gelatine culture Wood — „ „ Cloth — „ „ Linen — „ „ Paper — In both experiments, therefore, the 5 hours' exposure to formalin was effective in completely destroying the bacillus dipbtherise on all the four materials employed. 3.—Bacillus pyocyaneus. Experiment A.—The emulsion of this organism was made in separated milk, the materials, wood, cloth, linen and paper were charged liberally with the emulsion, and then, after drying in the air of the laboratory, were exposed to formalin in the same manner as in previous experiments. The result was that the microbe was disinfected and devitalised on all four materials; the broth cultures that received the materials after the treatment with the formalin yielding no pyocyaneus growth. Experiment B.—The former experiment was repeated with hot gelatine culture, i.e., the microbe was grown in gelatine at 37° C. for 24 hours, and then this was applied to the surface of the materials. The result of exposure to the formalin was the same as in the previous experiment, viz., complete disinfection. The following table III. shows these results— 6 Nature of the emulsion. Nature of the materials. Result of culture after exposure. Separated milk Wood - „ „ Cloth - „ „ Linen - „ „ Paper - (Hot) Gelatine culture Wood - „ „ „ Cloth - „ „ „ Linen - 11 11 11 Paper - Formalin is then, in the form and the amounts used in our experiment, a perfect disinfectant of bacillus pyocyaneus, on all the materials used. 4.—Vibrio of Asiatic cholera. Experiment A.—This, as also the following experiment, B., were made with the vibrio which has now been kept for many subcultures in the laboratory. It was originally derived from a case of true Asiatic cholera, and in morphological and cultural respects possesses all the characters of the typical cholera vibrio; except that its virulence on the guinea pig has suffered slight diminution. The emulsion was made by distributing in separated milk a relatively large amount of agar surface culture that had been incubated for 24 hours at 37° C. The culture was then liberally applied to wood, cloth, linen and paper, and was allowed to dry on these materials in the air of the laboratory, after which they were exposed to the action of formalin as in the previous experiments. Next day the materials were transferred to peptone salt solution, as mentioned on a former page, and incubated for 24 hours at 37° C. If the peptone solution became turbid, microscopic specimens—stained films—alone could be relied upon as showing the presence of the vibrio; if a positive result was hereby obtained the cholera red reaction was tested in order to confirm the previous results. Experiment B.—In this experiment the culture of the vibrio that was used was gelatine (melted) culture incubated for 24 hours at 37° C. The result of this, as also of the previous experiment, was entirely negative, that is to say, the culture in peptone salt made with the materials after exposure to the formalin yielded no growth of the cholera vibrio. Table IV. shows these results— Nature of emulsion of the vibrio. Nature of the materials. Result of culture after exposure. In separated milk On wood „ On cloth — ,, On linen — ,, On paper — As hot gelatine culture On wood — ,, ,, On cloth — ,, ,, On linen — ,, ,, On paper In order to make sure that the keeping per se of the vibrio on the materials for 24 hours, apart from any exposure to a disinfectant, has no deleterious effect on the vitality of the vibrio, a control experiment was made. In this the vibrio, grown in hot gelatine (i.e., at 37° C.), was applied to the same paper as used in all these experiments and kept for 24 hours. From the nature of the paper being denser than any of the other materials, the microbe would on it (paper) remain more superficial, i.e., more exposed to the drying process than on any of other materials, and therefore we would get a reliable answer to the above question, viz., whether or no the 24 hours' drying in the air of the laboratory did or did not injure the vitality of the microbe'. The result of this control experiment was that the control cholera-paper yielded, in peptone salt culture, copious growth of the vibrio after 24 hours' incubation. 5.—Staphylococcus aureus. The experiments that were made with this microbe were of exactly the same kind as with the above, and it is not necessary to describe them in detail. There is only one point that it is necessary to mention, it is this:—After exposure to formalin of the materials, wood, cloth, linen and paper impregnated with the emulsion—broth emulsion of a recent (24 hours' old) agar culture—they were placed in broth, and after 24 hours' incubation of this at 37° C., agar surface cultures were made; these would, after incubation for 24 hours at 37° C., infallibly show the golden yellow colonies of the microbe, if such were present, in a living condition. The experiments made showed that the formalin as used had completely killed the microbe. 7 The following table Y. shows the summary of the experiment— Nature of the emulsion. Nature of materials. Result of culture after exposure. Broth emulsion On wood — ,, ,, On cloth — ,, ,, On linen — ,, ,, On paper — G.—Spores of bacillus anthracis. As mentioned above, virulent spores of an agar culture of bacillus anthracis were used for the experiment; they were distributed in separated milk, and in this form were liberally applied to wood, cloth, linen and paper, and after drying were exposed to the formalin in the way above described. After exposure the materials were placed in broth, and whether or not after incubation at 24 hours at 37° C., growth appeared, a small amount of the broth was injected subcutaneously into a guinea pig, and the result watched. Where growth appeared in the broth, subculture was made on agar or on gelatine, and the resulting growth studied for identification of bacillus anthracis. The positive or negative result indicated in the following table YI. refers, it will be understood, both to the cultural test as also to experiment in the animal. Nature of emulsion. Nature of material. Result of culture and experiment. In separated milk On wood + ,, On cloth + ,, On linen - ,, On paper + It follows then that anthrax spores applied to linen were killed by the formalin, while those on wood, cloth and paper yielded growth of bacillus anthracis and killed a guinea pig with typical anthrax. 7.—Tubercular sputum. In this, as also in all other cases of disinfection with fluids, the sputum was derived from human tubercular lung, and on microscopic examination showed a fair number of tubercle bacilli. The sputum was applied on the surface of the materials and allowed to dry. This took generally 24-48 hours; but in order to insure that by this process the tubercle bacilli of the sputum remained uninjured, a control was at the same time made by allowing the sputum to dry on paper for 48 hours, and then using this directly without exposure to the disinfectant for injection of a control guinea pig. As might have been expected, this control guinea pig developed typical general tuberculosis in due course of time. The materials were exposed to the formalin in the manner already described. Next day the surface of the materials was scraped and the scraping distributed in a little salt solution, and guinea pigs were injected subcutaneously into the groin. After four weeks the animals were killed and a careful post-mortem examination was made on them. In this, as also in other experiments with the sputum to be described later, a positive result means local tuberculosis of the inguinal glands of the injected side, with typical tubercle bacilli in the caseous purulent gland, and tuberculosis of the viscera; either spleen alone, or spleen, and liver and lung; and the tubercles containing the typical tubercle bacilli. A negative result means negative locally and viscerallv. The following table shows the result after exposure to formalin as in the previous experiments— Table VII.—Disinfection with formalin of tubercular sputum. Nature of the sputum. Nature of the material. Result of experiment. The sputum contains crowds of tubercle bacilli On wood + ,, ,, On cloth + ,, ,, On linen — ,, ,, On paper — We have here the same distinction as was found in the first experiment with typhoid bacillus, viz., owing to the thickness of the wood and cloth the microbe that had been able to 8 penetrate into the depth was protected against the action of the formalin, whereas owing to the thinness of the linen and paper the microbe could well be acted upon by the formalin. Table VIII., General result.—Disinfection with formalin, cubic space 1,344 cubic feet, 80 formalin tablets burnt, time of exposure 5 hours. On wood. On cloth. On linen. On paper. Bacillus typhosus„ + + „ — — — — „ Bacillus diphtheria) — — — — jj ••• ••• Bacillus pyocyaneus — — — — jj •• • *'* Vibrio choleras ... — — — — jj • • • • • • • • • — — — — Staphylococcus aureus ... — — — — Spores of anthrax + + — + Tubercular sputum + + — Table VIII. gives in a comprehensive manner the general results of this series of disinfection experiments, viz., with formalin for five hours. The + sign means positive culture and experiment on animal after exposure, the sign — means failure to recover the microbe in a living condition. It will be seen from this table that all the microbes exposed on linen to the formalin were completely disinfected, and, with the exception of the spores of anthrax, also on paper. Further, complete disinfection of the wood and the cloth was effected by formalin except in three cases. One of these was in the first experiment with typhoid, when a broth emulsion of it was used; in two later experiments, however, typhoid was completely devitalised. The second case in which formalin failed to disinfect the wood and cloth was that of anthrax spores, and the third that of tubercular sputum. This appears to be due to the greater thickness of, and, therefore, imbibition into, the materials, and the consequently greater chance of escape of some of the microbes from the attack by the formalin. In cases, therefore, where wood flooring, unpainted or unvarnished articles of furniture, or similar absorbing materials and cloth fabrics are to be subjected to disinfection on account of their being possibly polluted with tubercular sputum, or highly resisting microbes like the spores of anthrax or other spores (e.g., tetanus), the disinfection with formalin alone will not suffice. But in the case of paper, linen, or similar thin fabrics (calico) the disinfection with formalin (except spores of anthrax or similar highly resisting spores) will presumably be attended with success. Series II.—Sulphurous Acid Gas (Sulphur Dioxide). The experiments with the sulphurous acid gas were performed in a room, the capacity of which was 1,075 cubic feet; three pounds and a half of sulphur were burned in the middle of the room on an ordinary " sulphur devil." As in the case of the formalin experiments the fireplace, window, and door were carefully and accurately sealed up with pasted paper. The room was left closed up for exactly 24 hours. The preparation of the microbes, their application on the materials, wood, cloth, linen, and paper, and the treatment subsequent to the exposure were exactly the same as in the case of the formalin experiments, and it is not therefore necessary to repeat the details of the individual experiments. 1.—Bacillus Typhosus. Table IX. gives the summary of the results in two experiments made with this microbe: experiment (a), with an emulsion in broth, experiment (b), with an emulsion in separated milk. Table IX. Nature of emulsion. Nature of material. Result of culture, after exposure. (a) In broth On wood ii ••• ••• On cloth — tt ••• On linen — a ••• On paper — (b) In separated milk ... On wood — » » On cloth — ,, ,, ... ... ... On linen — „ 5, ... On paper 9 From this it appears, then, that the typhoid bacillus on all materials had been completely devitalised. It has to be added that in both experiments (a and b), one " paper " on which the corresponding emulsion of the typhoid bacillus had been allowed to dry, had been kept for control ; this, on subsequent culture in phenol broth, and from this on phenol agar plate, yielded in 24 hours copious growth of the typhoid bacillus, typical in respect of morphology, culture, and agglutination by typhoid blood. 2.—Bacillus Diphtheria. The following table X. shows the result of the three experiments, a, b and c, performed with this microbe. Nature of emulsion. Nature of material. Result of culture after exposure. (a) In broth On wood — ,, On cloth — ,, On linen — ,, On paper — (b) In separated milk On wood — ,, On cloth — ,, On linen — ,, On paper — (c) As hot gelatine culture On wood — ,, On cloth — ,, On linen — ,, On paper — Here, also, disinfection was complete on all materials and in all three experiments. 3.—Bacillus pyocyaneus. Table XI.—Showing the result of exposure to SO2. Nature of emulsion. Nature of material. Result of culture after exposure. (a) In broth On wood - „ On cloth - „ On linen - „ On paper - (6) In separated milk On wood - „ On cloth - „ On linen - „ On paper - 4.—Vibrio choleræ. Table XII.—Showing the result of exposure to S02. Nature of emulsion. Nature of material. Result of culture after exposure. (a) In broth On wood — „ On cloth — „ On linen — „ On paper — (b) In separated milk On wood — „ On cloth — „ On linen — „ On paper — (c) As (hot) gelatine culture On wood — „ „ On cloth — „ „ On linen — „ „ On paper — 10 5.—Staphylococcus aureus. Table XIII. Nature of emulsion. Nature of material. Result of culture after exposure. (a) In broth On wood — „ On cloth — „ On linen — „ On paper — (b) In separated milk On wood — „ „ On cloth — „ „ On linen — „ „ On paper — Table XIV. 6,—Spores of bacillus anthracis. Nature of emulsion. Nature of material. Result of culture after exposure. (a) In broth On wood + „ On cloth — „ On linen — „ On paper — (b) In separated milk On wood + „ „ On cloth + „ „ On linen — „ „ On paper — Here, also, the disinfection was successful on linen and paper, but failed on wood (in both experiments) and on cloth (in one experiment); this same result we have mentioned already in the case of formalin disinfection, and we would explain it also here (S02) in the same way, viz., that owing to the thickness of the wood and the cloth, the deeper portions of the materials are not acted upon by the gas. It is, therefore, necessary to remember that as regards highly resisting microbes, such as spores, some stronger measures than formalin or sulphurous acid gas have to be employed for disinfection of wood or cloth materials. 7.—Tubercular sputum. The sputum was derived, as in the former case, from a case of pulmonary tuberculosis, and, as microscopic examination proved, was very rich in tubercle bacilli. The table XV. shows the result— Nature of microbe. Nature of material. Result of experiment on animal after exposure. Tubercular sputum On wood + „ On cloth + „ On linen + „ On paper + It ought to be stated that all four animals, as also a control animal (injected with control tubercular paper), were killed four weeks after injection, and all had the same lesions, viz., tubercular changes in the inguinal glands, and distinct tubercles in the spleen and liver. In this experiment, then, the inferiority of S02 (24 hours) to formalin (5 hours) as regards its efficacy on dried tubercular sputum is very striking, since the S02 had no effect even on thin material like linen and paper that had been charged with the sputum. 11 Table XVI.—Gives a general summary of the experiments made with S02 exposure 24 hours. On wood. On cloth. On linen. On paper. Bacillus typhosus — — — — „ „ — — — — ,, diphtherise — — — — „ „ — — — — „ „ — — — — „ pyocyaneus — — — — „ „ — — — — Vibrio choleræ — — — — „ „ — — — — „ „ — — — — Staphylococcus aureus — — — — „ „ — — — — Spores of bacillus anthracis + — — — „ „ + + — — Tubercular sputum + + + + B.—Fluid disinfectants. The microbes were the same as used in former experiments, viz., bacillus typhosus, bacillus pyocyaneus, vibrio choleræ, staphylococcus aureus and spores of bacillus anthracis. The bacillus diphtherise was left out because previous experience showed the very feeble resistance of this microbe. In all further experiments tubercular sputum was substituted for it. Except the spores of anthrax, the microbes were used as a 24-hour old gelatine culture incubated at 37° C., and therefore fluid. In this condition the culture was liberally applied to the surface of the materials; wood, cloth, linen and paper. The spores of anthrax were distributed in melted gelatine, and this was then applied to the surface of the materials and treated in the same manner as the other microbes. In cooling the gelatine set solid, and in this state the materials were placed in a large volume of the disinfectant solution. In this they were kept for 24 hours, then taken out and the fluid thoroughly sucked up with blotting paper. The materials charged with the typhoid culture were then placed successively in two lots of ordinary broth, those charged with the cholera vibrio were placed in peptone salt solution, and, after superficial washing herein, were transferred to a fresh tube of the peptone salt solution; both tubes were incubated at 37° C. The same was done in the case of the staphylococcus aureus and the spores of bacillus anthracis, two tubes of broth being substituted for peptone salt solution. The materials charged with the tubercular sputum, after removal from the disinfectant fluid, were washed in water, then the fluid was mopped up with blotting paper; after this the sputum was scraped off from the materials and distributed in salt solution and injected into guinea pigs. Series I.—Carbolic acid. This was ordinary pure carbolic acid, and was used as a watery 5 per cent solution Time of exposure, 24 hours. The result is shown in the following table XVII.— Nature of microbe. Nature of material. Result of culture and experiment after exposure. Bacillus typhosus On wood — „ On cloth — „ On linen — „ On paper — Bacillus pyocyaneus On wood — „ On cloth — „ On linen — „ On paper — Vibrio choleræ On wood — „ On cloth — „ On linen — „ On paper — Staphylococcus aureus On wood — „ On cloth — „ On linen — „ On paper — Spores of anthrax On wood + „ On cloth + „ On linen + „ On paper + Tubercular sputum On wood — „ On cloth — „ On linen — „ On paper — It follows then, from these experiments, that 5 per cent. carbolic acid liberally applied for 24 hours—placing the materials in a large volume of the acid—caused complete disinfection 12 on all materials of all microbes, inclusive of tubercle, except tbe resisting spores of anthrax. With the latter the result of disinfection was entirely negative, notwithstanding that they were practically soaked in the acid for 24 hours. It is, on the other hand, interesting to find that the tubercular sputum was completely disinfected, all the animals remaining well, whereas a control guinea pig injected with a control sputum paper succumbed in six weeks from typical local and visceral tuberculosis. Series II.—Condv's fluid. This was used in the proportion of one teaspoonful to one imperial pint of water; this would correspond to about 1 in 142. Time of exposure, 24 hours (see footnote). Table XVIII. Nature of the microbe. Nature of material. Result of culture and experiment after exposure. Bacillus typhosus On wood + „ On cloth + „ On linen + „ On paper + Bacillus pyocyaneus On wood + „ On cloth + „ On linen + „ On paper + Vibrio choleræ On wood + „ On cloth + „ On linen + „ On paper + Staphylococcus aureus On wood + „ On cloth + „ On linen + „ On paper + Spores of anthrax On wood + „ On cloth + „ On linen + „ On paper + Tubercular sputum On wood + „ On cloth + „ On linen + „ On paper + From this experiment it follows that the use of Condy's fluid, in the proportion stated, is of negative value, since steeping the materials for 24 hours in the solution failed to devitalise' any of the non-sporing microbes on any of the materials. On account of this unfavourable result, we have repeated the experiment, using, however, the solution five times as strong. Table XVIIIa gives the results obtained. Table XVIIIa.—Condy's fluid, 5 teaspoonfuls to one pint of water; time of exposure 24 hours. Nature of the microbe. Nature of material. Result of culture and experiment after exposure. Bacillus typhosus On wood + „ On cloth + „ On linen + „ On paper + Bacillus pyocyaneus On wood + „ On cloth + „ On linen + „ On paper + Vibrio choleræ On wood + „ On cloth + „ On linen - „ On paper + Staphylococcus aureus On wood + „ On cloth + „ On linen - „ On paper + Spores of anthrax On wood + „ On cloth + „ On linen + „ On paper + Tubercular sputum On wood + „ On cloth + „ On linen — „ On paper + Note.—The spores of anthrax were, as a matter of fact, exposed to the disinfectant for three times 24 hours. 13 From this last Table XVIIIa, it follows that the disinfecting power of Condy's fluid, even when used in the proportion of five teaspoonfuls to one pint of water, remained practically negative in our experiments. Whether this result is due to the disinfecting power of the fluid being consumed in the oxydising of the organic matter submitted with the microbes, we are unable to say. Series III.—Corrosive Sublimate. This was used according to the formula of the Local 'Government Board; 1 in 1,000. Time of exposure 24 hours. Table XIX. gives the results of the culture ami experiment after exposure; as might be expected, all microbes, including the spores of anthrax and the tubercular sputum, had been killed by the solution. Table XIX. Bacillus typhosus On all materials Bacillus pyocyaneus „ - Vibrio choleras „ - Staphylococcus aureus „ - Spores of bacillus anthracis „ - Tubercular sputum „ - Series IV.—Bleaching Powder* This was used in the form of a one per cent. solution. Time of exposure 1 hour. The result of the experiment is shown in Table XX. Nature of microbe. Nature of material. Result of culture and experiment after exposure. Bacillus typhosus On wood + „ On cloth + „ On linen — „ On paper — Bacillus pyocyaneus On wood — „ On cloth + „ On linen — „ On paper — Vibrio choleræ On wood — „ On cloth + „ On linen — „ On paper — Staphylococcus aureus ... On wood + „ On cloth + „ On linen — „ On paper — Spores of bacillus anthracis On wood + „ On cloth + „ On linen — „ On paper — Tubercular sputum On wood + „ On cloth + „ On linen — „ On paper — The result of this experiment is then this: a 1 per cent. solution of the bleaching powder is capable in one hour of disinfecting the spores of bacillus anthracis on paper and on linen, an effect more favourable than that obtained with a 5 per cent. solution of carbolic acid or five times Condy, even after an exposure of 24 hours. The experiment with the 1 per cent. solution of bleaching powder was repeated, this time leaving the materials 24 hours in the solution. Table XXa gives the results of this series. * Bleaching powder is a mixture of calcium chloride, CaCl2 and calcium hypochlorite, CaCl2O2. It in sometimes called chloride of lime and sometimes calcium hypochlorite. The substance used in our experiments is the article employed in commerce for bleaching purposes, and which is also largely used as a disinfectant and deodorant. 14 Table XXa.—Bleaching powder, 1 per cent. ; time of exposure, 24 hours. Nature of microbe. Nature of material. Result of culture and experiment after exposure. Bacillus typosus On wood — „ On cloth — „ On linen — „ On paper — Bacillus pyocyaneus On wood — „ On cloth + „ On linen — „ On paper — Vibrio choleræ On wood — „ On cloth — „ On linen — „ On paper — Staphylococcus aureus On wood — „ On cloth — „ On linen + „ On paper — Spores of bacillus anthracis On wood + „ On cloth + „ On linen + „ On paper — Tubercular sputum On wood — „ On cloth + „ On linen — „ On paper — From this table it appears that while a 24 hours' exposure to the 1 per cent. solution of the bleaching powder completely disinfected the typhoid bacillus and the cholera vibrio on all materials, it was not so uniformly successful with the other microbes. E. Klein. A. C. Houston. M. H. Gordon.