Lcc 19 London County Council. ANNUAL REPORT OF THE COUNCIL, 1910. VOL III. PUBLIC HEALTH (INCLUDING THE REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE COUNTY, THE REPORT OF THE MEDICAL OFFICER (EDUCATION), MAIN DRAINAGE, HOUSING OF THE WORKING CLASSES). Printed for THE LONDON COUNTY COUNCIL by southwood smith and co., ltd., And may be purchased, either directly or through any Bookseller, from P. S. KING AND SON, 2 and 4, Great Smith-street, Victoria-street, Westminster, S.W., Agents for the sale of the Publications of the London County Council. 6176 C. 415 CONTENTS. Chapter XXXI. Public Health Reports of the Medical Officer of Health (Sir Shirley Murphy) for the year 1910 7 Vital Statistics—Population—Marriages—Births—Deaths—Infantile mortality—Principal epidemic diseases—Smallpox and vaccination—Measles—Scarlet fever—Diphtheria—Whooping-cough —Typhus—Enteric fever—Diarrhoea—Erysipelas—Puerperal fever—Seasonal prevalence of and mortality from infectious diseases—Influenza, bronchitis and pneumonia—Phthisis Cancer— Cerebro- spinal fever—Anthrax—Glanders—Hydrophobia—Meteorology. Administration.— Dairies, cowsheds and milkshops— Offensive businesses—Nuisances—Housing of the Working Classes Act—Common lodging houses—Houses let in lodgings—Houses infested with vermin—Revenue Act, 1903—Underground rooms—Overcrowding—Factory and Workshop Act—Places where food is prepared for sale—Inspection of food—Disinfection—Shelters —Mortuaries—Cleansing of persons Act—Equalisation of Rates (London) Act—Water supply —Health visitors— Midwives Act. Chapter XXXII. Public Health Reports (continued)—Special reports submitted by the Medical Officer of Health during the year 1910 100 Chapter XXXIII. Public Health Reports (continued)—Report of the Education Committee, submitting the Report of the Medical Officer (Education) (Dr. J. Kerr) for the year 1910—Report of the Medical Officer (Education) for the year 1910 122 Elementary Schools.— Staff—Medical inspection—School buildings—Nutrition—PhysiqueRheumatism—Report on an East-End school—Care of the teeth—Centres for dental treatment—Qualified and unqualified dental treatment—Educational propaganda for dental matters—Examination of candidates. Training Colleges, Pupil Teacher Centres, Secondary and Trade Schools.— Medical inspection —Personal cleanliness—Feeding—Games—Homework and nerve strain—Spinal curvature in secondary schools— Kyphosis— Anthropometry. Personal Hygiene Schemes.— Staff of nurses—Organisation—Heads—Bodies and clothing—Cleansing stations—Sanitary authorities—Children's Country Holiday Funds—Ophthalmia—Scabies. Medical Treatment.— Revision of treatment—Tonsils and adenoids—Suppurating ears—Ringworm. Special Schools.— Schools for physically defective children—Epileptics—Combined mental and physical defect—Remediable physical defect—Heart disease in schools for physically defective children—The deaf—Lip reading and articulation. Miscellaneous.— Appendicitis at Mayford Industrial School—Playground classes—Open-air schools —Open-air residential schools— Kensal House tuberculosis school—Functional nervous trouble —Stammering—Teachers' health in relation to ventilation and heating of schools—School journeys—Private study of Hebrew—Disinfectants and cleansing. Infectious Disease.— Comparative incidence—Schools under special observation—School closure— Exclusion of unprotected children (measles)—Exclusion of all children under five—Diphtheria —German measles. Continuation School Work in Hygiene, etc.—Syllabuses— Voluntary aid detachments. Chapter XXXIV. Public Health—Infectious Diseases—Homeless persons—Transmigrants—Milk—Infant Life Protection—Midwives—Health Visitors—Common Lodging Houses—Seamen's Lodging Houses—Nuisances—Offensive businesses—Ice-cream—Mortuaries—Main DrainageAppeals—Diseases of Animals 179 Chapter XXXV. Housing of the Working Classes 190 Chapter XXXVI. Housing Accounts and Statistics—Report of the Comptroller (Mr. H. E. Haward) submitting Housing Accounts for the year ending 31st March, 1911—Memorandum of the Housing Manager (Mr. S. G. Burgess), submitting Housing Statistics for the year ending 31st March, 1911 197 4 Diagrams. Facing Page Diagram A.— Marriages, 1851-1910 11 B.— Births, 1851-1910 11 „ C.— Deaths (all causes), 1841-1910 14 „ D.— Infantile Mortality, 1858-1910 19 „ E.— Smallpox (mortality), 1841-1910 27 „ F.— Measles (mortality), 1841-1910 30 „ G.— Measles and Whooping-cough (monthly deaths), 1891-1910 31 „ H.— Scarlet Fever (mortality), 1859-1910 34 „ K.— Scarlet Fever (admissions to hospitals of Metropolitan Asylums Board, percent, of total notified cases in London), 1890-1910 34 ,, L.— Scarlet Fever (monthly notified cases and case-mortality), 1891-1910 34 „ M.— Diphtheria and Croup (mortality), 1859-1910 37 „ N.— Diphtheria (admissions to hospitals of Metropolitan Asylums Board, per cent, of total notified cases in London), 1890-1910 37 „ O.— Diphtheria (monthly notified cases and case-mortality), 1891-1910 37 „ P.— Whooping-cough (mortality), 1841-1910 42 „ Q.— Typhus (mortality), 1869-1910 44 „ R.— Enteric Fever (mortality), 1869-1910 44 „ S.— Enteric Fever (weekly notified cases, 1910, and mean weekly notified cases, 1890- 1910) 44 „ T.— Enteric Fever (monthly notified cases and case-mortality), 1891-1910 44 „ U.— Diarrhæa, Dysentery and Cholera (mortality), 1841-1910 47 „ V.— Seasonal prevalence of infectious disease, 1891-1910 50 „ W.— Phthisis (mortality—males and females), 1851-1910 59 „ X.— Scarlet Fever 175 „ Y.— Scarlet Fever 175 „ Z.— Diphtheria 175 „ AA. —Diphtheria 175 ,, BB.— Measles 175 Appendixes. page I.— Proceedings of sanitary authorities under the Factory and Workshop Act .. .. ii. II.— Cases of Human Glanders in London, 1893-1911 iv. III.— Summary of defects in children as found by School Doctors viii. IY.— Comparison of methods of administration of Medical Inspection x. V.— Form M.O. 190 xi. VI.— General reports on 356 school buildings where medical inspection was carried out in the year 1910 xii VII.— Number of candidates examined for the permanent service and the conditions found xiii. VIII.— Number of County Scholarship candidates examined and the conditions found xiv. IX.— Number of Trade Scholarship candidates examined and the conditions found xv. X.— Number of Special Scholarship candidates examined and the conditions found xvi. XI.— Number of candidates examined for the teaching profession and the conditions found xvii. XII.— Training college, pupil teacher centres, secondary and trade schools—Defects noted on medical examination xviii. XIII.— Results of enquiries into the history of 5,093 children under medical treatment xix. XIV.— Housing accounts— A.— Housing of the Working Classes Act, 1890 xx. B.— Dwellings under Improvement Acts xxvi. C.— Dwellings under the Housing of the Working Classes Act, 1890, and Improvement Acts combined xxix. 5 page D.— Details of Revenue Account— I.— Housing of the Working Classes Act, 1890 xxx. II.— Dwellings under Improvement Acts xxx. E.— Percentages on gross rental of the several items of Income and Expenditure in respect of dwellings in D xxxii. F.— Summary of Financial Results— I.— Housing of the Working Classes Act, 1890 xxxiv. II.— Dwellings under Improvement Acts xxxiv. G.— Details of Repairs and Renewals Fund xxxvi. H.— Contributions from and to rates xxxvi. XV.— Capital expenditure on clearance schemes under the Housing of the Working Classes Act, 1890 xxxvii. XVI.— Commercial and housing values of sites utilised for the erection of Working Class Dwellings xxxviii. XVII.— Housing Statistics— A.— Number of tenements in the Council's working-class dwellings xl. B.— Accommodation in the Council's working-class dwellings xliv. C.— Rents charged in the Council's working-class dwellings xlviii. D.— Accommodation provided and gross rent per annum on 31st March, 1893, and each subsequent year 1. E.—Number of persons re-housed 1. F.—Number of tenants transferred or who vacated, 1910-11 li. G.—Percentage of total outgoings on rent receivable for the last five years.. lii. H.—Population of the Council's dwellings according to a census taken in March, 1911 liii. K.—Cases of infectious disease removed from the Council's dwellings, 1910-1911 liv. L.—-Births and deaths in the Council's dwellings, 1910-11 lv. M..—Occupations of the Council's tenants lvi. XVIII.—Statement of the Statutes under which dwellings under Improvement Acts were erected lvii. Chapter XXXI. Report of the Medical Officer of Health (Sir Shirley Murphy) for the Year 1910. Vital Statistics. The mean temperature of the air during 1910 was very slightly above the average of the preceding 65 years. The greatest excess over the monthly average occurred in December, October and February, While in November and July the temperature was considerably below the average. The rainfall during the year was 3.9 inches above the average, the excess being most marked in the month of December, considerable excess being also shown in November, February, July and April; the deficiency was greatest in September, the other months below the average being October, March and January. In the preparation of this report the results of the census in 1911 contained in the Preliminary Census Report have been taken into account throughout, all the rates shown being based upon recalculated population-estimates for the intercensal years. It is to be noted, however, that as the age constitution of the 1911 population is not yet known, the death rates at ages have been calculated on the basis of the age constitution of the population recorded in 1901 ; consequently all such rates, and all rates to which corrective factors have been applied in the report, must be regarded to a certain extent as approximate. The marriage rate (17.2) was slightly above the marriage rate of the preceding year (16.8), The birth-rate (25.4) was the lowest on record in London since the institution of civil registration, as was also the infantile mortality (103), and the death-rate (13.7). The deaths from cancer and measles were above the annual average of the preceding 10 years, and the deaths from small-pox, whooping-cough, scarlet fever, diphtheria, enteric fever, diarrhoea, and phthisis were below the average. If the death-rate in 1910 be compared with that of the decennium 1891-1900, the result expressed in terms of lives and " life-capital," shows a saving of 25,179 lives, representing a gain to the community of 1,050,489 years of " life-capital." Population. The population of the Administrative County of London, estimated to the middle of the year 1910. was 4,5:32,545. The population of the City of London and of each metropolitan borough, as constituted by the London Government Act of 1899, estimated to the middle of 1910, is shown in the following table— Metropolitan borough. Estimated population (middle of 1910). Metropolitan borough. Estimated population (middle of 1910). Paddington 142,952 Shoreditch 112,212 Kensington 173,046 Bethnal Green 128,630 Hammersmith 121,132 Stepney 281,948 Fulham 152,414 Poplar 163,235 Chelsea 67,087 Southwark 193,382 Westminster, City of 162,285 Bermondsey 126,558 St. Marylebone 119,576 Lambeth 298,975 Hampstead 85,405 Battersea 168,195 St. Pancras 220,132 Wandsworth 306,037 Islington 328,612 Camberwell 261,702 Stoke Newington 50,821 Deptford 109,774 Hackney 222,749 Greenwich 96,143 Holborn 50,184 Lewisham 158,649 Finsbury 89,154 Woolwioh 121,317 London, City of 20,239 The County of London population shown above has been arrived at by the application of a finite difference interpolation formula to the census populations of 1891, 1896, 1901 and 1911 (provisiona figures). The mid-year populations thus obtained were, after making allowance for alterations of the county boundary in 1904 and 1908, as follows 4,539,647 in 1901; 4,550,098 in 1902 4,557,478 in 1903; 4,561,789 in 1904; 4,563,371 in 1905; 4,562,227 in 1906; 4,558,474 in 1907 4,j52,063 in 1908 ; 4,543,436 in 1909 and 4,532,545 in 1910. The natural increase of the population is the amount by which the number of births exceeds the number of deaths annually. In making a comparison of the rates of natural increase in different localities, it should be pointed out that these rates are affected by differences in the age and sex-constitution of the populations compared, as well as by the relative amount of emigration and immigration an his should be borne in mind in any general comparison of the crude natural increase rates. The following table shows the mean annual rate of natural increase of the population per 1,00( living in certain periods from 1886 to 1910 Natural increase. 8 Annual Report of the London County Council, 1910. Period. Mean of annual birth-rates per 1,000 living. Mean of annual death-rates per 1,000 living. . Mean of annual rate of natural increase per 1,000 living. London. Greater London. (.a) England and Wales. London. Greater London. (a) England and Wales. London. Greater London. (a) England and Wales. 1886-1890 32.10b 31.97 31.44 19.69c 18.68 18.89 12.41 13.29 12.55 1891-1895 30.76b 30.46 30.48 19.82c 18.49 18.71 10.94 11.97 11.77 1896-1900 29.66b 29.31 29.27 18.51c 17.23 17.69 11.15 12.08 11.58 1901-1905 28.43b 28.57 28.15 16.34 c 15.14 16.03 12.09 13.43 12.12 1906-1910 26.37b 26.28 26.22 14.80c 13.72 14.68 11.57 12.56 11.54 1906 27.45b 27.52 27.17 15.64c 14.66 15.44 11.81 12.86 11.73 1907 26.71b 26.75 26.40 15.24c 14.18 15.07 11.47 12.57 11.33 1908 26.56b 26.53 26.70 14.56c 13.56 14.78 12.00 12.97 11.92 1909 25.73b 25.58 25.78 14.93c 13.76 14.60 10.80 11.82 11.18 1910 25.41b 25.02 25.04 13.66c 12.44 13.49 11.75 12.58 11.55 Movement of population 1901-1910. The natural increase in the County of London during 1901-10 has not been sufficient to compensate for the loss by the outward movement of the population. The following table gives some indication of the nature of the migration which has taken place within the county, and from it outward. It will be seen that even the area of Greater London has lost nearly a quarter of a million of its population by migration during the 10 years; and it is estimated that nearly three-fourths of this loss has occurred in the latter half of the decennium. Gain ( + ) or loss ( —) of each area by migration Natural Actual of population. Metropolitan borough. increase (+) increase ( + ) or or Per cent of decrease (-). decrease (-). Number. 1901 population. Paddington + 13,889 — 1,201 — 15,090 —10.5 Kensington + 10,285 — 3,983 — 14,268 — 8.1 Hammersmith + 13,918 + 9,527 — 4,391 — 3.9 Fulham + 24,718 + 16,238 — 8,480 — 6.2 Chelsea + 4,215 — 7,341 — 11,556 —15.6 Westminster, City of + 6,781 — 22.496 — 29,277 —16 0 St. Marylebone + 7,536 — 14,905 — 22,441 —16.8 Hampstead + 5,932 + 3,684 — 2,248 — 2.7 St. Pancras + 23,950 — 16,549 — 40,499 —17.2 Islington + 38,641 — 7,108 — 45,749 —13.7 Stoke Newington + 4,466 — 493 — 4,959 — 9.7 Hackney + 26,217 + 3,946 — 22,271 —10.2 Holborn + 1,949 — 9,993 — 11,942 —20.0 Finsbury + 11,076 — 13,355 — 24,431 —240 London, City of — 747 — 7,234 — 6,487 —24.0 Shoreditch + 16,039 — 7,014 — 23.053 —19.4 Bethnal Green + 20,366 — 1,219 — 21,585 —16.7 Stepney + 51,918 — 18,175 — 70,093 —23.5 Poplar + 25,377 — 6,143 — 31,520 —18.7 Southwark + 25,997 — 13,952 — 39,949 —19.4 Bermondsey + 17,390 — 4,622 — 22,012 —16.8 Lambeth + 34,121 — 3,351 — 37,472 —12.4 Battersea + 23,610 — 880 — 24,490 —14.5 Wandsworth + 35,718 + 79,974 + 44,256 + 19.3 Camberwell + 32,183 + 2,380 — 29,803 —11.5 Deptford + 15,686 — 747 — 16,433 —14.9 Greenwich + 12,190 + 340 — 11,850 —12.4 Lewisliam + 18,444 + 33,550 + 15,106 +11.9 Woolwich + 17,571 + 4,391 — 13,180 —11.3 London County +539,436 — 6,731 —546,167 —12.0 "Outer Ring" (a) +363,026 +688,933 +325,907 +16.1 Greater London +902,462 +682,202 —220,260 — 3.4 (a) Greater London is the administrative area of the Metropolitan and City police. The "outer ring" is the part of Greater London by which the Administrative County is surrounded. (b) For the purposes of these rates the births in the principal lying-in institutions have been distributed to the district to which they belong. (e) These death-rates are fully corrected for institutions, 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 London, but occurring in London institutions situated outside the Administrative County. 9 Report of the Medical Officer of Health. The following table enables comparison to be made of the rates of natural increase of the London population with those of the principal towns of England. It will be observed that in 1910 the rates are below those of the quinquennium in 1905-9 in Leeds, Sheffield, Bristol, Bradford, Newcastle - on Tyne, Hull and Leicester:— Town. 1905-9. 1910. Town. 1905-9. 1910. London 11 .7 a 11.8a Bradford 5.0 4.7 Greater London 12.8 12.6 West Ham 15.9 16.8 Liverpool 12.8 12.8 New castle-on-Tyne 14.4 13.6 Manchester 10.7 11.2 Hull 13.7 13.6 Birmingham 12.9 13.6 Nottingham 10.3 11.0 Leeds 10.7 9.4 Salford 12.2 12.3 Sheffield 14.1 13.9 Leicester 11.3 11.1 Bristol 11.4 10.9 Natural increaserate in large English towns. The factors affecting the rates of natural increase in different localities to which reference has been made, probably tend more to vitiate accurate comparison when the populations concerned are of different nationalities, and this should be borne in mind in connection with the following table (6), showing the rate of increase in London and certain foreign towns :— Town. 1905-9. 1910. Town. 1905-9. 1910. London 117 a 11.8a St. Petersburg 3.5 3.7 Paris 0.9 1.3 Berlin 8.0 6.8 Brussels 3.5 3.2 Vienna 7.1 4.1 Amsterdam 11.7 11.4 Rome 4.5 5.1 Copenhagen 12.5 11.9 New York 9.7 10.9 Stockholm 9.3 8.6 Natural increaserate in foreign towns. The natural increase during the period 1905-9 in New York is probably understated, owing to incomplete registration of births prior to 1908. It will be noticed that the excess of births over deaths in 1910 is below the average of the preceding five years in all the foreign towns except Paris, St. Petersburg, Rome and New York. These rates can only be regarded as approximate, and in making comparison of one town with another it should be borne in mind that full correction for births and deaths in institutions might considerably modify the rates of some of the towns. Marriages. The number of marriages in the Administrative County of London in 1910, was 39,082 (365 days), giving an annual rate of 17.2 persons married per 1,000 living. The marriage-rate in successive periods has been as follows— Period. Marriage-rate per 1,000 persons living. Period. Marriage-rate per 1,000 persons living. 1851-1860 20.6 1903 17.7 1861-1870 20.3 1904 17.3 1871-1880 19.1 1905 17.4 1881-1890 17.6 1906 17.7 1891-1900 17.8 1907 17.8 1901-1910 17.4 1908 16.7 1909 16.8 1901 17.6 1910 17.2 1902 18.0 The accompanying diagram (A) shows the marriage-rate in each year since 1850, in relation to the mean marriage-rate of the period 1851-1910. In the year 1910 among males 2.9 per cent. married were under 21 years of age, and among females 10.8 per cent.; the figures for previous years are shown in the following table, the proportions in England and Wales being also given for the purpose of comparison. It will be seen that both in London and in England and Wales the proportion of male and female minors in every 100 marriages has been diminishing for a number of years, but there is some indication of a pause in the decline in the percentage of male minors:— Marriages of minors. (a) See footnotes (b) and (c) page 8. (b) All death-rates in this report relating to foreign towns are calculated upon figures published by the Registrar- 6176 B 10 Annual Report of the London Comity Council, 1910. Period. Marriages of minors per cent. of total marriages. London. England and Wales. Males. Females. Males. Females. 1851-1800 2.8 11.9 5.7 18.0 1861-1870 3.6 14.6 6.8 20.4 1871-1880 4.7 16.9 8.0 22.0 1881-1890 5.5 18.9 6.8 20.8 1891-1900 4.7 16.5 5.4 17.5 1901 4.4 15.0 5.0 16.0 1902 4.0 14.0 4.7 15.4 1903 3.8 13.7 4.6 15.2 1904 3.7 13.9 4.6 15.3 1905 3.6 13.0 4.4 14.7 1906 3.5 12.9 4.3 14.6 1907 3.2 11.8 4.1 14.2 1908 2.9 11.3 4.0 14.0 1909 3.1 11.1 4.0 13.7 If the marriage rate of 1910 be compared with the marriage-rate of 1870-72, it has decreased by 11 per cent., if based on the total population, and by 20 per cent., if based upon the total number of marriageable persons, i.e., on the unmarried and widowed portion of the population, aged 15 years and upwards. This latter figure may be said to represent the fall in the marriage-rate more accurately than the former. Births. The number of births registered in the Administrative County of London in 1910 (52 weeks) was 114,870, giving a birth-rate of 254 per 1,000 persons living per annum. The steady decline in the London birth-rate noted in previous reports has continued, and the birth-rate for 1910 is the lowest recorded rate on London since the institution of civil registration. Birth-rates — London. The birth-rate in successive periods has been as follows:— Period. Birth-rate per 1,000 persons living. Period. Birth-rate per 1,000 persons living. 1851-1860 33.6 1903 28.7a 1861-1870 35.4 1904 28.3a 1871-1880 35.4 1905 27.7a 1881-1890 33.2 1906 27.4a 1891-1900 30.2a 1907 26.7a 1901-1910 27.4 a 1908 26.6a 1909 25.7a 1901 28.9 a 1910 25.4a 1902 28.6a England and Wales. The corresponding figures for England and Wales, which show a similar decline to that noted in London, are as follows:— Period. Birth-rate per 1,000 persons living. Period. Birth-rate per 1,000 persons living. 1851-1860 34.1 1903 28.4 1861-1870 35.2 1904 280 1871-1880 35.4 1905 27.3 1881-1890 32.4 1906 27.2 1891-1900 29.9 1907 26.4 1901-1910 27.2 1908 26.7 1909 25.8 1901 28.5 1910 25.0 1902 28.5 (a) See footnote (b) page 8. Report of the Medical Officer of Health. 11 The following table enables comparison to be made of the birth-rate in London and Greater London with that of the chief towns of England ; but it is to be borne in mind that the London figures alone are fully corrected by the exclusion of births within the County to mothers not usually resident in London. Were births in other towns similarly corrected considerable modification of these rates might result. Town. 1905-9. 1910. Town. 1905-9. 1910. London 26.8a 2 5.4a Bradford 20.4 19.1 Greater London 26.8 25.0 West Ham 31.9 30.2 Liverpool 32.7 31.0 New castle-on-Tyne 31.3 28.5 Manchester 29.1 27.3 Hull 29.9 29.1 Birmingham 29.8 28.4 Nottingham 26.9 25.6 Leeds 26.8 24.5 Salford 30.6 28.3 Sheffield 31.0 28.1 Leicester 25.4 23.5 Bristol 25.7 23.3 • Birth-rates in large English towns. It will be seen from the following table that the decrease in birth-rate apparent in London is shared by all the chief foreign capitals, except Rome ; but that the London birth-rate compares not unfavourably with that of many of the largest of these capital towns. There is considerable difference in practice as to the registration and allocation of births occurring in these foreign towns, and the rates shown must, therefore, be regarded as affording only approximate material for comparison. Town. 1905-9. 1910. Town. 1905-9. 1910. London 26.8a 25.4a St. Petersburg 29.1 27.8 Paris 18.6 18.0 Berlin 23.8 21.5 Brussels 17.7 16.8 Vienna 24.8 19.9 Amsterdam 25.1 23.6 Rome 23.5 23.6 Copenhagen 28.0 26.1 New York 27.3 26.9 Stockholm 24.3 23.2 Birth-rates in foreign towns. The accompanying diagram (B.) shows the London birth-rate in each year since 1850, in relation to the mean birth-rate of the period 1851-1910. In connection with this diagram it should be noted that the registration of births was not made compulsory until the beginning of 1875; before that year many births were probably unregistered. From the year 1885 onwards the number of births has been corrected as far as possible by the exclusion of those which occurred in the chief lying-in institutions in cases where the mother resided outside the County of London. The following table shows the birth-rate in the several sanitary districts per 1,000 person living and per 100 married females aged 15-45 in the period 1905-9 and in the year 1910:— Metropolitan borough. Births, 1910 (52 weeks). (a) Birth-rate per 1,000 persons living. (a) Legitimate births per 100 married females aged 15-45.(a) 1905-9. 1910. 1905-9. 1910. Paddington 3,084 22.9 21.6 18.9 17.8 Kensington 3,217 19.9 18.6 18.3 17.1 Hammersmith 3,045 26.3 25.2 20.1 19.1 Fulham 4,303 31.4 28.3 20.8 19.0* Chelsea 1,382 22.1 20.7 19.2 18.0 Westminster, City of 2,554 17.3 15.8 15.4 14.1 St. Marylebone 2,331 21.4 19.5 17.9 16.6 Hampstead 1,340 16.6 15.7 15.4 14.5 St. Pancras 5,720 26.2 26.1 19.7 19.7 Islington 8,289 26.1 25.3 19.8 19.3 Stoke Newington 984 21.0 19.4 17.5 16.1 Hackney 5,298 25.2 23.8 20.3 19.2 Holborn 1,022 21.0 20.4 16.7 16.3 Finsbury 2,824 31.3 31.8 24.0 24.0 London, City of 227 13.1 11.2 14.6 12.9 Shoreditch 3,613 33.3 32.3 25.4 24.8 Bethnal Green 4,208 33.2 32.8 26.1 25.8 Birth-rates in London sanitary districts. (a.) See footnote (6), page 8, (Continued on next page.) 6176 B 2 12 Annual Report of the London County Council, 1910. Metropolitan borough. Births, 1910 (52 weeks). (a) Birth-rate per 1,000 persons living. (a) Legitimate births per 100 married females aged 15-45. (a) 1905-9. 1910. 1905-9. 1910. Stepney 9,258 35.6 32.9 27.6 25.5 Poplar 5,111 32.4 31.4 25.6 25.0 Southwark 5,873 31.3 30.5 22.9 22.2 Bermondsey 4,006 32.3 31.7 25.6 25.2 Lambeth 7,344 26.5 24.6 20.1 18.8 Battersea 4,483 27.6 26.7 20.0 19.3 Wandsworth 6,980 25.2 22.9 19.9 18.1 Camberwell 6,657 26.2 25.5 21.0 20.4 Deptford 3,004 29.4 27.4 22.2 20.6 Greenwich 2,432 26.9 25.4 22.1 20.9 Lewisham 3,439 24.0 21.7 19.1 17.2 Woolwich 2,842 27.5 23.5 20.2 17.2 London 114,870 26.9 25.4 21.1 20.0 It will be seen from the above table that the birth-rates of the several sanitary districts vary greatly, ranging from 12.9 in the City of London to 25.8 in Bethnal Green, when the rates for the year 1910 based on the number of married females of child-bearing age, are compared. Compared with the birth-rate in 1870-2, the London birth-rate of 1910 has decreased by 28 per cent. when calculated on the total population, and 31 per cent. when calculated on the female population aged 15-45 years; the legitimate birth-rate has declined 26 per cent, when calculated on the married female population aged 15-45 years, and the illegitimate birth-rate has declined 45 per cent. when calculated on the unmarried and widowed female population of that age period. Notification of births. Under the Notification of Births Act, 1907, the London County Council receives particulars of the births which have been notified to the medical officers of health of the several sanitary districts in London, and from the information thus received the following table has been prepared:— Metropolitan borough. Total births notified (corrected for institutions). Stillbirths (corrected). Births, less stillbirths (corrected). Births registered (corrected). Excess of registered over notified births (corrected). Paddington 2,938 73 2,865 3,081 + 219 Kensington 2,941 45 2,896 3,217 + 321 Hammersmith 2,420 57 2,363 3,045 + 682 Fulham 3,434 64 3,370 4,303 + 933 Chelsea 1,112 22 1,090 1,382 + 292 Westminster, City of 1,869 50 1,819 2,554 + 735 St. Marylebone 2,525 58 2,467 2,331 -136 Hampstead 1,260 22 1,238 1,340 + 102 St. Pancras 5,163 123 5,040 5,720 + 680 Islington 7,875 254 7,621 8,289 + 668 Stoke Newington 825 6 819 984 + 165 Hackney 5,438 140 5,298 5,298 - Holborn 937 29 908 1,022 + 114 Finsbury 2,938 56 2,882 2,824 - 58 London, City of 222 7 215 227 + 12 Shoreditch 3,495 70 3,425 3,613 + 188 Bethnal Green 3,774 80 3,694 4.208 + 514 Stepney 8,647 203 8,444 9,258 + 814 Poplar 4,661 102 4,559 5,111 + 552 Southwark 6,048 137 5,911 5,873 - 38 Bermondsey 3,901 38 3,863 4,006 + 143 Lambeth 7,358 118 7,240 7,344 + 104 Battersea 3,028 52 2,976 4,483 + 1,507 Wandsworth 4,393 79 4,314 6,980 + 2,666 Camberwell 5,799 156 5,643 6,657 + 1,014 Deptford 2,789 43 2,746 3,004 + 258 Greenwich 2,595 34 2,561 2,432 - 129 Lewisham 3,465 91 3,374 3,439 + 65 Woolwich 2,713 94 2,619 2,842 + 223 London 104,563 2,303 102,260 114,870 + 12,610 (a) See footnote (h) page 8. 13 Report of the Medical Officer of Health. The number and percentage of stillbirths and of multiple births notified in 1910 (uncorrected for institutions) is shown in the following table:— Metropolitan borough. Total births notified. Stillbirths. Percentage stillborn. Multiple births. Percentage of mothers delivered of more than one child at a birth. Twins. Triplets. Total born. Cases. Stillborn. Cases. Stillborn. One. both. One. Two. Three Paddington 2,736 72 2.6 40 - 2 l - - - 83 1.5 Kensington 2,778 45 1.6 33 4 - - - - - 66 1.2 Hammersmith 2,321 57 2.5 16 2 - - - - - 32 0.7 Fulham 3,333 64 1.9 2 1 - - - - - 4 0.1 Chelsea 1,054 22 2.1 15 1 1 - - - - 30 1.4 Westminster, City of 1,676 48 2.9 24 1 - l 1 - - 51 1.5 St. Marylebone 4,076 64 1.6 39 5 - - - - - 78 10 Hampstead 1,220 22 1.8 15 2 - - - - - 30 1.2 St. Pancras 4,633 119 2.6 57 5 - - - - - 114 1.2 Islington 7,572 243 3.2 75 9 4 - - - - 150 1.0 Stoke Newington 806 6 0.7 3 1 - - - - - 6 0.4 Hackney 5,438 140 2.6 87 4 4 2 - - - 180 1.7 Holbom 1,306 39 3.0 16 2 1 - - - - 32 1.2 Finsbury 3,552 79 2.2 38 7 - 1 - - - 83a 1.1 London, City of 212 6 2.8 4 2 - - - - - 8 1.9 Shoreditch 3,299 65 2.0 33 3 - - - - - 66 1.0 Bethnal Green 3,725 80 2.1 52 3 - 2 - - 1 110 1.5 Stepney 8,792 203 2.3 123 5 2 2 - - - 252 1.4 Poplar 4,557 102 2.2 43 6 - 3 - - - 95 1.0 Southwark 6,048 137 2.3 58 5 2 - - - - 116 1.0 Bermondsey 3,886 36 0.9 45 1 - 1 - 1 - 93 1.2 Lambeth 7,323 116 1.6 64 6 - - - - - 128 0.9 Battersea 3,013 52 1.7 44 - - - - - - 88 1.5 Wandsworth 4,371 78 1.8 38 3 - 1 - 1 - 79 0.9 Camberwell 5,799 156 2.7 49 1 - - - - - 98 0.9 Deptford 2,733 42 1.5 20 1 1 2 - - - 46 0.8 Greenwich 2,636 34 1.3 23 3 - 1 - - - 49 0.9 Lewisham 3,460 91 2.6 44 4 - - - - - 88 1.3 Woolwich 2,712 94 3.5 23 1 1 - - - - 46 0.9. London 105,067 2.312 2.3 1,123 88 18 17 1 2 l 2,301a 1.1 Stillbirths and multiple births, 1910. The annual reports of medical officers of health show that in the large majority of districts considerable effort is made to ensure the proper feeding and care of infants by visiting houses in which births have occurred. In some two-thirds of the London districts consultation centres have been provided to which infants can be taken, and in about one-third of the districts steps are taken to assist in the proper feeding of expectant and nursing mothers. In the early part of 1911 enquiry was made for the Council by Dr. Wanklyn as to the measures adopted in the several districts, and the information thus obtained is given in the following table. Infantile mortality. The need for the services of health visitors is especially urged in the report of the medical officer of health of Islington, where, as will be observed, no advantage is taken of the Notification of Births Act. Metropolitan borough. No. of health visitors. No. of women sanitary inspectors. Proportion of infants visited to total registered births. Consultation centres. Feeding of expectant or nursing mothers. Paddington - 2 73% Yes Yes. Kensington 2 2 About 65% Yes Yes. Hammersmith 1 - 75% No No. Fulham - 1 About 25% Yes Yes. Chelsea - 1 55% Yes Yes. Westminster, City of - 2 94% No No. St. Marylebone - 3 80% Yes Yes. Hampstead - 2 45% Yes Yes. St. Pancras - 2 21% Yes Yes. Islington - 2 None No No. Stoke Newington - 1 50% Yes Yes. Hackney 1 2 21% Yes No. Holborn - 1 75% No. No. Finsbury 2 1 41% Yes No. London, City of - 3 100% At P. H. Dept. weighing station. Yes Yes (a) In addition there was in Finsbury a case of quadruplets, none stillborn. (Continued on next page.) 14 Annual Report of the London County Council, 1910. Metropolitan borough. No. of health visitors. No. of women sanitary inspectors. Proportion of infants visited to total registered births. Consultation centres. Feeding of expectant or nursing mothers. Shoreditch 1 - 25% No No. Bethnal Green - 1 50% Yes No. Stepney 1 - 5% Yes Yes. Poplar 1 1 25% With voluntary helpers. Yes No. Southwark - 3 About 60% No No. Bermondsey 1 - About 65% Yes No. Lambeth 1 2 25% Yes No. Battersea 1 1 30 to 35% No No. Wandsworth - 2 About 50% No No. Camberwell - 1 None No No. Deptford 1 - About 45% No No. Greenwich - - None Yes No. Lewisham - 2 About 45% No No. Woolwich - 2 About 65% Yes No. Deaths. The number of deaths in the Administrative County of London in 1910 (52 weeks) was 61,756, giving an annual death rate of 13.7 per 1,000 of the estimated population. The death-rate in successive periods has been as follows :— Period. Death-rate (All Causes) per 1,000 persons living. Period. Death-rate (All Causes) per 1,000 persons living. 1841-1850 24.8 1902 17.3a 1851-1860 23.7 1903 15.3a 1861-1870 24.4 1904 16.4a 1871-1880 22.5 1905 15.5a 1881-1890 20.3 1906 15.6a 1891-1900 19.2a 1907 15.2a 1901-1910 15.6a 1908 14.6a 1909 14.9a 1901 17.2a 1910 13.7a The death-rate in each year since 1840 in relation to the mean death-rate of the period 1841-1910 is shown in diagram (C). The following table has been prepared for the purpose of comparing the death-rate of London with those of other English towns having populations which exceeded 200,000 persons at the census of 1901. Death-rates in large English towns. The columns showing "death-rates corrected for age and sex distribution" have been obtained by multiplying the crude death-rates by the "factors for correction" published by the Registrar-General in the Annual Summary for 1910. (b) Town. Estimated Population (middle of 1910). Crude death-rate per 1,000 persons living. Death-rate per 1,000 persons living (corrected for age and sex distribution). Comparative mortality figure. 1905-9. 1910. 1905-9. 1910. 1910. England & Wales 35,819,020 75.5 13.5 15.0 13.5 1,000 London 4.532,545 15.2 13.7 16.0 14.4 1,064 Liverpool 744,635 19.8 18.3 21.2 19.6 1,451 Manchester 710,253 18.4 16.2 20.5 18.0 1,336 Birmingham 526,779 16.9 14.8 18.2 15.9 1,180 Leeds 445,117 16.1 15.1 17.6 16.4 1,218 Sheffield 451,890 16.9 14.2 18.2 15.3 1,135 Bristol 356,318 14.3 12.4 14.7 12.7 943 West Ham 287,927 16.0 13.3 17.1 14.3 1,058 Bradford 288,375 15.4 14.4 17.1 15.9 1,179 Newcastle-on -Tyne 265,620 16.9 14.9 18.2 16.1 1,190 Hull 275,540 16.2 15.5 16.6 15.9 1,178 Nottingham 258,834 16.6 14.6 17.5 15.4 1,141 Salford 231,001 18.4 16.0 20.3 17.7 1,313 Leicester 226,434 14.0 12.4 15.0 13.2 980 (o) See footnote (c) page 8. (6) The corrective factors shown in the table and elsewhere in this report were calculated upon the age and sexconstitution of the population enumerated in 1901. Their application to the deaths in 1910 assumes that the constitution of the population has remained unchanged during ten years; it is, however, certain that some change has occurred, and consequently the modified rates shown can only be regarded as approximately corrected by these factors. 15 Report of the Medical Officer of Health. London had therefore (comparing the corrected death-rates), in the quinquennium 1905-9 a lower death-rate than any of these towns except Bristol and Leicester, and in 1910, a lower rate than all except Bristol, West Ham and Leicester. The following table enables comparison to be made of the crude death-rate of London with that of several foreign towns:— Town. 1905-9. 1910. Town. 1900-9. 1910. London 15.2a 13.7a Stockholm 15.0 14.6 Greater London 14.1 12.4 St. Petersburg 25.6 24.1 Paris 17.7 16.7 Berlin 15.8 14.7 Brussels 14.2 13.6 Vienna 17.7 15.8 Amsterdam 13.4 12.2 Rome 191 18.5 Copenhagen 15.6 14.2 New York 17.6 16.0 Death-rates in foreign towns. It will be seen from the foregoing table that in the quinquennium 1905-9 the London death-rate was exceeded by the death-rates of Paris, Copenhagen, St. Petersburg, Berlin, Vienna, Rome and New York, and in 1910 was lower than that of any except Brussels and Amsterdam. London mortality in 1910 compared with the mortality in the decennium 1891-1900. The following table shows the mean death-rates obtaining in London at the several age-periods and for each sex in the decennium 1891-1900 and in the year 1910. The figures for the year 1910 are fully corrected for institution deaths (see footnote (c), page 8), and the rates for the decennium 1891-1900 are based upon figures which have been corrected for institution deaths on the basis of the experience of the four years 1897-1900; a fuller discussion of this point will be found in the London Life Table appended to my report for the year 1901. (b) Age-period. Males. Females. Mean deathrate 1891-1900. Death-rate 1910. Difference per cent. Mean deathrate 1891-1900. Death -rate 1910. Difference per cent. 0- 71.97 40.41 -43.9 61.99 33.86 -45.4 5- 4.97 3.07 -38.2 5.17 2.87 -44.5 10- 2.46 1.74 -29.3 2.48 1.74 -29.8 15- 3.47 2.34 -32.6 2.94 2.13 -27.6 20- 4.59 3.01 -34.4 3.46 2.21 -36.1 25- 7.36 4.77 -35.2 5.65 3.47 -38.6 35- 14.22 9.66 -32.1 10.68 7.31 -31.6 45- 23.14 18.82 -18.7 17.12 13.24 -22.7 55- 40.68 35.89 -11.8 31.01 25.29 -18.4 65- 77.78 77.32 - 0.6 63.44 56.61 -10.8 75- 154.13 149.96 - 2.7 134.56 121.98 -9.3 85 and upwards 284.10 332.72 + 17.1 265.77 300.94 +13.2 All ages 20.88 14.94 - 284 17.88 12.52 -30.0 It will be seen from this table that the rate of mortality in 1910 was considerably lower than that of the period 1891-1900 at each age-period of life and for each sex, except at the period 85 and upwards. 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 adopted being similar to that employed by Dr. Tatham in a report on the health of greater Manchester for the period 1891-3. The advantages of this method and the formulae used are set out in some detail in the London Life Table appended to the annual report for 1901. It will be seen from the description therein contained that in order to apply this method of comparison it is necessary in the first place to ascertain from the Life Table the mean future lifetime of males and females in groups of ages corresponding to those age-groups to which the deaths relate. The following table shows the results thus obtained from the London Life Table, 1891-1900:— Age-group. Mean future lifetime, 1891-1900. Age-group. Mean future lifetime, 1891-1900. Males. Females. Males. Females. Years. Years. Years. Years. 0- 50.16 53.66 35- 23.98 26.89 5- 49.89 53.48 45- 17.75 20.04 10- 45.61 49.30 55- 12.35 13.93 15- 41.26 44.94 65- 7.98 8.90 20- 37.05 40.62 75- 4.91 5.37 25- 31.05 34.39 85 and upwards 3.02 3.19 (a) See footnote (c) page 8. (b) In the calculation of the death-rates at ages in this and the following tables the assumption is made that the age constitution of the population has remained constant since the census of 1901; it is however certain that some change has occurred and the rates calculated on this assumption can therefore only be regarded as approximate. 16 Annual Report of the London County Council, 1910. In the following table the number of deaths occurring in the year 1910 at each age-period and for each sex is compared with the number of deaths which would have occurred had the death-rates of the period 1891-1900 been maintained in the year 1910. The number of lives gained in the latter period is also shown, and the figures in the last column of the table express this gain in terms of "life-capital," these being obtained by applying the mean future lifetime figures given in the preceding table to the number of lives gained at each age-group.— "Lifecapital" gained in 1910. The number of lives gained in the latter period is also shown, and the figures in the last column of the table express this gain in terms of "life-capital," these being obtained by applying the mean future lifetime figures given in the preceding table to the number of lives gained at each age-group.— Age-group. Deaths calculated according to mean death-rates of 1891-1900. Deaths occurring in the year 1910. Gain ( + ) or loss (-) of lives in the year 1910, by fluctuations of mortality. Gain ( + ) or loss (-) of "life capital" in the year 1910 by fluctuations of mortality. Males. Years. 0- 17,763 9,973 + 7,790 + 390,746 5- 1,090 674 + 416 + 20,754 10- 509 360 + 149 + 6,796 15- 722 487 + 235 + 9,696 20- 993 652 + 341 + 12,634 25- 2,721 1,762 + 959 + 29,777 35- 3,974 2,699 + 1,275 + 30,575 45- 4,498 3,657 + 841 + 14,928 55- 4,808 4,242 + 566 + 6,990 65- 4,259 4,234 + 25 + 199 75- 2,614 2,543 + 71 + 349 85 and upwards 493 577 - 84 -254 All Ages—Males 44,444 31,860 + 12,584 + 523,190 Females. 0- 15,390 8,406 + 6,984 + 374,761 5- 1,152 640 + 512 + 27,382 10- 527 369 + 158 + 7,789 15- 686 498 + 188 + 8,449 20- 904 578 + 326 + 13,242 25- 2,479 1,522 + 957 + 32,911 35- 3,322 2 274 + 1,048 + 28,181 45- 3,746 2,896 + 850 + 17,034 55- 4,382 3,574 + 808 + 11,255 65- 4,945 4,413 + 532 + 4,735 75- 4,021 3,645 + 376 + 2,019 85 and upwards 1,090 1,234 -144 - 459 All Ages—Females 42,644 30,049 +12,595 + 527,299 Total—Persons 87,088 61,909 + 25,179 + 1,050,489 It will be seen from the preceding table that during the year 1910, compared with the decennium 1891-1900, there has been a saving of 25,179 fives, representing a gain to the community of 1,050,489 years of "life-capital." Deaths at all ages from certain diseases and groups of diseases. The following table shows the diminution or excess in the number of deaths from certain diseases and groups of diseases during the year 1910, compared with the mean of the annual deaths in the preceding 10 years, corrected for variations in the population. Cause of Death. Diminution or excess in number of deaths in 1910 compared with 1900-1909. Diminution. Excess. Smallpox 157 - Measles - 16 Scarlet Fever 272 - Typhus 1 - Influenza 286 - Whooping-Cough 147 - Diphtheria 451 - Pyrexia (origin uncertain) 1 - Enteric Fever 165 - Diarrhœa 1,728 - Pneumonia 18 - Erysipelas 61 - (Continued on next page.) 17 Report of the Medical Officer of Health. Cause of Death. Diminution or excess in number of deaths in 1910, compared with 1900-1909. Diminution. Excess. Tuberculous Phthisis 1,416 - Phthisis Tuberculous Meningitis 242 - Tuberculous Peritonitis 211 - Tabes Mesenterica Other Tuberculous Diseases (including Scrofula) 192 - Cancer - 422 Premature Birth 265 - Diseases of Nervous system 1,297 - Diseases of Circulatory system Diseases of Respiratory system 1,580 - Diseases of Digestive system 626 - Diseases of Urinary system 37 - Childbirth and Puerperal Septic Diseases 55 - Accident 497 - Homicide 12 - Suicide - 28 All other Causes 1,137 - Net diminution 10,388 The following table shows the crude death-rates, and the death-rates corrected for differences in the age and sex constitution of the population (a) of the several sanitary districts (b) during the year 1910; the mean death-rates for the period 1905-9 are also shown for the purposes of comparison. Area. Standard deathrate. Factor for correction for age and sex distribution. Crude death-rate per 1,000 persons living. Corrected deathrate per 1,000 persons living. Corrected comparative mortality figure (London, 1,000). 1905-9. 1910. 1905-9. 1910. 1906-9. 1910. England, and Wales 18.19 1.0000 - - - - - - London 17.31 1.0511 15.2 13.7 16.0 14.4 1,000 1,000 Paddington 17.04 1.0677 13.5 12.6 14.4 13.5 901 937 Kensington 16.88 1.0778 14.1 12.7 15.2 13.7 951 953 Hammersmith 17.47 1.0414 14.7 12.8 15.3 13.4 958 930 Fulham 17.39 1.0462 14.9 12.5 15.6 13.1 977 914 Chelsea 17.56 1.0361 16.0 14.2 16.6 14.7 1,040 1,025 Westminster, City of 16.22 1.1217 13.2 11.7 14.9 13.1 931 914 St. Marylebone 17.08 1.0652 15.2 13.4 16.2 14.3 1,017 995 Hampstead 16.13 1.1280 9.7 9.7 11.0 10.9 689 758 St. Pancras 17.40 1.0456 160 14.9 16.7 15.5 1,047 1,082 Islington 17.51 1.0391 14.9 13.8 15.5 14.4 968 1,000 Stoke Newington 17.43 1.0438 12.5 11.8 13.0 12.4 816 861 Hackney 17.46 1.0420 140 12.6 14.6 13.1 913 914 Holborn 16.90 1.0766 17.5 15.8 18.9 17.0 1,183 1,187 Finsbury 17.57 10355 19.9 18.6 20.6 19.3 1,294 1,344 London, City of 16.55 1.0993 16.1 13.1 17.7 14.4 1,110 1,002 Shoreditch 17.34 1.0493 19.4 17.0 20.4 17.9 1,276 1,244 Bethnal Green 18.01 1.0102 180 15.7 18.1 15.8 1,137 1,103 Stepney 17.41 1.0450 17.8 15.3 18.6 160 1,163 1,114 Poplar 17.64 1.0314 17.4 16.0 17.9 16.5 1,124 1,151 Southwark 17.41 1.0450 18.5 17.4 19.4 18.2 1,214 1,268 Bermondsey 17.76 1.0244 18.8 17.7 19.3 18.2 1,209 1,266 Lambeth 17.63 1.0320 15.2 13.7 15.7 14.2 983 986 Battersea 16.96 1.0728 14.2 12.6 15.3 13.6 958 944 Wandsworth 17.25 1.0547 12.1 10.2 12.8 10.7 802 747 Camberwell 17.54 10373 14.4 13.2 15.0 13.7 938 952 Deptford 17.31 1.0511 15.2 15.2 15.9 16.0 998 1,115 Greenwich 17.82 1.0210 14.3 13.6 14.6 13.9 916 969 Lewisham 17.46 1.0420 11.5 10.0 12.0 10.4 753 727 Woolwich 17.02 1.0690 13.3 11.7 14.2 12.5 888 870 It will be seen from the foregoing table (comparing the corrected death-rates) that in the quinquennium 1905-9 Finsbury (20.6) had the highest rate and Hampstead (11.0) the lowest; in the year 1910, Finsbury (19.3) had the highest, and Lewisham (10 4) the lowest. The death-rates in each of the four quarters of the year 1910, were as follows : first quarter 153; second quarter 12.5; third quarter 11.1; and fourth quarter 15.8, per 1,000 persons living. (a) See footnote (b) page 14. (6) All death-rates in this report relating to Metropolitan boroughs are fully- corrected for institutions. (See footnote (e) page 8). 18 Annual Report of the London County Council, 1910. Deaths at age-periods, 1910 (365 days). The following table shows the number of deaths (a) (All Causes) occurring at the several ageperiods in each of the sanitary districts of the Administrative County of London during the year. Metropolitan borough. Deaths at ages from all causes—1910 (365 days). 0- 1- 2- 3- 4- Under 5. 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85 & upwards All Ages. Paddington 297 108 31 13 17 466 47 21 21 37 81 138 215 223 270 203 78 1,800 Kensington 340 118 37 30 23 548 41 18 34 46 111 171 235 265 356 281 92 2,198 Hammersmith 303 98 25 20 18 464 32 18 27 42 76 118 137 201 198 196 41 1,550 Fulham 460 139 34 16 19 668 38 28 30 29 110 169 185 215 225 168 42 1,907 Chelsea 142 43 14 4 2 205 15 9 13 14 46 78 117 127 190 106 38 958 Westminster, City of 217 51 16 10 11 305 24 16 22 41 100 217 242 290 331 243 74 1905 St. Marylebone 258 61 24 20 7 370 27 13 22 27 72 156 217 228 258 164 48 1,602 Hampstead 81 22 12 8 7 130 9 11 11 18 39 39 98 126 169 117 57 824 St. Pancras 580 195 95 46 25 941 63 35 51 69 183 265 357 413 464 333 89 3,263 Islington 778 285 122 61 44 1,290 92 63 71 74 232 350 485 608 641 497 142 4,545 Stoke Newington 62 23 4 5 3 97 10 7 8 20 3 54 66 79 111 97 21 601 Hackney 520 148 61 30 19 778 47 34 58 76 190 207 287 383 388 294 85 2,837 Holborn 105 33 6 14 7 165 11 7 12 9 63 91 101 111 116 89 20 795 Finsbury 346 138 47 26 16 573 34 21 23 29 75 129 180 187 219 140 37 1,647 London, City of 16 6 3 - - 25 - - 6 6 9 24 33 45 63 37 18 266 Shoreditch 526 145 51 32 27 781 41 15 31 31 103 156 201 202 210 110 28 1,109 Bethnal Green 511 143 42 39 8 743 39 25 30 41 110 160 198 248 220 151 43 2,008 Stepney 1,038 326 99 59 38 1,560 87 58 63 92 224 369 497 527 469 285 74 4,305 Poplar 610 190 51 27 23 901 68 38 35 48 132 197 262 327 363 210 46 2,627 Southwark 686 297 113 69 33 1,168 72 39 45 64 186 296 345 414 4C4 242 60 3,365 Bermondsey 502 235 67 43 29 876 51 26 49 32 110 176 219 252 244 156 51 2,242 Lambeth 692 225 94 42 32 l,085 93 47 70 78 231 316 437 515 646 450 130 4,098 Battersea 438 125 55 22 28 668 64 26 35 50 123 149 233 264 266 200 49 2,127 Wandsworth 540 141 52 24 23 780 85 33 68 63 170 227 304 396 496 353 124 3,089 Camberwell 628 221 91 45 38 1,023 74 43 47 80 183 281 339 445 473 355 112 3,455 Deptford 367 115 43 32 20 577 37 21 22 24 79 113 168 185 225 174 43 1,668 Greenwich 263 89 41 26 10 429 31 16 29 26 66 95 112 133 169 153 44 1,303 Lewisham 275 55 29 16 12 387 47 17 25 34 63 105 148 207 258 223 74 1,588 Woolwich 243 52 26 7 18 346 35 24 27 30 86 127 135 200 205 161 41 1,417 London 11,824 3,827 1,385 786 557 18,379 1,314 729 985 1,230 3,284 4,973 6,553 7,816 8,647 6,188 1,811 61,909 Comparison can be made of death-rates from certain causes of death in London sanitarydistricts by reference to the following table. The death-rates shown are fully corrected for deaths in institutions (see footnote (c) page 8), but are uncorrected for differences in the age and sex constitiution of the population. Death-rates in sanitary districts from particular causes, per 00,000 living. In the case of phthisis and of "cancer," viz., carcinoma, sarcoma, and cancer (otherwise undefined) "factors for correction for differences in age and sex constitution" have been calculated, and these factors and the corrected death-rates are shown on pages 53 and 60 respectively. Metropolitan borough. Measles. Rheumatic Fever. Carcinoma. Sarcoma. Cancer (not otherwise defined). Tabes Mesenterica. Tuberculous Meningitis. Phthisis. Other Tuberculous and Scrofulous Diseases. Pneumonia. Other Respiratory Disesse. All other Causes. All Causes. Paddington 48 4 78 10 29 6 13 90 11 11 139 720 1,259 Kensington 30 3 61 4 37 11 7 87 9 144 124 753 1,270 Hammersmith 58 2 74 4 31 6 14 111 14 140 81 745 1,280 Fulham 43 6 69 4 26 5 20 113 16 135 96 718 1,251 Chelsea 28 12 98 9 34 3 12 127 12 139 125 829 1,428 Westminster, City of 13 4 80 4 29 4 12 117 13 116 91 691 1,174 St. Marylebone 23 8 78 3 53 2 10 117 15 125 132 774 1,340 Hampstead 18 1 65 11 28 7 9 66 9 78 68 605 965 St. Pancras 64 4 91 8 27 9 16 141 13 183 121 805 1,482 Islington 51 5 61 9 44 12 20 123 12 152 116 778 1,383 Stoke Newington 24 2 59 12 41 4 18 100 14 59 120 730 1,183 Hackney 30 5 65 7 31 9 17 118 11 113 112 756 1,274 Holborn 28 4 86 — 30 6 10 215 14 167 165 859 1,584 Finsbury 74 10 58 5 20 5 25 182 18 202 237 1,011 1,847 London, City of — 10 89 10 25 — 15 138 29 109 158 731 1,314 Shoreditch 75 4 55 5 24 11 34 153 22 234 177 907 1,701 Bethnal Green 46 3 40 7 51 13 25 147 12 186 169 862 1,561 Stepney 37 3 51 7 24 11 18 147 20 181 157 871 1,527 Poplar 26 6 60 9 22 8 24 146 23 184 168 933 1,609 Southwark 117 2 75 5 20 10 22 192 21 222 181 873 1,740 Bermondsey 115 10 80 9 27 17 21 178 23 205 193 894 1,772 Lambeth 41 5 76 3 28 10 14 130 14 157 142 751 1,371 Battersea 43 7 46 4 35 5 18 118 10 142 110 727 1,265 Wandsworth 14 5 56 7 36 4 15 84 10 86 80 616 1,013 Camberwell 52 6 49 6 35 9 14 124 14 119 125 767 1,320 Deptford 55 3 67 6 28 7 17 130 17 137 197 855 1,519 Greenwich 50 5 58 5 27 8 15 111 12 137 110 817 1,355 Lewisham 8 5 73 5 23 4 8 57 8 81 103 626 1,001 Woolwich 18 3 45 4 38 6 16 115 13 87 100 723 1,168 London 44 5 65 6 31 8 17 124 14 145 130 777 1,366 (u) See footnote (c) page 8, Diagram D . Infantile Mortality (Deaths under one year of age per 1000 births) Report of the Medical Officer of Health. 19 Infantile Mortality. The deaths of children under one year of age in the Administrative County of London during 1910 (52 weeks) numbered 11,809,.being in the proportion of 103 per 1,000 births. The proportion in successive periods has been as follows:— Period. Deaths under one year of age per 1,000 births. Period. Deaths under one year of age per 1,000 births. 1841-1850 157a 1902 140b 1851-1860 155a 1903 130b 1861-1870 162a 1904 145b 1871-1880 158a 1905 130b 1881-1890 152 1906 131b 1891-1900 159b 1907 116b 1901-1910 127b 1908 113b 1909 108b 1901 148b 1910 103b The accompanying diagram (D.) shows the infantile mortality in each year since 1857 in relation to the mean infantile mortality of the period 1858-1910, and also the infantile mortality in each year after exclusion of the deaths from premature birth, which cause of death would in all probability be affected in greater degree than the deaths under any other heading by the more complete registration of recent years. It will be seen that the rates of 1910 are the lowest recorded in this period. The following table enables comparison to be made of the infantile mortality in London and other large English towns. Town. 1905-9. 1910. Town. 1905-9. 1910. London 120b 103b Bradford 136 127 Greater London 115 95 West Ham 137 101 Liverpool 151 140 Newcastle-on-Tyne 133 121 Manchester 151 131 Hull 140 135 Birmingham 149 130 Nottingham 157 128 Leeds 138 132 Salford 148 130 Sheffield 146 127 Leicester 141 126 Bristol 115 90 Infantile mortality in large English towns. London had therefore in the period 1905-9 a lower infantile mortality than any of these towns except Bristol. In 1910 the London rate was below all except that of Bristol and West Ham. The rates are uncorrected (except in the case of London) for births in institutions. The uncorrected London rate for 1910 was 104. The comparison of the infantile mortality rates of towns in different countries is undoubtedly affected by differences in the practice with regard to the registration and allocation of births and also by the extent to which correction is made for deaths amongst infants put out to nurse in suburbs, or in institutions. The rates shown in the following table, which are calculated on the number of living births registered, can only be taken as approximately correct. The rate for New York is somewhat overstated for the period 1905-9, owing to the incomplete registration of births prior to 1908. Town. 1905-9. 1910. Town. 1905-9. 1910. London 120b 103b St. Petersburg . 259 262 Paris 105 118 Berlin 174 157 Brussels (1906-9) 147 136 Vienna 176 176 Amsterdam 96 78 Rome 141 123 Copenhagen 135 118 New York. 143 126 Stockholm 96 92 Infantile mortality in foreign towns. (a) The registration of births was not made compulsory until the beginning of 1875; before that year many birth were probably unregistered. (b) See footnotes (b) and (c) page 8. 20 Annual Report of the London County Council, 1910. The following table shows the deaths of infants under one year of age and the number of these deaths per 1,000 births in each of the sanitary districts of the County of London for the period 1905-9 and for the year 1910:— Metropolitan borough. Deaths under one year of age, 1910 (52 weeks). Deaths under one year of age per 1,000 births. 1905-9. 1910. Paddington 296 107 96 Kensington 340 126 106 Hammersmith 302 125 99 Fulham 462 125 107 Chelsea 140 116 101 Westminster, City of 215 103 84 St. Marylebone 252 109 108 Hampstead 80 76 60 St. Pancras 582 113 102 Islington 777 113 94 Stoke Newington 63 98 64 Hackney 520 116 98 Holborn 105 117 103 Finsbury 347 138 123 London, City of 15 109 66 Shoreditch 526 152 146 Bethnal Green 517 140 123 Stepney 1,037 129 112 Poplar 605 136 118 Southwark 682 135 116 Bermondsey 503 141 126 Lambeth 691 118 94 Battersea 434 115 97 Wandsworth 545 105 78 Camberwell 629 114 94 Deptford 367 118 122 Greenwich 261 113 107 Lewisham 274 91 80 Woolwich 242 100 85 London 11,809 120 103 It will be seen from the foregoing table that in the period 1905-9 and the year 1910 Shoreditch (152 and 146 respectively) and Bermondsey (141 and 126 respectively) had the highest infantile death-rates and Hampstead (76 and 60 respectively) had the lowest. The deaths under one year of age per 1,000 births, during each of the four quarters of the year, were as follows:—First quarter 101; second quarter 88 ; third quarter 91 ; fourth quarter 128. The reports of Medical Officers of Health of the several sanitary districts of the Administrative County for the year 1910 contain tables prepared in accordance with the instructions of the Local Government Board giving the number of deaths, from all causes and certain specified causes, of infants at different age-periods in the first year of life. From the information thus supplied, the following table has been compiled, showing the figures for London as a whole for the 52 weeks of 1910. It will be seen tnat tne total deaths here snown differ slightly from the total in the preceaing table derived from the annual summary of the Registrar-General. Cause of death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under one year. Common Infectious Diseases — Small-pox - - - - - - - - - - - - - - - - - Chicken-pox - - - - - 1 - - - - - - 1 2 - - 4 Measles 2 — 1 2 5 4 5 1 3 15 20 43 54 71 87 83 391 Scarlet Fever - - - - - - - - - - 2 1 2 2 — 3 10 Diphtheria and Croup — — — — — 2 — — — 3 3 4 4 3 6 5 30 Whooping-cough 1 1 9 6 17 58 47 38 42 42 67 45 62 60 63 61 602 Diarrhœl Diseases— Diarrhœa, all forms 2 9 17 17 45 87 94 126 99 98 66 74 67 60 45 39 900 Enteritis (not tuberculous) 2 10 6 10 28 67 60 62 54 56 45 24 33 37 26 21 513 Gastritis, Gastrointestinal Catarrh 3 5 5 8 21 20 25 16 6 7 4 4 8 2 7 3 123 Continued on next page 21 Report of the Medical Officer of Health. Cause of death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1 -2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under one year. Wasting Diseases— Premature Birth 1,427 223 151 99 1,900 120 35 17 4 5 2 — 1 - 2 - 2,086 Congenital Defects 322 70 38 37 467 58 35 32 16 13 7 9 7 5 2 6 657 Injury at Birth 96 6 — 1 103 3 2 — — — — - - - - 108 Want of Breast-milk 7 6 3 5 21 9 4 3 2 3 1 1 - 1 - - 45 Atrophy, Debility, Marasmus 253 100 101 86 540 288 203 156 118 80 80 52 43 26 36 15 1,637 Tuberculous Diseases— Tuberculous Meningitis 3 1 2 - 6 10 9 12 14 14 20 20 22 13 21 18 179 Tuberculous Peritoniti: Tabes Mesenteries - 1 1 2 4 9 19 21 12 13 14 10 8 7 9 3 129 Other Tuberculous Diseases - - - 1 1 9 9 8 12 15 12 19 12 17 19 9 142 Erysipelas — 1 1 7 9 9 3 — 2 1 3 2 1 2 — — 32 Syphilis 10 10 16 19 55 37 22 22 14 10 6 7 1 5 4 3 186 Rickets — — - 1 1 2 3 3 4 2 3 6 7 8 8 7 54 Meningitis (not Tuberculous) 8 6 1 2 17 6 4 10 16 9 31 13 21 15 15 17 174 Convulsions 88 50 32 20 190 59 41 44 30 17 22 14 15 14 19 10 475 Bronchitis 11 21 30 42 104 140 91 70 59 60 54 51 64 45 50 55 843 Laryngitis 1 — — — 1 — — 1 — 2 — 2 1 3 2 1 13 Pneumonia 17 20 34 40 111 139 124 117 92 108 116 108 133 136 115 143 1,442 Suffocation, overlaying 60 16 15 15 106 69 50 36 32 11 8 2 4 2 1 - 321 Other causes 152 42 37 31 262 81 44 39 47 52 38 53 36 34 35 30 751 Total (All Causes) 2,465 598 500 451 4,014 1,287 929 834 678 636 824 564 607 570 572 532 11,847 Comparison may be made between the number of deaths from the several causes in the above table with those of the five antecedent years by reference to the following table:— Cause of death. 1905. 52 weeks. 1906. 52 weeks. 1907. 52 weeks. 1908. 53 weeks. 1909. 52 weeks. 1910. 52 weeks. Deaths in 1910 in excess or defeat of the corrected average for 1905-9. Diminution in 1910 Excess in 1910 Small-pox - - - - - - - - Chicken-pox 3 3 5 3 10 4 1 - Measles 389 420 400 333 503 391 - 6 Scarlet Fever 34 18 35 24 20 10 15 - Diphtheria and Croup 52 59 53 67 60 30 25 - Whooping-cough 623 502 746 469 524 602 - 64 Diarrhœa 3,423 4,468 1,790 2,709 1,849 1,536 1,120 — Enteritis (not tuberculous) Gastritis, Gastro - intestinal Catarrh Premature Birth 2,423 2,208 2,299 2,197 2,122 2,086 26 - Congenital Defects 547 613 645 705 667 657 - 59 Injury at Birth 99 113 117 110 113 108 - 4 Want of Breast-milk 2,281 2,130 1,922 1,843 1,825 1,682 194 - Atrophy, Debility, Marasmus Tuberculous Meningitis 273 241 239 259 203 179 49 - Tuberculous Peritonitis: Tabes Mesenterica 192 225 153 168 145 129 36 - Other Tuberculous Diseases 284 246 264 255 188 142 90 - Erysipelas 64 50 52 35 48 32 15 - Syphilis 271 233 226 229 216 186 34 - Rickets 79 67 58 51 45 54 2 - Meningitis (not tuberculous) 300 302 210 246 170 174 55 - Convulsions 803 660 603 520 495 475 102 - Bronchitis 1,276 1,043 1,284 982 960 843 197 - Laryngitis 25 23 15 18 15 13 5 - Pneumonia 1,490 1,335 1,629 1,431 1,334 1,442 - 86 Suffocation, overlaying 462 417 421 417 322 321 61 - Other causes 1,004 1,009 979 885 852 751 136 - Total 16,397 16,385 14,145 13,956 12,686 11,847 Net defect 1,944 Number of births 125,939 124,880 121,408 122,898 116,559 114,870 22 Annual Report of the London County Council, 1910. The total deaths among children under one year of age from "all causes" at certain age periods in 1910 may be compared with similar figures included in the Annual Reports for the preceding five years as follows:— Year. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under one year. 1905 2,886 808 667 564 4,925 1,796 1,411 1,211 1,033 983 932 853 880 846 821 706 16,397 1906 2,683 707 722 545 4,657 1,690 1,417 1,279 1,080 1,080 970 917 849 884 774 788 16,385 1907 2,758 760 676 533 4,727 1,579 1,198 1,060 820 700 723 680 684 668 631 675 14.145 1908 2,645 651 631 485 4,412 1,566 1,211 1,035 898 803 733 675 684 639 643 652 13,956 1909 2,535 612 540 471 4,158 1,346 1,060 912 764 676 624 625 661 611 626 623 12,686 1910 2,465 598 500 451 4,014 1,287 929 834 678 636 624 564 607 570 572' 532 11,847 Death-rates per 1,000 living at beginning of each month of life, 1905-1910. The following table has been prepared to show the mortality rates among the survivors at the beginning of each age:— Tear. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6 -7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total under one year. (a) 1905 22.9 6.6 5.5 4.6 39.1 14.8 11.8 10.3 8.9 8.5 8.1 7.5 7.8 7.6 7.4 6.4 130.2 1906 21.5 5.8 5.9 4.5 37.3 14.1 12.0 10.9 9.3 9.4 8.5 8.1 7.6 8.0 7.0 7.2 131.2 1907 22.7 6.4 5.7 4.5 38.9 13.5 10.4 9.3 7.3 6.2 6.5 6.1 6.2 6.1 5.8 6.3 116.5 1908 21.5 5.4 5.3 4.1 35.9 13.2 10.4 8.9 7.8 7.1 6.5 6.0 6.1 5.8 5.8 5.9 113.6 1909 21.7 5.4 4.8 4.2 35.7 12.0 9.5 8.3 7.0 6.2 5.8 5.8 6.2 5.8 6.0 6.0 108.8 1910 21.5 5.3 4.5 4.1 34.9 11.6 8.5 7.7 6.3 5.9 5.9 5.3 5.8 5.4 5.5 5.1 103.1 1905-10 22.0 5.8 5.3 4.3 37.0 13.2 10.4 9.2 7.8 7.2 6.9 6.5 6.6 6.5 6.3 6.2 117.2 With a view to comparing the rates of mortality from the several groups of diseases in the years 1905-10 the following table has been prepared. It will be seen that in 1910 the death-rate from diarrhoeal diseases was low. This low death-rate is probably in the main due to the favourable meteorological conditions of 1910. Year. All causes. (a) Measles. Whoopingcough. Diarrhœal diseases. Wasting diseases. Tuberculous diseases. Meningitis and convulsions. Bronchitis. Pneumonia. Other causes. 1905 130.2 3.1 4.9 27.2 42.5 6.0 8.8 10.1 11.8 15.8 1906 131.2 3.4 4.0 35.8 40.5 5.7 7.7 8.4 10.7 15.0 1907 116.5 3.3 6.2 14.7 41.0 5.4 6.7 10.6 13.4 15.2 1908 113.6 2.7 3.8 22.0 39.5 5.6 6.2 8.0 11.7 14.1 1909 108.8 4.3 4.5 15.9 40.6 4.6 5.7 8.2 11.4 13.6 1910 103.1 3.4 5.2 13.4 39.5 3.9 5.6 7.3 12.6 12.2 In the following table are shown rates of mortality from tuberculous diseases in successive years. The decline observable in this class of disease in the early years of life has to be considered with that from tuberculous disease at the older ages. The degree in which question of nomenclature may affect the figures has also to be borne in mind, for in all probability the causes of death stated in certificates of death of young children, are more likely to be subject to variation from changes in nomenclature (a) These rates differ slightly from those shown on page 19, the latter being based upon figures in the RegistrarGeneral's Annual Summary, whilst the rates shown above are based upon the totals of the births and deaths, as corrected for each borough by the respective Medical Officers of Health. Report of the Medical Officer of Health. 23 than those relating to deaths of older persons. Nevertheless, the decline in recent years which the figures in the following table indicate is significant. Tuberculous diseases—Death-rate per 1,000 living at the beginning of each age. Year. 0— 1— 2— 3— 4— 1897 9.83 1898 10.33 598 1899 9.74 5-59 2*76 1900 8.57 5.68 2.90 1.70 1901 7.36 5.40 2.28 1.81 124 1902 7.36 4.95 2.21 1.72 1.33 1903 6.99 4.92 2.59 1.72 1.23 1904 6.68 4.72 2.60 1.54 107 1905 5.81 4.19 2.41 1.72 1.10 1906 5.69 4.79 2.72 1.49 1.44 1907 5.26 4.35 2.40 1.62 1.04 1908 5.48 4.71 2.25 1.51 1.30 1909 4.47 3.75 2.38 1.43 0.97 1910 4.02 3.12 1.88 1.15 0.81 Tuberculous Diseases— Death-rate per 1,000 living at each year of life among children under 5 years of age, 1897-1910 The following tables, which are based upon the figures in the table on page 21, show the number of survivors at the beginning of each of the first twelve months of life, and the probability of living for one month from the commencement of each month in the first year of life, out of 100,000 born in the year 1910. For the purpose of comparison, similar figures for the preceding five years are shown; these differ slightly from those contained in the life tables published in some former reports owing to the figures being recalculated upon the more fully corrected figures which have become available since the life table was first introduced into these reports. Number living at the beginning of each month of age. Age-period. l x/12 x/12. 1909. 1908. 1907.j 1906. 1905. 0—1 mth. 10,000 100,000 100,000 100,000 100,000 100,000 1—2mths. 96,562 96,567 96,437 96,219 96,320 96,188 2—3 ,, 95,457 95,450 95,173 94,953 94,983 94,795 3—4 „ 94,658 94,568 94,196 93,990 93,859 93,701 4—5 „ 93,939 93,809 93,360 93,137 92,845 92,761 5—6 „ 93,354 93,172 92,633 92,475 91,988 91,958 6—7 „ 92,805 92,605 91,985 91,910 91,130 91,194 7—8 „ 92,268 92,077 91,391 91,326 90,360 90,466 8—9 „ 91,782 91,546 90,847 90,774 89,631 89,799 9—10 „ 91,258 90,983 90,295 90,217 88,956 89,110 10—11 „ 90,764 90,461 89,779 89,670 88,254 88,444 11—12 „ 90,267 89,927 89,259 89,153 87,639 87,79 7 0-1 year 89,804 89,395 88,730 88,598 87,012 87,238 Infantile Life-Table. The probability of living for one month from the beginning of each month of life in the last six years of the decennium 1901-1910, is shown in the following table. The higher probabilities obtaining in the later years shown in the table is worthy of note. Probability of living for one month from the beginning of each month of life. Age-period. P x/12 1910. 1909. 1908. 1907. 1906.j 1905. 0—1 month .96562 .96567 .96437 .96219 .96320 .96188 1—2 months .98856 .98843 .98689 .98684 .98612 .98552 2—3 „ .99163 .99076 .98974 .98986 .98817 .98846 3—4 ,, .99240 .99198 .99112 .99092 .98919 .98996 4—5 „ .99377 .99321 .99222 .99290 .99077 .99135 5—6 ,, .99412 .99391 .99300 .99389 .99068 .99169 6—7 „ .99421 .99430 .99354 .99364 .99155 .99202 7—8 ,, .99473 .99423 .99405 .99396 .99193 .99263 8—9 ,, .99429 .99385 .99392 .99386 .99247 .99232 9—10 ,, .99459 .99427 .99429 .99394 .99211 .99253 10—11 ,, 99453 .99409 .99421 .99423 .99303 .99268 11—12 „ .99487 .99408 .99407 .99378 .99284 .99364 0—1 year 89804 89395 .88730 .88598 .87012 .87238 24 Annual Report of the London County Council, 1910. For the purpose of enabling comparison to be made of the age-distribution of the deaths under one year of age in the several sanitary districts of London, the following table has been prepared:— Metropolitan borough. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total under 1Year. Paddington 65 22 10 11 108 38 31 15 14 15 10 16 16 14 7 10 294 Kensington 89 10 13 8 120 28 29 30 11 15 23 16 24 14 18 17 345 Hammersmith 52 12 18 10 92 35 31 26 15 14 18 16 15 12 16 14 304 Fulham 99 22 20 20 161 56 31 29 30 18 37 26 21 19 21 13 462 Chelsea 34 10 6 4 54 11 7 10 6 13 10 6 8 5 5 6 141 Westminster,City of 53 9 4 12 78 30 19 25 11 10 10 6 5 6 10 4 214 St. Marylebone 66 13 16 7 102 19 16 25 18 9 10 9 9 13 12 11 253 Hampstead 22 8 5 3 38 8 5 5 3 7 3 2 1 4 2 3 81 St. Pancras 103 32 27 22 189 64 49 45 26 32 20 26 39 36 26 28 580 Islington 163 45 41 29 278 69 62 42 61 41 31 30 45 38 43 37 777 Stoke Newington 13 5 1 5 24 12 3 3 3 3 4 2 1 2 3 3 63 Hackney 139 28 23 20 210 59 42 36 32 27 30 21 29 20 18 19 543 Holborn 33 5 2 6 46 6 2 6 8 6 4 3 3 6 9 3 102 Finsbury 73 21 14 13 121 31 26 25 17 16 23 19 21 11 17 15 342 London, City of 5 3 - 1 9 - 1 — 1 - 2 — — 1 — — 14 Shoreditch 72 17 20 16 125 55 64 58 26 39 32 26 32 21 25 25 528 Bethnal Green 87 31 16 15 149 63 41 32 42 28 25 27 20 29 33 27 516 Stepney 186 56 44 42 328 107 84 84 55 64 45 48 68 59 48 51 1,041 Poplar 122 30 32 22 206 67 45 48 48 38 31 25 24 26 32 16 606 Southwark 145 27 18 24 214 55 45 45 28 44 41 41 45 38 41 39 676 Bermondsey 86 17 18 18 139 56 51 39 38 25 24 34 19 28 22 27 502 Lambeth 134 36 37 32 239 71 44 53 30 41 40 31 36 32 44 30 691 Battersea 92 12 19 24 147 51 44 21 27 14 27 18 25 25 15 20 434 Wandsworth 148 31 20 24 223 55 46 32 31 29 32 24 23 15 25 10 545 Camberwell 107 49 32 19 207 84 46 35 37 40 28 37 26 35 32 47 654 Deptford 72 12 11 15 110 54 19 19 23 20 24 26 21 14 17 19 366 Greenwich 59 8 11 13 91 27 16 14 15 13 11 11 13 18 12 20 261 Lewisham 69 17 10 6 102 47 14 20 11 7 17 9 8 18 8 10 271 Woolwich 72 10 12 10 104 29 16 12 11 8 12 9 10 11 11 8 241 London 2,465 598 500 451 4,014 l,287 929 834 678 636 624 564 607 570 572 532 11,847 Infantile mortality and " social condition 1910 (rt) The standard adopted throughout this report for determining the "social condition of a borough is the percentage of all children between the ages of 5 and 14 scheduled in the borough by the Co incu for education purposes in tho years 1905-7. The scheduling of children for this purpose is conducted annually by the Council, and the question whether or not a child is to be scheduled depends upon various circumstances which, it is thought, taken together, form a general measure of "social condition," _ „ „ The County has been divided into five groups of different grades of " social condition. Group I. contains all boroughs in which less than 82 per cent, of the children aged 5—14 were scheduled; Group II., 82 to 87 per cent.; Group III., 87 to 92 per cent.; Group IV., 92 to 97 per cent.; Group V., 97 per cent, and over. With a view to the consideration of the effect of "social condition" (a) on the rates of infantile mortality at different periods during the first year of life, the following table has been prepared, in which the rates of infantile mortality obtaining for groups of districts can be compared:— Infantile mortality in relation to "social condition"—1910. Age-period. Group of boroughs in order of "social condition." I. II. III. IV. V. Under 1 week 21.3 21.9 20.2 24.1 21.1 1-2 weeks 4.9 4.5 5.3 4.8 5.9 2-3 „ 2.9 3.8 4.9 4.4 4.7 3-4 „ 3.1 3.8 3.8 4.3 4.4 Under 1 month 32.2 34.0 34.2 37.6 36.1 1-2 months 8.9 10.8 10.4 12.3 13.0 2-3 ,, 5.2 8.2 7.5 7.4 11.1 3-4 ,, 4.8 7.3 6.4 7.2 10.0 4-5 ,, 4.1 4.5 5.8 6.6 7.4 5-6 ,, 3.8 5.0 5.1 6.1 7.2 6-7 ,, 4.5 5.1 4.6 6.9 6.3 7-8 ,, 2.9 4.4 4.3 6.0 6.4 8-9 ,, 2.7 4.9 5.2 5.7 6.7 9-10 „ 3.4 4.3 5.0 5.1 6.2 10-11 „ 3.4 4.2 4.7 5.8 6.1 11-12 „ 2.0 4.4 4.8 4.5 6.0 0-3 months 46.3 53.0 52.1 57.3 60.2 3-6 ,, 12.7 16.8 17.3 19.9 24.6 6-9 ,, 10.1 14.4 14.1 18.6 19.4 9-12 „ 8.8 12.9 14.5 15.4 18.3 0-12 months 77.9 97.1 98.0 111.2 122.5 Report of the Medical Officer of Health. 25 The foregoing table shews that there is a marked difference in the mortality among children under one year of age when the extreme groups of districts are compared. This agrees with the figures in corresponding tables published in previous annual reports. If the figures for each of the trimesters are considered in this connection, it will be seen that the same behaviour of the mortality is observable. This will be better appreciated by reference to the following table, in which the mortality of the group of districts of relatively highest " social condition " is taken as 100:— Comparative mortality—Group I. taken as 100. Number of group of Children aged Children aged Children aged Children aged Children under boroughs in order of "social condition" 0-3 months, 3-6 months. 6-9 months. 9-12 months. 1 year. 1905-9. 1910. 1905-9. 1910. 1905-9. 1910. 1905-9. 1910. 1905.9 1910. I. 100 100 100 100 100 100 100 100 100 100 II. 112 114 113 132 122 143 129 148 116 125 III. 112 113 115 135 126 140 141 165 118 126 IV. 118 124 130 156 143 185 154 176 128 143 V. 121 130 147 193 163 192 185 209 140 157 Thus in each successive trimester of the first year of life the difference in the mortality obtaining for the several groups of districts becomes generally more pronounced. The figures for 1910 are in general agreement with those for the period 1905-9. Principal Epidemic Diseases. The number of deaths in the Administrative County of London from the principal epidemic diseases, viz., smallpox, measles, scarlet fever, diphtheria, whooping-cough, typhus, enteric fever, pyrexia (a) and diarrhoea during 1910 (52 weeks) was 5,559, giving an annual death-rate of 1.23 per 1,000 persons living. The death-rates in successive periods have been as follows:— Period. Death-rate per 1,000 persons living. Period. Death-rate per 1,000 persons living. 1841-1850 5.20 1902 2.22b 1851-1860 5.13 1903 1.78b 1861-1870 5.23 1904 2.18b 1871-1880 3.86 1905 1.73b 1881-1890 3.02 1906 1.99b 1891-1900 2.66b 1907 1.48b 1901-1910 1.77b 1908 1.43b 1909 1.39b 1901 2.23b 1910 1.23b It will be seen from the following table that in the quinquennium 1905-9, London had a lower death-rate from these diseases than any of the undermentioned English towns, except Leeds, Bristol, Bradford and New castle-on-Tyne, and in 1910 had a lower death-rate, than any, except Birmingham, Bristol, Nottingham and Leicester. Town. 1905-9. 1910. Town. 1905-9. 1910. London l.60b 1.23b West Ham 2.81 1.37 Greater London 1.54 1.03 Bradford 1.30 1.28 Liverpool 2.54 2.36 Newcastle-on-Tyne.. 1.55 1.25 Manchester 2.24 1.81 Hull 2.13 1.78 Birmingham 2.17 1.21 Nottingham 1.93 1.04 Leeds 1.57 1.41 Salford 2.78 1.80 Sheffield 2.56 1.58 Leicester 1.62 0.75 Bristol 1.23 0.65 Epidemic diseases in large English towns. (a) Origin uncertain. Originally described as simple continued fever. (b) See footnote (c), page 8. 5176 c 26 Annual Report of the London-County Council, 1910. Six principal epidemic diseases in foreign towns. The following table shows that the London death-rate from six of these principal epidemic diseases, viz.: smallpox, measles, scarlet fever, diphtheria (including croup), whooping-cough and enteric fever was, in the quinquennium 1905-9, higher than the death-rates of all the undermentioned foreign towns except St. Petersburg and New York, and in 1910, was higher than that of all except Stockholm, St. Petersburg, and Rome. Town. 1905-9. 1910. Town. 1905-9. 1910. London 1.01a 0.93a St. Petersburg 31.6 2.72 Paris 0.51 0.60 Berlin 0.84 0.81 Brussels 0.49 0.48 Vienna 0.78 0.69 Amsterdam 0.84 0.46 Rome 0.97 1.45 Copenhagen 0.66 0.51 New York 1.02 0.90 Stockholm 0.56 1.16 The following table shows the deaths from the principal epidemic diseases and the death-rates per 1,000 persons living in each of the sanitary districts of the County in 1910, and the death-rates for the period 1905-9:— Metropolitan borough. Deaths, 1910 (52 weeks). Death-rate per 1,000 persons living. 1905-9. 1910. Paddington 164 1.16 1.15 Kensington 141 1.22 0.82 Hammersmith 170 1.60 1.41 Fulham 204 2.23 1.34 Chelsea 49 1.44 0.73 Westminster, City of 78 0.72 0.48 St. Marylebone 116 1.04 0.97 Hampstead 44 0.55 0.52 St. Pancras 330 1.33 1.50 Islington 432 1.36 1.32 Stoke Newington 31 0.98 0.61 Hackney 202 1.54 0.91 Holborn 49 1.19 0.98 Finsbury 182 2.49 2.05 London, City of 8 0.66 0.40 Shoreditch 217 2.83 1.94 Bethnal Green 192 2.27 1.50 Stepney 414 2.47 1.47 Poplar 259 2.55 1.59 Southwark 427 2.10 2.21 Bermondsey 310 2.38 2.46 Lambeth 322 1.44 1.08 Battersea 209 1.63 1.25 Wandsworth 185 1.21 0.61 Camberwell 308 1.43 1.18 Deptford 176 1.72 1.61 Greenwich 158 1.53 1.65 Lewisham 100 1.03 0.63 Woolwich 82 1.26 0.68 London 5,559 1.60 1.23 It will be seen from the foregoing table that the death-rate from the principal epidemic diseases in the period 1905-9 was highest in Shoreditch (2.83) and lowest in Hampstead (0.55), and in 1910 was highest in Bermondsey (2.46) and lowest in the City of London (0.40). The death-rates from these diseases during each of the four quarters of the year were as follows : First quarter, 1.07; second quarter, 1.15; third quarter, 1.22; and fourth quarter, 1.48 per 1,000 persons living. The abnormally high death-rate in the last quarter was mainly due to the high mortality from measles. Smallpox and Vaccination. Six cases of smallpox are known to have occurrred in the Administrative County of London during the year 1910, none of which was fatal; one death was attributed to cowpox. (a) See footnote (c), page 8. Diagram E. Smallpox Report of the Medical Officer of Health. 27 The death-rates from smallpox in successive periods have been as follows:— Period. Death-rate per 1,000 persons living. Period. Death-rate per 1,000 persons living. 1841-1850 0.402 1902 0.284a 1851-1860 0.280 1903 0.003a 1861-1870 0.276 1904 0.005a 1871-1880 0.457 1905 0.002a 1881-1890 0.142 1906 - 1891-1900 0.009a 1907 - 1901-1910 0.035a 1908 - 1909 0.000a 1901 0.051a 1910 - The smallpox death-rate, in each year since 1840 in relation to the mean death-rate during the period 1841-1910 is shown in diagram (E). During the complete years in which the notification of infectious diseases has been obligatory, the number of cases of smallpox (uncorrected for errors in diagnosis) notified to the medical officers of health in the various sanitary districts comprised in the Administrative County has been as follows:— Year. Cases of smallpox notified. Case-rate per 1,000 persons 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 1901 1,700 0.375 1902 7,796 1.683 1903 416 0.091 1904 489 0.107 1905 74 0.016 1906 31 0.007 1907 8 0 .002 1908 4 0.001 1909 21 0.005 1910 7 0.002 It will be seen from the following table that in the quinquennium 1905-9 only two of the undermentioned towns, namely Bristol and Hull, had a rate of 0.001 per 1,000., while in 1910, one death only occurred in Sheffield, Newcastle-on-Tyne, Hull and Nottingham. Town. 1905-9. 1910. Town. 1905-9. 1910. London O.OOa - West Ham . - Greater London o.oo - Bradford 0.00 - Liverpool o.oo - Newcastle-on-Tyne o.oo 0.00 Manchester — - Hull 0.01 0. 00 Birmingham o.oo - Nottingham o.oo o.oo Leeds o.oo - Salford - - Sheffield — 0.00 Leicester - - Bristol o.o1 . Smallpox death rates in Jarge English towns. 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. (a) See footnote (c), page 8. 5176 C2 28 Annual Report of the London County Council, 1910. Smallpox death-rates in foreign towns. The following table shows that of the undermentioned towns, St. Petersburg is the only one which has had an appreciable death-rate from smallpox during the last six years. Town. 1905-9. 1910. Town. 1905-9. 1910. London 0.00a - St. Petersburg 0.09 0.22 Paris 0.01 0.01 Berlin 0.00 0.00 Brussels 0.00 - Vienna 0.00 - Amsterdam - - Rome 0.00 - Copenhagen - New York 0.00 0.00 Stockholm - - 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. The actual cases of smallpox which occurred during the year were:— January.—C.S., aged 26 years, a male, removed from Victor-road, Islington, on January 6th. This man was mentioned in the last Annual Report as one of a group of cases, the first of which was infected in Dantzig. T.M., aged 56 years, a male, a casual dock labourer, removed on January 3rd from Aberfeldy-road, Poplar. The source of infection was unknown, but the patient had been working on board a vessel from Russia, in some of the ports of which smallpox was pre\alent. This case was also mentioned in the last Annual Report. June.—S.G., a female infant, aged six months, was removed on June 19th from the Charing Cross Hospital. The child had arrived the same day with her mother from Tientsin, China, which they left on June 7th, travelling by the Trans-Siberian Railway to Dover and London via Ostend. The child's father was suffering from smallpox when they left Tientsin, and the child became ill at Moscow. J.C., a male, aged 42 years, employed at a drug-grinders, removed on June 20th from Clarissa-street, Haggerston. The source of infection was not known. July.—R.C., a female, aged 35 years, wife of the above J.C., removed from the same house in Clarissa-street on July 3rd. W.S., a man, aged 55 years, the deputy of a common lodging-house in Warren-lane, Woolwich, on July 4th. The source of infection was unknown. Vaccination returns. The following table shows the proportion of children born in each year who were not finally accounted for in respect of vaccination. Year Children not finally accounted for (including cases postponed) per cent, of total births. Year. Children not finally accounted for (including cases postponed) per cent. of total births. 1872 8.8 1891 16.4 1873 8.7 1892 18.4 1874 8.8 1893 18.2 1875 9.3 1894 20.6 1876 6.5 1895 24.9 1877 7.1 1896 26.4 1878 7.1 1897 29.1 1879 7.8 1898 33.0 1880 7.0 1899 27.7 1881 5.7 1900 25.8 1882 6.6 1901 24.1 1883 6.5 1902 21.3 1884 6.8 1903 20.7 1885 7.0 1904 19.1 1886 7.8 1905 18.9 1887 9.0 1906 21.2 1888 10.3 1907 22.7 1889 11.6 1908 21.5 1890 13.9 1909 20.6 The percentage of children born who were exempted by "conscientious objection" certificates since and including 1898 has been as follows:—1898, 1.4; 1899, 1.0; 1900, 1.0; 1901, 1.1; 1902, 0.8; 1903, 1.0; 1904, 1.1; 1905, 1.2; 1906,1.5; 1907, 3.1; 1908, 7.3; 1909, 10.1. (a) See footnote (c), page 8. Report of the Medical Officer of Health. 29 During these years, the proportion of children exempted by certificate of conscientious objection, together with the proportion of children not finally accounted for in the several Unions, has been as follows:— Metropolitan Union. 1898. 1899. 1900. 1901. 1902. 1903. 1904. 1905. 1906. 1907 1908. 1909. Bermondsey 32.5 23.6 21.8 18.0 17.5 16.3 16.6 15.7 17.2 18.0 18.1 20.0 Bethnal Green 67.0 48.2 49.2 52.2 44.1 44.9 42.8 42.0 48.3 55.1 56.8 50.6 Camberwell 41.2 29.7 23.0 20.0 21.4 21.8 23.6 23.4 26.8 34.0 37.3 40.5 Chelsea 17.3 14.9 16.0 13.4 14.9 13.9 10.0 8.9 13.0 14.3 16.9 19.8 Fulham 15.4 12.6 13.7 12.0 11.8 12.7 11.5 10.8 14.6 18.1 19.3 21.8 George's, St., Hanover-square 11.1 9.0 7.1 5.8 7.5 5.1 4.9 4.4 4.3 7.2 8.4 10.3 George, St., in-theEast 34.6 35.0 33.5 30.6 29.7 27.7 15.7 17.3 16.8 17.7 15.6 18.3 Giles, St., and St. George 32.5 33.0 33.6 30.7 27.1 24.9 17.9 20.4 20.8 28.1 26.9 31.5 Greenwich 17.2 14.2 13.8 12.6 11.1 11.1 10.4 9.7 9.8 13.1 16.5 19.1 Hackney 49.0 38.6 40.4 38.5 26.1 25.5 26.9 28.2 36.8 33.2 34.4 39.0 Hammersmith 13.8 11.7 9.1 8.3 9.4 7.2 7.4 8.0 10.1 13.1 18.8 19.2 Hampstead 15.4 10.3 11.0 10.0 9.2 9.5 9.2 9.2 10.4 12.3 15.1 17.0 Holborn 43.8 31.8 28.5 27.6 23.2 20.7 20.4 20.6 24.5 26.7 29.3 31.8 Islington 31.1 29.2 26.2 21.6 17.7 17.0 15.9 17.5 18.2 21.2 25.2 27.1 Kensington 13.5 10.2 9.2 9.0 7.2 6.6 6.6 5.5 7.2 8.0 9.4 11.0 Lambeth 30.6 25.2 20.6 22.2 20.4 21.0 16.9 17.3 19.6 23.4 27.8 32.6 Lewisham 27.8 22.6 20.7 15.7 13.5 15.4 14.0 13.8 16.2 21.4 26.3 29.4 London, City of 25.4 18.3 14.2 11.3 11.3 11.8 13.0 15.3 16.8 17.5 18.2 18.2 Marylebone, St. 18.0 20.9 17.7 14.6 12.5 10.8 10.4 10.8 12.1 12.7 12.9 14.5 Mile End Old Town 68.9 69.9 68.0 66.1 58.8 59.8 47.3 47.1 48.4 52.3 53.9 51.8 Paddington 14.7 14.6 13.5 11.0 10.1 11.7 12.7 13.3 13.3 15.5 16.2 15.7 Pancras, St. 36.7 36.1 32.9 32.8 26.2 25.3 23.1 22.1 26.0 31.1 31.1 36.8 Poplar 63.6 50.1 49.0 49.1 44.2 46.9 45.4 45.3 49.3 53.9 55.1 53.3 Shoreditch 68.8 52.4 53.0 44.7 36.4 36.6 34.8 36.7 33.3 33.3 39.2 42.4 Southwark 32.6 30.3 27.6 26.8 25.4 24.9 24.3 24.2 28.4 31.1 32.0 34.3 Stepney 48.6 46.9 44.4 44.3 37.2 35.8 32.9) 32.9 32.9 38.1 50.6 51.3 Strand 25.2 19.7 19.2 16.1 19.0 18.6 15.0 11.8 11.7 14.2 24.9 21.4 Wandsworth and Clapham 32.2 25.1 23.0 20.5 19.2 17.2 16.3 14.8 18.0 22.8 28.2 30.1 Westminster 17.4 14.8 12.2 13.3 13.4 12.1 11.0 8.2 9.4 10.1 12.5 13.4 Whitechapel 11.8 14.5 13.1 10.5 9.5 10.1 9.1 10.6 11.5 14.1 17.1 15.9 Woolwich 10.2 8.3 7.5 9.8 9.7 7.1 7.2 6.6 9.3 15.0 23.2 23.9 London 34.4 28.7 26.8 25.2 22.1 21.7 20.2 20.1 22.7 25.8 28.8 30.7 Number of children un accounted for as regards vaccination per cent. of total births The above table shows increase since 1905 in the proportion of children born who are remaining unvaccinated, increase which causes serious anxiety to those who are concerned with the limitation of smallpox in London. Neglect to secure vaccination in infancy will probably in some degree be compensated for by the rush to the public vaccinator, which will occur, as in the past, when smallpox again becomes prevalent; but the conditions under which vaccination will then be performed will not be as satisfactory as those of times when there is no excessive demand for the services of the public vaccinator; and, beyond this vaccination will, no doubt, in many instances be then too late to prevent infection. Measles. The deaths from measles in the Administrative County of London during 1910 (52 weeks) numbered 1,980, as compared with 2,324 in 1909 (52 weeks). The death-rates from this disease per 1,000 persons living in 1910 and preceding periods have been as follows:— Period. Death-rate per 1,000 persons living. Period. Death-rate per 1,000 persons living. 1841-1850 0.62 1902 0.51a 1851-1860 0.53 1903 0.45a 1861-1870 0.58 1904 0.50a 1871-1880 0.51 1905 0.38a 1881-1890 0.64 1900 0.42a 1891-1900 0.58a 1907 0.40a 1901-1910 0.44a 1908 0.33a 1909 051a 1901 0.43 a 1910 0.44a (a) See footnote (c), page 8. 30 Annual Report of the London County Council, 1910. Inasmuch as the birth-rate has not been constant during these periods and the proportion of population in the early years of life has probably diminished in recent years, the death-rate of children under five years of age deserves to be stated. The following table shows the death-rate from measles of children at this age in successive periods:— Mortality among children at ages 0—5. Death-rate Death-rate Period. per 1,000 Period. Per 1,000 children living children living at ages 0—5. at ages 0—5. 1851-1860 3.89 1903 3.95 a 1861-1870 4.18 1904 4.37 a 1871-1880 3.65 1905 3.28 a 1881-1890 4.74 1906 3.70 a 1891-1900 4.82a 1907 3.44 a 1901-1910 3.80a 1908 2.86 a 1909 4.50 a 1901 3.70a 1910 3.79 a 1902 4.44a The death-rate in each year since 1840 in relation to the mean death-rate of the period 1841-1910, calculated on the population at all ages, is shown in diagram (F). The monthly deaths from measles in relation to the mean of the period 1891-1910 is shown in diagram (G). The following table shows the deaths and death-rates from measles in 1910 (52 weeks) in each of the sanitary districts of the County:— Metropolitan borough. Deaths, 1910 (52 weeks). Death-rate per 1,000 persons living. 1905-9. 1910. Paddington 69 0.26 0.48 Kensington 53 0.29 0.31 Hammersmith 70 0.39 0.58 Fulham 65 0.47 0.43 Chelsea 19 0.41 0.28 Westminster, City of 21 0.14 0.13 St. Marylebone 28 0.26 0.23 Hampstead 15 0.12 0.18 St. Pancras 140 0.36 0.64 Islington 168 0.44 0.51 Stoke Newington 11 0.20 0.22 Hackney 66 0.31 0.30 Holborn 14 0.27 0.28 Finsbury 66 0.73 0.74 London, City of - 0.12 - Shoreditch 84 0.76 0.75 Bethnal Green 59 0.56 0.46 Stepney 103 0.68 0.37 Poplar 42 0.63 0.26 Southwark 226 0.57 1.17 Bermondsey 145 0.80 1.15 Lambeth 122 0.32 0.41 Battersea 74 0.44 0.44 Wandsworth 43 0.26 0.14 Camberwell 136 0.36 0.52 Deptford 59 0.43 0.54 Greenwich 48 0.33 0.50 Lewisham 12 0.18 0.08 Woolwich 22 0.30 0.18 London 1,980 0.41 0.44 In the distribution of measles mortality throughout the year 1910, the highest death-rates obtained in Southwark (1.17) and Bermondsey (1.15) and the lowest in Lewisham (0.08), while in the City of London there were no deaths. For the period 1905-9, Bermondsey (0.80) had the highest measles deathrate, and the City of London and Hampstead (0.12) the lowest. The death-rates from this disease in London in each of the four quarters of the year 1910 were as follows—first quarter, 0.22; second quarter, 0.48 ; third quarter, 0.31 ; and fourth quarter, 0.75 per 1,000 persons living. (a) See footnote (c) page 8. Diagram F. Measles Diagram G. Measles & Whooping- Cough. (Deaths 1891-1910.) Report of the Medical Officer of Health. 31 The following table shows the measles death-rate (a) at ages 0-5 obtaining in the several sanitary districts of the County of London during the year 1910. Metropolitan borough. Death-rate per 1,000 children living aged 0-5, 1910. Metropolitan borough. Death-rate per 1,000 children living aged 0-5, 1910. Metropolitan borough. Death-rate per 1,000 children living aged 0-5, 1910. Paddington 4.59 Stoke Newington 2.14 Bermondsey 8.81 Kensington 3.61 Hackney 2.64 Lambeth 3.52 Hammersmith 4.90 Holborn 2.96 Battersea 3.41 Fulham 3.03 Finsbury 5.94 Wandsworth 1.21 Chelsea 3.34 London, City of - Camberwell 4.23 Westminster, City of 1.67 Shoreditch 5.75 Deptford 4.37 St. Marylebone 2.62 Bethnal Green 3.31 Greenwich 4.15 Hampstead 2.08 Stepney 2.69 Lewisham 0.65 St. Pancras 5.85 Poplar 2.02 Woolwich 1.33 Islington 4.36 Southwark 9.25 London 3.79 The following table shows the measles mortality under five years of age in five groups of districts, arranged in order of "social condition."(b) The figures show that there is marked parallelism between measles mortality and " social condition ":— Number of group of boroughs in " order of social condition." (b) Measles death-rate at ages 0-5 per 1,000 living 1901-10. (a) I. 2.28 II. 3.38 III. 3.59 IV. 4.15 V. 5.02 Measles mortality in relation to " social condition." 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 quinquennium 1905-9, the London death-rate was exceeded by the death-rates of Liverpool, Manchester, Birmingham, Sheffield, West Ham, Nottingham, Salford, and Leicester, and in the year 1910 exceeded that of all except Liverpool and Bradford. Town. 1905-9. 1910. Town. 1905-9. 1910. London 0.41a 0.44a West Ham 0.59 0.34 Greater London 0.36 0.32 Bradford 0.20 0.50 Liverpool 0.50 0.62 Newcastle-on-Tyne 0.36 0.32 Manchester 0.53 0.41 Hull 0.33 0.27 Birmingham 0.51 0.07 Nottingham 0.48 0.20 Leeds 0.34 0.36 Salford 0.63 0.36 Sheffield 0.64 0.26 Leicester 0.43 0.06 Bristol 0.31 0.09 Measles death-rates in large English towns. The following table shows that the London measles death-rate, in the quinquennium 1905-9, and in the year 1910 was higher than that of any of the undermentioned foreign towns except St. Petersburg and Rome. Town. 1905-9. 1910. Town. 1905-9. 1910. London 0 .41a 0 .44a St. Petersburg 0.88 1.07 Paris 0.18 0.27 Berlin 0.20 0.13 Brussels 0.15 0.10 Vienna 0.33 0.33 Amsterdam 0.37 0.20 Rome 0.46 0.81 Copenhagen 0.17 0.05 New York 0.20 0.16 Stockholm 0.07 0.38 Measles death-rates in foreign towns. (a) See footnote (c) page 8. (b) See footnote (a) page 24. 32 Annual Report of the London County Council, 1910. Number of deaths from measles at certain age- periods in London sanitary districts. The following table shows the number of deaths from measles at the several age-periods in each of the sanitary districts. For the purposes of this table deaths occurring in public institutions belonging to London have been distributed to the districts in which the deceased had previously resided. (See footnote (c), page 8). Measles—Deaths at ages, 1910 (365 days). Metropolitan borough. 0- 1- 2- 3- 4- Under 5. 5- 10- 15 and upwds. All Ages. Paddington 6 33 16 2 5 62 6 — 1 69 Kensington 11 25 6 3 5 5 0 3 — — 53 Hammersmith 17 27 9 6 5 64 6 — — 70 Fulham 16 30 10 2 2 60 4 — 1 65 Chelsea 6 8 4 1 — 19 — — — 19 Westminster, City of 4 9 3 1 2 19 2 — — 21 St. Marylebone 7 12 4 2 1 26 2 - 28 Hampstead 1 7 4 — 2 14 1 - — 15 St. Pancras 42 48 23 15 4 132 8 — — 140 Islington 20 58 37 !53 16 154 14 — — 168 Stoke Newington 1 8 — 1 — 10 2 — — 12 Hackney 11 28 14 8 4 65 1 — — 66 Holbom 5 3 2 2 — 12 2 — — 14 Finsbury 12 29 14 6 3 64 2 — — 66 London, City of — — — — - - - - -- Shoreditch 20 40 6 7 8 81 3 — — 84 Bethnal Green 16 29 6 5 2 58 1 — — 59 Stepney 37 43 13 6 2 101 2 1 1 105 Poplar 6 23 8 2 3 42 — 1 — 43 Southwark 39 107 42 22 10 220 7 — — 227 Bermondsey 23 83 19 13 5 143 3 — — 146 Lambeth 24 46 24 9 10 113 8 1 1 123 Battersea 10 25 19 7 8 69 4 — — 73 Wandsworth 7 22 6 3 1 39 4 — — 43 Camberwell 24 49 30 14 9 126 10 — — 136 Deptford 12 19 12 9 6 58 2 — — 60 Greenwich 7 23 12 3 1 46 2 — — 48 Lewisham 4 3 3 1 — 11 1 — — 12 Woolwich 5 10 4 — — 19 3 — — 22 London 393 847 350 173 114 1,877 103 3 4 1,987 Medical officers of health derive their information as to the occurrence of cases of measles mainly from the teachers of elementary schools. The majority of the annual reports show the number of cases of this disease concerning which the medical officers of health received intimation, and the following table has been compiled from the information thus supplied No. of cases No.of cases No. of cases Metropolitan of measles Metropolitan of measles Metropolitan of measles borough. 1910 borough. 1910. borough. 1910. Paddington 2,085 Islington 2,194 Bermondsey 950 Kensington 845 Hackney 778 Lambeth 2,393 Hammersmith 484 Holborn 234 Battersea 1,107 Fulham 677 Finsbury 898 Wandsworth 904 Chelsea 278 Shoreditch 578 Deptford 1,114 Westminster 567 Bethnal Green 519 Greenwich 969 St. Marylebone 892 Poplar 331 Lewisham 1,001 Hampstead 642 Southwark 2,307 Woolwich 396 St. Pancras 2,349a The age distribution of the cases made known to the medical officer of health is shown in the report relating to Paddington, thus: Metropolitan borough. 0— 1- 2— 3— 4— 5— 13— 15— Paddington 104 250 247 254 353 849 17 11 (a) Patients, contacts and suspects. Report of the Medical Officer of Health. 33 As in previous years, the medical officers of health of Paddington and Hampstead show the number of houses, in which there occurred during the year more than one case of measles, thus: Metropolitan Borough. Number of houses in which one or more cases occurred. One case. Two cases Three cases. Four cases. Five cases. Six cases. Seven cases. Eight cases Nine cases. Paddington 538 290 164 55 22 7 6 1 1 Hampstead 214 91 55 10 3 3 - 1 — Thus of 1,461 houses invaded in these districts multiple cases occurred in 709. In Paddington there were, in addition, 43 cases in an institution. The measures adopted for the limitation of measles prevalence include those taken in the schools, mainly by the school authority, and those taken in the homes. Nearly all the reports of medical officers of health tell of the closing of classrooms, or the exclusion of children under five years of age who had not been protected by previous attack, when measles has appeared among the scholars. Many of the reports show that the homes of the sufferers are visited by women sanitary inspectors, health visitors, or voluntary workers, who endeavour to ensure that such precautions are taken as are possible. In several reports the desirableness is discussed of raising the age limit of school attendance so as to exclude children under five years of age on account of the frequency with which measles spreads among the children attending the infant department. The extent to which measles thus caused gives rise to other cases in the homes of the school-attending children was well shown in the report of Dr. Butler, the medical officer of health of Willesden, for the year 1907. This report deals with 2,599 cases occurring in that district, of which 2,038, or 78 per cent., were due to infection in school or to infection introduced into the homes by the school-infected children. It is well to mention here that knowledge of measles cases is mainly obtained from the schools, and hence the remaining 22 per cent. must not be thought of as including more than a proportion of the cases of measles occurring in the district, and which had no association with attendance at the elementary schools. Of these 2,038 cases, however, as many as 1,859 were due either to infection in the infant department or to infection in the home received from children thus infected. Those actually infected in the infant department constituted about one-third of the 1,859 cases, and these children infected the other twothirds. The remainder of the 2,038 cases, 179 in number, resulted from attendance in the senior department, about one-quarter of them being actually infected in the school, and in turn giving rise to the remaining three-quarters who were infected by them in the homes. Dr. Butler's figures demonstrate the large part which the infant department plays in the causation of known cases of measles in Willesden. If infants did not attend school, or, indeed, if there were no school attendance, it does not follow' that any large proportion of the children who are now infected directly or indirectly through school attendance would ultimately escape attack by measles, but every circumstance in life which leads to the aggregation of children undoubtedly increases the opportunity for infection early in life, when the fatality of measles is highest. The effect of increase of aggregation would, in fact, if tested by the figures for a series of years, be manifested more by increased incidence on the early years of life than by increase in the amount of measles generally. The following figures relating to London are instructive in this connection ;— Measles mortality per 1,000 of population. Period. Comparative death - All ages. 0-3 vears. rate at ages 0-3 (Death-rate at "all ages " taken as unity.) 1861-1870 0.57 5.5 9.7 1871-1880 0.51 4.4 9.7 1881-1890 0.64 6.3 9.9 1891-1900 0.58 6.6 11.3 In the absence of material for the calculation of reliable rates for the last decennium, the following figures are of interest:— Period. Number of measles deaths at ages 0-3 in every 1,000 deaths at " all ages." 1861-1870 785 1871-1880 789 1881-1890 767 1891-1900 793 1901-1910 815 34 Annual Report of the London County Council, 1910. The lesson to be learnt from the behaviour of measles at the present time is that if on a balance of all considerations the aggregation of young children in schools is to be deemed to be a necessity in London, the groups which are constituted should be as small as possible. In addition to the reduction of risk to the individual child of exposure to infection which would result from the adoption of this course, there would be the added advantage that in times of special prevalence of measles in a locality, exclusion from school attendance could be limited to small groups of children. Obviously aggregation of young children in Sunday schools should be subject to like control. Scarlet Fever. The cases of scarlet fever notified in the Administrative County of London during 1910 (52 weeks) numbered 10,509, compared with 17,254 in 1909 (52 weeks). The number of deaths registered from this cause was 214 in the year 1910 (52 weeks), compared with 383 in 1909 (52 weeks). The scarlet fever case-rates, death-rates and case-mortality for 1910 and preceding periods are shown in the following table:— Period. Death-rate per 1,000 persons living. Case-rate per 1,000 persons living. Casemorlality per cent. 1861-1870 1.13 - a - a 1871-1880 0.60 - a - a 1881-1890 0.33 - a - a 1891-1900 0.19b 4.8 3.8 1901-1910 0.10b 3.9 2.7 1901 0.13b 4.1 3.2 1902 0.12b 3.9 3.1 1903 0.08b 2.8 2.9 1904 0.08b 3.0 2.7 1905 0.12b 4.3 2.8 1906 0.12b 4.5 2.6 1907 0.14b 5.7 2.5 1908 0.12b 4.8 2.5 1909 0.08b 3.8 2.2 1910 0.05b 2.3 2.0 The death-rate in each year since 1858 in relation to the mean death-rate of the period 18591910 will be seen on reference to diagram (H). It will be observed that the death-rate of 1910 was the lowest recorded in London. The monthly case-rate and case-mortality in each of the years 1891-1910 in relation to the mean of the whole period is shown in diagram (L). It will be seen from the following table that in the period 1905-9 the London scarlet fever deathrate was exceeded by that of Liverpool, Manchester, Birmingham, Sheffield, West Ham, Salford and Leicester. In 1910 it was exceeded by all except Bristol, Bradford, Newcastle-on-Tyne and Leicester. Scarlet fever death-rates in large English towns Town. 1905-9. 1910. Town. 1905-9. 1910. London 0.12b 0.05b West Ham 0.17 0.07 Greater London 0.11 0.05 Bradford 0 09 0.05 Liverpool 0.29 0.23 Newcastle-on-Tyne 0.07 0.05 Manchester 0.18 0.ll Hull 0 05 0.06 Birmingham 0.14 0.15 Nottingham 0.05 0.06 Leeds 0.07 0.09 Salford 0.28 0.13 Sheffield . 0.23 0.08 Leicester 0.16 0.05 Bristol 0.07 0.04 Scarlet fever death-rates in foreign towns. The following table shows that in the year 1910 the London scarlet fever death-rate was higher than that of Paris, Brussels and Amsterdam, and in the quinquennium 1905-9 was exceeded by the death-rates of Stockholm, St. Petersburg, Berlin, Vienna and New York. Town. 1905-9. 1910. Town. 1905-9. 1910. London 0.12a 0.05a St. Petersburg 0.56 0.46 Paris 0.06 0.03 Berlin 0.17 0.19 Brussels 0.07 0.02 Vienna 0.13 0.09 Amsterdam 0.05 0.01 Rome 0.02 0.05 Copenhagen 0.07 0.21 New York 0.18 0.20 Stockholm 0.17 0.29 (a) The Infectious Disease (Notification) Act came into force in 1889. (b) See footnote (c), page 8. Diagram H. Scarlet Fever. Mean of Death-rates 1859-1910 492 per million. Diagram K. Scarlet Fever. Number of admissions to Hospitals of the Metropolitan Asylums Board per cent of total cases notified in London 1890-1910 Diagram L . Scarlet Fever. Mean Case mortality 1891-910. 3-32 per cent. Mean Notifications 1891-1910. 1491 per month 35 Report of the Medical Officer of Health. The following table shows the scarlet fever cases, deaths, case-rates, and death-rates for the year 1910 and the case-rates and death-rates for the period 1905-9 in the several sanitary districts. Metropolitan borough. Notified cases, 1910 (52 weeks). Case-rate per 1,000 persons living. Deaths, 1910 (52 weeks). Death-rate per 1,000 persons living. 1905-9. 1910. 1905-9. 1910. Paddington 261 4.01 1.83 7 0.09 0.05 Kensington 263 2.52 1.52 1 0.07 0.01 Hammersmith 341 3.64 2.82 7 0.10 0.06 Fulham 354 4.36 2.33 7 0.11 0.05 Chelsea 120 3.44 1.79 — 0.10 — Westminster, City of 248 2.99 1.53 4 0.08 0.02 St. Marylebone 208 3.17 1.74 7 0.11 0.06 Hampstead 144 3.37 1.69 2 0.06 0.02 St. Pancras 681 3.85 3.10 17 0.11 0.08 Islington 731 3.91 2.23 11 0.09 0.03 Stoke Newington 85 3.43 1.68 1 0.09 0.02 Hackney 403 5.37 1.81 5 0.11 0.02 Holborn 68 2.78 1.36 — 0.07 — Finsbury 165 4.45 1.86 4 0.16 0.04 London, City of 21 3.35 1.04 1 0.08 0.05 Shoreditch 213 5.64 1.90 4 0.20 0.04 Bethnal Green 236 6.65 1.84 9 0.24 0.07 Stepney 554 6.64 1.97 12 0.18 0.04 Poplar 470 5.86 2.89 12 0.18 0.07 Southwark 419 4.92 2.17 9 0.15 0.05 Bermondsey 364 6.01 2.88 14 0.19 0.11 Lambeth 908 4.24 3.05 22 0.11 0.07 Battersea 488 5.62 2.91 7 0.12 0.04 Wandsworth 681 4.33 2.23 11 0.07 0.04 Camberwell 511 4.60 1.96 10 0.10 0.04 Deptford 301 5.66 2.75 3 0.10 0.03 Greenwich 171 4.83 1.78 3 0.10 0.03 Lewisham 573 4.39 3.62 12 0.08 0.08 Woolwich 526 6.13 4.35 12 0.09 0.10 Port of London 1 London 10,509 4.61 2.32 214 0.12 0.05 It will be seen that the scarlet fever death-rate was, in the period 1905-9, highest in Bethnal Green (0.24) and lowest in Hampstead (0.06); in the year 1910, Bermondsey (0.11) had the highest death-rate, and Kensington (0.01) the lowest, exclusive of Chelsea and Holborn, where no deaths occurred. The scarlet fever death-rates obtaining in London in the four quarters of the year 1910 were as follows: first quarter, 0.06; second quarter, 0.04; third quarter, 0.04; and fourth quarter, 0.04 per 1,000 persons living. The following table shows the notified cases, deaths, case-rates, death-rates, and fatality of scarlet fever at the several ages and for each sex in London during the year 1910. It will be seen that at " all ages " the case-rate, 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 both males and females of four years of age. The greatest incidence of death was upon males and females aged 2—3 years. Scarlet fever —Age and sex incidence. The fatality was highest among males aged 1—2 and females aged 0—1, if the obviously abnormal rates over 45 years of age, due to the smallness of the figures be disregarded. Age-period. Males. Females. Notified cases. (a) Deaths. (a) Casemortaiity per cent. Rates per 100,000 living. Notified cases. (a) Deaths. (a) Casemortality per cent. Rates per 100,000 living. Cases. Deaths. Cases. Deaths. All Ages 4,989 118 2.4 235 6 5,520 99 18 231 4 0— 60 4 6.6 110 7 53 7 13.2 97 13 1— 188 16 8.5 389 33 183 7 3.8 376 14 2— 398 21 5.3 814 43 294 19 9.4 600 39 3— 505 20 3.9 1,061 42 455 9 2.0 938 18 4— 523 14 2.7 1,122 30 567 12 2.1 1,214 26 5— 2,088 29 1.4 955 13 2,422 33 1.4 1,090 15 10— 687 9 1.3 333 4 845 7 •8 399 3 15— 226 1 •4 109 0 236 1 •4 101 0 20— 135 2 1.5 63 1 177 1 .6 68 0 25— 133 1 •7 36 0 218 2 •9 50 0 35— 32 — — 11 — 55 — — 18 — 45— 10 1 10.0 5 1 7 — — 3 — 55 & upwards 4 — — 2 — 8 1 12.5 3 0 (a) The cases are those notified during the year, but the deaths, which are fully corrected, relate to a period commencing somewhat later, in order that they may correspond more closely with the cases upon which the casemortality is calculated 36 Annual Report of the London County Council, 1910. Scarlet fever —Incidence in relation to school attendance. In connection with the reduction in the number of notified cases during the summer holiday of the schools it may be stated that the summer holiday of the London County Council schools began in 1910 on Thursday, the 21st July, i.e., the latter part of the 29th week, and the schools re-opened on Monday, the 22nd August, i.e., at the beginning of the 34th week. If the number of cases notified in the four weeks which would be most subject to holiday influence be compared with the number of cases notified in the four preceding and four succeeding: weeks, The results shown in the following table are obtained:— Period. Notified cases—Age-periods. Increase ( + ) or decrease ( —) per cent. 0-3 3-13 13 and upwards. 0-3 3-13 13 and upwards. Four weeks preceding weeks of holiday influence (27th to 30th) 94 609 114 — — Four weeks of holiday influence (31st to 34th) 87 499 92 —7.4 —18.1 —19.3 Four weeks following weeks of holiday influence (35th to 38th) 86 624 113 —1.1 + 25.1 +22.8 The mild character of the cases of scarlet fever which occurred in 1910 is referred to in many of the reports. The difficulty of discovering the source of infection of any particular case is therefore obvious, the disease, no doubt, being often caused by association with a previous case presenting inconspicuous or perhaps even no symptoms. Account is given in some of the reports of the proportion of cases in which it was possible to discover the source of infection. In Kensington, of 258 cases, in 80 contact with a previous case was traced, 20 were due to school infection, 8 to contact with persons recently discharged from hospital after an attack of scarlet fever, 5 to contact with persons who had suffered from attack of scarlet fever which had not been recognised. In St. Marylebone, of 207 cases, infection was thought to be due to a previous case in the family or in the same house in 27 instances; at school in 6 instances; from a previous case in the neighbourhood in 6 instances. In Hampstead, of 135 notified, in 43 the patient was found to be infected by a previous case. In Stoke Newington, of 84 cases, the source of infection was believed to be due to an antecedent case in the house in 5 cases, school attendance in 4 cases, and return case 1 case. In Finsbury, of 126 cases, 22 were due to visiting invaded houses in vicinity, 14 to previous cases in same family, 5 were contracted in hospital, 4 from associating with infected school-fellows, 2 from attendance at the outpatient departments of large hospitals. In Bermondsey, of 307 cases, 35 were infected by a previous case in house, family, or neighbouring houses, 6 at school, and 6 were return cases. In Battersea, of 439, the majority were found to be due to contact with a previous case. In Woolwich, of 506 cases, the source of infection was believed to be in 58 instances due to previous cases in the house, in 15 instances to school attendance, in 8 to infection from friends, in 5 to visiting hospitals. Multiple cases. The number of dwellings in which multiple cases occurred is shown in some of the reports, as follows:— Metropolitan borough. One case. Two cases. Three cases. Four cases. Fire cases. Paddington 198 21 7 2 1 Fulham 257 29 7 2 2 Westminster 181 18 4 1 — Hampstead 100 10 2 1 1 Islington 499 65 12 5 3 Holborn 43 2 2 — — Thus of 1,475 houses invaded, multiple cases occurred in 197, or 13.4 per cent. In 1909, the number of houses in which multiple cases occurred was 16 per cent, of the houses invaded in the districts concerning which the facts were stated in the annual reports. There is little reference in the reports to the occurrence of any prevalence of scarlet fever as the result of school attendance during the year 1910, and only in one instance was a department closed and in five instances were classrooms closed. It will be seen from diagram (K) that the proportion of cases of scarlet fever admitted to the hospitals of the Metropolitan Asylums Board was about the same as in the preceding year, viz., nearly 90 per cent, of the cases notified. Proportion of cases admitted to hospital, Diagram M. Diphtheria.- McJn of Death-rates 1859-1910. 213 per million. 'V Mean of Death-riles 1859-1910. 375 per million. Diagram N. Diphtheria. Number of admissions to Hospitals of the Metropolitan Asylums Board per cent of total cases notified in London. 1890-1910 Diagram O . Diphtheria. Mean Case-mortality 1891 -1910. M-87 per cent. Mean notifications 1891-1910. 752 per month 37 Report of the Medical Officer of Health. Cases certified to be those of scarlet fever and admitted into the hospitals of the Metropolitan Asylums Board in which the diagnosis was not subsequently confirmed, constituted in successive years the following percentage of the total cases admitted:— Year. Percentage. Year. Percentage. 1901 5.6 1906 4.9 1902 4.7 1907 6.8 1903 6.4 1908 5.8 1904 6.7 1909 6.9 1905 5.4 1910 9.5 Errors of diagnosis. Diphtheria. The cases of diphtheria (including membranous croup) notified in the Administrative County of London in 1910 (52 weeks) numbered 5,494, compared with 6,679 in 1909 (52 weeks). The number of deaths was 434 in 1910 (52 weeks), compared with 605 in 1909 (52 weeks). It is well to bear in mind that the case-rate and case-mortality may be affected by variations in the extent of use of bacteriological methods of diagnosis, the effect of which is to increase the notified number of clinically mild cases of the disease. The diphtheria case-rates, death-rates, and case-mortality in 1910, and preceding periods, are shown in the following table:— Period. Death-rate per 1,000 persons living. Case-rate per 1,000 persons living. Case-mortality per cent. 1861-1870 0.18 —a — a 1871-1880 0.12 —a —a 1881-1890 0.26 —a —a 1891-1900 0.496 2.6 18.8 1901-1910 0.176 1.8 9.3 1901 0.296 2.7 10.9 1902 0.256 2.3 10.8 1903 0.166 1.7 9.6 1904 0.166 1.6 10.0 1905 0.126 1.4 8.4 1906 0.156 1.8 8.6 1907 0.176 1.9 8.9 1908 0.166 1.7 9.0 1909 0.136 1.5 9.1 1910 0.106 1.2 7.9 The death-rate in each year since 1858 in relation to the mean death-rate of the period 1859— 1910 is shown for diphtheria and also for diphtheria and croup combined in diagram (M). It will be observed that the death-rate from diphtheria and croup of 1910 was lower even than that of 1905, being the lowest recorded in London. The case-rate and case-mortality were the lowest recorded in London. The monthly case-rate and case-mortality in each of the years 1891-1910 in relation to the mean of the period is shown in diagram (0). 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 quinquennium 1905-9 The London rate was exceeded by that of all except that of Leeds, Sheffield, Nottingham and Leicester, and in 1910 was exceeded by the rates of all except Sheffield and Leicester. Town. 1905-9. 1910. Town. 1905-9. 1910. London 0.156 0.106 West Ham 0.23 0.17 Greater London 0.16 0.10 Bradford 0.19 0.13 Liverpool 0.18 0.13 Newcastle on-Tyne 0.20 0.15 Manchester 0.18 0.14 Hull 0.30 0.17 Birmingham 0.18 0.12 Nottingham 0.15 0.12 Leeds 0.14 0.15 Salford 0.41 0.22 Sheffield 0.12 0.08 Leicester 0.07 0.05 Bristol 0.18 0.10 Diphtheria death-rates in large English towns. (a) The Infectious Disease (Notification) Act came into force in 1889. (b)See footnote (c), page 8. 38 Annual Report of the London County Council, 1910. Diphtheria death-rates in foreign towns. The following table shows that in the quinquennium 1905-9 the London death-rate from diphtheria and croup exceeded that of any of the undermentioned foreign towns except Stockholm, St. Petersburg, Berlin, Vienna, and New York; in 1910 the London rate was in addition exceeded in Rome;— Town. 1905-9. 1910. Town. 1905-9. 1910. London 015a 0.10a St. Petersburg 0.57 0.38 Paris 0.07 0.10 Berlin 0.23 0.34 Brussels 0.09 0.08 Vienna 0.20 0.13 Amsterdam 0.09 0.06 Rome 0.12 0.24 Copenhagen 0.08 0.08 New York 0.41 0.36 Stockholm 0.16 0.28 The following table shows the diphtheria cases, deaths, case-rates, and death-rates for the year 1910, and the case-rates and death-rates for the period 1905-9, in the several sanitary districts:— Metropolitan borough. Notified Cases, 1910 (52 weeks). Case-rate per 1,000 persons living. Deaths, 1910 (52 weeks). Death-rate per 1,000 persons living. 1905-9. 1910. 1905-9. 1910. Paddington 120 1.09 0.84 9 0.09 0.06 Kensington 155 1.11 0.90 16 0.11 0.09 Hammersmith 165 1.90 1.37 22 0.17 0.18 Fulham 257 2.72 1.69 14 0.22 0.09 Chelsea 83 1.76 1.24 4 0.16 0.06 Westminster, City of 149 1.04 0.92 10 0.08 0.06 St. Marylebone 127 1.01 1.07 9 0.09 0.08 Hampstead 51 0.92 0.60 5 0.07 0.06 St. Pancras 263 1.36 1.20 21 0.11 0.10 Islington 473 1.34 1.44 33 0.12 0.10 Stoke Newington 53 1.32 1.05 2 0.07 0.04 Hackney 190 1.77 0.86 8 0.14 0.04 Holborn 45 1.02 0.90 4 0.10 0.08 Finsbury 150 1.78 1.69 21 0.17 0.24 London, City of 20 0.98 0.99 — 0.10 — Shoreditch 131 1.65 1.17 14 0.15 0.13 Bethnal Green 182 2.02 1.42 20 0.18 0.16 Stepney 404 2.24 1.44 29 0.24 0.10 Poplar 175 1.96 1.08 21 0.21 0.13 Southwark 284 1.67 1.47 35 0.18 0.18 Bermondsey 210 1.98 1.66 19 0.16 015 Lambeth 327 1.28 1.10 26 0.16 0.09 Battersea 227 1.75 1.35 12 0.13 0.07 Wandsworth 286 1.77 0.94 13 0.13 0.04 Camberwell 272 1.36 1.04 22 014 0.08 Deptford 130 2.12 1.19 11 0.14 0.10 Greenwich 168 2.49 1.75 10 0.18 0.10 Lewisham 224 2.12 1.42 20 0.15 0.13 Woolwich 172 2.61 1.42 4 0.17 0.03 Port of London 1 London 5,494 1.67 1.22 434 0.15 0.10 It will be seen from the foregoing table that in the period 1905-9 the diphtheria death-rate was highest in Stepney (0.24) and lowest in Hampstead and Stoke Newington (0.07); in the year 1910 Finsbury (0.24) had the highest death-rate, and Woolwich (0.03) the lowest, exclusive of the City of London, where no death occurred. The diphtheria death-rates in London in each of the four quarters of the year 1910 were as follows: first quarter 0.l1; second quarter, 0.06; third quarter, 0.08; and fourth quarter, 0.13. To enable the variations in diphtheria prevalence in the several sanitary districts to be more clearly appreciated, the following table has been prepared. This table shows the comparative case-rates of each district in each of the years 1891-1910 inclusive, i.e., the case-rates of each district are shown (a) See footnote (c), page 8. 39 Report of the Medical Officer of Health. In relation to the London case-rate of the same year, the London rate being taken as 100. The figures for the years 1901-9 differ from those given in previous reports owing to the revision of the population estimates on the basis of the results of the 1911 census. Metropolitan borough. Diphtheria.—Comparative case-rate (London case-rate taken as 100). 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 Paddington 104 77 73 117 74 66 91 98 68 44 88 65 61 63 47 72 61 59 87 69 Kensington 78 60 68 63 86 70 67 49 51 74 53 45 60 67 52 57 74 78 69 74 Hammersmith 195 164 87 72 77 67 49 58 58 85 75 68 85 111 146 134 94 97 108 112 Fulham 61 58 78 126 139 99 109 145 135 178 175 130 122 132 139 156 212 152 145 139 Chelsea 138 110 83 107 143 184 107 79 61 74 54 77 67 80 54 51 130 118 117 98 102 Westminster, City of 58 91 57 53 61 53 59 67 50 59 52 61 52 48 69 44 64 93 76 St. Marylebone 70 81 88 78 64 66 53 64 47 59 73 76 103 58 72 63 53 55 63 88 Hampstead 105 96 73 53 61 84 47 65 48 74 70 50 61 43 55 67 69 43 38 49 St. Pancras 89 95 103 83 90 64 76 78 79 93 149 152 132 95 88 69 80 78 98 99 Islington 152 119 86 103 70 106 73 60 68 70 102 112 81 66 74 75 75 91 89 119 Stoke Newington 83 113 97 77 70 70 52 59 34 111 105 82 46 75 110 52 120 72 37 86 Hackney 131 147 135 108 93 89 122 152 106 107 167 139 145 163 122 99 127 99 81 70 Holborn 52 89 79 61 66 61 104 102 46 70 105 86 53 51 58 69 62 54 62 74 Finsbury 118 82 130 81 86 112 170 163 93 74 110 101 77 94 103 118 86 105 125 139 London, City of 59 130 60 49 51 74 71 60 68 89 95 158 63 102 47 44 65 76 62 82 Shoreditch 124 89 131 95 80 97 103 80 103 111 103 84 77 101 110 71 101 105 112 96 Bethnal Green 154 230 181 168 143 114 144 100 89 115 133 105 110 206 165 110 116 122 97 117 Stepney 106 132 112 123 157 150 128 93 89 107 106 111 108 176 154 118 135 131 139 118 Poplar 191 148 214 159 179 133 141 105 83 141 137 118 149 252 207 85 113 109 88 88 Southwark 71 72 116 113 86 106 102 151 207 141 101 111 102 88 106 114 110 78 89 121 Bermondsey 68 60 84 126 80 99 97 90 177 133 94 92 79 94 91 147 129 112 105 137 Lambeth 88 97 91 83 88 74 83 103 121 104 65 68 67 68 105 79 56 65 86 90 Battersea 144 123 132 122 97 81 125 178 116 70 59 74 109 85 80 92 110 123 116 111 Wandsworth 74 83 84 79 60 51 100 114 99 74 76 132 125 98 92 114 117 115 84 77 Camberwell 69 65 67 112 140 180 154 102 156 130 125 113 82 65 66 77 80 86 97 86 Deptford 72 68 86 153 225 113 141 132 121 111 144 103 243 111 94 156 150 107 121 98 Greenwich 60 43 84 85 137 189 82 105 122 89 73 81 127 100 107 240 138 132 115 144 Lewisham 48 74 82 70 57 122 85 127 170 126 87 129 121 59 77 101 105 176 170 117 Woolwich 32 68 66 66 81 96 91 86 100 115 69 91 91 85 161 182 120 173 150 117 London 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 The following table shows the notified cases, deaths, case-rates, death-rates and fatality of diphtheria at the several ages and for each sex in London during the year 1910. At "all ages" the fatality and the incidence of attack and of death was 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 aged 4—5 years; the greatest incidence of death was upon males and females aged 1—2 years. Diphtheria Age and sex incidence. The fatality was greatest among males aged 0—1, and females aged 1—2, if the obviously abnormal rate among females aged 55 and upwards, depending upon the smallness of the figures be disregarded. Age-period. Males. Females. Notified Cases. (a) Deaths. (a) Case mortality per cent. Rates per 100,000 living. Notified Cases. (a) Deaths. (a) Case mortality per cent. Rates per 100,000 living. Cases. Deaths. Cases. Deaths. All Ages 2,592 220 8.5 122 10 2,902 227 78 121 9 0— 84 19 22.6 154 35 52 10 19.2 95 18 1— 230 41 17.8 476 85 192 49 25.5 394 100 2— 260 37 14.2 532 75 210 27 12.8 428 55 3— 311 28 9.0 653 59 304 31 10.2 627 64 4— 319 29 9.1 685 62 308 32 10.4 660 68 5— 839 55 6.5 384 25 1,010 64 6.3 454 29 10— 265 8 3.0 128 4 371 8 2.2 175 4 15— 97 — — 47 — 130 2 1.5 56 1 20— 69 — — 32 — 110 2 1.8 42 1 25— 66 1 1.5 18 0 141 — — 32 — 35— 36 — — 13 — 54 1 1.8 17 0 45— 9 1 1l.l 5 1 17 — — 8 — 55 & upwards 7 1 14.2 4 1 3 1 33.2 1 0 (a) See footnote (a), page 35. 40 Annual Report of the London County Council, 1910. Diphtheria— Incidence in relation to school attendance. In connection with the question of the redaction in the prevalence of the disease among persons of school age during the summer holiday when the schools are closed it has been thought well to include, as in previous reports, the following table. The summer holiday of the schools of the London County Council began on Thursday, the 21st July, i.e., the latter part of the 29th week, and the schools re-opened on Monday, the 2'2nd August, i.e., at the beginning of the 34th week. If the number of cases in the four weeks preceding, and the four weeks subsequent to, the weeks most subject to holiday influence be compared, 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. Period. Notified cases—Age periods. Increase (+) or decrease ( -) per cent. 0—3. 3—13. 13 and upwards. 0—3. 3—13. 13 and upwards. Four weeks preceding weeks of holiday influence (27th to 30th) 72 268 45 — — — Four weeks of holiday influence (31st to 34th) 68 192 75 —5.6 —28.4 +66.7 Four weeks following weeks of holiday influence (35th to 38th) 70 314 66 +2.9 +63.5 —12.0 The annual reports of medical officers of health show that in no instance was any considerable outbreak observed during the year. In Bethnal Green 10 children in a Children's Home were attacked. In a few districts a special incidence upon children attending a particular classroom or school was found, but only a few children were attacked. Such occurrences are mentioned in the reports of the medical officers of health of Chelsea, Lambeth, Wandsworth and Woolwich. They were dealt with by the exclusion from school of particular scholars, bacteriological examination being made of material from children who were found to be suffering from sore throat, or who were contacts with the cases which occurred. Closure of schools or departments or classes of schools had not to be resorted to. In considering the sufficiency of the methods adopted for limitation of diphtheria or scarlet fever, it is all important to bear in mind that those which can be relied upon at times like the present, when these diseases are characterised by largely diminished prevalence and fatality, may not suffice in times of epidemic prevalence and high fatality, and that constant observation must be kept on the results which are being obtained in view of the expectation that the type of these diseases will, at a future date, revert to that which characterised them in former years. Careful enquiry has been made during the year into the source of infection of cases coming to the knowledge of the medical officers of health, and as a result other cases of the disease have frequently been found which were previously unknown. In Kensington, of 150 cases, association with a previous case was found in 17; in Finsbury, in 25 among 126 cases; in Shoreditch, in 22 of 120 cases; in Woolwich, in 39 of 147 cases. The discovery of other cases, as a result of such inquiries, is especially mentioned in the reports relating to Greenwich and Woolwich. Information as to the number of houses in which more than one case of diphtheria occurred is given in several of the annual reports. In Paddington this only occurred in one house among 102 invaded ; in Fulham in 20 houses among 231 invaded ; in Islington in 33 of 387. In August of 1910 the Local Government Board made an Order sanctioning the provision by sanitary authorities, in pursuance of Section 77 of the Public Health (London) Act, of a temporary supply of diphtheria anti-toxin for the poorer inhabitants of their districts, and of medical assistance in connection with such supply. In many districts in London the sanitary authorities have, for a number of years, given facilities for medical practitioners to obtain without delay anti-toxin for use in their practices. The effect of the Order has been to legalise this action and to increase the number of authorities who are prepared to give this opportunity for the early treatment of diphtheria by the use of anti-toxin; but in some districts, for instance, Paddington, Hammersmith, Chelsea and Woolwich, the sanitary authorities decided not to take any action on the Order. A circular letter from the Local Government Board points out that anti-toxin may be used as both a prophylactic and a curative agency. The value of its use for curative purposes has been demonstrated for a number of years. Experience of its use for prophylactic purposes is more limited. In connection with the larger use of anti-toxin for the prevention of attack among persons who are exposed to infection there needs to be taken into account the condition of hypersensitiveness to subsequent injection of serum if the patient becomes attacked by diphtheria, and of which an account has been given during the present year by Dr. E. W. Goodall, Medical Superintendent of the Eastern Fever Hospital.(a) (a) "Public Health," vol. xxiv., p. 132. 41 Report of the. Medical Officer of Health. Information concerning the number of specimens examined for diphtheria bacilli at the expense of the sanitary authorities is contained in the reports relating to the following districts:— Metropolitan borough. Number of specimens examined. Number found positive. Metropolitan borough. Number of specimens examined. Number found positive. Paddington 114 28 Shoreditch 45 18 Kensington 43 10 Bethnal Green 87 25 Fulham 336 92 Stepney 95 28 Chelsea 131 37 Poplar 81 29 Westminster, City of 184 51 Southwark 187 35 St. Marylebone 107 27 Bermondsey 382 34 Hampstead 51 18 Lambeth 377 39 St. Pancras 91 21 Battersea 410 129 Islington 401 125 Wandsworth 289 71 Stoke Newington 104 40 Deptford 149 35 Hackney 167 51 Greenwich 984 134 Holborn 26 7 Lewisham 326 79 Finsbury 69 22 Woolwich 526 73 London, City of 4 3 Bacteriological diagnosis. Proportion of cases admitted to Hospital. Errors of diagnosis. It will be seen from diagram (N) that the proportion of cases of diphtheria removed to the hospitals of the Metropolitan Asylums Board was about the same as in the preceding year. Cases certified to be those of diphtheria and admitted into the hospitals of the Metropolitan Asylums Board, but in which the diagnosis was not subsequently confirmed, constituted the following percentage of total cases admitted in successive years:— Year. Percentage. Year. Percentage. 1901 12.8 1906 15.5 1902 13.5 1907 17.0 1903 14.7 1908 18.1 1904 16.1 1909 16 .8 1905 18.0 1910 14.2 Whooping-cough. The deaths from whooping-cough in the Administrative County of London during the year 1910 (52 weeks) numbered 1,363, as compared with 1,246 in 1909 (52 weeks). The death-rates from this disease in 1910 and preceding periods have been as follows:— Period. Death-rate per 1,000 persons living. Period. Death-rate per 1,000 persons living. 1841-1850 0.87 1902 0.41a 1851-1860 0.88 1903 0.36a 1861-1870 0.88 1904 0.33a 1871-1880 0.81 1905 0.33a 1881-1890 0.69 1906 0.27a 1891-1900 0.50a 1907 0.39a 1901-1910 0.32a 1908 0.21 a 1909 0.27 a 1901 0.35a 1910 0.30a The following are the death-rates of children under five years of age. Period. Death-rate per 1,000 children living at ages 0-5. Period. Death-rate per 1,000 children living at ages 0-5. 1851-1860 6.56 1903 3.17b 1861-1870 6.53 1904 2.93b 1871-1880 6.02 1905 2.92b 1881-1890 5.34 1906 2.38b 1891-1900 4.21b 1907 3.49b 1901-1910 2.87b 1908 1.91b 1909 2.44b 1901 3.13b 1910 2.68b 1902 3.60b (a) See footnote (c), page 8. (b) Including deaths of Londoners in the Metropolitan Workhouses, Hospitals, and Lunatic Asylums outside the county, but excluding those of non-Londoners in the London Fever Hospital, the West Ham Union Workhouse at Hackney, the Metropolitan Asylums Hospitals and the Middlesex County Asylum, within the County of London. 5176 D 42 Annual Report of the London County Council, 1910. The death-rate in each year since 1840 in relation to the mean of the period 1841-1910 is shown in diagram (P.), while the deaths in each month since 1890 in relation to the mean monthly deaths of the period 1891-1910 are shown in diagram (G.), facing page 31. It will be seen from the following table that in the quinquennium 1905-9 the London whoopingcough death-rate was exceeded bv that of all the undermentioned towns except Leeds. Bristol. Bradford, Whoopingcough deathrates in large English towns. Nottingham and Leicester, while in the year 1910 it exceeded that of all except Liverpool, Manchester, Birmingham, Leeds, Sheffield, Newcastle and Salford:— Town. 1905-9. 1910. Town. 1905-9. 1910. London 0.30a 0.30a West Ham 0.48 0.29 Greater London 0.28 0.26 Bradford 0.22 0.15 Liverpool 0.38 0.60 Newcastle-on-Tyne 0.37 0.30 Manchester 0.33 0.56 Hull 0.31 0.24 Birmingham 0.40 0.40 Nottingham 0.28 0.25 Leeds 0.29 0.34 Salford 0.34 0.44 Sheffield 0.32 0.41 Leicester 0.23 0.23 Bristol 0.25 0.19 Whoopingcough death rates in foreign towns. The following table shows that the London whooping-cough death-rate was, in the quinquennium 1905-9, higher than that of any of the undermentioned foreign towns except Copenhagen, and in the year 1910 higher than all. Town. 1905-9. 1910. Town. 1905-9. 1910. London 0.30a 0.30a St. Petersburg 0.25 0.22 Paris 0.10 0.12 Berlin 0.21 0.11 Brussels 0.08 0.09 Vienna 0.09 0.10 Amsterdam 0.23 0.12 Rome 0.10 0.09 Copenhagen 0.29 0.14 New York 0.08 0.06 Stockholm 0.15 0.17 The following table shows the whooping-cough deaths and death-rates for the year 1910 and the death-rates for the period 1905-9 in the several sanitary districts:— Metropolitan borough. Deaths, 1910 (52 weeks). Death-rate per 1,000 persons living. 1905-9. 1910. Paddington 32 0.22 0.22 Kensington 32 0.24 0.19 Hammersmith 26 0.29 0.22 Fulham 60 0.37 0.39 Chelsea 12 0.27 0.18 Westminster, City of 18 0.12 0.11 St. Marylebone 44 0.19 0.37 Hampstead 11 0.13 0.13 St. Pancras 96 0.29 0.44 Islington 124 0.27 0.38 Stoke Newington 7 0.26 0.14 Hackney 61 0.24 0.27 Holborn 16 0.29 0.32 Finsbury 36 0.46 0.40 London, City of 2 0.16 0.10 Shoreditch 46 0.60 0.41 Bethnal Green 35 0.40 0.27 Stepney 114 0.37 0.41 Poplar 84 0.45 0.52 Southwark 60 0.35 0.31 Bermondsey 43 0.34 0.34 Lambeth 54 0.26 0.18 Battersea 51 0.35 0.30 Wandsworth 70 0.27 0.23 Camberwell 70 0.28 0.27 Deptford 48 0.34 0.44 Greenwich 57 0.28 0.59 Lewisham 29 0.21 0.18 Woolwich 25 0.20 0.21 London 1363 0.30 0.30 (a) See footnote (c) page 8. Diagram P. Whooping - Cough; Mean of Death-rates 1841-1910 708 per million 43 Report of the Medical Officer of Health. It will be seen from the foregoing table that in the period 1905-9 the highest whoopingcough death-rate obtained in Shoreditch (0.60), and the lowest in Westminster (0.12); in the year 1910 Greenwich (0.59) had the highest death-rate and the City of London (0.10) the lowest. The whooping-cough death-rates in London in each of the four quarters of the year 1910 were as follows: first quarter, 0.52 ; second quarter, 0.40; third quarter, 0.17; and the fourth quarter, 0.12. The following table snows that when the London sanitary districts are grouped according to the social condition of the population, the incidence of whooping-cough mortality progressively increases from the highest to the lowest social group. Number of group of boroughs in order of " social condition." (a) Whooping-cough death rate (b) at ages 0-5 per 1,000 living, 1901-10. I. 2.33 II. 2.74 III. 2.80 IV. 3.05 V. 3.21 Whooping cough mortality in relation to "social condition. The annual reports of medical officers of health make no mention of any special prevalences in their districts, except that the medical officer of health of Greenwich, referring to the high death-rate from whooping-cough in that district, anticipates that the measures which are adopted in respect of cases of other infectious diseases will eventually have to be extended to cases of whooping-cough. Information which medical officers of health obtain concerning the occurrence of attacks of whooping-cough is derived, in the main, from school teachers. The number of cases reported, so far as stated in the annual reports, was as follows:— Metropolitan borough. Number of cases. Metropolitan borough. Number of cases. Paddington 518 Finsbury 208 Kensington 365 Shoreditch 256 Hammersmith 200 Southwark 475 Chelsea 152 Bermondsey 300 Westminster, City of 163 Lambeth 719 St. Marylebone 278 Battersea 509 St. Pancras 941c Wandsworth 919 Islington 892 Greenwich 302 Hackney 446 Lewisham 498 Holborn 91 Woolwich 377 Typhus. There were no deaths from typhus registered in the Administrative County of London during the year 1910. The death-rates from this disease in successive periods have been as follows:— Period. Death-rate per 1,000 persons living. 1871-1880 •055 1881-1890 •008 1891-1900 •0016 1901-1910 •0006 1901 •0016 1902 — 1903 •0016 1904 — 1905 — 1906 — 1907 — 1908 — 1909 — 1910 — In this table •000 indicates that the deaths were too few to give a rate of •0005; where — is inserted no death occurred. (a) See footnote (a) page 24. 5176 (b) See footnote (c) page 8. (c) Patients, contacts and suspects. D 2 44 Annual Report of the London County Council, 1910. The death-rate in each year since 1868 in relation to the mean death-rate of the period 18691910 is shown in diagram (Q). Question of typhus arose in connection with the illness of four patients admitted into the hospitals of the Metropolitan Asylums Board during 1910. A young man, aged 18, was admitted from St. Marylebone; he was found later to be suffering from endocarditis. A shop boy, aged 15, was admitted from Islington ; the disease from which he suffered was not finally regarded as typhus, A child, aged about 10 years, was admitted from Lambeth. The symptoms after admission suggested typhus, but later the child was thought to be suffering from meningitis. The only actual case of typhus was J. B., aged 37 years, who was admitted in June on a certificate that he was suffering from enteric fever. Later his disease was identified as typhus. He resided in Pennyfields, Poplar, and had been employed as a painter in Bethnal Green. The source of infection was not known. Enteric Fever. The number of cases of enteric fever notified in the Administrative County of London during 1910 (52 weeks) was 1,284, compared with 1,043 in the year 1909 (52 weeks). The deaths from this disease numbered 196 in 1910 (52 weeks), comnared with 146 in 1909 (52 weeks). The case-rates and death-rates per 1,000 persons living and the case-mortality per cent, in 1910 and preceding periods were as follows:— Period. Death-rate per 1,000 persons living. Case-rate per 1,000 persons living. Case-mortality per cent. 1871-1880 0.24 —a —a 1881-1890 0.19 —a —a 1891-1900 0.14b 0.8 17.4 1901-1910 0.06b 0.4 15.3 1901 0.11b 0.7 15.6 1902 0.12b 0.7 15.8 1903 0.08b 0.5 15.7 1904 0.06b 0.4 15.1 1905 0.05b 0.3 15.1 1906 0.06b 0.3 16.3 1907 0.04b 0.3 13.9 1908 0.05b 0.3 16.6 1909 0.03b 0.2 14.0 1910 0.04b 0.3 15.3 The death-rate in each year since 1868 in relation to the mean death-rate of the period 1869-1910 is shown in diagram (R). The notified cases in each week of 1910 may be compared with the average weekly notifications of the period 1890-1910 on reference to diagram (S). The monthly case-rate and case-mortality in each of the years 1891-1910 in relation to the mean of the whole neriod is shown in diagram (T). The following table shows the enteric fever cases, deaths, case-rates and death-rates for the year 1910, and the case-rates and death-rates for the period 1905-9 in the several sanitary districts— Metropolitan borough. Notified cases, 1910 (52 weeks). Case-rate per 1,000 persons living. Deaths, 1910 (52 weeks). Death-rate per 1,000 persons living. 1905-9. 19.0. 1905-9. 1910. Paddington 40 0.24 0.28 4 0.03 0.03 Kensington 37 0.25 0.21 5 0.04 0.03 Hammersmith 31 0.27 0.26 4 0.05 0.03 Fulham 18 0.32 0.12 2 0.06 0.01 Chelsea 16 0.24 0.24 2 0.04 0.03 Westminster, City of 48 0.24 0.30 6 0.04 0.04 St. Marylebone 22 0.29 0.18 6 0.03 0.05 Hampstead 20 0.24 0.23 3 0.04 0.04 S . Pancras 63 0.29 0.29 4 0.04 0.02 Islington 89 0.32 0.27 17 0.05 0.05 Stoke Newington 10 0.22 0.20 2 0.03 0.04 Hackney 64 0.44 0.29 10 0.07 0.05 Holborn 25 0.34 0.50 5 0.05 0.10 Finsbury 30 0.38 0.34 4 0.09 0.04 London, City of 4 0.29 0.20 2 0.04 0.10 Continued on next page. (a) The Infectious Disease (Notification) Act came into force in 1889. (b) See footnote (c), page 8. Diagram Q. Typhus. Mean of Death-rates 1869-1910. 24.2 per million. Diagram R . Enteric fever. Mean of Death -rates 1869 -1310. 165 per million Diagram S. Enteric Fever. Notified Cases. Mean Notifications 54.0 per week. Mean Notifications 24.7 per week Diagram T. Enteric Fever. Mean Case-mortality 1831-1310. 16.68 per cent. Mean Notifications 1891-1310. 205 per month. 45 Report of the Medical Officer of Health. Metropolitan borough. Notified cases, 1910 (52 weeks). Case rate per 1,000 persons living. Deaths, 1910 (52 weeks). Death-rate per 1,000 persons living. 1905-9. 1910. 1905-9. 1910. Shoreditch 48 0.46 0.43 8 0.05 0.07 Bethnal Green 108 0.44 0.84 18 0.07 0.14 Stepney 118 0.37 0.42 15 0.06 0.05 Poplar 62 0.43 0.38 13 0.07 0.08 Southwark 54 0.35 0.28 7 0.05 0.04 Bermondsey 38 0.33 0.30 4 0.05 0.03 Lambeth 78 0.22 0.26 18 0.04 0.06 Battersea 45 0.26 0.27 7 0.04 0.04 Wandsworth 54 0.28 0.18 9 0.04 0.03 Camberwell 76 0.22 0.29 9 0.03 0.03 Deptford 24 0.31 0.22 5 0.06 0.05 Greenwich 20 0.32 0.21 3 0.06 0.03 Lewisham 29 0.20 0.18 3 0.02 0.02 Woolwich 10 0.21 0.08 1 0.04 0.01 Port of London 3 London 1,284 0.30 0.28 196 0.05 0.04 It will be seen that among the several sanitary districts in the period 1905-9 the enteric fever death-rate was highest in Finsbury (0.09), and lowest in Lewisham (0.02); in the year 1910, Bethnal Green (0.14) had the highest enteric fever death-rate, while Fulham and Woolwich (0.01) had the lowest. The death-rates from enteric fever in London, in each of the four quarters of the year 1910 were as follows : first quarter, 0.03 ; second quarter, 0.02 ; third quarter, 0.04 ; and fourth quarter, 0.07. The following table shows the notified cases, deaths, case-rates, death-rates and fatality of enteric fever at the several ages and for each sex in London during the year 1910. The case-rate and death-rate were, at "all ages," higher among males, while the fatality was higher among females. In the age groups adopted for the purposes of this table the greatest incidence of attack was upon males aged 10-15 and females aged 15-20, and the greatest incidence of death was upon males and females aged 35-45. The fatality was greatest among males and females aged 55 and upwards:— Enteric fever.—Age and sex incidence. Males. Females. Age-period. Notified Cases. (a) Deaths. (a) Casemor tality per cent. Rates per 100,000 living. Notified Cases. (a) Deaths. (a) Casemor tality per cent Rates per 100,000 living. Cases. Deaths. Cases. Deaths. All Ages. 678 97 14.3 32 5 606 105 17.3 25 4 0— 1 - - - 1— 5 - 1 - 2— 7 1 2.8 14 0 6 — 3.8 11 0 3— 9 — 7 1 4— 14 — 12 — 5— 79 5 6.3 36 2 74 4 54 33 2 10— 101 6 5.9 49 3 72 9 12.5 34 4 15— 88 9 10.2 42 4 82 5 6.1 35 2 20— 91 7 7.7 42 3 88 11 12.5 34 4 25— 143 23 16.1 39 6 144 30 20.8 33 7 35— 76 26 34.1 27 9 75 27 35.9 24 9 45— 43 12 27.8 22 6 31 10 32.2 14 5 55 &upwards 21 8 38.0 11 4 14 8 57.0 6 3 The accounts of the behaviour of enteric fever in the several districts of London, contained in the annual reports, supply evidence of the considerable efforts made to discover the sources of infection of the cases which occurred. Upon a correct appreciation of the conditions which have given rise to the cases which occur must depend in large degree the success of future administration aiming at the prevention of this disease. It is interesting to note the large proportion of cases which must have been infected outside the district where the patient resided, and indeed often outside London, some sea-side resort where shell-fish had been consumed being frequently mentioned in the reports as the locality in which infection was received. Thus, of 735 cases occurring in twenty of the metropolitan boroughs, 115, or 15.7 per cent., are stated to be "imported" cases. In the reports relating to these twenty districts account is given of the number of cases in which it was found that an article of food had been eaten which is commonly believed to be a frequent cause of infection, and that its consumption had occurred at a time which was consistent with the hypothesis that it had been the cause or infection. (a) See footnote (a), page 36. 46 Annual Report of the London County Council, 1910. It should be stated that in some of the reports the information given does not include that concerning cases in which the patients were infected outside London. Adding together the cases in which particular articles of food are mentioned, the resulting numbers are: shell fish (unspecified), 100; oysters, 15; cockles, 2; whelks, 2; cockles and whelks, 1; mussels, 17; mussels and cockles, 1; periwinkles, 1; mussels and periwinkles, 1. So far as these figures indicate, some 19 per cent, of the 735 persons who suffered from enteric fever in these districts had eaten shell fish shortly before their illness began, a proportion, the significance of which entirely depends upon the proportion of shell fish eaters in the population. In numerous instances the consumption of fried fish is also mentioned among the articles of food which had been consumed, the statement being made that the patient was an eater of fried fish. It has, however, to be remembered that the London poor are large eaters of fried fish, and the question whether this article of food has been responsible for enteric fever occurrences cannot be judged by the circumstances of isolated cases. Inquiry into the circumstances of groups of cases occurring among poor people has been frequently made by Dr. Hamer, who has found reason for associating these outbreaks with the occasional supply of fried fish from particular shops. A report by him on a localised prevalence of enteric fever in Bethnal Green in 1910 will be found in Chapter XXXII., page 100. Of the 735 cases mentioned, 43 cases are stated to be due to infection from an antecedent case, and to the 43 cases must be added "a number" observed in one of the districts. Several of the annual reports contain interesting particulars of such occurrences. Dr. Thomas mentions a group of cases in model buildings in the borough of Finsbury, one of the cases being nursed by a woman who herself contracted the disease, and apparently while ill conveyed infection to a child under her care in a creche. Dr. Priestley gives account of a series of six cases in a court in Lambeth which appeared to have had origin in a person who had been thought in the first instance to have influenza. Dr. Lennane found several groups of cases in Battersea, which appear to have been caused by infection from one person to another, and Dr. Caldwell Smith gives the particulars of a series of cases in Wandswort, apparently due in the first instance to infection of a child through eating winkles, and afterwards by infection of an infant who had been taken to the house of the first case and who in turn subsequently gave rise to five other cases. Reference is made in several of the annual reports to an inquiry which the Medical Officer of the Local Government Board is making into the persistence of the existence of the bacillus typhosus in some persons who have suffered from enteric fever, and in which the medical officers of health are assisting him by collection of material from patients who have been discharged from the hospitals of the Metrooolitan Asvlums Board. Bacteriological diagnosis. The number of cases in which blood was examined by the Widal test at the expense of the sanitary authority is shown in the reports relating to the following districts:— Metropolitan borough. No. of specimens examined. No. found positive. Metropolitan borough. No. of specimens examined. No. found positive. Paddington 26 11 Shoreditch 17 9 Kensington 2 2 Bethnal Green 28 10 Fulham 18 12 Stepney 20 8 Chelsea 1 1 Poplar 35 17 Westminster, City of 21 5 Southwark 15 2 St. Marylebone 16 5 Bermondsey 24 4 Hampstead 4 2 Lambeth 44 20 St Pancras 29 14 Battersea 30 8 Islington 61 32 Wandsworth 29 14 Stoke Newington 9 3 Deptford 11 4 Hackney 22 6 Greenwich 23 7 Holborn 6 2 Lewisham 28 5 Finsbury 11 1 Woolwich 18 6 London, City of 1 - Enteric feverErrors of diagnosis. Cases certified to be those of enteric fever admitted into the hospitals of the Metropolitan Asylums Board, but in which the diagnosis was not subsequently confirmed, constituted the following percentage of total cases admitted in successive years:— Year. Percentage. Year. Percentage. 1900 18.3 1906 25.2 1901 25.4 1907 29.1 1902 21.2 1908 28.1 1903 24.2 1909 37.9 1904 26.3 1910 24.8 1905 29.7 Diagram U. Diarrhoea, Dysentery & Cholera. 47 Report of the Medical Officer of Health. Diarrhœa. The deaths (a) within the Administrative County of London during 1910 (52 weeks) attributed to epidemic diarrhoea and infective enteritis numbered 642, while 771 deaths were attributed to diarrhoea and dysentery. The corresponding figures for 1909 (52 weeks) were 794 and 832 respectively. The age-distribution of such of these deaths as belonged to London was, in 1910, as follows :— Disease. Under 1 year. 1-5. 5-20. 20-40. 40-60. 60-80. 80 and upwards All ages. Epidemic diarrhœa, infective enteritis 438 153 11 8 11 5 — 626 Diarrhœa and dysentery 488 127 4 28 39 40 16 742 Total 926 280 15 36 50 45 16 1,368 No accurate comparison can be made of the deaths from epidemic diarrhoea for a long series of years in London, owing to changes made in methods of classification; diagram (U),however, shows the death-rate from cholera, dysentery and diarrhoea combined, in each year since 1840 in relation to the mean death-rate of the period 1841.1910. The following table shows that the London diarrhoea death.rate was in the quinquennium 1905.9 lower than the death-rate of any of the undermentioned large English towns, except Bristol, Bradford and Newcastle-on-Tyne, and in 1910 was lower than that of any except Bristol. Town. 1905.9. 1910. Town. 1905.9. 1910. London 0.59b 0.30b West Ham 1.25 0.44 Greater London 0.58 0.26 Bradford 0.49 0.34 Liverpool 1.09 0.73 Newcastle-on-Tyne 0.50 0.39 Manchester 0.91 0.50 Hull 1.04 0.94 Birmingham 0.86 0.42 Nottingham 0.86 0.36 Leeds 0.64 0.43 Salford 0.94 0.56 Sheffield 1.16 0.71 Leicester 0.70 0.31 Bristol 0.38 0.21 Diarrhœa death-rates in large English towns. The deaths and death-rates from diarrhoea for the year 1910, and the death-rates for the period 1905.9 in each of the sanitary districts of London, are shown in the following table:— Metropolitan borough. Deaths, 1910 (52 weeks). Death-rate per 1,000 persons living. 1905-9. 1910. Paddington 43 0.46 0.30 Kensington 34 0.47 0.20 Hammersmith 41 0.59 0.34 Fulham 56 1.00 0.37 Chelsea 12 0.47 0.18 Westminster, City of 19 0.26 0.12 St. Marylebone 22 0.36 0.18 Hampstead 8 0.14 0.09 St. Pancras 52 0.42 0.24 Islington 78 0.40 0.24 Stoke Newington 8 0.34 0.16 Hackney 52 0.68 0.23 Holborn 10 0.40 0.20 Finsbury 50 0.88 0.56 London, City of 3 0.16 0.15 Shoreditch 61 1.06 0.55 Bethnal Green 51 0.83 0.40 Stepney 141 0.93 0.50 Poplar 87 1.02 0.53 Southwark 90 0.82 0.47 Bermondsey 85 0.83 0.67 Lambeth 80 0.55 0.27 Battersea 57 0.55 0.34 Wandsworth 39 0.43 0.13 Camberwell 61 0.51 0.23 Deptford 50 0.64 0.46 Greenwich 37 0.58 0.39 Lewisham 24 0.40 0.15 Woolwich 17 0.45 0.14 London 1,368 0.59 0.30 (a) See footnote (b) page 41. (b) See footnote (c) page 8. 48 Annual Report of the London County Council, 1910. It will be seen from the foregoing table that the diarrhoea death-rate in the quinquennium 1905-9 was highest in Shoreditch (1.06) and lowest in Hampstead (0.14), while in 1910 it was highest in Bermondsey (0 67) and lowest in Hampstead (0 09). The diarrhoea death-rates in London in each of the four quarters of the year 1910 were as follows: first quarter, 0.12; second quarter, 0.15 third quarter, 0.57; and fourth quarter, 0.38. The annual reports give account of the steps taken to limit diarrhœal mortality, and these do not differ from those of the previous year, except that in Woolwich the supply of milk from a milk depot provided by the Borough Council has been abandoned. The voluntary notification of cases of diarrhoea in the summer months in this borough was continued. Erysipelas. The deaths (a) from erysipelas in the Administrative County of London during 1910 (52 weeks) numbered 133, as compared with 180 in 1909 (52 weeks). The age-distribution of such of these deaths as belong to London was as follows — Under 1 Year. 1-5. 5-20. 20-40. 40-60. 60-80. 80 and upwards. All ages. 32 7 4 12 28 36 11 130 The number of cases notified and the number of deaths registered from this disease since 1890 have been as follows— Year. Notified Cases. Case-rate per 1,000 persons living. Deaths. (a) Death-rate per 1,000 persons living. 1891 4,764 1.13 214 0.05 1892 6,934 1.63 292 0.07 1893 9,700 2.26 424 0.10 1894 6,080 1.40 221 0.05 1895 5,660 1.30 179 0.04 1896 6,436 1.43 207 0.05 1897 5,794 1.31 184 0.04 1898 5,169 1.16 165 0.04 1899 5,606 1.25 213 0.05 1900 4,762 1.06 182 0.04 1901 4,604 1.02 171 0.04 1902 5,536 1.20 183 0.04 1903 4,372 0.96 183 0.04 1904 4,943 1.09 232 0.05 1905 4,972 1.09 226 0.05 1906 5,019 1.10 245 0.05 1907 4,497 0.99 189 0.04 1908 4,203 0.91 160 0.03 1909 4,192 0.92 180 0.04 1910 3,982 0.88 133 0.03 The number of cases of erysipelas notified and the case-rate for the year 1910, together with the case-rate for the period 1905-9, in the several sanitary districts are shown in the following table:— Metropolitan borough. Notified Cases, 1910 (52 weeks). Case-rate per 1,000 persons living. 1905-9. 1910. Paddington 100 0.85 0.70 Kensington 142 0.80 0.82 Hammersmith 62 0.79 0.51 Fulham 112 0.89 0.74 Chelsea 20 0.79 0.30 Westminster, City of 61 0.63 0.38 St. Marylebone 117 1.13 0.98 Hampstead 32 0.51 0.38 St. Pancras 191 0.85 0.87 Islington 213 0.75 0.65 Stoke Newington 31 0.61 0.61 Hackney 254 1.27 1.14 Holborn 42 0.82 0.84 Finsbury 170 1.26 , 1.91 Continued on next page. (a) See footnote (b) page 41 49 Report of the Medical Officer of Health. Metropolitan borough. Notified Cases, 1910 (52 weeks). Case-rate per 1,000 persons living. 1905-9. 1910. London, City of 16 0.68 0.79 Shoreditch 130 1.22 1.16 Bethnal Green 174 1.70 1.36 Stepney 381 1.60 1.36 Poplar 209 1.17 1.28 Southwark 244 1.35 1.27 Bermondsey 130 1.26 1.03 Lambeth 193 0.80 0.65 Battersea 170 0.97 1.01 Wandsworth 182 0.80 0.60 Camberwell 219 1.05 0.84 Deptford 144 1.46 1.32 Greenwich 89 1.01 0.93 Lewisham 61 0.65 0.39 Woolwich 90 0.80 0.74 Port of London 3 London 3,982 1.00 0.88 The following table shows the age and sex distribution of the notified cases of erysipelas in 1910— Sex. All Ages. 0- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75 and upwards. Males 1,721 134 80 62 72 78 204 329 342 227 130 63 Females 2,261 146 65 101 125 123 289 403 409 310 194 96 Persons 3,982 280 145 163 197 201 493 732 751 537 324 159 The table shows, so far as the figures relating to notified cases of this disease can be trusted in this connection, that the number of females attacked exceeds the number of males attacked, and this is true, even when allowance is made for the excess of females in the total population. Puerperal Fever. The deaths(a) in the Administrative County of London during the year 1910 (52 weeks) attributed to puerperal fever(b) numbered 161, as compared with 180 in 1909 (52 weeks). The number of cases notified and the number of deaths registered from this cause since the year 1890 have been as follows— Year. Notified cases. Deaths.(a) 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 1901 253 184 1902 311 201 1903 233 170 1904 273 198 1905 292 183 1906 298 187 1907 254 152 1908 228 137 1909 287 180 1910 292 161 (a) See footnote (b) page 41. (b) Including deaths from puerperal septicaemia and puerperal pyaemia. 50 Annual Report of the London County Council, 1910. If these cases and deaths are considered in relation to the total population and total births the following rates are obtained— Year. Case-rate per 1,000 living. Case-rate per 1,000 births. Death-rate (a) per 1,000 living. Death-rate (a) per 1,000 births. 1891-1895 0.07 2.17 0.06 1.97 1896-1900 0.06 2.03 0.05 1.50 1901-1905 0.06 2.10 0.04 1.44 1906-1910 0.06 2.27 0.04 1.36 1891 0.05 1.64 0.05 1.65 1892 0.08 2.55 0.07 2.37 1893 0.09 2.98 0.08 2.65 1894 0.06 1.92 0.05 1.60 1895 0.05 1.76 0.05 1.56 1896 0.06 2.04 0.05 1.66 1897 0.06 1.98 0.05 1.61 1898 0.05 1.86 0.04 1.39 1899 0.07 2.45 0.05 1.57 1900 0.05 1.81 0.04 1.29 1901 0.06 1.94 0.04 1.41 1902 0.07 2.35 0.04 1.52 1903 0.05 1.79 0.04 1.30 1904 0.06 2.12 0.04 1.54 1905 0.06 2.32 0.04 1.45 1906 0.07 2.39 0.04 1.50 1907 0.06 2.09 0.03 1.25 1908 0.05 1.86 0.03 1.11 1909 0.06 2.46 0.04 1.54 1910 0.06 2.54 0.04 1.40 An account of puerperal fever in the practice of mid wives will be found on page 94. Seasonal prevalence of and mortality from infectious diseases. Diagram (V) shows composite curves based on the number of cases of the several infectious diseases notified and deaths therefrom registered in the weeks of the period 1891-1910. The curves relating to deaths are reproduced from the Annual Summary of the Registrar-General for the year 1910. The curves indicating cases may be compared with those relating to the years 1890-1903, included in the annual report for the year 1903. No conspicuous or large differences are found by this comparison. The curves of 1891-1910 relating to deaths may be compared with curves relating to deaths in 1841-1900, included in the annual report for the year 1900, and with curves based on the deaths of 1841-1910 shown in the Annual Summary of the Registrar-General for 1910. The curves of smallpox for the several periods exhibit no conspicuous differences. The curve of measles shows in the later period a conspicuous increase in the spring months, and decrease in the autumn months. The curves of whooping-cough manifest no striking differences, except that there is a slight tendency of the whooping-cough curve in the later period to change in the same direction as the later measles curve. No conspicuous changes are observable in the curves of enteric fever, erysipelas and puerperal fever. The resemblance between the mortality curves of erysipelas and puerperal fever is deserving of note. The scarlet fever mortality curve of the more recent period shows conspicuous flattening. The autumnal high prevalence is in this period much diminished, and the spring low prevalence is less marked. These changes coincide with a declining death-rate. A conspicuous feature in the more recent mortality curve is a marked depression occurring a little later than the depression in the notified case curve which has been discussed in these reports in connection with the school holiday in August. The diphtheria mortality curve of the later period presents no conspicuous differences from the curve of the earlier period, except that it also exhibits, but in more marked degree, the same depression as in scarlet fever, occurring a little later than the depression in the notified case curve which has also been discussed in relation to the school holiday in August. This depression is indicated, but to a less extent, in the curves relating to the earlier periods. The question whether this August decrease in the number of scarlet fever and diphtheria cases notified was in any important degree due to exodus from London at the time of the summer holiday was discussed as long ago as the year 1894 (b), but no reason was found for assuming that this exodus was to any substantial extent responsible for the decrease. It was pointed out that the decrease in the cases notified among children of school age began about a week later than that of the closure of the schools, and that a smaller decrease occurred among children of a pre-school age and of persons of a post-school age a week still later, suggesting that the diminished prevalence among the two last sections of the population was due to diminished infection from the children of school age. Increase in the number of cases notified was found about a week after the re-opening of the schools. It might be anticipated that if exodus from London were a dominant factor in determining the diminished (a) See footnote (b), page 41. (b) Presidential address to the Epidemiological Society. Trans. 1894. Diagram V. Seasonal Prevalence of Infectious Disease 1891 -1910. Cases notified and deaths registered during successive weeks of the year in relation to the average per week for the 20 years. 51 Report of the Medical Officer of Health. prevalence of scarlet fever and diphtheria, the amount of decrease would not differ very widely from year to year, and further that in the same year the decreases in scarlet fever and diphtheria would in some degree resemble each other. There are, however, wide differences in these respects, as will be seen from the following table, which shows the number of cases of scarlet fever and diphtheria notified during the month of holiday influence and the succeeding month among children aged 3—13, per cent, of cases in the preceding four weeks:— Year. Scarlet fever. Diphtheria. Month of holiday influence. Post-holiday month. Month of holiday influence. Post-holiday month. 1892 -9 +52 —3 +29 1893 -26 + 65 —27 + 81 1894 -21.2 + 33.5 —23.9 +44.5 1895 -22.0 + 40.0 —36.0 + 49.0 1896 -2.9 +21.3 —14.9 +34.0 1897 -12.4 +45.4 —28.7 +30.4 1898 -31.8 + 33.4 —35.4 + 47.4 1899 -24.5 +53.8 —34.7 +44.6 1900 -15.7 + 68.9 —32.3 + 45.3 1901 -22.0 +56.3 —19.3 +55.8 1902 -22.7 +22.9 —25.1 + 3.7 1903 -24.4 +28.9 -31.7 +22.0 1904 -24.0 +51.6 —16.7 +16.6 1905 + 6.1 +42.0 —35.6 +57.5 1906 -28.8 +55.3 —24.2 +17.7 1907 -7.2 +44.5 —26.1 +58.7 1908 -10.9 +43.0 — 1.0 +21.0 1909 -26.2 +52.5 —36.6 +60.7 1910 -18.1 +25.1 —28.4 +63.5 Thus it is difficult to believe if exodus were the main factor in the causation of the holiday depression that in one year, 1896, exodus should in the main account for a decrease in August of 2.9 per cent, of the cases of scarlet fever, and in 1906 a decrease of 28.8 per cent., or a decrease in 1900 of 32. per cent, of the cases of diphtheria, and in 1892 a decrease of 3 per cent.; or in 1900 a decrease of 15.2 per cent, of the cases of scarlet fever and of 32.3 per cent, of the cases of diphtheria, (a) Similar differences are observable in the increase which occurs after the close of the holidays, which, as already stated, is found about a week after the reopening of the elementary schools. More recently the suggestion has been made that the diminished notifications of August are due to the non-discovery of cases through loss during that month of the opportunity of the school teachers to call attention to children who are absent from school, or whose state of health indicates the need for inquiry. To whatever extent this loss may have had effect upon the figures of notified cases it is obvious it would not have affected those relating to registered deaths, and the August depression in the mortality curves for scarlet fever and diphtheria published in the Annual Summary of the Registrar General definitely negatives the suggestion that the August depression in the case curves is materially affected by this cause. The total figures showing the number of cases of scarlet fever and diphtheria notified in the London population in the 19 years 1892-1910 (b) were as follows:— Period. Scarlet Fever. Diphtheria. Notified cases. Increase ( +) or decrease (—) Notified cases. Increase (+) or decrease (—) Cases. Per cent. Cases. Per cent. Four weeks preceding period of holiday influence 32,862 - - 15,506 - - Four weeks of holiday influence 28,312 -4,550 —13.9 12,815 -2,691 -17.4 Four weeks following period of holiday influence 38,144 + 9,832 + 34.7 16,184 +3,369 + 26.2 (a) The differences between the numbers of cases of diphtheria notified in the years selected for comparison are not likely to be vitiated by differences in amount of use of bacteriological methods. (b) The figures relating to the later years in the case of diphtheria may not improbably be somewhat affected by increased use of bacteriological methods of diagnosis. 52 Annual Report of the London County Council, 1910. Owing to the fact that in the period of the year under consideration these diseases have a natural tendency to increase in prevalence, the reduction shown in August understates the effect of the holiday, while the figures showing the subsequent increase overstates the effect of the conclusion of the holiday. Influenza, Bronchitis and Pneumonia. The deaths (a) attributed to influenza, which in 1909 numbered 1,216 (52 weeks), fell to 723 in 1910 (52 weeks). The deaths from bronchitis numbered 5,043 in 1910, as compared with 6,128 in 1909. In 1910 there were 6,729 deaths attributed to pneumonia, as compared with 7,591 in 1909. The deaths and death-rates from these diseases since 1889 have been as follows :— Year. Influenza (a). Bronchitis (a). Pneumonia (a). Deaths. Deathrate. Deaths. Deathrate. Deaths. Deathrate. 1890 652 0.15 12,448 2.93 6,224 1.46 1891 2,336 0.55 13,136 3.12 6,915 1.64 1892 2,264 0.53 11,183 2.63 6,164 1.45 1893 1,526 0.35 10,413 2.42 7,198 1.67 1894 750 0.17 7,816 1.80 5,321 1.23 1895 2,156 0.49 10,633 2.43 5,989 1.37 1896 496 0.11 7,558 1.68 5,537 1.23 1897 671 0.15 7,408 1.67 5,053 1.14 1898 1,283 0.29 7,779 1.74 5,440 1.22 1899 1,817 0.41 9,195 2.05 6,666 1.49 1900 1,950 0.43 8,699 1.93 7,189 1.60 1901 664 0.15 7,317 1.62 6,121 1.35 1902 1,073 0.23 7,901 1.71 6,801 1.47 1903 644 0.14 5,240 1.15 5,826 1.28 1904 709 0.16 6,373 1.40 6,609 1.45 1905 689 0.15 6,049 1.33 6,965 1.53 1906 895 0.20 5,373 1.18 6,586 1.45 1907 967 0.21 6,010 1.32 7,538 1.66 1908 1,350 0.29 5,342 1.15 6,751 1.46 1909 1,216 0.27 6,128 1.35 7,591 1.68 1910 723 0.16 5,043 1.12 6,729 1.49 InfluenzaDeaths registered in London in four-weekly periods. The distribution of deaths (a) from influenza throughout the year (b) for each of the years 1890 to 1910 is shown in the following table:— No. of weeks. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1— 4 303 9 1,308 52 272 59 37 40 244 66 1,016 57 77 141 67 94 56 291 87 61 112 5— 8 167 7 637 96 96 164 58 55 368 259 298 75 224 103 62 119 44 186 276 90 151 9—12 75 8 119 162 69 1,343 61 94 193 430 130 134 298 89 74 119 98 104 424 430 98 13—16 39 29 42 180 56 257 50 121 140 302 172 102 89 54 62 75 129 81 209 257 64 17—20 13 770 33 125 32 106 50 96 61 121 105 81 58 46 40 56 105 48 94 85 41 21—24 5 1,044 22 72 27 35 33 54 51 82 57 30 35 37 21 38 40 41 36 46 16 25—28 6 242 15 49 19 28 17 26 25 42 16 21 20 25 17 16 21 25 28 34 11 29—32 6 51 7 23 17 14 15 18 27 27 12 18 7 18 5 4 20 14 15 15 9 33—36 3 32 9 23 20 17 10 13 10 11 11 11 16 6 9 11 15 18 12 10 17 37—40 6 13 6 18 14 15 12 19 17 19 15 12 13 17 24 22 18 19 21 15 29 41—44 5 15 20 28 29 22 27 29 46 55 17 23 35 13 92 39 35 42 30 31 25 45—48 13 35 18 152 41 47 56 35 49 61 55 44 65 44 98 44 86 39 45 56 75 49—52 6 81 28 546 58 49 56 71 52 342 46 56 99 51 138 52 228 59 57 86 75 Phthisis. The deaths from phthisis, fully corrected for institutions, in the Administrative County of London during 1910 (52 weeks) numbered 5,555, as compared with 6,337 in 1909 (52 weeks). The death-rates from this disease in successive periods have been as follows:— Period. Death-rate per 1,000 persons living. Period. Death-rate per 1,000 persons living. 1851-1860 2.86 1903 1.57c 1861-1870 2.84 1904 1.65c 1871-1880 2.51 1905 l.46c 1881-1890 2.08 1906 1.49c 1891-1900 1.79c 1907 l.46c 1901-1910 1.49c 1908 l.39c 1909 1.40c 1901 1.66c 1910 1.23c 1902 l.61c (a) See footnote (b) page 41. (b) The deaths occurring in the 53rd week of the years 1890, 1896, 1902 and 1908, which are not shown, numbered 1, 14, 37 and 16 respectively. (c) See footnote (c) page 8. 53 Report of the Medical Officer of Health. The phthisis death-rate since 1850 (corrected (a) for differences in the age constitution of the population) in relation to the mean death-rate of the period 1851-1910 (males and females) is shown in diagram (W). This diagram shows the marked decline of phthisis mortality in both sexes, the greater incidence of such mortality on males than on females, and the fact that until the last seven years the decline has been more manifest in females than in males. The following table shows the crude phthisis death-rate, and the rate corrected for differences in the age and sex constitution of the population of the various sanitary districts, (a) The factors for correction, also shown in the table, have been calculated by applying the population at each age and for each sex of each of the London sanitary districts to the death-rates at each age and for each sex obtaining for London in the five years 1897-1901:— Metropolitan borough. Standard deathrate, (b) Factor for correction for age and sex distritribution. Crude death-rate. Corrected death-rate. Comparative mortality figure. (London 1,000.) 1905-9. 1910. 1905-9. 1910. 1905-9. 1910. London 1.74 1.00000 1.44 1.23 1.44 1.23 1,000 1,000 Paddington 1.80 0.96659 1.10 0.90 1.06 0.87 736 708 Kensington 1.78 0.97419 1.12 0.82 1.09 0.80 757 651 Hammersmith 1.74 0.99600 1.23 1.09 1.23 1.09 854 887 Fulham 1.69 1.02786 1.32 1.12 1.36 1.15 944 936 Chelsea 1.83 0.95018 1.57 1.30 1.49 1.24 1,035 1,009 Westminster, City of 1.95 0.89205 1.39 1.15 1.24 1.03 861 838 St. Marylebone 1.85 0.93836 1.44 1.15 1.35 1.08 937 879 Hampstead 1.75 0.98862 0.77 0.66 0.76 0.65 528 529 St. Pancras 1.80 0.96551 1.70 1.38 1.64 1.33 1,139 1,082 Islington 1.75 0.99145 1.31 1.21 1.30 1.20 903 976 Stoke Newington 1.77 0.97914 1.09 0.99 1.07 0.97 743 789 Hackney 1.68 1.02969 1.27 1.17 1.31 1.20 910 976 Holborn 1.97 0.87894 2.47 2.10 2.17 1.85 1,507 1,505 Finsbury 1.72 1.01050 2.26 1.80 2.28 1.82 1,583 1,481 London, City of 1.89 0.91946 1.62 1.44 1.49 1.32 1,035 1,074 Shoreditch 1.66 1.04206 1.98 1.52 2.06 1.58 1,431 1,286 Bethnal Green 1.59 1.08984 1.89 1.47 2.06 1.60 1,431 1,302 Stepney 1.65 1.05281 1.76 1.46 1.85 1.54 1,285 1,253 Poplar 1.66 1.04772 1.45 1.44 1.52 1.51 1,056 1,229 Southwark 1.74 0.99829 2.09 1.91 2.09 1.91 1,451 1,554 Bermondsey 1.65 1.05026 1.87 1.77 1.96 1.86 1,361 1,513 Lambeth 1.75 0.99258 1.51 1.28 1.50 1.27 1,042 1,033 Battersea 1.69 1.02483 1.35 1.16 1.38 1.19 958 968 Wandsworth 1.72 1.01050 0.97 0.86 0.98 0.87 681 708 Camberwell 1.68 1.03522 1.29 1.18 1.34 1.22 931 993 Deptford 1.69 1.02969 1.32 1.30 1.36 1.34 944 1,089 Greenwich 1.67 1.04143 1.25 1.11 1.30 1.16 903 944 Lewisham 1.69 1.02543 .87 0.57 0.89 0.58 618 472 Woolwich 1.70 1.01881 1.39 1.12 1.42 1.14 986 928 It will be seen from the foregoing table (comparing the corrected death-rates) that among the several sanitary districts in the quinquennium 1905-9, Finsbury (2.28) had the highest phthisis death-rate and Hampstead (0 76) the lowest; in the year 1910 Southwark (1.91) had the highest death-rate, the lowest obtaining in Lewisham (0.58). The death-rates from phthisis in London in each of the four quarters of the year 1910 were as follows: first quarter, 1.38; second quarter, 114; third quarter, 0.99; and fourth quarter, 1.41. The following table enables comparison to be made between the phthisis death-rates in the several sanitary districts for each of the years 1901-1910, inclusive. These death-rates are corrected for differences in the age and sex constitution of the various populations,(a) and it will be seen that while there is a general tendency to decline in the death-rates, there is a considerable difference in the amount of decline in the rates of the different districts. To facilitate comparison the districts are arranged in the ascending order of their death-rates in the first year shown in the table, viz., 1901:— (a) See footnote (b) page 14. (b) The standard death-rate used in the calculation of the " factor for correction " has been calculated to more than the two places of decimals shown in the table 54 Annual Report of the London County Council, 1910. Metropolitan borough. Corrected phthisis death-rates per 1,000 persons living (1901-1910). 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. Lewisham 0.92 1.10 0.85 0.93 0.88 0.87 0.96 0.90 0.83 0.58 Hampstead 0.93 0.90 0.72 0.86 0.86 0.69 0.72 0.81 0.67 0.65 Paddington 1.07 1.04 1.02 1.19 0.94 1.14 1.05 1.01 1.13 0.87 Wandsworth 1.16 0.95 0.93 1.11 1.01 1.00 0.97 0.96 0.95 0.87 Greenwich 1.22 1.28 1.22 1.48 1.38 1.37 1.20 1.32 1.19 1.16 Deptford 1.23 1.11 1.44 1.52 1.28 1.37 1.50 1.25 1.40 1.34 Stoke Newington 1.32 1.22 1.26 1.69 1.32 0.99 0.90 1.07 0.90 0.97 Kensington 1.34 1.20 1.22 1.39 1.14 1.30 1.10 1.04 0.96 0.80 Hammersmith 1.40 1.43 1.47 1.37 1.17 1.27 1.24 1.26 1.13 1.09 Fulham 1.42 1.47 1.49 1.55 1.35 1.28 1.37 1.34 1.39 1.15 Battersea 1.51 1.34 1.38 1.51 1.46 1.38 1.35 1.32 1.37 1.19 Islington 1.51 1.48 1.42 1.57 1.27 1.25 1.36 1.30 1.30 1.20 Camberwell 1.51 1.61 1.28 1.42 1.30 1.35 1.40 1.20 1.35 1.22 Hackney 1.52 1.49 1.34 1.46 1.20 1.40 1.23 1.34 1.33 1.20 Chelsea 1.60 1.39 1.45 1.72 1.47 1.58 1.55 1.31 1.54 1.24 Lambeth 1.65 1.70 1.40 1.47 1.39 1.41 1.60 1.50 1.50 1.27 Westminster, City of 1.67 1.59 1.49 1.33 1.34 1.25 1.22 1.13 1.23 1.03 St. Marylebone 1.71 1.76 1.78 1.56 1.34 1.50 1.39 1.06 1.30 1.08 St. Pancras 1.78 1.86 1.78 1.86 1.47 1.82 1.63 1.57 1.65 1.33 Woolwich 1.79 1.54 1.51 1.76 1.61 1.45 1.33 1.34 1.32 1.14 Bermondsey 1.85 1.90 1.80 2.23 1.86 2.08 1.98 1.97 1.87 1.86 Poplar 1.89 1.83 1.82 1.84 1.63 1.67 1.45 1.51 1.40 1.51 London, City of 1.92 1.41 1.45 1.33 1.15 1.54 1.75 1.47 1.53 1.32 Stepney 2.22 2.00 2.30 2.31 1.88 1.91 1.72 1.79 1.93 1.54 Shoreditch 2.24 1.89 2.40 2.30 2.02 2.14 2.16 2.10 1.84 1.58 Finsbury 2.26 2.31 2.27 2.52 2.07 2.22 2.44 2.27 2.38 1.82 Bethnal Green 2.35 2.17 2.31 2.36 2.22 2.45 2.12 1.74 1.71 1.60 Holborn 2.43 2.65 2.59 2.45 2.49 2.16 2.17 1.81 1.94 1.85 Southwark 2.48 2.61 2.42 2.46 2.20 2.16 2.15 1.99 1.93 1.91 The following table shows the number of deaths from phthisis at several age-periods in each of the sanitary districts. Metropolitan borough. Phthisis—Deaths at the several age-periods in sanitary areas—1910 (365 days). 0- 5- 10- 15- 20- 26- 36- 45- 55- 66- 75- 85and upwards All Ages. Paddington 4 1 1 4 15 26 27 26 13 10 - 1 128 Kensington 3 — 3 8 18 30 37 23 23 5 — — 150 Hammersmith 1 — 3 10 15 28 31 22 15 7 2 — 134 Fulham 5 2 3 9 13 39 49 26 18 6 3 — 173 Chelsea — — — 2 2 19 15 21 17 8 1 - 85 Westminster, City of 3 2 3 2 10 32 51 33 35 13 4 1 189 St. Marylebone 6 1 — 2 9 20 32 33 20 17 — — 140 Hampstead — — 1 4 7 8 7 16 6 7 — — 56 St. Pancras 8 3 4 13 27 65 60 58 47 25 1 — 311 Islington 14 2 6 21 34 96 72 82 53 17 5 — 402 Stoke Newington 1 — 2 1 9 11 9 13 3 2 — — 51 Hackney 8 2 6 12 23 65 53 49 30 14 2 — 264 Holborn 5 — 2 3 4 22 32 24 9 5 2 — 108 Finsbury 6 2 — 3 12 23 41 33 27 15 — - 162 London, City of — — — 4 3 4 4 5 3 3 2 — 28 Shoreditch 13 1 1 7 4 41 40 38 21 6 — — 172 Bethnal Green 10 4 2 9 15 42 48 35 20 2 2 — 189 Stepney 15 4 5 17 50 80 109 81 39 12 3 — 415 Poplar 5 2 4 8 18 44 53 46 37 19 2 — 238 Southwark 17 3 6 20 28 66 95 71 53 10 2 — 371 Bermondsey 10 2 1 15 14 41 72 35 25 9 1 — 225 Lambeth 16 5 4 26 34 78 83 81 40 18 3 — 388 Battersea 1 4 6 11 27 41 42 38 18 9 1 —. 198 Wandsworth 5 2 7 20 31 60 54 38 23 13 2 — 255 Camberwell 8 5 5 14 34 64 75 62 45 10 3 — 325 Deptford 2 5 6 9 25 35 38 18 5 — — 143 Greenwich 7 1 2 11 14 21 16 19 10 5 1 — 107 Lewisham 4 — 3 7 10 19 24 12 7 4 — — 90 Woolwich 2 1 3 9 14 26 41 20 15 8 — — 139 London 179 49 88 278 503 1136 1307 1078 690 284 42 2 5636 55 Report of the Medical Officer of Health. The following table shows the mortality from phthisis during the period 1901-1910 in groups of London sanitary districts, arranged in order of " social condition." (a) Number of group of boroughs in order of "social condition." Crude phthisis death-rate per 1,000 persons living. Corrected death-rate per 1,000 persons living. Corrected death-rate (London, 1,000). I 1.098 1.072 721 II. 1.283 1.234 830 III. 1.443 1.439 968 IV. 1.650 1.683 1,132 v. 1.938 2.037 1,370 London 1.487 1.487 1,000 Phthisis death-rates in relation to "social condition," 1901-10. Tables similar to the above have been published in previous annual reports, and the close relationship existing between "social condition" and phthisis mortality is conspicuous. It will be seen that in the lowest social group the death rate from phthisis is approximately twice that in the highest group. The Registrar-General has again included in the Annual Summary tables showing for London and for each of the London sanitary districts the number of deaths from phthisis which occurred at each age in each sex, distinguishing between those which occurred at home, in workhouse establishments, in hospitals, and in lunatic and imbecile asylums, as well as the proportions of the total deaths from phthisis which thus occurred. In the years 1909 and 1910 these proportions in London were as follows:— Place of death. Deaths—per cent, of total, 1909. Deaths—per cent, of total, 1910. Males. Females. Males. Females. Home 44.1 55.4 43.9 54.6 Workhouse establishments 44.0 31.8 44.5 31.3 Hospitals 7.3 6.4 7.3 7.7 Lunatic and imbecile asylums 4.6 6.4 4.3 6.4 In 1909, 48.4 percent, and in 1910, 48.0 per cent, of the total deaths occurred in the homes. The proportions occurring in the homes in the several districts in 1910 varied between 28.5 per cent, in St. Marylebone to 72.0 per cent, in Stoke Newington. In the following table the districts are arranged in order, according to the proportion in which deaths occur in the homes:— Deaths from phthisis occurring in the homes per cent, of total deaths from phthisis, males and females, 1910. Metropolitan borough. Percentage. Metropolitan borough. Percentage. Metropolitan borough. Percentage. St. Marylebone 28.5 St. Pancras 43.7 Kensington 54.2 Holborn 31.4 Southwark 44.3 Paddington 54.7 Westminster, City of 37.1 Chelsea 44.8 Ueptford 55.6 London, City of 37.9 Poplar 44.9 Greenwich 56.6 Finsbury „ 39.4 Hammersmith 45.5 Hampstead 57.1 Shoreditch 40.0 London 48.0 Battersea 60.3 Bethnal Green 40.4 Hackney 48.3 Wandsworth 61.7 Bermondsey 41.7 Camberwell 50.2 Lewisham 62.2 Stepney 42.0 Islington 52.9 Woolwich 62.5 Fulham 43.5 Lambeth 53.9 Stoke Newington 72.0 If the above table be compared with that on page 53 showing the comparative phthisis death-rates in London sanitary districts, it will be seen that the districts in which a smaller proportion of the deaths occur at home than the London average are largely those in which the phthisis death-rates are above the London average. The governing factor in both is the proportion of the population which is poor. The poor go into Poor Law institutions to die, the poor (a) See footnote (a) page 14. 56 Annual Report of the London County Council, 1910. suffer exceptionally from phthisis. This fact is especially indicated if the place of death be observed in groups of districts, arranged in relation to "social condition," (a) as will be seen from the following table:— Number of group of boroughs in order of " social condition." Place of death of persons aged 25-55 in relation to "social condition," 1909-1910. Males. Females. At home. In workhouse. In hospital or asylum. At home. In workhouse. In hospital or asylum. I 50.8 36.8 12.4 61.5 26.7 11.8 II 47.0 38.0 15.0 52.9 31.0 16.1 III 45.9 43.3 10.8 56.3 33.1 10.6 IV 41.3 50.3 8.4 58.6 33.7 7.7 V 36.5 54.3 9.2 47.1 40.0 12.9 An exception to the general trend of the figures is seen in the proportions dying in hospital, both in the case of males and females, in groups II. and V., due probably to the fact that in those groups there are hospitals for consumption. The deaths in hospitals for consumption in the five groups were as follow:— Deaths in hospitals for consumptives. Group. 1909. 1910. Total. I. 34 21 55 II. 70 87 157 III. — — — IV. — — — V. 103 110 213 The existence of a hospital for consumption in the neighbourhood thus appears to affect the figures, and indeed may in some degree affect the phthisis death-rate of the locality by leading in the first instance to the residence in it of persons suffering from phthisis who desire to take advantage of the opportunities for treatment given by the out-patient department. Again, the existence of common lodging-houses may affect the phthisis death-rates of the districts in which they are situated. The percentage of deaths of males which occur at home in 1910 ranges between 22.1 in St. Marylebone and 64.6 in Woolwich, and the percentage of deaths of females which occur at home, between 39.1 in Holborn, and 93.3 in Stoke Newington. In every district except four the proportion of male deaths which occur at home is less than the proportion of female deaths. The exceptions are Hackney 49.4 per cent, of males and 46.2 per cent, of females, Kensington 55.7 males and 52.5 females, Battersea 61.0 males and 59.5 females, and Woolwich 64.6 males and 60.0 females. Information as to the length of institutional treatment immediately prior to death in the case of 46 persons dying in the Paddington Workhouse and Infirmary was given in Dr. Dudfield's report for the year 1909. In his report for the year 1910 Dr. Dudfield gives like particulars in respect of 35 persons dying in Poor Law institutions, the length of institutional treatment immediately prior to death being as follows:— Duration of treatment in Poor Law Institutions—Paddington, 1910. Under 1 week. 1—4 weeks. 1—3 months. 3—6 months. 6—9 months. 9—12 months. Under 1 year. 1—2 years. 2—3 years. Years. 2 8 8 7 3 2 30 2 2 1 Moreover, Dr. Dudfield states the duration of isolation in months of 21 patients, the period of whose illness had lasted less than three years. Thus:— Duration of disease in years. Duration of isolation in months. 0— 1— 3— 6— 9— 12 + 0— 3 4 2 1 - - 1— 3 1 1 2 — — 2—3 2 - 1 - — 1 (a) See footnote (a) page 24. 57 Report of the Medical Officer of Health. The following table has been prepared with a view to learning whether the London figures give any indication that phthisis mortality is declining more rapidly in districts inhabited by poor persons or in those whose inhabitants are better circumstanced. Comparison is made between the deathrates of three groups of districts in the two periods 1901-5 and 1906-10, the "social condition" of the inhabitants of the districts being judged by the proportion of the child population—5-14 years—attending elementary schools. Thus Group I. includes districts with less than 87 per cent, of children scheduled as of the elementary school class. „ II. includes districts with 87-97 per cent, of children scheduled as of the elementary school class. „ III. includes districts with over 97 per cent, of children scheduled as of the elementary school class. The following figures are thus obtained:— Number of group of boroughs in order of "social condition." Death-rate corrected for difference in population from year to year. Percentage decrease in rate. 1901-1905. 1906-1910. I. 1.256 1.080 14.0 II. 1.508 1.367 9.4 III. 1.985 1.736 12.6 London 1.583 1.392 120 The figures do not afford any indication of the sort mentioned. Under the regulations as to tuberculosis made by the Local Government Board, medical officers of health receive notification of all cases of pulmonary tuberculosis occurring in poor law practices. Regulations made in March, 1911, extend the requirement of notification to cases receiving medical attendance at hospitals, dispensaries, and similar institutions, and further require the medical officers of health of London sanitary districts to send weekly to the medical officer of health of the county lists of the cases of which they receive notification. The annual reports of medical officers of health contain information relating to notifications in 1910 from which the following table has been prepared. The figures relating to deaths in workhouse establishments have been derived from the Annual Summary of the Registrar-General:— Metropolitan borough. No. of persons fied under the Order. Voluntary. Deaths in Workhouse Establishments. Paddington 93 248 35 Kensington 193 112 43 Hammersmith 123 40 53 Fulham 259 67 76 Chelsea 118 28 39 Westminster, City of 140 135 78 St. Marylebone 436 101 71 Hampstead 31 33 15 St. Pancras 317 198 124 Islington 478 58 132 Stoke Newington 21 18 7 Hackney 242 46 99 Holborn 154 16 59 Finsbury 188 131 78 London, City of 40 4 12 Shoreditch 241 51 90 Bethnal Green 182 28 94 Stepney 397 60 181 Poplar 314 — 110 Southwark 370 112 169 Bermondsey 183 106 101 Lambeth 659 115 133 Battersea 166 103 58 Wandsworth 219 75 67 Camberwell 326 — 120 Deptford 91 — 55 Greenwich 102 177 29 Lewisham 73 28 26 Woolwich 102 94 37 London 6,258 2,184 2,191 5176 E 53 Annual Re-port of the London County Council, 1910. In 1909, 8,382 persons in London were notified under the Regulations, in 1910 the number of persons thus notified was 6,258. The year 1909 was the first year in which the Regulations came into operation, the 1st of January of that year being specified for this purpose in the Regulations. The notifications of the first year may be thought of as including the total number of persons thus suffering who received poor law medical relief in that year, and, provided duplicate notifications were excluded, the figures of subsequent years should include only new cases receiving poor law medical relief. As a matter of fact, the figures of 1909 are not complete, for the reason that prior to the Regulations the system of voluntary notification instituted in many districts had already brought to the knowledge of the medical officers of health numerous cases of pulmonary tuberculosis, many of which were notified by poor law medical officers, and these cases were not generally included in the figures relating to cases occurring in poor law practices notified in 1909 under the Regulations. The 8,382 persons notified in London in 1909 must not, therefore, be regarded as more than a proportion of the total cases occurring in poor law practices in that year, but the 6,258 cases notified in 1910 give a number more nearly approximating to the total number of new cases in these practices, a number which may be thought of in connection with the number of deaths—viz., 2,191, occurring in workhouse establishments in that year. The experience of further years is obviously needed for more precise indication of the proportion which cases bear to deaths in this class of the population. During 1910 nineteen of the London medical officers of health were good enough to favour me with list3 of cases occurring in poor law practices and notified to them. I am thus able to show in total the number of notification certificates received in the districts of Kensington, Hammersmith, Chelsea, St. Marylsbone, Hampstead, Islington, Stoke Newington, Hackney, Finsbury, Shoreditch, Bethnal Green, Stepney, Poplar, Southwark, Bermondsey, Battersea, Camberwell, Lewisham, and Woolwich. These notifications numbered 7,523. The number of persons at the several ages cannot be shown, but if the fact be ignored that several notifications were often received in respect of the same person, the following figures are obtained :— Age-distribution of poor-law notifications during 1910. Sex. All ages. 0— 5— 10— 15— 20— 25— 35— 45—55— 65— 75+ Males 47 105 87 194 315 995 1,399 1,163 643 175 14 5,137 Females 37 96 126 169 213 557 504 389 200 79 16 2,386 Persons 84 201 213 363 528 1,552 1,903 1,552 843 254 30 7,523 The number of voluntary notifications in 1908 was 3,166, in 1909 1,715, and in 1910 2,178. The fall in 1909 was due to the issue of the Regulations leading to notification under them of cases which would before have appeared as voluntary notifications. It is interesting to note that the system of voluntary notification has led to increase in 1910 upon the number of cases notified in 1909. The authorities of some of the hospitals (Brompton, Mount Vernon and Middlesex) have communicated to the county medical officer particulars of some of the cases of phthisis attending their institutions, for distribution to the medical officers of health, and the age distribution of 630 patients is thus obtainable. The number of patients at the several ages was as follows:— Age-distribution of voluntary notifications, 1910. Sex. 0— 15— 20— 25— 35— 45— 55— 65+ All ages. Males 3 26 80 131 86 49 7 1 383 Females 8 25 53 84 54 20 3 — 247 Comparison of the above with the age distribution of cases in poor law practices shows that among males the greatest number of cases in these practices occurred at the age period 35-45, but in hospital practice at the age 25-35. In the case of females, the greatest number of cases occurred at the age 25-35 in both classes of patients. The highest death-rate in the general population among males is at the age period 45-55, and among females at the age 35-45. The age distribution of cases occurring in the common lodging-house population is necessarily in large degree governed by the special age distribution of that population. Enquiry has been made with regard to 201 persons notified under the Order, and giving addresses at common lodging-houses licensed by the Council—viz., 184 males and 17 females. The age distribution of 199 of these cases was— 0— 5— 10— 15— 20— 25— 35— 45— 55— 65 + — — — 2 4 32 56 60 34 11 Diagram W. Phthisis Mortality in London 1851-1910. Annual Death-rate among males and females per 1,000 living. (Corrected for differences in age-constitution of the population ) 59 Report of the Medical Officer of Health. As the result of enquiry, information was obtained in respect of 185 of the patients as to whether their illness began before or after they had resorted to this mode of living. Of the total (185) the onset of illness was stated in 69 cases to date from a time prior to that when resort was made to common lodging-houses, while in 12 other cases it was practically coincident with entry. As regards cases developing after commencement of this mode of life, in 36 cases the illness was first manifested before the expiration of three years; in 13 in from three to five years; in 28 between five and ten years; in 18 between ten and twenty years; and in 9 cases the illness developed after more than twenty years of common lodging-house life. It is too early to estimate with any sufficient accuracy the total number of persons suffering from recognisable phthisis in the general population, but it may be stated that the figures at present available indicate that the number of persons notified under the Regulations requiring the notification of phthisical persons attending hospitals and dispensaries exceeds those notified in poor law practices. Moreover, it may be expected that any measure increasing the facilities for the medical treatment of the population will tend to increase the number of persons who are found to be suffering from pulmonary tuberculosis, but even the figures which will then be arrived at will not indicate the whole of the persons so suffering. The trend of knowledge of the behaviour of tuberculosis in the general population is to show that a considerable number of persons are at one or other period of life attacked by tuberculous infection, that in many so attacked this invasion is overcome, while in others the powers of resistance are insufficient and recognisable illness and often death ensues. The important fact, however, remains that the London death-rate from phthisis has been declining for more than forty years, and during this period has fallen some 60 per cent., and this not as the result of any effort especially directed to the prevention of this disease. Assuming that the figures have not been materially affected by changes in nomenclature, it is difficult to believe that this result is not due to an actual or relative increase of ability to resist infection, whatever the cause or causes of this increase may be. The figures showing the decline in the death-rate during more recent years are shown in the following table:— Average annual death-rate. Area. Decrease Percent, 1901-4. 1906-9. England and Wales 1.24 1.13 8.7 London 1.62 1.43.11.6 England and Wales, excluding London 1.17 1.08 7.8 Decrease per cent in the phthisis death-rate, England and Wales and London, Nearly all of the annual reports give account in more or less detail of the steps taken in connection with cases of pulmonary tuberculosis which came to the knowledge of medical officers of health. These steps include visits to the homes of patients, the giving of advice which aims at the safeguarding of other persons, and the adoption of measures in the interest of the sufferers. In many of the reports the institution of anti-tuberculosis dispensaries is recommended by the medical officers of health. Such a dispensary was provided in Paddington, and its use extended to the inhabitants of Kensington and another was provided in St. Marylebone. In Hampstead, Hackney, Stoke Newington, Wandsworth and Greenwich the medical officers of health recommend the institution of a dispensary, and similar provision was contemplated in Fulham and Battersea, in the report relating to Greenwich the opinion being expressed that it would be well for the work to be undertaken by an existing institution. A conference of sanitary authorities was held in May, 1910, at which resolutions were adopted (a) that the provision of sanatoria for the educational and curative treatment of tuberculosis is desirable, (b) that such provision for the use of the metropolis should be made by the Metropolitan Asylums Board, (c) that pending such provision the sanitary authorities should secure beds in existing sanatoria, and (d) that the establishment of a dispensary in each metropolitan borough was desirable. The annual reports show that the Kensington Borough Council decided to secure one bed at Benenden or elsewhere, and authorised five others to be utilised as required; that the Westminster City Council sent 26 patients to sanatoria; the Bethnal Green Borough Council engaged six beds for 12 months at the Fairlight Sanatorium; the Southwark Borough Council five beds at Benenden; and at Woolwich the borough council continued the use of seven beds at Peppard. Dr. Davies writes favourably of the results obtained in Woolwich, and describes a " shelter," two of which are provided by the borough council for the use of consumptives, and in which they sleep at night, going to work during the day. The Kensington Borough Council has also decided to provide shelters as required. The home conditions of some of the cases of phthisis in Hackney brought to the knowledge of the medical officer of health are well shown in Dr. Warry's report relating to that district. In six instances a patient occupying a single room shared it with other persons, in two instances with one and in four instances with two other persons. In forty-seven instances the patient occupied two rooms with other persons, in thirteen instances with two, in ten with three, in twelve with four, in eight with five, and in four with six other persons. Similar information is given in respect of the occupation of three and four rooms by patients. In Kensington the borough council authorised the purchase of an additional bed where this was needed to obviate the necessity of persons sleeping in the same bed as the patient. 5176 E 2 60 Annual Report of the London County Council, 1910. Baterio- logical diagnosis The following table shows the number of instances in which material was sent to the medical officers of health with a view to examination for tubercle bacilli, and the number of instances in which the result was positive:— Metropolitan borough. No. of specimens examined. No. found to be tuberculous. . Metropolitan borough. No. of specimens examined. No. found to be tuberculous. Paddington 54 7 Shoreditch 7 3 Kensington 2 — Bethnal Green 16 3 Fulham 347 67 Stepney 340 139 Chelsea 5 1 Southwark 209 53 Westminster, City of 65 15 Bermondsey 239 46 St. Marylebone 112 28 Lambeth 173 77 Hampstead 14 4 Battersea 183 46 St. Pancras 74 16 Wandsworth 143 42 Islington 220 63 Camberwell 225 46 Stoke Newington 78 32 Greenwich 69 19 Hackney 128 26 Lewisham 112 38 Holborn 10 3 Woolwich 210 64 Finsbury 33 10 Cancer. The deaths from cancer, fully corrected for institutions, in the Administrative County of London during 1910 (365 days), numbered 4,654, as compared with 4,706 for the 365 days of 1909. The death-rates from this disease in successive periods have been as follows Period. Death-rate per 1,000 persons living. Period. Death-rate per 1,000 persons living. 1851-1860 0.42 1903 0.97a 1861-1870 0.48 1904 0.94a 1871-1880 0.55 1905 0.95a 1881-1890 0.68 1906 1.01a 1891-1900 0.85a 1907 0.98a 1901-1910 0.97a 1908 1.01a 1909 1.04a 1901 0.88a 1910 l.03a 1902 0.93a For the purpose of enabling the incidence of cancer on the several populations of the sanitary districts to be more precisely stated, factors have been calculated for correcting the death-rates, as far as possible, for differences in the age and sex constitution of the several populations concerned. These factors are shown in the following table, together with the death-rates for each sanitary district, corrected by their application.(b) Metropolitan borough. Standard deathrate. (c) Factor for correction for age and sex distribution. Crude death-rate per 1,000 persons living. Corrected death-rate per 1,000 persons living. Comparative mortality figure (London 1,000). 1905-9 1910. 1905-9. 1910. 1905-9. 1910. London 0.87 1.00000 1.00 1.03 1.00 1.03 1,000 1,000 Paddington 0.98 0.89478 1.17 1.18 1.05 1.05 1,051 1,022 Kensington 1.02 0.85622 1.11 1.02 0.95 0.87 951 847 Hammersmith 0.90 0.96811 1.07 1.08 1.04 1.05 1,041 1,022 Fulham 0.77 1.13828 0.94 0.99 1.07 1.13 1,071 1,100 Chelsea 1.03 0.84874 1.13 1.42 0.96 1.20 961 1,168 Westminster, City of 0.96 0.91348 1.10 1.13 1.00 1.03 1,001 1,003 St. Marylebone 0.99 0.88571 1.27 1.35 1.12 1.19 1,121 1,159 Hampstead 0.92 0.94816 0.96 1.03 0.91 0.98 911 954 St. Pancras 0.92 0.95229 1.09 1.26 1.04 1.20 1,041 1,168 Islington 0.90 0.96704 1.08 1.14 1.04 1.10 1,041 1,071 Stoke Newington 0.98 0.89387 1.19 1.12 1.06 1.00 1,061 974 (Continued on next page.) (a) See footnote (c), page 8. (b) See footnote (b), page 14. (c) See footnote (b), page 53. 61 Report of the Medical Officer of Health. Metropolitan borough. Standard deathrate.(a) Factor for correction for age and sex distribution. Crude death-rate per 1,000 persons living. Corrected death-rate per 1,000 persons living. Comparative mortality figure (London 1,000) 1905-9. 1910. 1905-9. 1910. 1905-9. 1910. Hackney 0.88 0.99341 0.93 1.02 0.92 1.01 921 983 Holborn 0.95 0.91924 1.04 1.16 0.96 1.06 961 1,032 Finsbury 0.84 1.04071 0.89 0.84 0.93 0.88 931 857 London, City of 1.06 0.82316 1.26 1.24 1.04 1.02 1,041 993 Shoreditch 0.79 1.10518 0.84 0.85 0.93 0.94 931 915 Bethnal Green 0.78 1.12077 0.89 0.98 1.00 1.10 1,001 1,071 Stepney 0.74 1.17976 0.81 0.83 0.96 0.98 961 954 Poplar 0.81 1.08327 0.84 0.91 0.91 0.98 911 954 Southwark 0.82 1.06350 0.97 1.00 1.03 1.06 1,031 1,032 Bermondsey 0.81 1.08462 0.96 1.15 1.04 1.25 1,041 1,217 Lambeth 0.92 0.95333 1.14 1.07 1.09 1.02 1,091 993 Battersea 0.79 1.10798 1.00 0.86 1.11 0.95 1,111 925 Wandsworth 0.88 0.99116 0.94 0.99 0.93 0.98 931 954 Camberwell 0.87 1.00483 0.97 0.90 0.97 0.91 971 886 Deptford 0.81 1.07396 0.90 1.02 0.97 1.10 971 1,071 Greenwich 0.87 1.01064 0.92 0.90 0.93 0.91 931 886 Lewisham 0.92 0.95333 0.97 1.01 0.92 0.96 921 935 Woolwich 0.78 1.11933 0.88 0.87 0.99 0.97 991 944 It will be seen from the foregoing table (comparing the corrected death-rates) that in the quinquennium 1905-9 among the several sanitary districts St. Marylebone (1.12) had the highest cancer death-rate and Hampstead and Poplar (0.91) the lowest; in the year 1910, Bermondsey 1.25) had the highest, the lowest obtaining in Kensington (0.87). The following table shows the corrected death-rate from cancer in each of the sanitary districts of London, annually for the last ten years:— Metropolitan borough. Corrected Cancer death-rates. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. Paddington 0.93 0.86 1.02 0.99 0.94 1.04 1.12 1.17 0.96 1.05 Kensington 0.96 0.77 0.93 0.88 0.84 0.87 1.05 0.93 1.06 0.87 Hammersmith 0.82 0.83 0.84 0.98 1.00 1.17 1.12 0.98 0.92 1.05 Fulham 1.01 0.88 0.95 1.02 1.07 1.09 1.21 0.89 1.08 1.13 Chelsea 0.77 0.90 1.09 1.07 0.91 1.05 0.87 0.91 1.07 1.20 Westminster, City of 0.76 0.98 0.94 0.93 0.97 0.92 0.90 1.10 1.11 1.03 St. Marylebone 0.92 0.98 1.19 0.98 1.19 0.95 1.09 1.20 1.20 1.19 Hampstead 0.91 1.07 1.23 0.97 0.70 1.10 0.81 1.00 0.96 0.98 St. Pancras 0.84 0.99 1.04 0.94 0.97 1.05 0.90 1.24 1.05 1.20 Islington 0.88 0.96 1.06 0.94 0.98 1.09 1.02 1.08 1.04 1.10 Stoke Newington 0.82 0.77 0.99 0.94 0.96 0.96 1.13 1.19 1.09 1.00 Hackney 0.80 0.88 0.90 0.85 0.91 0.83 0.91 1.00 0.97 1.01 Holborn 0.92 0.99 0.93 0.88 0.86 1.08 0.77 0.89 1.18 1.06 Finsbury 0.81 0.84 0.96 0.87 0.74 0.92 0.96 0.98 1.04 0.88 London, City of 1.05 1.26 0.81 1.10 1.10 1.03 0.99 1.02 1.06 1.02 Shoreditch 0.90 1.15 0.94 0.86 0.98 0.81 1.05 0.89 0.94 0.94 Bethnal Green 0.96 0.92 0.97 0.97 0.91 1.09 0.97 0.99 1.04 1.10 Stepney 0.87 0.79 0.94 0.93 0.90 1.16 0.91 0.95 0.86 0.98 Poplar 0.79 0.92 0.91 0.77 0.91 0.84 0.86 0.96 0.99 0.98 Southwark 0.92 0.90 1.06 0.93 1.16 0.98 1.03 0.99 1.02 1.06 Bermondsey 0.73 1.03 0.93 0.78 0.91 1.05 1.09 0.94 1.22 1.25 Lambeth 0.95 0.97 0.99 1.01 1.04 1.01 1.08 1.08 1.22 1.02 Battersea 0.90 0.97 0.97 1.08 1.15 1.12 1.05 1.01 1.20 0.95 Wandsworth 0.88 0.91 1.02 0.97 0.84 0.97 0.98 0.94 0.91 0.98 Camberwell 0.98 0.96 0.88 0.90 0.89 1.03 0.92 1.01 1.01 0.91 Deptford 0.88 1.04 1.00 1.03 1.00 1.08 0.78 0.95 1.02 1.10 Greenwich 0.71 0.88 0.80 0.91 1.03 0.83 0.87 1.00 0.91 0.91 Lewisham 0.91 0.94 0.83 0.82 0.88 0.92 0.94 0.93 0.96 0.96 Woolwich 0.79 0.98 0.90 0.95 0.78 1.11 1.04 0.88 1.11 0.97 London 0.88 0.93 0.97 0.94 0.95 1.01 0.98 1.01 1.04 1.03 The following tables show the deaths during 1910 (365 days) in each of the sanitary districts from cancer at several age-periods under three headings, viz., sarcoma, carcinoma, and cancer, deaths (a) See footnote (b), page 53. 62 Annual Report of the London County Council. 1910. classified under the last-named term being those for which the information given on the certificate of death was insufficient to distinguish them further for purposes of classification:— Metropolitan borough. Sarcoma—Deaths at ages—1910 (365 days.) 0- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85 and upwards All Ages Paddington 1 - 3 1 1 1 2 2 1 2 - - 14 Kensington — 1 — - - - 3 - - 1 2 - 7 Hammersmith — - - - - 1 1 - 2 - 1 - 5 Fulham — — 1 — — 1 - - 3 1 - - 6 Chelsea - - - - - 2 1 2 - - 1 - 6 Westminster, City of 1 - 1 — — - - - 1 2 1 - 6 St. Marylebone 1 - 1 1 — — 1 - — - - - 4 Hampstead — - - - 1 3 - 1 3 1 - - 9 St. Pancras 1 - - 1 - 3 3 4 4 1 - - 17 Islington 1 1 - 2 1 2 8 4 8 2 - - 29 Stoke Newington — 1 — - - - 2 - 1 1 1 - 6 Hackney 1 1 — 1 — — 2 3 4 - 3 — 15 Holborn — - — — — — — — — - - — - Finsbury — - — — - 1 - 1 1 2 - - 5 London, City of - - - - - - - 1 1 - - - 2 Shoreditch — - — — — - 2 3 1 - - - 6 Bethnal Green 2 - 1 — — 1 2 - 3 - - - 9 Stepney 1 3 1 — — 1 4 3 5 - 2 - 20 Poplar — 1 2 1 2 2 - 1 2 3 - - 14 Southwark — 1 — 1 1 2 - 3 2 - - - 10 Bermondsey 3 2 — — — - 3 2 1 - - - 11 Lambeth 1 — 1 1 — - 1 1 3 1 - - 9 Battersea — 1 — — 1 — 2 1 2 - - - 7 Wandsworth 1 2 — 1 1 4 1 6 5 1 - - 22 Camberwell 1 — — 1 - 3 3 2 2 4 1 - 17 Deptford - — — 1 — 1 2 - 1 1 - 1 7 Greenwich 1 1 — — — — 1 1 1 - - - 5 Lewisham 1 - - - - - 1 - 3 2 - - 7 Woolwich — — — — — 1 - 2 2 - - - 5 London 17 15 11 12 8 29 45 43 62 25 12 1 280 Metropolitan borough. Carcinoma—Deaths at ages—1910 (365 (days). 0- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- No and upwards All Ages. Paddington - - - - 1 - 5 36 25 30 14 2 113 Kensington - — — — — 2 15 11 28 31 16 2 105 Hammersmith - — — — — 4 7 17 35 16 9 1 89 Fulham - — - — 1 4 14 23 29 27 6 1 105 Chelsea - — — — — 2 12 14 18 12 8 - 66 Westminster, City of - — — — 1 1 8 23 39 43 14 1 130 St. Marylebone - — — — - 1 6 21 31 26 6 2 93 Hampstead - — — — - 2 2 12 16 16 7 - 55 St. Pancras - — — — 2 7 16 45 50 55 21 4 200 Islington - — — — — 3 24 40 51 48 32 3 201 Stoke Newington - — — — 1 — 2 8 9 7 3 - 30 Hackney - — — — 5 14 29 45 41 8 2 144 Holborn - — — - — 1 3 11 14 10 4 - 43 Finsbury - — — - — — 5 17 11 17 2 - 52 London, City of - — — - — — 1 5 3 5 3 1 18 Shoreditch - — — — — 2 6 20 22 11 1 - 62 Bethnal Green - - - - - 1 7 17 15 8 3 1 52 Stepney - — — — 1 4 12 41 43 33 9 1 144 Poplar - — — — — 3 6 16 36 23 13 1 98 Southwark - — — 1 — 6 13 32 44 32 15 1 144 Bermondsey - — — — — 1 11 26 30 22 9 2 101 Lambeth - — — — 1 5 17 54 55 67 25 4 228 Battersea - - - - - 1 5 20 19 25 8 - 78 Wandsworth - — — — — 2 18 34 46 47 22 2 171 Camberwell - — — 1 1 3 12 24 38 37 9 3 128 Deptford - - - - - 2 6 16 25 19 5 1 74 Greenwich - - - - - 3 7 9 16 14 7 - 56 Lewisham - - - - - 1 9 29 34 34 8 1 116 Woolwich - - — — — 2 7 12 12 15 6 - 54 London - - - 2 9 68 270 662 839 771 293 36 2,950 63 Report of the Medical Officer of Health. Metropolitan borough. Cancer (otherwise undistinguished).—Deaths at ages—1910 (365 days). 0- 5- 10- 15- 20- 25. 35- 45- 55- 65- 75- 85 and upwards All Ages. Paddington - - - - - - 3 9 16 8 5 - 41 Kensington - - - - - 3 5 13 18 18 7 - 64 Hammersmith 1 — — — — 1 1 4 15 9 5 1 37 Fulham - — — — 1 1 5 11 10 6 6 - 40 Chelsea - — — — — — 1 4 7 8 3 - 23 Westminster, City of - - - - - 1 5 9 12 9 11 - 47 St. Marylebone - — — — — 1 6 21 20 13 3 - 64 Hampstead - — — - — 1 2 5 11 5 - 24 St. Pancras 1 — — — — 4 1 15 15 18 6 - 60 Islington - — — — — 2 11 29 45 38 19 - 144 Stoke Newington - - — - - - - 2 10 6 2 1 21 Hackney 1 — — - — — 7 16 21 17 5 1 68 Holborn - - — - - - - 4 5 3 2 1 15 Finsbury - — - — — 1 3 — 4 8 2 — 18 London, City of - - - - - - - 1 2 2 - - 5 Shoreditch - — - — — — — 6 7 10 4 - 27 Bethnal Green - — - - - 4 5 12 20 13 9 2 65 Stepney - — - — — — 2 16 30 17 2 2 69 Poplar - - - - - 1 3 10 7 13 2 - 36 Southwark 1 - — — — 2 2 10 14 6 4 - 39 Bermondsey - — — — 1 1 1 5 9 12 4 1 34 Lambeth - 1 1 — - 1 6 10 22 26 15 2 84 Battersea - — — — 1 5 15 20 11 5 2 59 Wandsworth - — — — — 3 5 15 34 36 15 1 109 Camberwell 1 — 1 - — 3 9 12 32 29 4 — 91 Deptford - — — - — - 3 9 7 10 2 — 31 Greenwich - — — - 1 — 3 2 7 8 4 1 26 Lewisham - 1 — 1 — 1 2 7 10 11 3 1 37 Woolwich - — - — 1 5 10 17 10 3 — 46 London 5 2 2 1 3 32 100 279 441 386 157 16 1,424 The following table shows the proportional age-distribution of the deaths in London during 1910 (365 days) classified under the three headings— Type of cancer. All ages. Under 35. 35- 45- 55- 65- 75 85 and upwards. Sarcoma 1,000 329 161 154 221 89 43 3 Carcinoma 1,000 27 92 224 285 261 99 12 Cancer (not otherwise defined ) 1,000 32 70 196 310 271 110 11 Total 1,000 47 89 212 288 254 99 11 In the report for the year 1909 a table was included showing the cancer death-rates in the period 1901-9 in areas presenting different degrees of overcrowding, the object being to compare the death-rates of populations differently circumstanced in respect of "social condition." The following table shows the death-rates for the period 1901-10 according to "social condition" as defined in footnote (a) page 24. Number of group of boroughs in order of "social condition." Crude cancer deathrate per 1,000 persons living. Corrected death-rate per 1,000 persons living. Corrected death-rate (London, 1,000). I. 0.983 0.943 968 II. 1.054 0.956 983 III. 1.027 1.003 1,030 IV. 0.892 0.974 1,000 V. 0.845 0.949 974 London 0.974 0.974 1,000 Cancer death-rates in relation to "social condition," 1901-1910. These figures and those contained in previous reports appear to indicate that there is no relation between cancer mortality and social condition, whether measured by the degree of overcrowding or by the percentage of children scheduled for compulsory education, and in this respect the behaviour of cancer differs altogether from that of phthisis (see page 55). 64 Annual Report of the London County Council, 1910. Cerebrospinal Fever. During 1910, 115 persons were certified to be suffering from cerebro-spinal fever and 10 deaths were attributed to this disease. The number of deaths in each year since 1901. has been as follows:— Deaths.(a) 1902 4 1903 6 1904 6 1905 5 1906 4 Deaths.(a) 1907 25 1908 12 1909 15 1910 10 As stated in the last annual report, the larger number of deaths attributed to this cause in 1907 was probably an indirect effect of the Council making an Order requiring cases of this disease to be notified. The requirement of notification did not become operative until the 12th of March, 1907, and during the remainder of that year 135 cases were notified, or 50 more than in the whole of the year 1908. In 1909 there were 111 notified cases, and 115 in 1910. In March, 1910, the Council extended the Order for another period of twelve months. The age distribution of the 115 cases notified in 1910 was as follows:— Sex. Cerebro-spinal fever—Age distribution of notified cases, 1910. All ages. 0- 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 13- 15 + Males 58 28 6 3 3 1 4 1 — — — 3 2 7 Females 57 25 10 6 1 1 — - 2 1 1 1 4 5 Persons 115 53 16 9 4 2 4 1 2 1 1 4 6 12 Seven of the deaths were those of infants under one year of age, one that of a child aged between one and five years, and the remaining two those of persons over five years of age. The notified cases occurred in every district of London except Chelsea. Inquiry was made into the notified cases by Dr. Wanklyn, who states that nothing was discovered which threw light on the causation of this disease; in no single instance was there evidence that any one verified case had any connection with another. Moreover, he reports that of the cases originally certified, in only forty did the final diagnosis agree with that originally made, and of these forty "no bacteriological or post mortem examination was made in twelve cases, and in another thirteen cases the disease was specified as post-basic meningitis, which is regarded as a sub-acute form of cerebro-spinal fever. Thus only fifteen cases remain out of a total of 115 in which the acute form as originally diagnosed, was confirmed bacteriologically." Anthrax. On the 6th April, 1909, the Council made an Order requiring the notification of cases of glanders, anthrax and hydrophobia in man; the Order came into force on the 26th April. Six notifications were received by medical officers of health relating to persons who were believed to be suffering from anthrax. In respect of three of these persons the diagnosis was erroneous. Three other cases which were not notified also became known to the medical officers of health. The six actual cases which occurred were as follows:— Hammersmith.—J. R. G., aged 19 years, was employed in the business of animal hair sorter. Poplar.—Male, aged 42 years, had been working in a ship at a time when hides were being loaded. Bethnal Green.—H. P., a checking clerk at some river-side premises, where he had been inspecting some foreign hides. Southwark.—A. C., aged 19 years, living in Southwark, but employed as a riverside labourer in Bermondsey. He had been engaged in unloading foreign hides. Finsbury.—A man in the employ of a horse-hair manufacturer. He had been handling English and South American hair. Bermondsey.—C. L., a wharf labourer, living in Barking, who had been employed in handling Cape sheep skins in BermOndsey. None of these cases proved fatal. Glanders. One person was certified to be suffering from glanders, but the diagnosis was subsequently not confirmed. A report by Drs. J. M. Bernstein and W. H. Hamer on human glanders in London during the period 1893-1910 will be found in Chapter XXXII., page 109. (a) See footnote (b), page 41. Report of the Medical Officer of Health. 65 Hydrophobia. A man, E. S., aged 24 years, died from hydrophobia in the Hackney Union Infirmary. Dr. Warry has kindly supplied me with notes of this case by Dr. W. I. Cowell, acting medical superintendent of the infirmary. The patient, who had been a soldier, was, with another man, bitten by a rabid dog on the 8th September, 1909; both were treated at the Pasteur Institute, the other man dying fourteen days after his admission. E. S. remained well until the 19th March, 1910, when he suffered from symptoms resembling those of hydrophobia, and died on the 22nd March. The spinal cord was not examined. Meteorology. The tables published in the Annual Summary of the Registrar-General, deduced from observations at Greenwich under the superintendence of the Astronomer Royal, show that the mean temperature of the air in 1910 was 50.2 deg. Fahrenheit, which is 0.1 degrees above the average of the preceding 65 years. The rainfall during the year amounted to 28.06 inches, an excess of 3.93 inches over the average of the preceding 65 years. The temperature and rainfall in each month of the year 1910 are shown in the following table :— Month. Temperature of the air. Departure of mean monthly temperature from average of preceding 65 years. ' Rain and other forms of precipitation. Departure of mean monthly rainfall from average of preceding 65 years. Absolute maximum. Absolute minimum. Mean for the month. Number of days it fell. Amount collected. deg. F. deg. F. deg. F. deg. F. Inches. Inches. January 55 20 39.7 + 1.3 15 1.72 -0.16 February 56 28 41.8 +2.0 24 2.69 + 1.21 March 58 26 43.0 +0.5 10 1.10 -0.42 April 66 26 47.1 -1.0 16 2.62 + 1.05 May 78 30 54.3 +0.5 19 2.24 +0.32 June 82 44 61.3 + 1.0 13 2.08 +0.04 July 76 47 59.4 -4.3 18 3.52 + 1.12 August 77 49 61.8 -l.l 17 2.43 +0.09 September 75 39 56.6 -1.6 3 0.74 -1.41 October 73 40 53.7 +3.3 14 1.81 - 0.97 November 55 22 38.9 -4.5 17 3.57 + 1.35 December 55 27 44.2 +4.6 19 3.54 + 1.71 66 Annual Report of the London County Council, 1910. Administration. Dairies. Cowsheds and Milkshops. Cowshed premises The County Council received during the year 203 applications for cowhouse licences, of which 199 were granted. The number of applications for licences received during the last seventeen years and the number granted are shown in the following table. It will be seen that the number of these premises in London is continually decreasing. No. of applications received. No. of premises for which licences were granted. Year. 1894 456 446 1895 427 416 1896 405 393 1897 379 374 1898 357 354 1899 338 330 1900 323 321 1901 306 295 1902 294 291 1903 282 277 1904 266 259 1905 257 255 1906 244 240 1907 234 233 1908 229 225 1909 216 214 1910 203 199 Milkshop premises In 1903 effort was made, in conjunction with the medical officers of health of metropolitan boroughs, to secure uniform statistical statement of the proceedings of the local authorities in London. Tables showing these proceedings included in this report have therefore, in the main, been compiled from tabular statements in the annual reports of medical officers of health, or from figures otherwise contained in their reports or specially furnished by them. The following table relating to cowsheds has been thus prepared:— Metropolitan borough. Number of cowshed premises. Number of inspections by the sanitary authority. 1910. Number of prosecutions by sanitary authority, 1910. On register at end of 1909. Added in 1910. Removed in 1910. On register at end of 1910. Battersea 3 - - 3 - Bermondsey 5 - 1 4 51 — Bethnal Green 15 — — 15 56 — Camberwell 14 — 3 11 235 — Chelsea 2 — 1 1 13 — Deptford 3 — 1 2 23 — Finsbury 3 — — 3 17 — Fulham 2 — - 2 20 — Greenwich 4 — - 4 13 — Hackney 21 — 2 19 251 — Holborn 1 — 1 — — Islington 7 — 2 5 64 — Kensington 1 — — 1 43 - Lambeth 13 — — 13 26 — Lewisham 13 — — 13 135 — Paddington 1 — — 1 4 — Poplar 15 — 1 14 58 - St. Marylebone 5 — — 5 41 - St. Pancras 7 — — 7 117 — Shoreditch 7 - — 7 47 — Southwark 4 - — 4 47 — Stepney 36 - 3 33 80 — Stoke Newing'on 2 — - 2 6 — Wandsworth 12 — — 12 54 - Westminster, City of 1 - — 1 25 — Woolwich 17 — - 17 68 - Report of the Medical Officer of Health. 67 In 1908 the London County Council obtained the sanction of Parliament to a provision contained in the General Powers Act of that year, authorising any sanitary authority to remove from the register of milk vendors, or to refuse to register the name of any person carrying on or proposing to carry on the business of a dairyman or purveyor of milk upon premises which, in the opinion of the sanitary authority, are unsuitable for the sale of milk. The Act provides an appeal to a Court of summary jurisdiction. These powers have been largely used in London. In Paddington 69 premises which were unsuitable were removed from the register. In Kensington 101 premises were removed from the register, a small proportion being subsequently reinstated after necessary changes had been made. Dr. Sandilands states that many of the premises to which exception was taken were small, ill-ventilated, crowded with a great variety of general goods, and often very dirty. Dr. Jackson reports that the new powers have enabled the sanitary authority to secure in Fulham better conditions for safeguarding the purity of the milk while stored in retail shops. In Westminster in two instances applications for registration were refused. In St. Marylebone 72 premises were removed from the register on account of unsuitability and 11 applications were refused for the same reason. In Hampstead there were two refusals of applications for registration. In the City, premises were removed from the register in one instance; in Bethnal Green 106 premises were removed; in Stepney 9 premises were removed and 71 applications were refused; in Battersea a large number of premises were removed from the register; in Greenwich there was refusal of registration in respect of six premises; in Woolwich there were several refusals. In a few instances there were appeals to the magistrate against the decision of the sanitary authority and in some instances prosecution of the milk vendors for carrying on the trade of a milk vendor after refusal of registration. The results of the appeals as shown in the annual reports were that in some instances the hearing of the case was adjourned to enable the vendor to comply with the requirements of the sanitary authority, and in no instance does it appear that the case was decided against the authority. The annual reports show that the action of the sanitary authorities led, in many instances, to improvement of the premises, in order to secure registration, and thus, as Dr. Lennane reports in respect of Battersea, a distinct improvement was effected as regards the sanitary conditions under which milk is sold. The experience of the administration of these powers in Islington indicates the need for definition of the term "premises" in the Act. Dr. Porter includes in his annual report reference to a decision of the Court of Appeal, in a case in which a magistrate refused to convict a peripatetic milk vendor for supplying milk in St. Marylebone without being registered in that borough. The Court held that his registration in another district was sufficient. The following table shows the number of milkshop premises at the end of 1909 and 1910 in the metropolitan boroughs of London, the number of inspections and the proceedings taken. The table has mainly been compiled from information contained in the annual reports:— Metropolitan borough. Number of premises. (a) Number of inspections, 1910. Number of notices, 1910. Number of prosecutions, 1910. On register at end of 1909, Added in 1910. Removed in 1910. On register at end of 1910. City of London 602 61 25 638 2 1 Battersea 178 41 34 185 836 35 - Bermondsey 273 40 27 286 559 20 - Bethnal Green 327 48 132 243 1,413 226 3 Camberwell 604 43 37 610 1,262 17 - Chelsea 113 17 15 115 137 20 - Deptford 199 52 45 206 474 6 1 Finsbury 265 41 43 263 224 47 — Fulham 193 28 46 175 640 5 - Greenwich 206 11 35 182 261 22 - Hackney 362 26 37 351 1,475 8 — Hammersmith 334 48 27 355 779 34 1 Hampstead 115 6 14 107 495 38 — Holborn 168 21 17 172 613 2 — Islington 587 46 68 565 2,113 299 1 Kensington 271 36 111 196 1,150 17 1 Lambeth 298 46 - 344 627 151 - Lewisham 186 51 38 199 481 11 - Paddington 183 — 69 114 200 - — Poplar 322 14 18 318 1,376 4 — St. Marylebone 264 51 107 208 451 8 — St. Pancras 413 413 1,225 — - Shoreditch 302 14 24 292 2,949 23 1 Southwark 421 105 98 428 1,326 17 - Stepney 976 135 9 1,102 1,943 197 15 Stoke Newington 53 1 3 51 61 5 - Wandsworth 331 36 31 336 995 44 5 Westminster, City of 350 42 19 373 633 28 - Woolwich 128 24 15 137 205 10 — (a) Figures in italics refer to persons registered. 68 Annual Report of the London County Council, 1910. Tuberculosis of the udder in London cows. London County Council (General Powers) Act, 1904 (Part V.) The Dairies, Cowsheds and Milkshops Order, 1899, provides that the milk from cows certified by a veterinary surgeon to be affected with tubercular disease of the udder shall not be (a) mixed with other milk, or (b) sold or used for human food, or (c) sold or used for the food of swine without having first been boiled. In 1904 this power was supplemented in London by additional powers, incorporated in the London County Council (General Powers) Act of that year, to remove any cow from any dairy, farm or cowshed in the County (elsewhere than in the City), if such cow is suspected to be suffering from tuberculosis of the udder, and if, upon slaughter, these suspicions are verified, a sum equal to threequarters of the agreed value of the animal (not exceeding £22 10s.) is payable by the Council. If, however, the cow is proved to be free from tuberculosis of the udder, the full agreed value (not exceeding £30), together with a further sum of £1, is payable by the Council. The cows in the London cowsheds have, since the date of the Dairies Order of 1899, been periodically inspected by the County Council's veterinary inspector, with a view-to the detection of cows suffering from tubercular disease of the udder. During the year 1910 there were five inspections of all the cows in the London cowsheds, and the results of the veterinary inspector's examination are shown in the following table:— Details of Examination. 1st period, 1st Dec., 1909 to 4th Feb., 1910. 2nd period, 6th Feb. to 14th June., 1910. 3rd period, l5th June to 4th August, 1910. 4th period, 6th August to 22nd Oct., 1910. 5th period, 23rd Oct. to 10th Dec., 1910. Total number of cows examined 3,306 2,925 2,821 3,053 3,162 Affected with disease or defects of the udder 181 178 239 185 156 Affected with tubercular disease of the udder 3 10 3 10 2 Suspected cases of tubercular disease — — - - - Subjects of acute mastitis 24 32 35 16 21 Affected with chronic induration of the udder 6 28 76 64 61 Atrophy of one or more quarters 112 88 97 43 56 Injuries, abscesses, simple eruptions, strictures and obliterations of milk ducts 17 4 8 1 16 Hypertrophied udders without induration — - - — - Giving milk of poor quality (dried-off cows) 19 16 20 51 - The 28 cows suffering from tubercular disease of the udder were slaughtered, and the carcases destroyed, compensation being paid by the Council to the owners in accordance with the provisions of the London County Council (General Powers) Act of 1904. Tuberculous milk; London County Council (General Powers) Act, 1907. part IV. Part IV. of the London County Council (General Powers) Act of 1907 empowers the County Medical Officer of Health or other duly authorised person to take, within and without the County, samples of milk produced or sold or intended for sale within the County ; and, having obtained a justice's order, in company with a veterinary surgeon, to enter any dairy from which milk is being sold or suffered to be sold or used within the County, and to inspect the cows kept therein, and if the Medical Officer or such authorised person has reason to suspect that any cow is suffering from tuberculosis of the udder he may take samples of the milk of such cow. If it appears to the Council that tuberculosis is caused, or is likely to be caused, to persons residing in the County from the consumption of milk from any dairy, or from any cow kept therein, the Council may make an order prohibiting the supply of such milk in the County until the order has been withdrawn, and any person contravening the order is liable to a penalty not exceeding £5, and for a continuing offence to a daily penalty not exceeding 40s. Appeal may be made against the Council's order. On 11th February, 1908, the Council delegated to the Public Health Committee, the authority conferred by Part IV. of this Act, dealing with tuberculous milk, and fixed the 1st July, 1908, as the date upon which the Act should become operative. During the year under review the method of procedure adopted was as follows: Samples were taken by the Council's inspectors from churns of milk consigned from the country to the various London railway termini, and these were submitted to the Lister Institute for bacteriological examination. In the case of those samples in respect to which the examination proved that there was evidence of the presence of tubercle bacilli, a clinical examination of the cows at the dairy farm from which the milk had been consigned was made by a veterinary inspector, appointed for the purpose under the Act, and cows found to have tuberculous udders were certified for the purposes of the Dairies and Cowsheds Orders and copies of the certificates were forwarded to the local sanitary authorities concerned. During the year under review 2,769 samples of milk were taken. The milk had been sent to London from the following counties: Bedfordshire, Berkshire, Buckinghamshire, Cambridgeshire, Cheshire, Derbyshire, Dorsetshire, Essex, Gloucestershire, Hampshire, Herefordshire, Hertfordshire, Huntingdonshire, Kent, Leicestershire, Lincolnshire, Middlesex, Norfolk, Northamptonshire, Nottinghamshire, Oxfordshire, Rutlandshire, Shropshire, Somersetshire, Staffordshire, Suffolk, Surrey, Sussex, Warwickshire, Wiltshire, and Worcestershire; 69 Report of the Medical Officer of Health. the samples were taken principally from churns at stations of the Great Western, the Great Eastern, the Great Northern, the Great Central, the Midland, the Metropolitan, the London, Brighton and South Coast, the London and North-Western, the London and South-Western, the North London, and the South-Eastern and London, Chatham and Dover Railway Companies. The following table shows the number of samples taken during the year under review, the counties from which they were derived, and the results of bacteriological examination at the Lister Institute. County. No. of samples taken from churns for examination. No. of samples found to be tuberculous. No. of samples found not to be tuberculous. No. of samples the examination of which was not completed owing to accident and other causes. Bedfordshire 38 2 31 5 Berkshire 201 10 176 15 Buckinghamshire 85 3 76 6 Cambridgeshire 7 — 7 — Cheshire 10 1 8 1 Derbyshire 393 47 324 22 Dorsetshire 43 3 32 8 Essex 172 30 90 52 Gloucestershire 74 2 72 — Hampshire 79 12 51 16 Herefordshire 1 — 1 - Hertfordshire 54 9 36 9 Huntingdonshire 3 — 3 — Kent 54 1 47 6 Leicestershire 181 20 150 11 Lincolnshire 6 — 6 - Middlesex 5 — 4 1 Norfolk 11 1 6 4 Northamptonshire 94 5 80 9 Nottinghamshire 11 1 10 — Oxfordshire 144 5 129 10 Rutlandshire 5 — 4 1 Shropshire 5 — 4 1 Somersetshire 167 20 132 15 Staffordshire 230 34 170 26 Suffolk 33 5 22 6 Surrey 57 5 46 6 Sussex 124 12 103 9 Warwickshire 38 8 30 — Wiltshire 437 32 375 30 Worcestershire 4 — 4 — Total 2,766 268 2,229 269 This table shows that out of 2,497 completed examinations of samples taken from churns consigned to London, 268 proved to be tuberculous, i.e., 10.7 per cent. Some of the samples were derived from churns containing milk from more than one farm. The last annual report gave a similar account of 1,966 samples of milk examined during the year 1909, of which 205, or 10.4 per cent., were found to be tuberculous. The following table shows the number of farms visited, the number of cows inspected and the number of cows certified to have tuberculosis of the udder during the year:— County. No. of farms inspected. No. of cows inspected. No. of cows with tuberculous udders. Bedfordshire 2 124 2 Berkshire 8 273 5 Buckinghamshire 3 91 - Cheshire 25 367 1 Derbyshire 160 3,017 21 Dorsetshire 52 1,056 11 Essex 16 914 9 Gloucestershire 2 105 - Hampshire 23 666 3 Hertfordshire 3 112 3 Leicestershire 20 571 9 Continued on next page. 70 Annual Report of the London County Council, 1910. County. No. of farms inspected. No. of cows inspected. No. of cows with tuberculous udders. Norfolk 1 20 1 Northamptonshire 6 162 5 Nottinghamshire 1 37 1 Oxfordshire 3 108 1 Somersetshire 55 1,315 8 Staffordshire 57 1,918 14 Suffolk 2 49 2 Surrey 5 149 1 Sussex (East) 5 142 1 Sussex (West) 6 209 3 Warwickshire 6 129 3 Wiltshire 29 1,341 13 Total 490 12,875 117 This table shows that 0.9 per cent. of the cows examined were certified by the Council's veterinary inspector to have clinical symptoms of tubercular disease of the udder. The supply of milk for human consumption from the cows thus affected was immediately stopped. Milk exami nation: mortality of inoculated guinea-pigs Reference to the table on page 69 shows that in 269 cases the examination of samples was not completed owing to accident and other causes. In the large majority of these cases the inoculated gninea-pigs died of some acute infection before there was time for tuberculosis to develop. In this way it was found, for example, that prior to June, 1909, in some 16 per cent. of the samples taken, the examination for tubercle could not be successfully concluded. The Council decided, therefore, on 15th June, 1909, to have the matter investigated by the Lister Institute with a view to learning the causes of this "non-tubercular mortality" among guinea-pigs, and in due course Dr. Martin, F.R.S., the Director of the Institute, submitted a report on the enquiry made by Dr. R. A. O'Brien (see Chapter XXXII., page 115). Dr. O'Brien found that more than one-third of the guinea-pigs inoculated (3,069 out of 9,016) died before tuberculosis had time to develop, and he notes that the two main causes of this "nontubercular mortality," were two diseases in which deposits were found, in the liver and spleen, from which deposits in one disease, B. pseudo-tuberculosis rodentium, and in the other, B. aertryck, were recoverable in pure culture. As regards B. aertryck, Dr. O'Brien points out that this bacillus is an occasional inhabitant of healthy guinea-pigs' intestines, and is under normal conditions not pathogenic, but that, if the animal's resistance is lowered, as for example by injection of milk sediment, the bacillus may migrate from the intestines into the organs and produce septicaemia. In the same way B. pseudo-tuberculosis rodentium is commonly met with in guinea-pigs, producing normally a chronic disease, though occasional outbreaks of a more acute form may occur. Dr. O'Brien inclines, therefore, to the view that a large part of the mortality among guinea-pigs inoculated with the sediment of milk results from a lowering of the general health of the guinea-pig by the inoculation, and that this permits a disease which is latent or chronic to progress to a fatal issue or enables bacilli normally present in the guinea-pig's intestines to escape into the circulation and cause death. Offensive businesses. Slaughterhouses In the year 1909 the County Council received 257 applications for licences for slaughter-houses' and granted 255. The following table shows the number of applications received and the number of slaughter-houses licensed in recent years. It will be seen that the number of these premises is con tinually decreasing:— Year. No. of applications received. No. of premises for which licences were granted. Year. No. of applications received. No. of premises for which licences were granted. 1892 543 537 1902 371 362 1893 538 529 1903 350 346 1894 518 506 1904 338 333 1895 497 485 1905 322 318 1896 478 470 1906 310 308 1897 460 460 1907 301 294 1898 442 429 1908 281 273 1899 419 411 1909 265 264 1900 405 393 1910 257 255 1901 384 381 71 Report of the Medical Officer of Health. The number of slaughter-houses in each metropolitan borough (other than those at the City Corporation Markets in Islington and Deptford), and the frequency with which these slaughter-houses, in most of the boroughs, were inspected, is shown in the following table:— Metropolitan borough. Number of slaughter-houses (a). No. • °finspections, 1910. No. of notices, 1910. Licensed at end of 1909. Licence lapsed or refused in 1910. Remaining at end of 1910. Battersea 5 5 295 - Bermondsey 1 — 1 21 — Bethnal Green 5 — 5 24 — Camberwell 13 —- 13 119 — Chelsea 6 — 6 78 — Deptford 3 — 3 40 - Finsbury 3 — 3 63 — Fulham 4 — 4 64 1 Greenwich 4 — 4 54 3 Hackney 21 — 21 334 1 Hammersmith 9 — 9 108 9 Hampstead 5 1 4 59 3 Holborn 1 — 1 11 — Islington 34 2 32 1,770 — Kensington 10 — 10 225 — Lambeth 24 4 20 40 4 Lewisham 15 — 15 114 —. Paddington 7 — 7 464 — Poplar 16 — 16 116 3 St. Marylebone 7 — 7 142 — St. Pancras 18 — 18 603 1 Shoreditch 7 1 6 22 — Southwark 6 — 6 23 — Stepney 6 — 6 14 Stoke Newington 5 1 4 11 — Wandsworth 18 1 17 457 4 Woolwich 11 - 12 (b) 52 4 During the year the following authorised offensive businesses, other than that of a slaughterer of cattle, were discontinued: the business of a fat-melter in Hackney, and the business of a fat-melter at four registered premises in Hammersmith: and the Council sanctioned the establishment anew of the business of a fat-melter at premises in the Deptford Foreign Cattle Market. Hence the number of premises on which scheduled offensive businesses were carried on declined from 71 in 1909 to 67 in 1910. Other offensive businesses The number of such authorised offensive businesses, except those in the markets under the jurisdiction of the City Corporation, was at the end of the year as follows:— Fat melters 16 Tripe boiler 22 Glue and size manufacturers 5 Knackers 5 Fellmongers 6 Bone boilers 2 Manure manufacturers 2 Soap boilers 12 Tallow melters 6 Gut manufacturers 3 79 In several instances more than one offensive business is carried on at the same premises, hence the number of premises used for the purpose of these businesses is smaller than the number of such businesses. The boroughs in which these premises are situated, the number of premises, and for most boroughs, the number of inspections, are shown in the following table:— Metropolitan borough. No. on Register at end of 1910. No. of inspections, | 1910. Metropolitan borough. No. on Register at end of 1910 No. of inspections, 1910. Battersea 2 16 Lambeth 4 16 Bermondsey 12 115 Poplar 8 34 Bethnal Green 1 3 St. Marylebone 2 40 Camberwell 4 St. Pancras 2 20 Deptford 3 49 Shoreditch 1 12 Finsbury 1 14 Southwark 6 72 Greenwich 3 Stepney 7 28 Hackney 1 17 Wandsworth 4 134 Islington 6 96 (a) The seven slaughter-houses under the jurisdiction of the City of London are not licensed by the London County Council. (b) A new slaughter-house was licensed in 1910 in Woolwich viz., Bostall Farm, Abbey Wood. 72 Annual Report of the London County Council, 1910. Smoke nuisance Nuisances. The annual reports of medical officers of health show that considerable effort is made in London to deal with smoke nuisance, and in some the statement is made that smoke nuisance is of less frequent occurrence than formerly. The premises dealt with under the smoke provisions of the Public Health Act include various manufacturing premises, electricity supply works, laundries, bakehouses, fried fish shops, hotels, clubs, etc. Both Dr. Collingridge and Dr. Allan, in their reports relating respectively to the City and Westminster, comment on nuisances experienced from the chimneys of small houses, the smoke from which enters the windows of neighbouring houses situated at a higher level. In the last annual report it was stated that the Council was seeking powers for sanitary authorities to deal with smoke nuisance other than that arising from black smoke; but this application to Parliament was not successful. The Council obtained powers which enable it on the request of a sanitary authority in any special case to enforce the provisions of sections 23 and 24 of the Public Health (London) Act, 1891, and, with the consent of the Local Government Board, to enforce the provisions of these sections in their application to any building or premises belonging to or used by a sanitary authority. The following table, which is compiled mainly from information contained in the annual reports, shows the action taken by local authorities in respect of smoke nuisance during the year:- Metropolitan borough. Observations and inspections. Nuisances and complaints. Intimations. Notices. Summonses. City of London 360 9 - 9 - Battersea 51 23 2 — Bermondsey 223 (chimneys) 22 — Bethnal Green 617 20a 22 — — Camberwell 91 91 9 8 — Chelsea 9 1 — - — Deptford 34 6 6 — Finsbury 81 38 10 14 5 Fulham 24 10 5 — Greenwich 267 15 1 Hackney 1,145 37 37 1 — Hammersmith 35 (premises) 9 9 — — Hampstead 10 5 — — — Holborn 157 35 10 2 1 Islington 252 56 14 — Kensington 288 4 2 2 — Lambeth 520 25 27 — — Lewisham 259 18 11 5 — Paddington 20 (premises) 13 — — — Poplar 62 35 15 — St. Marylebone 1,385 21 21 1 — St. Pancras 614 71 14 8 — Shoreditch 46 28 7 — — Southwark 615 127 29 10 1 Stepney 89 89 1 Stoke Newington 150 5 5 — Wandsworth 220 68 62 — Westminster, City of 3,009 27 a 86 . 6 3 Woolwich 29 2 2 — Nuisance from stable manure The references to nuisances from stable manure in the annual reports of medical officers of health are comparatively few, and there can be no doubt that the decrease in the horse population of London must be having effect in reducing the amount of manure which is produced. In the reports relating to Paddington and Stoke Newington this reduction is commented upon and directly attributed to this cause. In the report relating to Wandsworth, Dr. Caldwell Smith states that the accumulations which had to be removed after notice were more numerous in 1910 than in the preceding year. It may be that owners of small accumulations of manure are meeting with greater difficulty than before in finding contractors willing to undertake the work of manure collection. The sanitary authority, however, is empowered by section 36 of the Public Health (London) Act to employ scavengers or to contract with scavengers for this purpose, and the question of the exercise of this power is, in this event, deserving of consideration. The medical officer of health of Finsbury states that the by-law prescribing the conditions under which stable manure must be conveyed through the streets is inadequate for the prevention of nuisance. Other nuisances The annual reports show that nuisances of various kinds were dealt with during the year, in some instances involving application to the magistrate. The keeping of swine is referred to in the reports relating to Hammersmith and Finsbury. The removal of offensive matter during prohibited (a) Complaints only. 73 Report of the Medical Officer of Health. hours is mentioned in many reports. Dr. Harris, Medical Officer of Islington, points out the need for a bi-weekly collection of refuse from restaurant kitchens and all places where food is prepared. Several of the reports contain accounts of nuisances from fried fish shops; some mentioning especially dirty conditions, imperfect and unwashed floors, and two (Finsbury and Stepney) effluvium nuisance at the time of frying. The Council's by-laws for regulating this trade and that of the business of a marine store dealer are now the subject of communication between the Local Government Board and the Council. In connection with the removal of house refuse, the most important fact to be recorded is the completion in Westminster of the extension of a system of daily collection to all parts of the city. The practicability of applying this system to a London district inhabited by some 160,000 persons is thus demonstrated, and other London sanitary authorities should without delay utilise the experience of Westminster in improving the system of collection in their own areas. Westminster is inhabited by persons of all classes, the houses in the city are commercial and residential, the residential houses being occupied by well-to-do and by poor persons. Hence there are no exceptional conditions in Westminster which do not exist in other boroughs which can be thought of as giving facilities for the institution of a system of daily collection. In connection with this change in the system of collection of house refuse in Westminster, Dr. Allan mentions improvement in the diarrhoea death-rate of Westminster beyond that of London as a whole. Dr. Porter also records that a system of daily collection has been extended in St. Marylebone to three additional streets, and of a collection thrice weekly to 60 streets, mews and other places; he writes that "practically all the streets in which the frequency has been increased consist of houses, mainly of the tenement class, occupied by more than one family of persons in poor circumstances. Many of the houses are without open spaces, or have only a small yard, so that the dustbin must be kept inside or close to the premises, and is apt to cause nuisance unless frequently emptied." In connection with the institution of a system of weekly collection of house refuse in Islington, Dr. Harris states that the number of instances in which application had to be made by householders for the removal of their refuse had decreased in 1910 to 44. The number of such applications in 1891 was 10,138. Housing of the Working Classes. In November the Council resolved to make an improvement scheme in respect of two areas in Southwark, known as the Tabard-street and Grotto-place areas, and an area in Bermondsey, known as the Crosby-row area, which had been represented to the Council by the respective medical officers of health of those boroughs. In a report presented by the Housing of the Working Classes Committee to the Council the areas were thus described:— Proceedings under Part I. of the Housing of the Working Classes Act 1891. The Tabard-street area as represented is about 13½ acres in extent, contains 649 houses, and has a population of 3,552 persons, nearly all of whom are persons of the working class. The area is situated between Long-lane and Great Dover-street, and is in two detached sections lying north and south of the London County Council school in Westcott-street. The main (northern) portion is bounded on the north by Sterry-street and on the south by Pardoner-street, and includes part of Tabard-street, Henry-place, Fox's-buildings, St. Stephen's-square (excluding St. Stephen's Church), Wickham-place, parts of Chapel-place and Staple-street, Delph-street, Camelot-street, Elthamstreet, part of Globe-street, some houses on the south side of Nebraska-street and a number of small courts and alleys. The smaller (southern) portion of the area contains a group of houses in Falstaff-yard and Paul's-yard, and some houses fronting on Little Hunter-street, Tabard-street, Law-street and Lansdowne-place. The characteristic feature of the area is the narrowness of the streets and the bad arrangement of both streets and houses. George-court is, in parts, only 3 ft. wide; Little Britain, 5 ft.; Wickham-court, 7½ ft.; and several other streets do not exceed 10 ft. in width, including the footways. Out of 32 streets in the area no less than 13 are culs de sac. The houses in Tabard-street are three storeys in height, but nearly all the other houses on the area consist of two storeys and contain either two or four rooms. Many of the houses have back yards which are small and in which are situated the waterclosets and dustbins. The yards of some of the houses are at a much lower level than the houses themselves and are approached by narrow, dark staircases. These yards are very small and very little sunlight and fresh air can reach them. In a few streets, for instance Wickham-place, there is more space at the rear, but the houses in these streets do not differ materially in character from other two-storey houses in the area. The front doors of the houses in a large number of cases open directly into the ground floor room. The ground floor in many instances is some inches below the street level, and the ceilings are low pitched, the rooms varying in height from 6½ feet to a little over 7 feet. The houses generally are worn out; the walls of many of the ground floor rooms present evidence of dampness or have been matchboarded in such a way as to conceal the dampness; and the staircases are, in a number of instances, narrow, dark and dangerous. The houses in Tabard-street itself are, as stated above, larger than other houses in the area, and in some cases have cellars beneath them. In numerous instances these houses are provided with central staircases, unventilated, dark and dangerous. The whole of the area is populated by a very poor class, many of the inhabitants occupying cheap furnished rooms. The Grotto-place area, which comprises some 1½ acres, lies to the west of Southwark-bridge-road, and includes a number of badly-arranged courts, most of which are culs de sac, and some houses in Great Suffolk-street. The area contains 138 houses, all of which, with the exception of those fronting on Great Suffolk-street, are one or two storeys in height. With the exception of the houses in two courts where the yards have been thrown into one, the space at the rear of the houses is very confined. In most cases the front door opens directly into the ground floor room and the staircase to the upper room opens out of the ground floor room. In some instances the ground floor is below the level of the street or back yard. The houses with few exceptions are quite worn out, and the inhabitants, who number 567, are of the poorer class. The Crosby-row area, which is situated on the eastern side of Crosby-row between Snow's-flelds and Longlane, Bermondsey, is about one acre in extent and contains 88 houses occupied by 474 persons, most of whom are very poor. The houses in Crosby-row are two and three storeys in height and a few have basements. Nearly all the other houses on the area are two storeys in height and contain two, three and four rooms. These latter houses are situated in courts approached either by narrow archways or passageways from Crosby-row and in most cases the front door opens directly into the living room. The courts are some feet below the level of the pavement of Crosbyrow. The houses generally are worn out, are surrounded by high buildings, and have insufficient space about them. Many of them show signs of dampness or are matchboarded in such a way as to conceal the dampness. 5176 F 74 Annual Report of the London County Council, 1910. Particulars of the death-rates in the three areas, as compared with the death rates in their respective boroughs and in the whole of London, are given in the following table:— Area Average yearly death-rate per thousand. All causes. Phthisis. Principal epidemic diseases. Period 1904-8. London 14.9 1.44 1.71 Southwark 18.2 2.09 2.29 Tabard-street area 36.8 3.88 6.07 Period 1905-9. London 14.5 1.38 1.64 Southwark 17.5 1.98 1.99 Grotto-place area 39.1 6.10 2.60 Bermondsey 18.9 1.87 2.38 Crosby-row area 30.9 2.46 6.27 It will be seen that the death-rate from all cases of mortality in the Tabard-street area was more than twice that of the metropolitan borough of Southwark, which was, in the same period, considerably above that of London as a whole. The death-rate from phthisis in the area was nearly twice that of the borough, and nearly three times that of London. The death-rate from the principal epidemic diseases was more than two and a-half times that of the borough and more than three and a-half times that of London. The Grotto-place and Crosby-row areas are small for the calculation of reliable death-rates, but the figures that have been obtained show that in the former area the death-rate from all causes was more than twice, that from phthisis more than three times, and that from the principal epidemic diseases nearly one and a-half times that of Southwark. The death rate from all causes in the Crosby-row area was more than one and a-half times, that from phthisis nearly one and a-half times, and that from the principal epidemic diseases more than two and a-half times the corresponding death-rate of Bermondsey. The number of persons of the working class who will be displaced by the clearance of the three areas is: Tabard-street, 3,517; Grotto-place, 567; and Crosby-row, 468; making a total of 4,552. The Committee's proposals for laying out the areas included the use of about five acres in the central part of the Tabard-street area as a public open space. The gross cost of acquisition of property, laying out open space, cost of roads, etc., was estimated to be for the Tabard-street area £394,600; Grotto-place area £47,600, and Crosby-row area £31,100; amounting in all to £473,300, which, after deduction of the estimated value of surplus lands and rehousing sites, left £387,700 as the estimated net cost of the scheme. Complaint under sec. 5 (2) of the Act During the year the County Medical Officer received a complaint, signed by 12 ratepayers in the County of London, under section 5 (2) of the Act, with regard to the alleged unhealthiness of an area in the Royal Borough of Kensington, comprising Bangor-street, Crescent-street and those parts of Sirdar-road and St. Anne's-road which lie between Bangor-street and Crescent-street. The area was accordingly inspected and an official representation was made to the Council stating the facts of the case and giving the opinion that neither the said area nor any part thereof was an unhealthy area. Proceedings of the Council under Part III. of the Act In May the Council accepted a tender of £11,668 for the erection of 66 cottages on the fourth part of the Tower-gardens section of the White Hart-lane Estate. In July the Council accepted tenders of £15,828 and £14,153 for the erection respectively of 82 and 74 additional cottages on Section C of the Totterdown Fields Estate, and a tender of £18,765 for the erection of 112 cottages on Section B of the Norbury Estate. Housing and Town Planning Act, Section 17 Article V. of the regulations made by the Local Government Board in September, 1910, under this Act, requires that the "medical officer of health shall include in his annual report information and particulars in tabular form in regard to the number of dwelling houses inspected under and for the purposes of section 17 of the Act of 1909, the number of dwelling houses which on inspection were considered to be in a state so dangerous or injurious to health as to be unfit for human habitation, the number of representations made to the local authority with a view to the making of closing orders, the number of closing orders made, the number of dwelling houses the defects in which were remedied without the making of closing orders, the number of dwelling houses which, after the making of closing orders, were put into a fit state for human habitation, and the general character of the defects found to exist. He shall also include any other information and particulars which he may consider desirable in regard to the work of inspection under the said section." In only two or three reports is information of these proceedings given in tabular form, the result probably of the regulations being interpreted to relate only to proceedings instituted after the date of their issue. The following table has been mainly compiled from the information otherwise contained in the annual reports. 75 Report of the Medical Officer of Health. Metropolitan borough. No. of houses inspected. No. of houses unfit for habitation. No. of representations. No. of closing orders. No. of houses, defects remedied without closing orders. No. of houses, defects remedied after closing orders Remarks. Battersea Bermondsey 21 21 21 2 houses demolished. Bethnal Green Camberwell 1 appeal against closing order; appeal allowed. Chelsea 175 14 14 88 10 houses demolished. Deptford Finsbury Fulham 103 22 6 25 Greenwich Hackney Hammersmith Hampstead 1 1 1 appeal against closing order; appeal dismissed. Holborn 2 1 1 1 l Islington 11 11 11 11 Kensington 5 5 Lambeth Lewisham Paddington Poplar 25 9 16 2 7 houses demolished. St. Marylebone 17 13 3 Use of 1 house as dwelling house abandoned. St. Pancras Shoreditch 27 3 2 2 1 house closed without order. Southwark Stepney 55 55 55 Stoke Newington Wandsworth 8 5 5 3 Westminster, City of 21 9 9 Woolwich 62 10 10 9 1 In addition to the above, 12 underground rooms in Westminster were represented and 11 closed under section 17 of the Act. In Lambeth, houses in 10 streets were inspected for the purposes of the Act, but no representations concerning them were made and defects found in them were remedied under the provisions of the Public Health (London) Act 1891. Proceedings under section 15 of the Housing and Town Planning Act, relating to the maintenance of houses in habitable condition, were instituted in Kensington in 15 instances, in Bethnal Green in 15 instances, and in Paddington in one instance. Referring to the administration of this section in Paddington, Dr. Dudfield writes: "The landlord failed to comply with the notices, and the Council resolved to invite tenders for the execution of the work. It was, however, found impossible to proceed with the case as vacant possession of the house was necessary to enable the work to be done. There is no provision in the Acts by which such vacant possession can be obtained." The difficulty experienced was reported to the Local Government Board. The following death-rates obtaining among tenants of the Council's buildings relate to dwellings within the county which were occupied during the whole of the year 1910. within the county which were occupied during the whole of the year 1910. The population thus dealt with comprised 28,370 persons, and the death-rate at "all ages," after correction for age and sex distribution, was 9.5 per 1,000 living, compared with 13.7 for London:— Death-rate per 1,000 liviug, 1910. Cause of death. Council's dwellings. London. All Causes—All Ages 9.5 13.7 ,, „ age 0—5 22.9 37.1 ,, ,, ,, 5—20 1.8 2.3 ,, ,, ,, 20 and upwards 9.9 14.8 Diarrhœa 0.4 0.3 Principal epidemic diseases (excluding Diarrhœa) 0.7 0.9 Phthisis 1.0 1.2 Tubercular diseases other than Phthisis 0.3 0.4 Bronchitis 0.7 1.1 Pneumonia 1.0 1.5 Death rates in Council's dwellings. 5176 F 2 7G Annual Report of the London County Council, 1910. Common Lodging-Houses. The administration of the Common Lodging Houses Acts devolved upon the Council in 1894. By the passing of the London County Council (General Powers) Act, 1902, the Council obtained powers to license common lodging-houses annually. New by-laws for the regulation of common lodginghouses came into force on the 1st October. 1903. 99 1896 596 29,140 28,331 — 31 30 71 1897 581 28,718 26,121 — 31 30 48 1898 560 28,332 27,658 — 29 29 44 1899 544 28,448 28,229 1,162 25 22 54 1900 528 28,311 28,428 668 16 13 40 1901 514 28,037 35,225 2,133 16 15 166 1902 491 28,970 40,512 1,449 22 21 684 1903 470 28,893 33,402 4,790 6 6 53 1904 451 28,896 27,501 2,970 15 14 66 1905 413 27,571 28.158 1,565 21 16 14 1906 402 28,063 30,028 2,349 4 4 22 1907 395 28,651 33,630 2,307 3 3 27 1908 387 28,379 32,297 2,429 1 1 13 1909 383 28,302 29,324 1,286 3 3 19 1910 .. ! 368 27,914 1 26,733 1,589 2 2 13 It will be observed that since 1894 the number of common lodging-houses has steadily diminished. This reduction, however, is more apparent than real, inasmuch as in earlier years every house was separately counted, whereas now adjoining houses in the same occupation are counted as one house and included under one licence. It will be seen, moreover, that although the number of houses has been reduced the authorised number of lodgers varies but little, thus showing that there is a tendency for the smaller houses to be replaced by a smaller number of larger houses. The number of cases of notifiable infectious disease reported in common lodging-houses was as follows :—Erysipelas, 6 ; scarlet fever, 1 ; diphtheria, 2 ; enteric fever, 3 : smallpox, 1—total, 13. The following table shows the total number of common lodging-houses, and the authorised accommodation for the different classes of lodgers in the several districts, other than the City of London, on 31st December, 1910 :— Metropolitan borough. No. of h0U868. Authorised accommodation. Men. Women. Couples. Total. Battersea 9 157 144 23 347 Bermondsey 5 1,073 — — 1,073 Bethnal Green 13 684 — — 684 Camberwell 6 570 — — 570 Chelsea 6 248 — — 248 Deptford 8 1,155 80 — 1,235 Finsbury 8 539 — — 539 Fulham 2 43 51 — 94 Greenwich 3 121 — — 121 Hackney 7 495 — — 495 Hammersmith 9 466 — 4 474 Hampstead — — — — — Holborn 25 1,512 162 — 1,674 Islington 42 1,181 276 18 1,493 Kensington 22 405 272 — 677 Lambeth 7 693 — — 693 Lewisham 1 30 — — 30 Paddington 7 195 ' 40 — 235 Poplar 9 1,143 — — 1,143 St. Marylebone 15 1,249 109 — 1,358 St. Pancras 9 721 36 — 757 Shoreditch 12 764 — — 764 Southwark 42 3,272 449 — 3,721 StepDey 54 5,310 667 180 6,337 Stoke Newington 1 37 — — 37 Wandsworth .. .. .. .. j 10 185 5£ (n) 20 230J Westminster, City of 13 2,248 75 — 2,323 Woolwich 23 486 76 — 562 London—excluding the City of 368 24,982 2.442J 245 27,914 J London («) j = l child. 77 Report of the Medical Officer of Health. The following table shows the proportion of deaths from several causes per 1,000 deaths among males in common lodging houses, the corresponding figures for London being shown for comparative purposes. The deaths of persons removed from common lodging-houses to public institutions have been included. The total number of deaths among lodgers (males and females) in common-lodging houses during the vear was 812: the larse majority of these deaths occurred in public institutions. Deaths among inmates of common lodging- houses. It has not been found possible to calculate reliable death-rates in connection with inmates of common lodging-houses owing to the difficulty in arriving at an accurate estimate of the population at risk, in consequence of the migratory character of persons of the common lodginghouse class. Cause of death. Age 25 to 35. Age 35 to 45. Age 45 to 55. Age 55 to 65. Age 65 and upwards. London 1909. C.L.H. 1909. C.L.H. 1910. London, 1909. C.L.H. 1909. C.L.H. 1910. London, 1909. C.L.H. 1909. C.L.H. 1910. London' 1909. C.L.H. 1909. C.L.H 1910. London, 1909. C.L H. 1909. . 1910. Phthisis 374 512 415 316 589 460 206 289 325 108 260 205 27 119 83 Other tubercular diseases 27 23 24 16 11 — 12 13 6 5 — 12 1 9 - Alcoholism (including cirrhosis of the liver) 15 23 47 32 11 19 37 26 32 28 39 24 10 - Urinary diseases 45 23 47 51 21 46 63 77 57 80 79 69 75 43 73 Violence, suicide 87 — 70 77 21 27 65 19 19 45 6 19 21 4 14 Cancer 30 — 24 55 21 10 124 77 69 154 120 106 96 64 79 Circulatory diseases 84 93 24 120 63 82 164 141 76 213 62 87 243 136 51 Nervous diseases 31 70 24 32 32 55 41 7 76 33 62 81 37 64 47 Bronchitis 19 47 24 30 42 73 54 115 107 112 175 154 161 191 216 Pneumonia 107 116 93 121 105 109 109 134 107 95 96 94 78 89 106 Other causes 181 93 208 150 84 119 125 102 126 127 101 149 251 281 331 Total (all causes) 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 Seamen's lodging-houses. By an Order in Council dated 19th February, 1910, powers were conferred on the London County Council for the licensing of seamen's lodging-houses. The text of the Order was as follows:— "Whereas by Section 214 of the Merchant Shipping Act, 1894, it is provided that a local authority, whose district includes a seaport, may, with the approval of the Board of Trade, make byelaws relating to seamen's lodging-houses in their district, and that those byelaws shall be binding upon all persons keeping houses in whieh seamen are lodged, and upon the owners thereof and persons employed therein: and further, that such byelaws shall, amongst other things, provide for the licensing, inspection, and sanitary conditions of seamen's lodging-houses, for the publication of the fact of a house being licensed, for the due execution of the byelaws, for preventing the obstruction of persons engaged in securing that execution, for the preventing of persons not duly licensed holding themselves out as keeping or purporting to keep licensed houses, and for the exclusion from licensed houses of persons of improper character, and shall impose sufficient fines, not exceeding fifty pounds, for the breach of any byelaw: and further, that whenever His Majesty in Council orders that in any district, or any part thereof, none but persons duly licensed in pursuance of byelaws under the said Section shall keep seamen's lodging-houses or let lodgings to seamen from a date therein named, a person acting in contravention of that order shall for each offence be liable to a fine not exceeding one hundred pounds : "And whereas the London County Council is the local authority in the Administrative County of London and a local authority within the meaning of the said Section: "And whereas the said County Council have, with the approval of the Board of Trade, made the byelaws and regulations contained in the Schedule hereto: "Now therefore, His Majesty in Council, by virtue of the powers vested in Him by the said Act, doth order that, from and after the date hereof, none but persons duly licensed in pursuance of the said byelaws and regulations shall keep seamen's lodging-houses or let lodgings to seamen in the district of the Administrative County of London or in any part thereof." As to what constitutes a seamen's lodging-house, the Board of Trade have been advised by the Law Officers of the Crown as follows:— "We do not think the reception of a single seaman constitutes the house a seamen's lodging-house within the meaning of the Act. There must be something in the nature of a course of business, and whether a particular house is a seamen's lodging-house is a question of fact in each case. . . ." An amended series of bylaws made under section 214 of the Merchant Shipping Act, 1894, came into force on the 1st January, 1910. The first licensing meeting was held on 30th May, when 57 applications were considered and licences granted in 53 cases, subject to compliance with any requirements the Council might deem necessary with regard to the sanitary condition of the premises, and to the means of escape in case of fire. Of the four applications refused, two were in respect of beer houses, and the remaining two on the ground that the premises were unsuitable. In all cases the licences expired on 31st December. A further licensing meeting was held in November to consider applications for renewals for the ensuing year, or for the granting of new licences. 78 Annual Report of the London County Council, 1910. At the end of the year the number of seamen's lodging-houses under supervision was 37, situated in the following metropolitan boroughs:— Metropolitan borough. Houses. Lodgers. Poplar 11 317 Stepney 26 840 Total 37 1,157 In the following table will be seen the number of houses, the authorised number of lodgers, the number of convictions, with the penalties inflicted, and other particulars, during each year since the supervision of seamen's lodging-houses was undertaken by the Council:— Year. No. of houses on register. Authorised number of lodgers. No. of day visits by inspectors. No. of night visits. No. of prosecutions. No. of convictions. Penalties and coats. No. of cases of infectious disease. £ s. d. 1902 97 1,665 2,842 - - - - - 1903 102 1,748 1,956 4 2 1 1 16 0 7 1904 90 1,585 1,298 10 3 3 11 7 0 10 1905 77 1,509 1,509 15 5 5 9 13 6 1 1906 84 1,551 1,431 38 9 8 43 7 0 2 1907 82 1,550 2,169 70 8 7 38 19 0 5 1903 85 1,571 2,081 78 3 3 24 0 0 6 1909 80 1,524 1,983 84 7 6 15 0 0 — 1910 37 1,157 2,404 197 15 14 90 9 0 — In the year 1910 proceedings before the magistrate were instituted in 15 instances, resulting in 14 convictions, the penalties amounting to £76 16s. and £13 13s. costs. The increase in the number of prosecutions over previous years will be noted. The persons convicted during 1910 were in all cases keepers of Chinese seamen's lodging-houses, the repeated convictions of one such keeper accounting for half the total amount of the penalties inflicted during the year. The renewal of this keeper's licence was subsequently refused. No cases of infectious disease were reported among inmates of seamen's lodging-houses during the year. Transmigrants. The Council has for some years endeavoured to use its influence to prevent the housing of transmigrants in tenement houses, where the transmigrants were temporarily boarded with families occupying the tenements, thus leading to overcrowding. In the absence of proper provision especially made for transmigrants the use of particular common lodging-houses set aside for this purpose was encouraged, but the need of permanent provision for persons of this class has been fully recognised, and the use of common lodging-houses for their accommodation has been regarded but as best as a temporary expedient until the arrangements for the housing of transmigrants were placed on a much better footing. In March and April of 1910, circumstances occurred which manifested the need for suitable and permanent provision being made for these people, and upon this need the Public Health Committee thus reported to the Council in April:— Our attention has been directed to the accommodation provided for transmigrants during their stay in London. It appears that as the result of the institution of an especially cheap service by a shipping company, some eight or nine thousand persons of many nationalities, including Russians, Italians and the mixed races from the Balkan peninsula, are at Rotterdam, waiting to be sent to America. Some of these intending emigrants are being brought to London from Rotterdam and re-shipped. The first batch of emigrants travelling by way of London arrived here about 25th March, 1910, and was followed by other batches on 27th and 31st March, and succeeding days. Arrangements were made by the persons who had undertaken this duty for finding accommodation for these transmigrants during their stay in London, but, after the arrival of the first batch, great difficulty was experienced in doing this. A certain number were housed in the Jews' Temporary Shelter, and in various common lodging-houses, those in some of the lodging-houses being fed at the Friends' Meeting Hall, in Commercial-road. Unfortunately, great confusion resulted from the transmigrants coming from the several lodging-houses to their centre for their food, and to this the lack of interpreters contributed. As the numbers of new arrivals increased the confusion became worse, and it became impossible even to feed such a large number of persons. Arrangements were, therefore, made for food to be prepared in bulk at two lodging-houses in Poplar, and to be distributed to the several common lodging-houses, where the transmigrants were housed. This system failed completely, and a number of emigrants in a house in the Borough had nothing but bread and water from 3rd to 5th April. On 6th April between 700 and 800 of these aliens left the common lodging-houses to join the s.s. Cairnrona in the Surrey Commercial Docks. Unfortunately, a fire broke out on the vessel when she was in the Channel and at midnight on 7th April the police informed one of the Council's inspectors that 300 of the Cairnrona's passengers were expected at London-bridge railway station that night. The inspector at once proceeded to the station, and, with the help of other of the Council s officers, assisted in finding accommodation for all these persons in common lodging-houses. 485 more of the vessel's passengers arrived at London-bridge on the 8th, but in the meantime the Salvation Army had arranged for their accommodation at Great Peter-street, Westminster. Of the passengers of the Cairnrona who returned to London the women and children were the most distressed, several of them having been injured in the explosion which 79 Report of the Medical Officer of Health. occurred on the vessel; a larger number was without suitable clothing. Medical aid was subsequently provided by the shipping company for the women in a common lodging-house used especially for transmigrants, and clothes were provided for both sexes by the Jews' Temporary Shelter authorities, the Salvation Army, the Willow-street Mission, and the Sailors' Home. There was at first considerable overcrowding both by night and day, but this was remedied to a considerable extent, although it is difficult to prevent crowding of the day rooms. In the present emergency the Council's inspectors have made every effort to assist in placing transmigrants in suitable houses, and it will be necessary to devote special attention to this work for some time to come. Of the transmigrants thus dealt with only about 10 per cent. were Jews, We should state that the Council has no responsibility in this matter of providing accommodation but we had previously pointed out to the Home Secretary the objection to the course which was formerly adopted by the shipping agents of accommodating the transmigrants in tenement houses in Whitechapel. As a result of this representation, It was arranged that these persons should be received into oertain common lodging-houses specially set aside for this purpose. This accommodation sufficed when the number of transmigrants arriving in London was small, but has entirely failed in respect of the large number now brought over and for whom practically no provision was made. We consider that the attention of the Secretary of State should be called to the matter, as he has power, under the Aliens Act, to require shipping companies to give security that transmigrants will be properly maintained and controlled during their transit. We recommend:— That in the opinion of the Council the unsatisfactory conditions obtaining in London with regard to transmigrants are such as to require provision of a permanent character for the accommodation of such persons whilst in London ; that the attention of the Secretary of State be called to the facts, and that he be urged to require such permanent provision. The recommendation of the Committee was adopted by the Council. Houses let in lodgings. In London there were approximately 24,500 houses let in lodgings subject to regulation by by-laws made under section 94 of the Public Health (London) Act. These houses are (apart from those which are common lodging-houses) occupied by the poorest class of the London population and the special powers which are given by that section for their maintenance in clean and wholesome condition are the most valuable of any which can be exercised by local authorities for this purpose. In the following table are shown the number of houses let in lodgings on the register in each metropolitan borough, and the number of inspections and of proceedings under the by-laws relating to such houses:— Metropolitan borough. Number of places. No. of Inspections, 1910. No. of Notices, 1910. No. of Prosecutions, 1910, On register at end of 1909. Added in 1910. Removed in 1910. On register at end of 1910. City of London 286 248 309 (c ) Battersea 123 — — 123 305 154 — Bermondsey 219 8 — 227 908 14 (b) — 74 (c) — Bethnal Green 517 21 21 517 2,334 640 — Camberwell 254 — — 254 989 29 (b) — 412 (c) 1 (c) Chelsea 589 - 6 583 147 8(b) - 124 (c) — Deptford 273 - — 273 273 304 - Finsbury 1,223 - 14 1,209 10,074 130 (b) - 1,309 (c) - Fulham 114 Greenwich 68 27 95 - 33 (b) - 40 (c) - Hackney 463 — - 463 394 235 - Hammersmith 3,532 368 299 3,601 1,343 455 1 Hampstead 364 — — 364 103 — - Holborn 637 27 23 641 1,083 21(b) - 181 (c) 4 (c) Islington (a) (a) 11,080 138 (b) — 814 (c) 1 (c) Kensington 2,076 16 1 2,091 9,406 274 (b) 3 (b) 1,144 (c) 2(c) Lambeth 372 — — 372 372 — — Lewisham 15 — — 15 86 1 (b) — 12 (c) — Paddington 1,320 20 14 1,326 7,104 102 (b) 1 (b) 3,822 (c) 10 (c) Poplar 1,044 58 7 1,095 2,796 97 (b) 1 Night 116 406 (c) Continued on next page. (a) No register is now kept, under the Islington Borough Council's by-laws, but tho number of houses let in lodgings subject to inspection during tho year was 1,009. (b) For overcrowding. (c) For other conditions. 80 Annual Report of the London County Council, 1910. Metropolitan borough. Number of places. No. of Inspections, 1910. No. of Notices, 1910. No. of Prosecutions, 1910. On register at end of 1909. Added in 1910. Removed in 1910. On register at end of 1910. St. Marylebone 758a - - 758a 6,280 692 4 St. Pancras 2,280 2 — 2,282 2,700 72b — 1,302c - Shoreditch 258 5 — 263 637 84 1 Southwark 1,265 35 30 1,270 4,183 140b — 3,529c 4(c) Stepney 2,798 100 17 2,881 4,162 351b — 2,184c — Stoke Newington 273 10 20 263 - Wandsworth 275 17 — 292 790 59b — 452c 1(b) Westminster, City of 1,481 — 34 1,447 7,507 63b - 1,292c — Woolwich 395 22 8 409 669 269 — The table shows that the extent to which these houses are inspected differs widely in the several districts. In some districts the inspections are three or even four times as numerous as the houses registered, in others the number of inspections is only equal to or even less than the number of houses subject to regulation. In respect of the latter districts it must be said that the fewness of the inspections at least raises question as to whether compliance with the by-laws is being required. The question of the sufficiency of the staff of inspectors is referred to in some of the annual reports. In St. Marylebone the staff of inspectors has been increased and " a special house-to-house inspector" appointed. Dr. McCleary reports that in Hampstead the number of tenements which might with advantage be dealt with under by-laws is considerably in excess of the number actually registered, "but hitherto, the staff of inspectors has been inadequate to deal with a greater number." In Greenwich, Dr. Annis writes: "Towards the latter part of the year a lady sanitary inspector was appointed, one of whose duties being to specially take in hand the question of registration of this class of property." In the last annual report it was stated that in an appeal case "Arlidge v. Islington Borough Council," a by-law relating to cleansing was held to be unreasonable, inasmuch as it required the landlord of a house let in lodgings to cause the house to be cleansed, although he might not be able to do this without committing a trespass. Hence this by-law was rendered invalid. To meet this difficulty, a provision (Section 16) was included in the Housing and Town Planning Act, but it has become necessary to amend by-laws which were made prior to the coming into force of the Act, so as to make the provisions of Section 16 available. Dr. Dudfield reports that new by-laws for Paddington were under consideration at the end of the year. Dr. Sandilands states that new by-laws for Kensington were awaiting the approval of the Local Government Board, and Dr. Annis states that new by-laws for Greenwich were approved by the Local Government Board. Furnished room. The subject of the regulation of "furnished rooms" in tenement houses was referred to in the last annual report. There is a class of house thus let which has increased in number since the provision for "married couples" in common lodging-houses has decreased. These houses are largely situated in the neighbourhood of common lodging-houses, are occupied by persons of the same class as that which resorts to common lodging-houses, and, indeed, are often owned by the keepers of these houses. The conditions needing control extend beyond those which can be dealt with by enforcement of sanitary requirements, and a system of licensing would appear to provide the best remedy. A precedent for the application of the principle of licensing of particular keepers is to be found in the law relating to common lodging-houses under the Public Health Act of 1875. A keeper who has been convicted three times may be required to obtain the licence of the local authority. Keepers of houses let in furnished rooms and whose houses have been proved to be a nuisance to the neighbourhood in which those houses are situated might well be placed under similar obligation. Water Bupply to upper floors of tenement houses Sanitary authorities have increasingly used the powers provided by section 78 of the London County Council (General Powers) Act, 1907, for requiring the provision of a water supply to the upper floors of tenement houses. (a) The registered premises are being re-examined and re-registered, and at the end of the year 501 of tli9se premises had b een so dealt with. (b) For overcrowding. (c) For other conditions. 81 Report of the Medical Officer of Health. The following table shows the extent to which the powers referred to have been applied during 1910:— Metropolitan borough. No. of premises caused to be supplied. No. of legal proceedings. Battersea 126 - Bermondsey 41 — Bethnal Green 6 — Chelsea 2 — Deptford 2 — Finsbury 118 1 Fulham 55 — Greenwich 3 — Hackney 5 — Hammersmith 16 — Hampstead 99 — Holborn 80(a) — Islington 417 2 Lambeth 45 — Paddington 4 — St. Marylebone 215 4 Shoreditch 17 1 Southwark 251 12 Stepney 40 — Wandsworth 6 — Westminster, City of 1,049 6 Woolwich 3 — The effect of the administration of these powers is mentioned by Dr. McCleary in his report relating to Hampstead. He states that: "This Act has led to a considerable improvement. The number of houses dealt with in Hampstead during the last three years is as follows—1908, 24; 1909, 85; 1910, 99. In each house a watertap and a glazed earthenware sink were provided on each floor. These alterations have been greatly appreciated by the tenants and have had a beneficial effect in improving the general sanitary conditions of the houses." Section 20 of the London County Council (General Powers) Act, 1904, empowers sanitary authorities to require the cleansing of rooms and their contents from vermin, and in default to do such cleansing themselves. Under these powers a large number of rooms and articles have been cleansed during 1910, and in a few instances prosecutions were instituted and penalties obtained for non-compliance with the order of the sanitary authorities. Houses infested with vermin. The following table has been compiled mainly from information on this subject contained in the annual reports of medical officers of health:— Metropolitan borough. Number of rooms or premises cleansed. Metropolitan borough. Number of rooms or premises cleansed. Bermondsey 349 rooms. Lambeth 207 houses & clothing. Bethnal Green 397 rooms. Camberwell 40 premises. Paddington 189 premises. Chelsea 217 rooms. Poplar 216 rooms. Deptford 20 rooms. St. Marylebone 103 rooms. Finsbury 142 premises. St. Pancras 189 rooms. Fulham 28 rooms. Shoreditch 197 premises. Greenwich 5 premises. Southwark 2,842 rooms. Hackney 191 premises. Stepney 1,742 rooms. Hammersmith 43 premises. Stoke Newington 35 rooms. Hampstead 22 rooms. Wandsworth 277 premises. Holborn 69 premises. Westminster, City of 249 rooms. Islington 188 premises. Woolwich 143 rooms. Kensington 245 premises. Medical officers of health are informed by the Council of children found in the schools to be infested with vermin, and are requested to cause the homes to be dealt with under the Council's General Powers Act. Dr. Bryett supplies in his annual report the results of visits in Shoreditch in 260 instances to which his attention was so called, in which the conditions observed were specially noted— (a) Number of notices served. It is stated that in the majority of instances the work was completed during the year. 82 Annual Report of the London County Council, 1910. In 30 cases there was evidence of the existence of lice in the bedding or clothing found in the dwellings ; in the remaining 230 no such evidence was obtained. In 186 the dwelling rooms were described as being clean or fairly so, in 35 as being dirty, in 22 there was marked evidence of bugs, and in 17 instances the rooms were both dirty and infested with bugs. In 160 instances the bedding was described as clean or fairly so, in 60 it was dirty, in 23 evidence of lice was observed, in 3 it was dirty, and also contained lice, in 10 it was dirty and contained bugs, and in 4 instances lice were observed in both bedding and clothing. In 18 instances the dwellings were markedly infested with fleas and in 8 cases overcrowding was noted. It may be mentioned that in several cases evidence of extreme poverty was manifest. Revenue Act, 1903 Under section 11 of the Revenue Act, 1903, on the certificate of the medical officer of health that the house is so constructed as to afford suitable accommodation for each of the families or persons inhabiting it, with due provision for their sanitary requirements, there is exemption from or reduction of inhabited house duty, as follows:— (1) Where a house, so far as it is used as a dwelling house, is used for the sole purpose of providing separate dwellings— (a) The value of any dwelling in the house which is of an annual value below twenty pounds shall be excluded from the annual value of the house for the purposes of inhabited house duty; and (b) The rate of inhabited house duty, in respect of any dwelling in the house of an annual value of twenty pounds, but not exceeding forty pounds, shall be reduced to threepence; and (c) The rate of inhabited house duty, in respect of any dwelling in the house of an annual value exceeding forty pounds, but not exceeding sixty pounds, shall be reduced to sixpence. For the purposes of these provisions medical officers of health were called upon to certify numerous houses during the year, and in some instances the application was granted, in others it was refused, while in others, agaip, it was only granted after alterations had been made to meet the conditions necessary, before certification. The Act appears to be instrumental in ensuring a higher standard of dwelling accommodation than before. The number of applications received and certificates granted during 1910 is shown in the Eollowing table:— Metropolitan borough. No. of houses for which applications for certificates were received during 1910. No. of tenements comprised therein. No. of tenements for which applications for certificates were Granted. Refused. Deferred or withdrawn. Battersea 5 11 2 3 6 Bermondsey 13 146 146 — — Bethnal Green 10 27 — 27 — Camberwell 26 31 10 4 17 Chelsea 6 41 24 17 — Deptford — — — — — Finsbury 6 38 38 — — Fulham 234 615 158 42 415 Greenwich 16 32 — Hackney 4 10 10 — — Hammersmith 58 178 16 1 161 Hampstead 15 51 17 — 39a Holborn — — — - — Islington 452 518 371 147 — Kensington 12 50b 27 — — Lambeth 37 101 94 7 — Lewisham 65 136 136 - — Paddington 5 83 83 — — Poplar 2 12 12 — — St. Marylebone 6 64 64 — — St. Pancras 7 92 84 8 — Shoreditch 2 4 4 - - Southwark 13 29 29 - — Stepney 70 198 86 112 — Stoke Newington 8 30 30 — — Wandsworth 81 164 147 5 12 Westminster, City of 12 46 46 — — Woolwich 7 28 22 6 — Section^55 of the Housing and Town Planning Act extends to common lodging-houses at which the charge does not exceed sixpence per night the provisions of Section 11 of the Revenue Act, and hence reference is made in some of the reports to the action taken by medical officers of health in respect of these houses. In certain instances modifications and improvements of houses were made by keepers with a view to their obtaining exemption from inhabited house duty. (а) Includes 5 applications from previous year again deferred. (б) Includes 23 tenements to which the applications for certificates did not apply. 83 Report of the Medical Officer of Health. Underground rooms. The number of underground rooms dealt with in 1910 in the several metropolitan boroughs is shown in the following table:— Metropolitan borough. No. of rooms illegally occupied. No. of rooms closed or illegal occupation discontinued. Metropolitan borough. No. of rooms illegally occupied. No. of rooms closed or illegal occupation discontinued. Battersea 33 33 Islington 39 39 Bermondsey 4 4 Kensington 16 16 Bethnal Green 1 1 Lambeth 28 28 Chelsea 1 1 Paddington 8 9 Deptford 5 5 St. Marylebone 118 118 Finsbury 25 25 St. Pancras 471 Fulham 7 7 Shoreditch 4 4 Greenwich 3 3 Southwark 3 3 Hackney 3 2 Stepney 42 15 Hampstead 115 60 Westminster, City of 50 48 Holborn 17 17 Woolwich 3 3 Under Section 17 (7) of the Housing and Town Planning Act, a room habitually used as a sleeping place, the surface of the floor of which is more than three feet below the surface of the part of the street adjoining or nearest to the room, is deemed to be unfit for human habitation, if it is not on an average at least seven feet in height from floor to ceiling, or does not comply with regulations which the local authority with the consent of the Local Government Board may prescribe. So far as is shown by the annual reports of medical officers of health, regulations were made by the local authorities of St. Marylebone and Woolwich, and were consented to by the Local Government Board. Regulations were also made by the local authorities of Hampstead, Stoke Newington and Poplar, and draft regulations were under the consideration of the local authorities of Kensington, Fulham, Holborn and Bethnal Green. Dr. Allan reports that "the Council [of the City of Westminster] has not made regulations under this section, as it does not seem clear from the wording of the section that it-would be possible to enforce such regulations with regard to rooms seven feet or over in height." Overcrowding. The following table, showing the number of dwelling rooms found overcrowded in each metropolitan borough, is compiled from information supplied by the medical officers of health, mainly in their annual reports:— Metropolitan borough. No. of dwellingrooms overcrowded. No. remedied. No. of prosecutions. City of London 15 15 - Battersea 79 79 — Bermondsey 129 127 — Bethnal Green 182 167 — Camberwell 94 94 2 Chelsea 11 11 — Deptford 18 18 — Finsbury 216 216 — Fulham 35 35 — Greenwich 34 34 — Hackney 134 132 — Hammersmith 21 21 — Hampstead 7 7 — Holborn 41 41 — Islington 198 198 1 Kensington 147 147 3 Lambeth 73 73 — Lewisham 1 1 — Paddington 313 257a 1 Poplar 141 141 — St. Marylebone 159 159 — St. Pancras 141 141 — Shoreditch 104 104 — Southwark 444 444 — Stepney 668 668 — Stoke Newington 14 14 — Wandsworth 129 129 — Westminster, City of 156 156 — Woolwich 78 78 - (a) No action taken in 56 cases, the deficiency of air space being very slight. 84 Annual Report of the London County Council, 1910. Dr. Brown gives account of the circumstances of the family in a number of cases of overcrowding in Bermondsey which were inquired into by him. There can be no doubt that in many of these cases the overcrowding was due to the inability of the family to pay for additional accommodation. On the question of sufficiency of accommodation Dr. Thomas states that in Finsbury one room was found empty for every 12 occupied in the houses in which overcrowding occurred. Factory and Workshop Act, 1901. The Factory and Workshop Act, 1901, requires every medical officer of health to report specifically on the administration in his district of those provisions of the Act the administration of which is imposed upon sanitary authorities, and a form of table is prescribed by the Home Secretary for the exhibition of those particulars which lend themselves to statistical statement. From such tabulated statements contained in the annual reports of medical officers of health of metropolitan boroughs a summary table has been prepared for the year 1910. (See Appendix I.) Comparison of the figures illustrating the work done in 1910 and those of antecedent years, shows that the number of workshops in London under inspection differs but little in the several years, and that in respect of numbers of inspections the vear 1910 shows some increase. Again, the number of defects, whether total or particular defects, shows very little variation from year to year. This will be seen by reference to the following table:— 1904. 1905. 1906. 1907. 1908. 1909. 1910. Number of workshops on register 34,488 35,187 36,632 37,891 37,673 37,782 37,742 Number of inspections, excluding inspections of outworkers' premises 84,600 86,071 79,526 81,171 84,058 84,174 89,040 Total number of defects found 18,922 19,023 19,407 22,071 22,012 21,522 21,888 Want of cleanliness 5,752 6,522 7,206 8,319 7,130 7,256 7,248 Want of ventilation 799 828 736 652 639 727 607 Overcrowding 413 347 461 295 237 278 250 Sanitary conveniences Insufficient 403 284 296 256 278 377 262 Unsuitable or defective 3,645 3,411 3,717 4,229 5,255 5,377 5,402 Not separate for sexes 308 239 251 388 376 292 312 The use of underground or basement rooms as workshops or workplaces is discussed in several of the annual reports of medical officers of health. Dr. Parkes states that there are 52 basement rooms in Chelsea with accommodation for about 400 workers. He says that the sanitary condition of these basement workrooms are by no means satisfactory in respect of lighting, warming, ventilation and, in some cases, aerial disconnection from waterclosets. He reiterates his opinion expressed in his annual reports for 1904-9 that the use of underground rooms for workshops should be prohibited unless they complied with certain conditions which should be prescribed in regulations applying to all new underground workrooms and to existing underground workrooms after a certain period. Dr. Porter discusses steps he took in his endeavours to prevent badly lighted and badly ventilated underground workrooms being used in St. Marylebone. The unsatisfactory condition of underground' kitchens used as workplaces is referred to in the reports relating to Islington and the City. Dr. Collingridge states that the majority of basement kitchens in the City are entirely unsuited to the purpose for which they are used, and he recommends that the occupiers should be required to give notice to the sanitary authority of intention to use such rooms, and that restriction should be placed upon their occupation. The failure of employers to send in lists of outworkers is a subject of comment in some of the reports. The Kensington Borough Council, Dr. Sandilands states, prosecuted two employers failing in this respect, and subsequently informed all others that in future like proceedings would be instituted without notice in cases of default. Dr. Allan writes that less trouble has been experienced in this matter in Westminster since the City Council has adopted the practice of sending to the employers forms to be filled in by them. The use of gas stoves, unprovided with flues, is shown by the annual reports to be a subject which still requires constant attention. Eight such stoves were found in Hampstead, and Dr. Allan states that although they are fewer than before many are still found in Westminster. The annual reports show that much work is being done in London in connection with workshops and in the inspection of outworkers' premises, and the progress made in St. Marylebone since the appointment of two additional inspectors deserves to be noted. Ice-cream premises Places where food is prepared for sale. The annual reports give information as to the adminstration of the powers conferred on sanitary authorities by the London County Council (General Powers) Act of 1902 (sec. 43) for controlling the conditions under which ice cream is prepared for sale. These reports show that the provisions of this section are now widely applied, and are in no way limited to premises occupied by itinerant vendors. Thus Dr. Dudfield states that in Paddington the business of ice-cream vendor was combined with other businesses in 58 sweet shops, 24 bakers' shops, 4 milkshops, 15 restaurants, 2 newspaper and tobacco shops, 4 confectioners, 1 cook shop and 8 general shops. The number of barrow men actually resident in Paddington was only four, while ten barrow men residing in other districts had regular pitches in the borough. Dr. Lennane reports that of 185 premises in Battersea on which ice cream is manufactured or sold, 9 are occupied by Italians, who employ 25 barrows for the sale of this article. He writes: "The number of these alien manufacturers and vendors of ice cream appears to be diminishing in the borough, while, on the other hand, the industry is increasing amongst the native population, with, on the whole, desirable results in the matter of cleanliness." 85 Report of the Medical Officer of Health. In the following table the number of these premises in each metropolitan borough, and other particulars, are shown:— Metropolitan borough. N umber of places. No. of inspections, 1910. No. of notices, 1910. No. of prosecutions, 1910. On register at end of 1909. Added in 1910. Removed in 1910. On register at end of 1910. City of London 243 241 Battersea 156 57 28 185 403 50 2 Bermondsey 133 11 — 144 165 10 — Bethnal Green 88 24 8 104 258 59 1 Camberwell 219 30 46 203 465 11 — Chelsea 33 4 4 33 29 1 — Deptford 132 6 16 122 172 6 — Finsbury 82 6 6 82 76 17 — Fulham 136 8 15 129 180 4 — Greenwich 118 15 7 126 134 11 — Hackney 138 32 11 159 248 28 — Hammersmith 224 5 17 212 241 5 — Hampstead 78 12 7 83 289 27 — Holborn 39 8 7 40 120 1 — Islington 230 25 20 235 136 15 — Kensington 177 11 15 173 219 39 — Lambeth 24 — — 24 20 32 — Lewisham Paddington 120 — 4 116 65 — — Poplar 125 59 33 151 261 9 — St. Marylebone 80 10 4 86 126 19 — St. Pancras 491 491 340 — 2 Shoreditch 89 5 5 89 186 22 — Southwark 119 18 8 129 270 62 — Stepney 144 28 12 160 273 56 — Stoke Newington 38 — — 38 76 Wandsworth 274 28 15 287 427 51 — Westminster, City of 146 4 — 150 188 3 — Woolwich 98 4 16 86 198 5 — Powers for the sanitary control of other premises upon which food is prepared for sale are conferred upon sanitary authorities by section 8 of the London County Council (General Powers) Act of 1908. Other premises where food is prepared for sale. This section provides against contamination of the food by urinals, waterclosets, ashpits, etc., requires that the water supply shall be free from contamination by any watercloset, prohibits drain inlets within the building and the deposit of refuse, beyond that which is required for the purposes of the trade, and, moreover, requires due cleanliness to be observed in regard to the room or shop, and the apparatus and utensils and persons employed in it. A considerable amount of work has been done in London under these powers, varied conditions being dealt with in their administration. Thus Dr. Sandilands reports that in Kensington "In 33 instances a sanitary convenience was found opening directly into a place where food was deposited for sale: drain inlets in places where food was stored were found and abolished on 62 of the premises visited. . . . . A peculiarly objectionable arrangement was found in some of the butchers' shops, whereby waste water from the ice safe or cold storage room was carried off by an untrapped pipe into a gully which was connected with the general drainage system of the premises." The reports also show the need for improved cleanliness in restaurant and eating house kitchens, a result which the exercise of these powers should do much to promote. The annual reports of medical officers of health supply information as to the number of premises inspected and the number of inspections as shown in the following table:— Metropolitan borough. Premises used for the preparation and sale of food.(a) Number of inspections. Metropolitan borough. Premises used for the preparation and sale of food, (n) Number of inspections. City of London 868 1,643 Kensington 535 400 Battersea 274 Lambeth 296 164 Bermondsey 800 3,403 b Lewisham 58 92 Bethnal Green 219 793 Paddington 405 704 Camberwell 192 393 Poplar 329 853 Chelsea 64 70 St. Marylebone 169 389 Deptford 119 153 St. Pancras 610 1,539 Finsbury 246 246 Shoreditch 258 526 Fulham 89 145 Southwark 311 1,939 Greenwich 122 156 Stepney 343 881 Hackney 91 154 Stoke Newington 26 52 Hammersmith 158 Wandsworth 508 645 Hampstead 523 970 Westminster, City of 1,140 3,740 Holborn 387 2,216 Woolwich 90 102 Islington 746 497 (а) Other than bakehouses, milkshops, slaughterhouses, and ice-cream premises. In some cases the figures relate to restaurant-kitchens only. (b) Including visits for the purpose of sampling under the Food and Drugs Act. 86 Annual Report of the London County Council, 1910. Inspection of food. Dr. Collingridge reports that the inspectors of the City Corporation seized 1,675 tons 2 cwt. 1 qr. of diseased and unsound meat, poultry, offal and fish during the year. Over 22 tons 4 cwts. of meat, including offal, was tuberculous. At Billingsgate Market 1,288 tons of fish was condemned by the inspectors of the Fishmongers' Company. As the result of inspection at the City wharves 110 loads of unsound food were removed by the City Corporation. In Finsbury over 83 tons of diseased meat and 56 tons of unsound food were seized. Dr. Thomas states that eight sides of tuberculous beef were seized in Finsbury, all bearing the official label of the Belgian administration, as having been satisfactorily examined at Antwerp. "They were said to be a part of a much larger consignment of old Danish cattle which, while still alive, had been tested with tuberculin in German ports and had been refused admission to Germany. They therefore were consigned via Antwerp and Harwich to various English districts. A percentage examination—10 per cent.—was made at Harwich, and some of the tuberculous carcases found and seized. The rest escaped detection and came into the Central Meat Market, Finsbury and other districts, where they were dealt with." Both Dr. Collingridge and Dr. Thomas refer in their reports to the delivery in London of a large quantity of quarters of Queensland beef presenting nodular masses containing a parasitic worm identified as Onchocerca gibsoni. It was decided to require the excision and destruction of the flanks and briskets and the removal from the hind quarters of any parts which were affected. The Local Government Board issued in January of 1911 reports on this parasite by Dr. MacFadden and Dr. Robert Leiper. In Islington 4 tons 1 cwt. 1 qr. of unsound food were destroyed, of which 1 ton 18 cwt. 1½ qrs. was diseased or unsound meat removed chiefly from the slaughterhouses. In Stepney 2 tons 9 cwt. of meat from the slaughterhouses, and 19 tons 10 cwt. from shops and stalls were seized or surrendered, and 379 tons 9 cwt. of unsound food from the wharves were destroyed. In Southwark nearly 26 tons of food were surrendered to the inspectors and 4 cwt. seized by them, while over 166 tons was surrendered on the wharves. In Bermondsey 26½ tons of unsound food were surrendered, and a considerable quantity of foodstuff was dealt with on the wharves. In Poplar also a large quantity of foodstuff from the wharves was dealt with. In Westminster much foodstuff was surrendered and three seizures made. Various quantities of food were surrendered or seized in Paddington, Hampstead, St. Pancras, St. Marylebone, Stoke Newington, Hackney, Holborn, Shoreditch, Bethnal Green, Lambeth, Battersea, Dentford, Greenwich. Lewisham. Wandsworth and Woolwich. The reports relating to the following districts show that proceedings before the magistrates in connection with unsound food were instituted in the number of instances stated:— No. of proceedings. No. of proceedings. No. of proceedings. London, City of 2 Kensington 1 Shoreditch 3 Fulham 3 Westminster 3 Bermondsey 1 Finsbury 3 St. Pancras 1 Lambeth 1 Stepney 11 St. Marylebone 10 Battersea 2 Southwark 2 Holborn 2 Woolwich 1 Convictions were obtained in all except one case, in Westminster, in which the summons was withdrawn. Dr. Collingridge calls attention to the wording of section 47 of the Public Health (London) Act, which in respect of any article which has been seized or is liable to be seized under this section provides a penalty for "the person to whom the same belongs, or did belong at the time of sale or exposure for sale or deposit for the purpose of sale, or of preparation for sale, or in whose possession or on whose premises the same, shall be found." Dr. Collingridge states that " In many cases the guilty party is rendered completely immune from the consequences of their evil deeds, the owner escaping because he had no knowledge, and the butcher because he is not the owner." He cites two cases in which there was failure to secure a conviction for this cause, and states that a clause for meeting the difficulty has been inserted in the City of London (General Powers) Bill. Disinfection. The principal change in the arrangements for disinfection in London effected during the year is the provision by the Council of the City of Westminster of a new disinfecting station, replacing stations which had been provided by the authorities which had existed before the passing of the London Government Act. Dr. Allan reports that the" provision now made includes accommodation for the reception and cleansing of verminous persons. The annual report of Dr. Sandilands relating to Kensington shows that the borough council undertook in a certain number of instances the washing of infected articles of clothing for the convenience of householders, a charge being made for this service. In Paddington the disinfection is still done by a contractor. Shelters. Dr. Alexander reports' that, in Poplar, plans for the utilisation of the upper workshops at the destructor depot, for the purpose of an infectious disease shelter and plans for the disinfesting house and yard, were approved by the Public Health and Housing Committee. 87 Report of the Medical Officer of Health. The following figures, which are mainly taken from the annual reports, show the extent to which the existing shelters were used during the year 1910 :— Metropolitan borough. No. of persons accommodated. Metropolitan borough. No. of persons accommodated. City of London 8 Kensington (a) Battersea 17 Lambeth - Bermondsey 18 Lewisham - Bethnal Green 8 Paddington (a) Camberwell - Poplar — Chelsea 43 St. Marylebone 14 Deptford 4 St. Pancras 26 Finsbury 5 Shoreditch 7 Fulham - Southwark 665 Greenwich - Stepney 51 Hackney 34 Stoke Newington — Hammersmith (a) Wandsworth — Hampstead Westminster, City of 1 Holborn 16a Woolwich — Islington 14 Mortuaries. The number of bodies received into the mortuaries of the metropolitan borough councils during the year is shown in the following table:— Metropolitan borough. Total number of bodies received into mortuary. Number of infectious "bodies received into mortuary. Metropolitan borough. Total number of bodies received into mortuary. Number of infectious bodies received into mortuary. City of London 180 Kensington 289 1 Battersea 234 12 Lambeth 361 — Bermondsey 216 6 Lewisham 129 3 Bethnal Green 325 6 Paddington 276 3 Camberwell 329 2 Poplar 342 — Chelsea 129 — St. Marylebone 328 1 Deptford 89 1 St. Pancras 417 10 Finsbury 209 10 Shoreditch 382 — Fulham 147 1 Southwark 645 2 Greenwich 121 — Stepney 629 3 Hackney 399 — Stoke Newington 46 — Hammersmith 223 5 Wandsworth 186 — Hampstead 87 — Westminster, City of 333 5 Holborn 121 — Woolwich 139 1 Islington 609 2 Dr. Alexander reports that on the completion of the new mortuary in Cottage-street, Poplar, directions were given for it to be used for the whole borough of Poplar, and for the mortuaries in St. Leonard's-road, Brickmore-street, Wellington-road and Bow Churchyard to be closed. Dr. Caldwell Smith states that the question of the provision of a new mortuary for Wandsworth was under consideration, but no decision as to the site had been arrived at, and that the mortuary at Tooting had been closed pending the erection of a new one in Wandsworth. Cleansing of persons. The number of verminous persons cleansed in 1910 is shown in some of the annual reports, and the following table has been compiled from the information thus supplied :— Metropolitan borough. Adults. Children. Metropolitan borough. Adults. Children. Battersea 1,583 341 Poplar 686 99 Bermondsey 111 318 St. Marylebone 8,484 1,372 Bethnal Green 15 — St. Pancras 2,839 2,042c Camberwell 93 2,301 Southwark 114 600 Finsbury 13 - Stepney 1,268 252 Hackney 216 352 Stoke Newington 3 92 Holborn 168 — Wandsworth 5 4 Islington 19 — Westminster, City of 6 — Kensington 20b - Woolwich 139 451 (a) No shelter is maintained by the Borough Council. In the case of Holborn, 16 persons were accommodated in the Finsbury Borough Council's shelter. (b) Daalt with by the Board of Guardians at the expense of the Kensington Borough Council. (c) In addition to the number of children disinfected shown in the table, 354 children, bed-fellows of such children, were also cleansed. 88 Annual Report of the London County Council, 1910. During 1910 the Council was engaged in negotiating with the sanitary authorities for th cleansing of children from the schools, and of adults from common lodging-houses. The principle adopted by the Council in respect of adults from common lodging-houses was that the sanitary authorities should cleanse free of charge any persons sent for that purpose to the cleansing station by the Council from common lodging-houses in their district, but that any person sent by the Council from common lodging-houses in neighbouring districts, in which no provision for cleansing had been made, should be paid for by the Council. Arrangements have thus been made during the present year with the sanitary authorities of St. Marylebone, St. Pancras, Hackney, Poplar, Bermondsey, Camberwell, and Woolwich. With respect to the cleansing of children from the schools, the Education Committee of the Council proposed to utilise under certain conditions cleansing stations of the sanitary authorities, where suitable provision for this purpose had been made, the Council paying a fee for each child cleansed. The London Equalisation of Rates Act, 1894. The Equalisation of Rates Act provides that the London County Council shall in each year form a fund from a rate of sixpence in the pound on the rateable value of London. The contribution from each parish to the fund is to be in proportion to its rateable value, and the amount thus produced is to be distributed among the local authorities in proportion to population. Where a sanitary district comprises two or more parishes, and the aggregate of the contributions from such parishes is less than the grant apportioned to the district, the difference is paid out of the fund to the sanitary authority of the district, and no payment towards any equalisation charge is required from any parish in the district. Subject to the above, when the contribution from a parish is less than the grant due, the difference is paid out of the fund to the sanitary authority of the district forming or comprising the parish ; and if it exceeds the grant to the parish, the Council, for the special purpose of meeting the excess, levies on the parish a county contribution as a separate item of the county rate. Every sum paid to a sanitary authority must be applied in defraying the expenses of the sanitary authority incurred under the Public Health (London) Act, 1891, and so far as not required for that purpose those incurred in respect of lighting, and so far as not required for that purpose those incurred in respect of streets, and where the sanitary district comprises two or more parishes the sum paid must be apportioned among such parishes in proportion to their population, and the amount apportioned to each parish credited to each parish in the reduction of the rate required from such parish towards the above-mentioned expenses. A statement of the amount of the grant or equalisation charge made to or levied upon each sanitary district in the county in respect of the year ended 31st March, 1911, will be found in Volume I., page 51. Water supply. In his fifth annual report Dr. Houston states that while he recognises the remarkable bacteriological improvement of water effected by sand filtration, he is not satisfied that sand filters exercise a special selective action in the separation of pathological bacteria, but that on the contrary it is known that excremental bacteria may pass through them in much the same proportion as innocuous microbes. He has satisfied himself that the raw sources of London's water supply, notwithstanding their being sewage polluted, do not uniformly contain the microbes of water-borne diseases unless in such small numbers as to be practically negligible in view of the further purification processes. He adds, however, that the purification policy of the Water Board is wisely based on the supposition that the Thames and Lea should always be regarded as potentially dangerous sources of supply, and, therefore, an equalising and devitalising process (storage) is now interposed between the river and the filter beds and that the present position, though not entirely satisfactory, marks a great advance, for now all the storage reservoirs are utilised to the fullest possible extent, and that so far as this is practically possible, he is informed, no river water is ever passed on to the filter beds without previous storage. Dr. Houston further states that belief in the value of storage does not justify the Board in relaxing vigilant watch over the quality of water taken into its storage reservoirs and that his bacteriological examinations of London raw river water in 1910-1911 show wide range between the best and worst month's results, indicating the need for judicious selection of river water for waterworks purposes, and forces the conclusion that the more water that is abstracted from the river the less easy will it be in the future to avoid using water of bad quality. Health visitors. During the year 1910 owing " to the small and rapidly sinking surplus on the Exchequer Contribution Account " the Council felt itself obliged to attach the following conditions to contributions by the Council to salaries of health visitors, viz. :— (1) That the contributions are for one year only. (2) That the contributions are dependent upon there being sufficient surplus on the Exchequer Contribution Account to enable payments to be made after making provision for the discharge of the existing statutory charges on that account in full; and (3) That in the event of the available surplus being insufficient to meet the payments in full the Council's contribution will be liable to abatement or may be discontinued altogether. Report of the Medical Officer of Health. 89 Midwives Act, 1902. The number of midwives giving addresses in London whose names appear on the Roll of Mid- Registration wives for 1910 is 3,526. This number includes midwives who may perhaps have removed from the County, but, owing to the fact that they are not practising, their present addresses have not been reported to the Central Midwives Board, and consequently appear as London addresses. Of this number, 561 notified their intention to practise during the whole year or for shorter periods. The qualification of the London midwives is as follows:— Qualification of Midwife. Number not giving notice of intention to practise. Number giving notice of intention to practise. Total. (a) Holding certificates from the Central Midwives Board 1,523 248 1,771 (b) Holding a certificate, obtained as the result of an examination prior to the passing of the Midwives Act 1,365 222 1,587 (c) Enrolled by virtue of having been in bona fide practice as midwives a year previous to the passing of the Act 77 91 168 2,965 561 3,526 The midwives in classes (a) and (b) are entitled to use the description " certified midwife by examination." Of those giving notice of their intention to practise, the untrained midwives, class (c) represent 16 per cent. On 1st April, 1910, the provisions of Section 1 (2) of the Midwives Act came into operation, and no woman who was not a certified midwife was allowed to practise habitually and for gain. The Privy Council, however, sanctioned a rule allowing the Board to enrol up to 30th September, 1910, any woman who was qualified either under (b) or (c), but who had failed to secure enrolment before 1st April, 1905. In the County of London it was felt that there was no lack of midwives and that no good purpose would be served by adding to the list the names of women who had failed to obtain enrolment, and the Council informed the Board of their opinion. As a result the women who applied under this rule, with one exception, were not admitted to the roll. The exception was made in favour of a woman who, owing to illness, had failed to apply at the proper time for enrolment. The 561 midwives who gave notice of intention to practise cannot be taken as the number of midwives practising at any given time in the County. In some institutions it is the custom for a midwife to act as an assistant for three months or less after she is qualified, and her place is then filled by another newly qualified assistant, who in her turn gives notice of intention to practise. At any given time it may be estimated that some 420 midwives, or nearly 13 per cent. of those on the roll are in actual practice in London. The remaining 87 per cent. act for the most part as monthly or general nurses under medical supervision. Of the practising midwives 53 were working entirely within poor-law institutions or lyingin hospitals and were under medical supervision ; 169 others were attending patients on behalf of charitable, poor-law or other institutions, and were paid either a salary or a fee for each case allotted to them. The remainder practised independently. All practising midwives, except those working in hospitals under medical supervision, are subject to supervision by the Council's officers, to ascertain whether they are complying with the rules of the Central Midwives Board as to cleanliness, the possession of antiseptics and appliances, the keeping of registers and case books and the sending of the required notices to the Local Supervising Authority. The work of inspection was carried out by Miss I. R. Shields, M.B., B.S., and Miss E. Macrory, M.B., Ch.B., L.M., D.P.H. In July Miss Shields resigned her appointment and Miss M. A. Pilliet, M.B., Ch.B. was appointed. In addition to the ordinary routine inspection, special visits are paid to the midwife when any case of a septic nature or a persistent high temperature occurs in her practice, and in all cases oi inflammation of the infants' eyes. The inspectors also advise midwives on any points of difficulty which may arise in the course of their duties, and in some instances instruct the midwives as to methods o: work. On occasion a midwife is accompanied either to a confinement or on a subsequent visit to a patienl to ascertain whether her methods of work are efficient. This is done where there is any reason to believe that the midwife's work is not up to standard, and also in cases where a midwife has applied to th< Central Midwives Board for approval to supervise the training of pupils for the Board's examination The inspectors paid 1,571 visits to midwives or institutions employing midwives. In 958 cases t-lu report was satisfactory, in 70 unsatisfactory, and in 543 the midwife was not seen. The 70 unsatisfactory reports relate to 58 midwives, 47 were reported unsatisfactory on one occasion, 10 on two occasions and one on three occasions. Most of the unsatisfactory reports related to cases in which some slight breach of the rules had occurred, and the midwife's attention was called to the matter by the inspector, who was subsequently able to report favourably. In cases of a more serious nature, or where the midwife had a bad record 5716 g Inspection 90 Annual Report of the London County Council, 1910. previously, the matter was reported to the Midwives Act Committee of the Council, and a letter of caution was sent to the midwife. This occurred in seven cases on the following grounds:— Delay in advising medical assistance for the mother 2 „ „ „ „ feeble child 4 „ „ „ „ inflammation of child's eyes 1 Prima facie cases of negligence or misconduct were found against two midwives, and in one case a charge of drunkenness made against a midwife was communicated to the Board without investigation owing to the dismissal of the midwife from the institution at which she was engaged, and the absence of any knowledge of her address. The name of this woman was removed from the roll subsequently. Charge. Result. Neglect and incompetence Cautioned by Board. Falsifying register and want of cleanliness Name removed from Roll Drunkenness while on duty Name removed from Roll. There is a gradual improvement in the work of midwives, and, as the number of untrained midwives diminishes year by year, the number of instances of disregard of the rules as to cleanliness and of failure through ignorance to recognise serious conditions has also diminished. The Council's inspectors have paid special attention to the untrained midwives and instructed them as to the use of antiseptics and the reading of the clinical thermometer. There are some five midwives who are illiterate, but other members of their family enter up their registers for them. A copy of the rules of the Board translated into Yiddish by the Jewish Board of Guardians at the request of the Council was supplied to the Jewish women in East London who have difficulty in understanding English. There are some 12 or 13 Jewish midwives and two Italians in practice in London. Fees charged by Midwives The fee a midwife receives for attending a confinement and the subsequent visiting for 10 days varies in different localities from 5s. per case upwards, but usually a fee of 7s. 6d. to 10s. is expected. The charities employing midwives pay 5s. or 6s. a case, and provide the midwife with registers, forms, antiseptics, etc. It is apparent from the number of cases taken by midwives and the small fees paid that very few can rely solely on their practice as a means of livelihood. Many of them are married women who do not trouble to obtain a large practice, a few keep lying-in homes ; others, especially those with a fairly large practice, are approved by the Central Midwives Board to give practical instruction to pupils preparing for the Board's examination. The pupil resides with the mid-wife and goes with her to cases. The fees for pupils are usually about £1 Is. per week, which includes board and lodging in addition to the practical instruction eiven bv the midwife. Maternity charity In answer to a question in the House of Commons, the President of the Local Government Board stated that in 1910, 3,125 maternity cases were admitted to the wards of the London workhouses and infirmaries and 329 midwifery orders were given by the guardians to midwives working outside the infirmaries. A large proportion of the indoor cases are conducted by midwives, and many of the infirmaries are approved as training schools for pupil midwives. Over 5,000 cases are taken annually into the maternity hospitals, and some 18,000 to 20,000 are delivered in their own homes by midwives working for maternity hospitals or in connection with one or other of the free maternity charities. From information received under the Notification of Births Act the following figures have been obtained shoiving the number of births notified by midwives :— 12 midwives reported over 500 cases in the year. 3 „ „ between 400 and 500 cases in the year. 8 „ „ „ 300 and 400 „ „ 12 „ „ „ 250 and 300 „ „ 12 „ „ 200 and 250 „ „ 30 „ „ „ 150 and 200 „ „ 45 „ „ „ 100 and 150 „ „ 72 , „ „ 50 and 100 „ „ 64 , „ „ 20 and 50 Most of the midwives who had 300 cases and upwards have qualified assistants, and many are approved by the Central Midwives Board to supervise the work of pupils. From information received under the Notification of Births Act, it is computed that some 30,000, or 25 per cent. of the total births in London, are attended by midwives, excluding the cases attended by midwives in infirmaries. Uncertified women. After March, 1910, by Section 1 (2) of the Act, no woman, unless she be certified under the Act may habitually and for gain attend women in childbirth except under the direction of a registered medical practitioner. The Council had already compiled a list of names of women who were known to be attending women in childbirth, and a letter was addressed to these women calling their attention to the provisions of this section. As already mentioned a new rule was framed allowing the Board to enrol women who might have been enrolled, but who had failed to apply for enrolment prior to March 1905. Several uncertified women made application under the new rule, but were refused by the Board, who laid down as one of the conditions, the want of certified midwives in the neighbourhood where the applicant resided. Report of the Medical Officer of Health 91 Enquiries were made into all cases in which it came to the knowledge of the Council that a delivery had been conducted by an uncertified woman, and in six instances there was evidence that the woman had been engaged beforehand and had received fees for two or more confinements. Proceedings were instituted and fines in four cases amounting to £3 12s. with £4 10s. costs were imposed. In one case the woman was convicted and bound over for 12 months in the sum of £2, and in one case the summons was dismissed. Most of the other women reported as having conducted cases were found on enquiry to have acted in emergency, or else they had only conducted one case and could not be described as practising habitually; these women were informed of the provisions of the Act, and in some cases cautioned by letter. The rules of the Central Midwives Board provide that in certain circumstances a midwife must decline to attend alone and must advise in writing that the case is one requiring medical help. The form on which this written advice is given is sent to a medical practitioner, and a copy is forwarded to the local supervising authority. During the year 3,026 of these notices were received. The figures for the previous years were : 1905, 1,113 ; 1906, 2,320 ; 1907, 2,533 ; 1908, 2,755 ; 1909, 2,894. The rise in the figures is no doubt due to the fact that midwives realise more fully the importance of complying with this rule of the Board. Notices were received from 337 midwives. Midwives in infirmaries and hospitals under the direction of a qualified medical practitioner are not required to comply with this rule. Medical help. 1 midwife reported advising medical help 149 times during the year. 5 midwives „ „ „ 40 to 60 times during the year. 32 „ „ „ „ 20 to 40 „ 64 „ „ „ „ 10 to 20 „ „ 235 „ „ „ „ less than 10 times during the year. The reasons assigned by the midwife for giving the advice were as follows:— Pregnancy— Abortion or miscarriage 44 Deformed pelvis 11 Varicose veins 24 Ante partum haemorrhage 100 General unhealthy conditions 70 249 Labour— Presentations— Unable to make out 31 Difficult breech 49 Face 23 Funis 27 Transverse 57 Difficult twins 15 Persistent occipito posterior 35 Hand 15 Placenta praevia 18 Prolonged labour (uterine inertia, contracted pelvis, etc.) 511 Laceration of perineum 267 Prolapse of uterus 2 Haemorrhage during labour 15 Retained or adherent placenta 210 Exhaustion or collapse 48 Dyspnoea 1 Hysteria l Excessive liquor amnii 2 Uterus not contracting 2 1,329 Lying-in— Rise of temperature 194 Post partum haemorrhage 104 Pain or swelling in leg 14 Abdominal pain or swelling 15 Pain or swelling of breast 9 Quick pulse 7 Eclampsia, convulsions 20 Puerperal mania 7 Offensive lochia 4 Sub-involution of uterus 2 Other illness 49 425 5716 G2 Pregnancy. 92 Annual Report of the London County Council, 1910. Child— Injury at birth 6 Malformation or deformity 105 Skin eruption 18 Jaundice 17 Convulsions 36 Partial asphyxia 40 Bronchitis, etc. 27 Inflammation of eyes 160 Feebleness and prematurity 480 Bleeding from cord 2 Stillborn (before midwife arrived) 61 Death of infant 39 Other conditions in child 21 1,012 No reason stated 11 3,026 Assuming that 30,000 births are attended annually by midwives, the above figures show that medical assistance was required in 10 per cent. of the cases ; in 6-6 per cent. on behalf of the mother and 3-3. per cent. on account of the child. During the year, 204 midwives reported having stillbirths in their practice. The number of stillborn children being 606. This represents 2 per cent. of the births. 1 midwife reported 15 stillbirths 15 1 „ „ 13 „ 13 1 „ „ 11 „ 11 2 midwives each reported 10 stillbirths 20 1 midwife reported 9 stillbirths 9 3 midwives each reported 8 stillbirths 24 6 „ „ 7 42 12 „ „ 6 „ 72 14 „ „ 5 „ 70 13 „ „ 3 „ 52 44 „ „ 3 „ 132 40 „ „ 2 „ 80 66 „ „ 1 stillbirth 66 204 606 Still births The form for notifying stillbirths provides for information as to (a) sex of child ; (b) period of gestation ; (c) whether macerated or not; (d) presentation. The information obtained under (a) showed that 341 still-born infants were males, 262 females, and in three cases the sex was not stated. The following table shows the information obtained under (b) and (c):— Condition of child. Total cases. Period of gestation. Full term. 8 months. 7 months. 6 months or less. Not stated. Macerated 348 149 91 65 41 2 Not macerated 250 157 38 31 23 1 No statement 8 2 — 2 2 2 Total 606 308 129 98 66 5 The presentations were as follows:— Vertex 377 Complicated vertex 48 Breech 79 Complicated breech 9 Footling 37 Transverse 7 Face or brow 1 Funis 13 Placenta praevia 1 Born before arrival and presentation not known 22 No statement 12 Total 606 Report of the Medical Officer of Health. 93 Some additional information was obtained as to still-born infants not macerated, of eight or more months' gestation, as follows :— One of twins 16 Ascites 1 Abnormally large child 2 Anencephalic head 1 Hydrocephalus 4 Malformed child 4 In mother— White asphyxia 2 Ante partum haemorrhage 4 The rules of the Central Midwives Board require the midwife to notify to the local supervising Death of authority all cases in which the mother or child dies before the attendance of a registered medical or practitioner. In 42 cases midwives notified the deaths of infants, and in three cases notices of deaths of mothers were received. Inquests are held in these cases and also in cases where a medical man, although in attendance before death occurs, does not arrive at a conclusion as to the cause of death. By the courtesy of the London coroners notices are sent of inquests in which midwives are concerned and the Council's inspector attends the court to hear the evidence and learn whether the midwife has complied with the rules of the Board. Reports of 89 inquests were made. These include cases attended by uncertified women, as well as by certified midwives. The verdict in 80 cases attributed no blame to the person in attendance. The following table summarises the verdict with respect to cases in which blame was attributed :— Total number Deaths of mothers. Deaths of infants. Confinement conducted by of inquests. Censured. No censure. Censured. No censure. Midwives 82 — 11 5 66 Uncertified women 7 2 — 2 3 89 2 11 7 69 The cause for the censure shown in the foregoing table was as follows :— Not advising medical assistance to mother early enough 1 „ „ „ for a case of pyaemia 1 Want of ordinary skill (uncertified women) 2 Delay in advising medical assistance for infant 5 In each case where a midwife was found to have failed to comply with the rules of the Central Midwives Board, a letter of caution was addressed to her. The medical evidence given at the inquests as to the cause of death was as follows :— Mothers. Infants. Pyaemia I Atelectasis 15 Pneumonia I Suffocation at birth 13 Pulmonary embolism 4 Suffocation in bed 7 Heart disease 1 Prematurity 8 Haemorrhage on brain 1 Convulsions .* 5 Haemorrhage during labour 3 Bronchitis and pneumonia 5 Collapse from ante partum haemorrhage 1 Tuberculosis 1 Suffocation from air embolism 1 Cerebral haemorrhage 4 i Concussion of brain at birth 1 Jaundice 2 Syphilis 1 Inflammation of lungs 1 Enlarged glands 1 Haemorrhage from cord 1 Septic absorption from bowels 1 Congenital heart disease :r 3 Stillbirth 7 13 76 During the year 1910, 292 cases of puerperal fever were notified in the County and the Registrar General records 161 deaths from puerperal septic disease during the year. Two deaths recorded by the Registrar General refer to cases which were notified in 1909, and two deaths occurred in 1911 of cases notified in 1910, while in one case notified as puerperal fever the death was certified to be due tc secondary post partum haemorrhage, and the death was classified by the Registrar General as accident of childbirth. The term puerperal septic disease used by the Registrar General includes puerpera septicaemia, pyaemia and sapr^mia, as well as peritonitis and metritis occurring in connection witl parturition. A list of deaths is received weekly from the Registrar General and the deaths are compared Puerperal fever 94 Annual Report of the London County Council, 1910. with the notified cases so that it is possible to ascertain whether the latter terminate fatally. Of the 292 notified cases, 102 proved fatal, a case mortality of 35 per cent. Of the remaining deaths recorded, 8 were deaths in London institutions of women confined outside London, and probably notified as puerperal fever in the district where the confinement took place. The other deaths were those of cases which were not notified. Early information of notification of cases of puerperal fever is received from the Metropolitan Asylums Board or from the borough medical officers, and I am indebted to the latter for information as to by whom the patient was delivered. The following table gives the results of these inquiries which relate to the 292 notified cases and 60 deaths of cases not notified in London :— Delivery conducted by Cases. Deaths. (а) Medical practitioners (including cases attended by medical students 219 99 and also cases in which a medical practitioner was in charge of the case, but the birth took place before his arrival) (b) Certified midwives (including cases in which birth took place before 64 20 her arrival) (c) Medical practitioner and certified midwife, i.e., cases in which a 10 3 midwife was unable to deliver and called in a medical practitioner (d) Hospitals and poor law institutions 25 16 (e) Uncertified women 9 5 (f) Cases of miscarriage or abortion where no attendant was engaged 17 11 (g) Cases where patient died in London, but was confined elsewhere 8 8 352 162 The cause of death as stated in the death certificates in the 154 fatal cases where the deceased was confined in London is shown in the following table:— Cause of death. Notified cases. Unnotified cases. Total. Puerperal septicaemia, toxaemia, and septic absorption 70 16 86 (16) Puerperal peritonitis 5 18 23 (10) Pyæmia 7 — 7 Sapræmia 3 2 5 Septic pneumonia — 2 2 Puerperal fever (not defined) 5 — 5(1) Metritis, perimetritis, parametritis and endometritis 4 2 6(3) Toxæmia of pregnancy 2 2 4 Infective endocarditis 1 — 1 Phlegmasia alba dolens — 2 2 Post partum eclampsia — 1 1 Pelvic cellulitis — 2 2 Phlebitis after parturition — 3 3 Erysipelas after parturition — 1 1 Puerperal mania — 1 1 Septicæmia or peritonitis following extra—uterine gestation 2 - 2 Post partum hæmorrhage 2 — 2 Salpingitis 1 — 1 102 52 154 The number of fatal cases of puerperal fever which followed abortion or miscarriage was 30. The classification of these cases is shown by the figures in brackets in the last column of the above table. The age incidence of the 352 cases was as follows: Total. 15-20 20-25 25-30 30-35 35-40 40-15 Over 45 Age not given. Recovery cases 190 7 36 56 38 29 14 1 9 Fatal cases 162 3 26 49 36 29 16 2 1 Report of the Medical Officer of Health. 95 In cases where a midwife was concerned the Council's inspector visited the midwife, learnt particulars of the case from her, made enquiries as to any other patients recently attended, and took steps to ensure that the rules as to disinfection were fully carried out before the midwife resumed her work. In addition to this the inspector ascertained the views of the medical practitioner who was called in to the case. The 64 cases attended by midwives were diagnosed as follows :— Diagnosis. Recovery cases. Fatal cases. Septicaemia 9 14 Peritonitis 1 3 Pysemia — 2 Sapraemia 21 1 Puerperal mania 1 — Salpingitis 1 — Chronic metritis 1 — High temperature due to excitement 2 — Influenza 1 — Constipation and pyrexia 2 — Not given 5 — 44 20 The rule which requires that medical help shall be advised when the patient's temperature rises to 100.4 deg. and remains above that figure for 24 hours has proved useful in affording information concerning cases in which there is danger of the development of puerperal fever; 194 notices were received stating that medical assistance had been advised for this reason. The inspector learnt from the midwife whether the high temperature was persistent and in 141 cases it was found that the temperature had fallen, and no further symptoms of puerperal fever occurred. In some cases where the temperature remained high, although the case had not then been notified, the midwife was directed to undergo the usual disinfection before going to another case. In 53 instances the rise of temperature proved to be the first indication of septic trouble and the inspector was thus able in some cases, before the notification as puerperal fever was known to her, to prevent the midwife from attending other patients until disinfection had been thoroughly carried out. In cases of puerperal fever the services of the nurses of the Queen Victoria Jubilee Institute, the Ranyard and the Holloway Institutes are usually available so that when the midwife ceases to visit, the patient is left in the hands of a skilled nurse to carry out the directions of the medical practitioner called in. In cases where a midwife has pupils or assistants one of them is sometimes set apart to nurse the septic case, attending no other patients meanwhile. A midwife is thus usually able to carry out disinfection and resume her work with as little delay as is necessary to ensure that she is no longer likely to be a source of infection to other patients. The following table shows the day of the puerperium in which (a) the rise of temperature occurred, (b) medical aid was obtained, (c) the case was notified as puerperal fever, and (d) the death took place if the case were fatal. Day of confinement. 2nd day. 3rd day. 4th day. 5th day. 6th day. 7th day. 8th day. 9th day. 10th day. After 10th day. Tot+al. Rise of temperature— Recovery cases 3 — 7 9 3 4 1 3 1 1 5 37 Fatal cases 1 — 4 5 3 1 — 1 1 — — 16 Medical aid obtained— Recovery cases 5 - 6 9 3 4 2 4 1 1 9 44 Fatal cases 1 2 2 6 2 3 — 1 1 - 2 20 Notified as puerperal fever— Recovery cases — 1 1 4 4 5 2 1 2 3 21 44 Fatal cases — — 1 3 1 1 1 4 1 1 7 20 When death took place in fatal cases — - - — 2 - 1 1 4 1 11 20 Of the 11 deaths occurring after the 10th day of lying in, five occurred before the 20th day, four before the 30th day, and two after the 30th day. In 11 cases (4 of them fatal) no rise of temperature above 100-4 deg. was noted by the midwife during her attendance, and medical help was either called by her for some other reason or else it was called by the patient's friends after the midwife had ceased to attend. 96 Annual Report of the London County Council, 1910. The parity of women who contracted puerperal fever was ascertained from the midwife to be— Total Primipara. 2 para. 3 para. 4 para. 5 para. 6 para. 7 para. 8 para. 9 para. 10 para. Over 10 para. Multipara no definite statement. No statement. Recovery 44 11 5 5 3 2 3 2 l 3 l 3 2 3 Fatal 20 7 1 1 2 3 2 — — 3 — — 1 — The following conditions were noted among the cases of puerperal fever attended by midwives:— Recovery. Fatal. Laceration of perineum 3 3 Retained or adherent placenta 2 1 Ante partum hæmorrhage 1 — Post partum hæmorrhage 4 2 Ragged placenta (thought complete by midwife) 2 1 Prolonged labour 1 1 Syphilis 1 — Abscess in uterus 1 1 In five cases of puerperal fever, birth took place before the arrival of the midwife and consequently she was unable to do the usual cleansing of her patient before labour. One midwife had three cases of puerperal fever (two fatal) in her practice during the year. The cases occurred at intervals of 12 and 8 weeks. She has a very large practice and after disinfection attended many cases which were normal throughout. One midwife had two cases (both fatal) during the year, one occurred in January and the next one in December. Two midwives had each two cases (one of which was fatal). A's cases were in March and September, and in the interval she attended some 80 cases, all of whom did well. B's cases were in June and November, and she had several cases in the interval that did well. Three midwives had each two non-fatal cases— A had two cases in September, confined on the 5th and 6th of the month. The symptoms of puerperal fever occurred in the first case on 14th September, and on the 20th September in the second case, after the midwife had ceased attending and had been disinfected. B's cases occurred at an interval of nine weeks. She was disinfected after the first case and delivered some 40 cases before the second case occurred. C's cases occurred at an interval of 14 weeks. She has a very extensive practice and the first of her cases was subsequently diagnosed in hospital as high temperature due to excitement. Accidents of Childbirth In addition to the list of deaths irom puerperal septic diseases, the Registrar-General supplies me with lists of deaths from accidents of childbirth. Among these are included cases of eclampsia, pulmonary embolism, puerperal mania and pneumonia occurring after confinement, as well as deaths resulting from haemorrhage and difficult labours. 148 deaths from accidents of childbirth were recorded during 1910. In 13 of these cases the deceased was attended in her confinement by a midwife. The cause of death in the 13 cases was as follows:— Collapse following ante partum haemorrhage 1 „ „ post partum „ 3 Rupture of the uterus 2 Syncope and cardiac disease after parturition 2 Pulmonary embolism 1 Cerebral embolism 1 Suffocation from air embolism, due to partial separation of placenta 1 Thrombosis of pulmonary artery 1 Lobar pneumonia 1 13 Ophthalmia Neonatorum It is the duty of a midwife to advise that medical help is required when inflammation of the eyes, however slight, occurs in infants. Great stress has been laid by the Council on the importance of strictly observing this rule. When a notice is received from a midwife that medical assistance has been sought on this account, the Council's medical inspector at once visits the infant to ascertain that it is receiving the medical assistance which the midwife has advised, and the midwife is also visited to learn particulars as to the case, the antiseptic precautions taken beforehand, and the disinfection adopted by the midwife after each visit to the case. It was found in some cases that when medical assistance was obtained, the medical practitioner, after examining the infant's eyes, gave directions to the parents as to the course of treatment and left instructions for them to again seek medical help if the inflammation did not yield to treatment, and if there was no improvement in the condition of the child's eyes. So long as the midwife remained in attendance, the treatment was for the most part carried out, at all events once a day ; but many of these cases had not recovered by the tenth day, the time the midwife Report of the Medical Officer of Health. 97 usually ceases her attendance. It was also found impossible for the midwife personally to attend to the infant's eyes as often as was requisite, i.e., in some cases four or five times daily, and this duty was then left to the friends of the patient, who were utterly ignorant of the need for using clean rags and sterile water. The Council felt therefore that risk was being incurred by allowing cases of inflammation of the eyes to receive no more attention than was bestowed on them by the people living in the house. The Queen Victoria Jubilee Institute, the Ranyard Nurses Society, the Holloway Nursing Institute, and the Nursing Sisters of St. John the Divine were therefore approached and asked if they would be willing to allow their nurses to undertake, under the direction of the medical practitioner called in, the care of these infants in order to see that the necessary irrigation or swabbing of the eyes was properly done, and at the proper intervals. All the above societies readily consented and have since rendered valuable services in these cases. The arrangement by which the Council secured the voluntary services of the nurses of these societies was made in August, and from that time until the end of the year nurses attended some 22 cases; 18 of these subsequently recovered. It is, of course, only the more severe cases that the nurses are asked to attend. During the year 160 notices were received from midwives, stating that medical assistance had been advised on account of inflammation of the eyes of infants, and, in addition to these, five other cases came to light in which the onset is stated to have occurred after the midwife had ceased to attend. In two instances where medical help was advised it was not obtained ; neither of these cases was very severe and the infants eventually recovered. There was delay in obtaining medical help in 17 cases, in three instances due to the fact that there were no signs of inflammation during the time the midwife attended, and when the symptoms did appear the friends did not seek medical assistance for some time. In two instances the midwife advised medical assistance, but her advice had not been acted upon when the Council's inspector visited the infant. One mother persisted in refusing to have medical assistance for a period of five days. In one case, a midwife who noticed some inflammation on the twelfth day of life, did not consider the case serious and delayed to advise medical assistance for five days, and in 10 cases where there was practically no inflammation at first, there was a delay of two days in obtaining medical assistance. In all other cases medical help was obtained either on the day of onset or the following day. The Council's inspectors investigated all the cases and endeavoured to watch the progress of the patients and learn the final result. 141 cases were reported to be completely cured. In 11 cases there was impairment of vision, two died while still suSering from the disease, and in 11 instances the result could not be ascertained owing to the removal of the parents, who could not be traced. The duration of the illness in the 141 cases which recovered was :— Disease lasting less than 10 days 58 cases. „ between 10 days and 1 month 45 „ „ more than 1 month 38 , The day of the puerperium on which signs of inflammation were first noticed was : day of confinement, 20 cases ; second day, 21; third day, 12 ; fourth day, 18 ; fifth day, 17 ; sixth day, 12 ; seventh day, 13 ; eighth day, 16 ; ninth day, 18; tenth day, 10; after tenth day, 8. A history of vaginal discharge in the mother was obtained in 59 cases, i.e., in 36 per cent. of the cases. The antiseptics used for the child's eyes at birth, or as soon after as possible, in these cases were boracic lotion in 61 instances, perchloride of mercury in 65, silver nitrate or protargol in 32, biniodide of mercury in 1 case ; boiled water only was used in the remaining 6 instances. In 124 cases the antiseptic was used at the moment of birth ; in 26 an interval of less than half-an-hour occurred, and in 9 a longer interval elapsed, owing to the infant being born before the midwife arrived. The following particulars were learnt with regard to the 11 cases in which impairment of vision supervened, and the extent of impairment is given in the " result." 1. Leucorrhoea in mother (who developed puerperal fever). Boracic lotion used for eyes at birth. Onset of symptoms on fourth day. Medical practitioner in attendance before onset. Result.—Sight in one eye lost. 2. No history of discharge in mother. Child born one hour before midwife arrived. Boracic lotion followed by silver nitrate used for eyes by midwife at earliest opportunity. Onset of symptoms on tenth day (after midwife had ceased attending), medical help obtained on thirteenth day. Result.—Opacity covering right pupil. Nebula over inner half of left pupil. 3. Leucorrhoea in mother. Infant born three-quarters of an hour before midwife arrived Boracic lotion followed by silver nitrate used by midwife for eyes at earliest opportunity. Onset of symptoms on fourth day. Parents would not have medical assistance, although advised, until tenth day. Result.—Nebula slightly encroaching on inner half of left pupil about one-eighth of an inch in diameter. 4. Vaginal discharge in mother. Perchloride of mercury used for eyes at birth. Onset of symptoms on second day and medical help obtained on third day. Result.—Opacity covering inner three-quarters of right pupil. 5. No history of discharge in mother. Boracic lotion and protargol used for eyes at birth. Onset of symptoms on second day and medical help obtained at once. , Result.—Opacities over lower three-quarters of both pupils. 98 Annual Report of the London County Council, 1910. 6. Vaginal discharge in mother. Silver nitrate and boracic lotion used for eyes at birth. Onset on second day and medical help obtained at once. Result.—Opacity over lower half of left pupil and healed corneal ulcer. Slight opacity over inner half of right pupil. Infant can see with both eyes. 7. No history of discharge in mother. Boracic lotion used for eyes at birth. Onset on the second day and medical help obtained on the fourth day. Result.—Opacity of both cornese. 8. No history of vaginal discharge in mother, but previous child, two years old, had ophthalmia and is blind. Perchloride of mercury solution used for eyes at birth. Onset of symptoms on seventh day and medical help obtained at once. Result.—Very slight scar in centre of right pupil. 9. Vaginal discharge in mother. Perchloride of mercury solution, followed by boracic lotion, used for eyes 15 minutes after birth (infant was born before midwife arrived). Onset on the fifth day and medical help obtained on sixth. Result.—Slight opacity over left eye. Child seems able to distinguish light from darkness with that eye. 10. Vaginal discharge in mother. Perchloride of mercury used for eyes at birth. Onset on the seventh day, medical help obtained on eight day. Result.—Opacity over the lower half of right cornea and pupil. 11. Vaginal discharge in mother. Boracic lotion used for eyes at birth. Onset on fifth day, medical help obtained on sixth day. Result.—Cornea of one eye quite opaque. These results summarised are as follow :— Blind in both eyes 1 case. Blind in one eye, other damaged 1 „ Blind in one eye, other uninjured 2 cases. Both eyes damaged 2 „ One eye damaged 5 „ In eight of the cases where there was impairment of vision, the onset occurred on or before the fifth day of life, and in seven instances a history of vaginal discharge in the mother was obtained. The 165 cases of inflammation of the eyes occurred in the practices of 102 midwives— One midwife and her assistants had 10 cases during the year 10 One „ „ „ 9 „ „ 9 One „ „ „ 7 „ „ 7 One midwife had 6 cases during the year 6 One midwife and her assistants had 5 cases during the year 5 Three midwives each had 4 cases during the year 12 Three „ „ 3 „ „ 9 Sixteen „ „ 2 „ „ 32 Seventy-five „ 1 case „ 75 165 All the midwives who had three or more cases during the year have extensive practices, and with one exception the cases occurred at intervals throughout the year. The exception was a midwife who had three cases in one week. The mothers of two of these three infants gave a history of vaginal discharge during pregnancy, and in the third case it was found that three other members of the family had chronically unhealthy eyes; the midwife is said to have disinfected her hands with corrosive sublimate after treating the eyes. So far as could be ascertained, in no case was there evidence that infection had been carried by the midwife from one case to another. Some of the cases of inflammation of the eyes were treated as outpatients at hospitals and a few of these were subsequently admitted as inpatients. When an infant is breast fed it is not, of course, advisable to take it from the mother if arrangements can possibly be made to admit the mother also to the hospital/ With a view to ascertaining whether it would be possible to secure the removal of the mother and child in very severe cases, the various ophthalmic hospitals were approached, but it was found that accommodation was not available in these institutions. Further endeavours have been made by the Council to secure hospital accommodation for mother and infant in severe cases, and the matter is still receiving attention. Classes for Midwives The Council has arranged classes at four centres for the instruction of midwives, and these classes have been attended by midwives who have been in practice for many years, and also to some extent by pupils to supplement the training they were receiving for the examination of the Central Midwives' Board. Midwives showing lack of knowledge of their work have been advised by the Council's medical insnectors to attend these classes. Midwives Bill A Bill based, for the most part, on the report of the Departmental Committee appointed in 1908 to consider the working of the Midwives Act, 1902, was introduced into the House of Lords in March, ]910, by the Lord President of the Council. The Bill was amended in the report stage, but finally not proceeded with. The main provisions of the Bill were : 1. To amend the constitution of the Central Midwives Board. 2. To apportion the financial deficit of the Board among the various counties and county boroughs on a basis of population instead of in proportion to the number of midwives giving notice of intention to practice. Report of the Medical Officer of Health. 99 3. To make an annual registration fee of Is. for all certified midwives. 4. To empower the Board to suspend (with compensation if necessary) any midwife during the time proceedings against her are pending. 5. To require the Supervising Authority to supply gratis to midwives all forms they are required to send and to prepay the postage on such forms. 5. To empower the local supervising authority to aid by grant or otherwise the training of midwives. 6. To give power of entry to inspect lying-in homes where a midwife or an uncertified woman is believed to be practising. 7. To provide that medical practitioners called in at the instance of midwives in pursuance of the rules of the Central Midwives Board shall be entitled, subject to regulations to be framed by the Local Government Board, to recover fees from the Boards of Guardians. Chapter XXXII. Special reports submittted by the Medical Officer of Health during the year 1910 I.—Report by Dr. Hamer on the Typhoid Fever Outbreak of 1910. General Account of the Outbreak with Special Reference to the Bethnal Green Prevalence. On September 15th examination of the weekly notification list showed unusual prevalence of typhoid fever in East London; for there had been notified, in the week ending September 10th, 13 cases in Bethnal Green, 12 in Stepney and 5 in Poplar. The total number of cases in the " east districts " during the week in question was 31 compared with 8, 6 and 8 in the three preceding weeks. The total number for London as a whole, for the week in question, was 57 as comparad with 31, 25 and 20 in the three preceding weeks. Having regard to the behaviour of typhoid fever in relation to season, increase at this time was, of course, to be expected, but it is important to note that the augmented figures, for London as a whole, manifested in the returns for the week in question, are to a large extent accounted for by the heightened incidence in the three " east districts " already named. The Medical Officer instructed me to proceed at once to the implicated districts and confer with the medical officers of health. The facts thereupon elicited made it clear that some special cause or causes of typhoid fever had commenced to operate in Bethnal Green, Stepney and Poplar, approximately at some time during the second week in August. In Bethnal Green, where information already relating to as many as 20 cases was at once available, it was clear that the sufferers belonged in the main to the poorest class of the population, that they had in almost all instances been in London at the time when infection was presumably contracted, and further that there was no reason for suspecting that water or milk was at fault. It was noted, however, that several of the sufferers gave a history of having recently eaten mussels, and many of them further stated that they had on one or more occasions partaken of fried fish. Dr. Bate, Medical Officer of Health of Bethnal Green, had already communicated with Dr. Collingridge, Medical Officer of Health of the City of London, suggesting that enquiries should be made with regard to certain mussels, large quantities of which were being purchased by Bethnal Green vendors at Billingsgate. After conference with Dr. Bate, it was decided it would be well to have further investigation made, concerning the retail sources of milk supply to the sufferers, with a view to learning whether by any possibility a particular wholesale supply was common to two or more of the retailers. Furthermore, it was agreed that, with the assistance of the Bethnal Green inspectors, I should at once commence detailed enquiries into the history of the movements and doings of patients prior to the onset of their illness, so far as these facts could be elicited at the patients' homes; it was later found necessary to follow up these enquiries in most instances by visits to the hospitals to which patients had been removed. It appeared, as the investigation proceeded, that the outbreak involved a larger area than had at first been supposed. Attention was, in fact, speedily directed to small localised prevalences of typhoid fever, practically coincident in time with those already under investigation, in Shoreditch, Islington, Holborn, Finsbury, St. Pancras and Tottenham ; moreover, on communicating with Dr. C. W. F. Young, County Medical Officer of Middlesex, concerning the last-named district, he informed me that there was some increased incidence of the disease in Edmonton also. I placed myself in communication, therefore, with the medical officers of health of all these districts, and, with their co-operation, systematic investigation of the circumstances of the outbreak was undertaken. These enquiries were extended so as to include nearly 300 cases notified during the thirty-third to forty-second weeks of the year, and some later cases also. Having regard to the behaviour of typhoid fever in these localities during the period in question, as compared with preceding and succeeding periods in 1910, and as compared with the behaviour of the disease in adjoining areas, it is clear that at least two-thirds of the total 300 cases must be attributed to some special cause; while the remaining 100 cases represent the number which might reasonably be attributed to the causes ordinarily operating. The result of the examination of possible explanations of the outbreak may be shortly summarised as follows:— Water.—The cases occurring in the localities affected by the special incidence of typhoid fever between the thirty-third and forty-second weeks of the year showed a marked tendency to develop in clusters or groups, of which, as will be seen later, there were 33 in all. This concentration of the cases was especially marked in Bethnal Green, where some 50 cases occurred in a circumscribed area having a population of about 30,000 persons ; but there was also marked grouping of cases in Stepney, Poplar, Shoreditch, and in parts of Islington, St. Pancras, Holborn, and (outside London) of Tottenham and Edmonton. Furthermore, throughout all the areas, the exceptional incidence of cases in these groups upon members of the poorest class of the population was conspicuously apparent. Among the 300 sufferers there were some 20 persons not belonging to this class ; but the 200 associated with the groups and clusters almost all belonged to the poorest class of the population. The circumstances in 5 or 6 of the last-named cases were, it is true, of a special character (a) but this fact rather emphasises than otherwise the limitation of the special prevalence to poor persons. This feature cannot be explained (a) Four were nurses, and one was the wife of a fishvendor. Report of the Medical Officer of Health. 101 on the assumption that the outbreak was water-borne. I have, moreover, had the advantage of conferring with Dr. Houston, the Director of Water Examinations. As a result of this conference it appeared to me impossible to fit the facts of the outbreak with a hypothesis of water causation. Milk.—The source of the milk consumed was investigated in all instances. In Bethnal Green each retail supply was traced to the wholesale source. It was found that the milk partaken of by the various sufferers came from widely separated parts of the country. There was no indication of common origin for any notable percentage of the cases in any of the affected localities. Spread of disease from case to case.—The outbreak was explosive. The dates of onset of illness in Bethnal Green, and in most of the other localities affected, suggest that infection was contracted on Auguat the 10th, 11th, or 12th ; but there were other later (and much smaller) explosive prevalences in some of the London boroughs, the time ot contraction of infection in the most marked of these being about September 1st; there were, moreover, one or more earlier prevalences, contributing, however, only a few cases. In the " multiple house invasions " the dates of onset were, as a rule, within a few days of one another ; and, though there are a few cases in which there may be some doubt on this point, in the majority infection seems to have been introduced into the invaded households at one and the same time. In 24 of the 31 London groups, the dates of onset of cases range from August 10th, or 11th to nearly the end of September (see Diagram). In seven other groups the dates of onset commence and correspondingly terminate two or three weeks later. Cases belonging to the same house are connected together on the Diagram by lines, and it will be seen that few of them admit of being regarded (from the point of view of time of occurrence) as " secondary cases." Speaking generally, it was noted that there was an almost absolute absence of intercourse, relationship, or association between the sufferers in different houses which were invaded. Dr. Byett, Medical Officer of Health of Shoreditch, who devoted careful attention to this question, was of this opinion, and my own detailed investigations, more particularly in Bethnal Green, led me to a similar conclusion. The possibility was considered of common visits to the hopping grounds in Kent, for example, or to seaside resorts, such as Southend, Yarmouth, Ramsgate, Folkestone, etc., and the subject of country outings generally was carefully enquired into. Incidentally the question of conveyance of infection by bathing in the sea, or in canals, rivers, etc., and by the use of swimming baths was investigated, but, generally speaking, in the 200 cases with entirely negative results. Throughout the enquiry the possible operation of a carrier or carriers was prominently kept in mind. As facts, however, were gradually accumulated, it became increasingly clear that none of these hypotheses could be accepted in explanation of the outbreak. Food infection.—In all instances, in Bethnal Green, enquiries were made as to the consumption of shellfish, fish, uncooked vegetables and ice-cream, and questions were generally asked as to the drinking habits of the sufferers (ginger-beer, aerated-waters, etc.). Two articles of food only (mussels and fried fish) had been partaken of by a considerable percentage of the Bethnal Green patients within a month preceding the onset of illness. As regards the former, among the total number of cases (79), occurring in the whole of Bethnal Green, between 10th August and 18th October, it was found that there were at least 45 in which mussels had not been consumed. Limiting consideration, however, to the cases occurring in the area of special prevalence between the dates named, there are found to be, out of a total of 50 cases, 26 with a negative history as regards mussels, and 24 with a positive history. It is thus impossible to regard infection by mussels as the sole and sufficient cause of the special incidence in Bethnal Green. It will be seen, however, that the percentage of mussel eaters is a high one. From a calculation made for me by Mr. Roberts, chief inspector at Billingsgate, it appears that nearly 300,000 Londoners were every week consuming mussels at the time of the outbreak. This is considerably less than ten per cent. of the total population of London. But Bethnal Green consumes far more than its share of mussels, and it may be assumed that, in a population such as that attacked in this outbreak, nearly half would (at this time of year) give a history of eating mussels. In a number of instances the patients themselves were found to be under the impression that their disease was due to their having eaten mussels on a particular occasion. Examination of these instances and of other cases, in which, apart from any belief on the patient's part, mussels might conceivably have been at fault, shows that it had not infrequently happened that other persons as well as the sufferers had consumed the suspected mussels, thus:— In case (6), the mussels were shared with the patient's wife, who remained quite well. In case (15), the mussels were shared with the rest of the family, who remained quite well. In cases (20), the mussels were shared with other members of the family, who remained quite well. In case (24), the mussels were shared with the patient's wife, who remained quite well. In case (27), the mussels were shared with the patient's wife, who remained quite well. In case (39), the mussels were shared with the patient's mother, who remained quite well. In case (47), the whole family ate mussels two or three times a week ; only one member suffered. In case (48), the mussels were shared with the patient's wife, who remained quite well. In case (57), the mussels were shared with the patient's mother, who remained quite well. This list must not be regarded as including all the cases in which more than one person had partaken of a particular batch of suspected mussels, for the number of instances in which the patient was definitely known to have purchased mussels not consumed by other members of the family was very small. There was, moreover, no single instance of " multiple house invasion," in which all the members of the family attacked gave a history of having eaten mussels. 102 Annual Report of the London County Council, 1910. In striking contrast stand the facts relating to fried fish. Among the total number of cases (79) in Bethnal Green there were 68 giving a history of having eaten fried fish within a month of the onset of illness. Limiting consideration to the area of special prevalence, out of 50 cases, all but one had eaten fried fish obtained in the area ; and this last case was subsequently ascertained, at the Metropolitan Asylums Board Hospital to which the patient was sent, to have been notified in error. Examination of my notes shows that in all the " multiple house invasions " the sufferers had partaken of the suspected fish en famille ; while, in the large majority of cases in which only one member of a family suffered, it was found that that member had been in the habit of obtaining a fish dinner or fish supper away from home. (b). In many of the instances last named it ultimately transpired that while the fish consumed by other members of the family was from a shop to which no suspicion was attached, the fish consumed by the sufferer was obtained at one of the shops supplying numerous other sufferers. Thus cases (28), (37), (48), and (52), are instances in point; the patient had obtained fried fish from a suspected source, while other members of the household had not eaten this fish. Examination of a fried fish hypothesis of causation.—With a view to testing further a fried fish hypothesis, the whole subject of retail fish supplies in the special Bethnal Green area was made the subject of careful study. In this enquiry, I was fortunate in having the help of Mr. Rowsell, the Bethnal Green food inspector, who has intimate local knowledge, and who gave me every assistancein his power (c). Within the special area in Bethnal Green there are 27 fried fish shops. The approximate extent of trade done by each shop can be roughly estimated ; some are quite small, only disposing of one or two trunks of fish daily ; the majority deal on an average with three or four trunks daily ; there are a few shops carrying on a larger trade than this. The question now arises, assuming that 50 fried fish eaters be selected at random within the special area, and that they be asked to name the fried fish shops from which they had during the preceding month obtained fried fish, how often might it be anticipated that each of the 27 fried fish shops in the area would be named ? Regard must obviously be paid to the extent of the business done at each shop, and to the shop's position in the area ; shops centrally situated in relation to the aggregation of cases are obviously more likely to be named than those situated on the area's confines. It would, of course, be expected that some of the 50 fried fish eaters would name more than one shop. As a matter of fact the 50 sufferers gave some 80 names; of these 71 were those of shops within or close to the area, the others being, as a rule, in the neighbourhood. Using the information given by Mr. Rowsell, I estimated that if 71 names had to be distributed among the shops (within or immediately adjoining the area) in the proportions which mere chance would determine, having regard as aforesaid to the amount of trade done and the position of the shop within the area, it might be anticipated that:—In one instance a particular shop would be named 5 times. In 3 instances particular shops would be named 4 times. In 3 instances particular shops would be named 3 times. In 12 instances particular shops would be named twice. In 8 instances particular shops would be named once. There would then remain 13 names to distribute; these might reasonably be allotted to shops just outside the area, as obviously some of these shops would be patronised as well as the shops within the area. Against each shop can now be set the number of times it is, so to speak, entitled to be named, and the number of times it actually was named, by the sufferers from typhoid fever. The list is as follows :— Number ol times Number of times Shop. shop was entitled Number of times Shop. shop was entitled number ot times to be named, (d) shop was named. to be named, (d) shop was named. 1 5 2 15 2 1 2 4 — 16 2 — 3 3 2 17 2 — 4 4 2 18 2 12 5 4 25 19 1 2 6 2 — 20 2 2 7 3 — 21 1 — 8 3 2 22 1 1 9 2 2 23 1 — 10 2 1 24 1 — 11 2 12 25 1 — 12 2 1 26 1 1 13 2 1 27 1 I 14 2 1 (b) This was in marked contrast to the facts observed concerning mussels. (c) The question of the age-incidence of the sufferers was of course considered. Hitherto, in fish outbreaks, the ages 3-25 had been found to be more especially attacked. The cases in Bethnal Green, at these ages, slightly exceeded, and in the London prevalences generally such cases considerably exceeded, those at other ages. On the whole it was found that the ages of the Bethnal Green sufferers corresponded with the ages of the purchasers at the Bethnal Green shops. (d) Owing to the nature of the assumptions made and the approximate character of the results, fractions have been disregarded and a whole number has been placed opposite each shop in this column. Obviously if the data available had been quite precise the sum of the numbers in columns two and three of the Table would have approximated more closely to one another. If case 69 be included, shop B was named 13 times, and if two cases at a little distance from the special area be included, shop 5 was named 27 times. (See Diagram.) Report of the Medical Officer of Health. 103 It transpires, therefore, that shop 5 is named more than 6 times as often; shop 11, G times as often ; and shop 18, 6 times as often, as would have been anticipated were the distribution of names a mere matter of chance. Furthermore, it will be seen that 49 of the 50 sufferers had obtained fried fish from one or other of these three shops. The fiftieth was the case diagnosed in error. It remains to be stated that the fish sold at shops 11 and 18 was brought by a particular man from Billingsgate. This incidence upon three shops, or as it may also be put upon two fish supplies, is very striking. It cannot be urged in explanation that these shops happened to be centrally situated, and therefore were named more frequently ; for shops Nos. 1, 4, and 8 are, as a matter of fact, situated, if anything, more centrally than are shops 5, 11 and 18. Shop 5 is close to shops 4 and 8; and yet while shops 4 and 8 were only quite exceptionally mentioned, no fewer than 25 of the sufferers had purchased fish at shop 5. It should be noted that shop 5 was, moreover, a shop which especially fell under suspicion in connection with typhoid fever in 1908. (See Appendix I. to Annual Report of the Medical Officer of Health, County of London, 1908.) • So far as the Bethnal Green special area was concerned, therefore, an hypothesis of infection by two particular consignments of fish sold at three fried fish shops affords complete explanation of the outbreak. Outside the special area, however, but within Bethnal Green, there were certain small groups of typhoid fever cases. It is necessary now to discuss these and other groups in London and the suburbs occurring at the time of the prevalence in the special area itself. Examination of the Behaviour of Typhoid Fever in London Generally and in some Areas Outside the County Boundary. Question was, in fact, now seen to arise as to the possibility that fish, sold at various shops throughout London during August and September, gave rise to typhoid fever. The cases in 10 London boroughs, and in two districts just outside London showing special prevalence of typhoid fever during these months, were found, as has already been stated, to fall into clusters or groups. These groups, 33 in number, consist in the main of cases in which none of the ordinarily accepted modes of origin of typhoid fever could be appealed to for explanation, but in which the sufferers had either eaten fried fish purchased at one particular shop in each group, or had eaten fish purchased in the uncooked condition from one or another common source (shop, stall or market street). After separating out these groups of fish cases there remain in each district residua of cases which cannot be associated with fish obtained from any particular source. The cases forming these residua present, in a few instances, a history suggesting infection abroad, or in some other part of England; in other cases (the majority), no obvious source of infection was ascertainable. The residual cases represent, area by area, approximately the number of cases which might reasonably be expected to occur, apart from any special cause in the 12 areas. So far as the London boroughs are concerned, the date of onset of symptoms has been determined in every case, and each has been given a distinctive serial number in the particular group in the borough to which it belongs. This arrangement of the cases will be rendered clear on study of the accompanying Diagram. The cases are distributed in horizontal zones or sections of the Diagram, p.s follows; — 1. Bethnal Green—Cases include those supplied from shops A, B, C, and D. ; from market streets a and b ; and a residuum of cases. 2. Shoreditch—Cases include those supplied from market streets b, c, and from a market street d ; those last-named being included with a residuum of cases. 3. Islington.—Cases include those supplied from shops E, F, G, H, I, K, and stall L, with a residuum of cases. 4. Finsbury—Cases include those supplied from stall, L, shop M, and a residuum of cases. 5. Stoke Newington—Cases include those supplied from shop N, and a residuum of cases. 6. Hackney—Cases include those supplied from market streets b and e, shop P, and a residuum of cases. 7. Poplar—Cases include those supplied from shops D and S, by a coster R, and a residuum of cases. 8. Stepney—Cases include those supplied from shops S, T, and Y, stall U, market streets a and /, and a residuum of cases. 9. St. Pancras—Cases include those supplied from stalls W and X, from street g, and a residuum of cases. 10. Holborn—Cases include those supplied from stall X, and a residuum of cases. As regards distribution of the cases in time—the whole period covered dates from early August to the middle of October. It will be seen, however, that while in 24 of the horizontal sections which correspond to sources of fish supply, the dates of onset range (with one or two exceptions to be later referred to) from early August to late September, in seven of the horizontal sections the dates commence some three weeks later, and correspondingly terminate about three weeks later also. The seven sections in question are : Islington (shop K), Hackney (sources e and P), Stepney (shop V), St. Pancras (sources g, W and X)—X appearing also in Holborn. The sections shaded include the residual cases, those apparently not due to fish infection. It should be noted that towards the right hand side of some of the shaded sections (Bethnal Green, Islington and Stepney), there is some grouping or aggregation of cases. The explanation of this aggregation may possibly be that some unrecognised source of infection was playing a part in the boroughs concerned at the time; it has, however, been found impossible to indicate this particular source. 104 Annual Report of'the London County Council, 1910. In Islington cases 31, 32a, 37 and 38 obtained fried fish from a common source, a shop J. If they were fish-infected cases it will be observed from the time of their occurrence, that they belong to the later of the two infections already referred to. In Stepney it will be seen (See notes on Diagram) that three or four of the cases included in the horizontal shaded section were possibly cases of fish infection. Nos. 36 and 42 obtained fried fish from a common source, and 37 was probably infected by fish from shop S. A word remains to be said concerning certain cases in which the onset occurred in the first few days of August. It is possible in the light of subsequent events, that two or three of the cases developing at that time in the following boroughs, viz. : Bethnal Green (market street a, case 1); Islington (shaded section, cases 2 and 3) ; Islington (stall L, cases 4 and 5) ; Finsbury (shop M, case 1) ; were really due to infected fish distributed late in July, i.e., some time before the date of distribution of the fish causing the main explosive outbreak. It must, of course, be borne in mind that, in those instances in which a retail source of supply of fish was situated near the boundaries of two or more boroughs, it may have supplied sufferers in more than one borough. (See Diagram.) Thus source a supplied cases in Bethnal Green and Stepney ; source b, cases in Bethnal Green, Shoreditch and Hackney ; source d, supplied cases in Bethnal Green and Poplar ; and source X supplied cases in St. Pancras and Holborn. It will be noted that the source from which fish was obtained was sometimes a fried fish shop, in other instances a shop or stall in a market street, or a perambulating coster's barrow. Wherever a fried fish shop was the common source it will be seen that the numbers indicating the cases are all ringed around. The circle signifies that these sufferers were ascertained to have purchased the fish in the fried condition. Where, however, the suspected retailer, who supplied all the sufferers in the group, sold the fish wet, it was often found that no history to the effect that fried fish had habitually been purchased could be obtained. The point is an important one, affording as it does corroborative evidence of the correctness of the fish hypothesis (e). It will be noted further that 32 out of 96, i.e., some 34 per cent. of those sufferers who formed the residuum of cases in each borough were not fried fish eaters. In previous enquiries concerning typhoid outbreaks attributed to fried fish, a considerable sample of the population of the affected area has been made the subject of study, in order to obtain a " control " showing the extent to which fried fish eating obtained in the affected area. Thus in Southwark, in 1900, it was found that 58 per cent. of the population had eaten fried fish within a month of the time of the enquiry. Again, when, in 1908, question arose as to the prevalence of typhoid fever in Bethnal Green, a number of streets comprised within the area then involved (and, as it happens, also within the special area involved this year) were sampled in a similar way. It was found (See Appendix I., Annual Report for 1908) that 63 per cent. of the control population had consumed fried fish within a corresponding period just preceding the time of the enquiry. It must be borne in mind that in both the Southwark and Bethnal Green areas an exceptionally large amount of fried fish is eaten. In any area taken at random in London, a far smaller percentage of fried fish eaters would probably be found. As has been shown (Appendix I., Annual Report 1903) typhoid fever in London mainly occurs in a class of the population among whom fried fish eating is particularly common. In the prevalence of 1910, in the Bethnal Green area, fried fish alone was in question. This circumstance greatly simplified study of the relation of fish-eating to typhoid prevalence. Out of the total 50 sufferers only 32 could have been expected, as a matter of chance, to give a history of eating fried fish ; but, as a fact (excluding the wrongly diagnosed case) all the sufferers gave such a history. Of course in localities in which wet fish comes in question the matter is more complicated, for many persons who never consume fried fish may clearly, be expected to give a history of eating wet fish. It should, however, be noted that the sufferers in the present outbreak, whether fried fish eaters or not, had all consumed fish of a particular kind (plaice, flounders, or dabs), but of this more must be said in the sequel. Analysis of the history as to fish eating of the sufferers in the outbreak, leads, therefore, to the grouping of the London cases topographically into 31 clusters or groups, and in their time relations into two main divisions as already mentioned. The 31 clusters centre around 24 shops or stalls and 7 market streets in which presumably a single shop or stall was at fault, but such shop or stall cannot be more precisely indicated. In addition to the 31 London groups, there are those in Tottenham and Edmonton; furthermore, some scattered groups of cases occurred in Bermondsey, Lewisham, Battersea and Acton (vide infra). It was clearly important to ascertain whether the 31 London retail supplies which thus fell under suspicion were in any way associated one with another. Were they in fact derived from common wholesale sources ? It was ascertained that in every instance the retail supply was obtained direct from Billingsgate, and in all instances in which information with reference to this point could be obtained, the fish falling under suspicion was " plaice " (including " flounders " and " dabs "), and was, moreover, what is known as " late steamer fish." This exclusive derivation from Billingsgate is not, at first sight, remarkable ; but having in view the fact that quite a considerable percentage of the small retail shops have fish sent direct from the coast by rail, it is a priori exceedingly unlikely that among 31 retail vendors questioned, no single one would be so supplied. As regards the Billingsgate fish, roughly two-thirds is " rail," and one-third " steamer fish" ; and though the category " late steamer fish " (/) is one difficult to define precisely, it may certainly be assumed that considerably less (e) It will be noted that whether the fish was sold wet or cooked it had been derived, in the case of each group of sufferers, from one source. * (/) The fish sold between, say, 9 and 10 a.m., after the higher-priced fish has been disposed of, would appear to be that referred to. Report of the Medical Officer of Health. 105 than one-tenth of the fish sold at Billingsgate could be thus classified. There is, moreover, the further consideration that the fish which came under suspicion was " plaice." Hence it may be stated that with regard to at least 95 per cent. of the Billingsgate fish, no question whatever arises. It transpires, in fact, that all the retail vendors coming under suspicion had obtained fish included in a category comprising only a comparatively small percentage of the fish sold at the market. The odds against such a distribution of fish to the 31 retailers being the result of mere chance are, of course, enormous. The attempt was made to pursue the matter further and to learn whether the fish had passed through the hands of any particular salesman or salesmen in the market, or whether one or other of the four steamer companies supplying the market was solely implicated ; but the records kept by the retail vendors were not of a kind to enable this to be done. Incidentally, however, some curious facts were elicited with regard to the conveyance of fish from the market. It has already been noted that the supplies to shops A and B were brought from Billingsgate by the same man. It was further ascertained that a particular fish carrier supplied shops F, G. and H all in one borough, and shop I and some neighbouring shops at a considerable distance from shops F, G, and H, and, situated in another borough. It was found, moreover, that a second carrier who supplied vendor D occasionally supplied fish to fishmongers in market street e. This man sometimes supplied shop 0, and he always carried the empty boxes back to market from this shop. It is, moreover, probable that he supplied the suspected stall U. A third carrier frequently supplied the retailers Q and N, and this carrier on his outward route passed by street c, and occasionally supplied fish there. He also supplied fish to vendors in North Hackney, where a group of six cases occurred. It should be noted, however, with regard to this group that the patients did not belong exclusively to the poorest class of the p6pulation. Lastly, a fourth carrier, one of whose customers was the fishmonger P, also supplied a vendor in Islington, two of whose customers were attacked early in August; it is probable, moreover, that he occasionally supplied K, and in the course of his rounds to his other customers he passed the shops of two retailers whose supplies came under suspicion, and it is possible that he supplied yet another suspected retailer. This carrier said he could not furnish a list of those whom he supplied, and no further light on the matter could be obtained from the retail vendors themselves. The series of coincidences just detailed is especially remarkable in view of the fact that the general practice in the fried fish trade is for vendors to cart their own fish home; indeed, it is only in rare instances that the employment of a carrier, even on exceptional occasions, is resorted to. The Tottenham and Edmonton Cases.—For the information with regard to these, I am indebted to the County and District Medical Officers and to Dr. F. Thomson of the North-Eastern Hospital, to which Institution some of the Tottenham cases were admitted. Here again, in Tottenham and Edmonton, as in I ondon, comparatively well-to-do persons are included among the residual cases outside the groups, but within them the same class as in the London groups was affected, and fried fish eating is the only ascertainable common circumstance. In the case of both districts the evidence pointed to particular fish shops having been concerned in supplying the patients. The September groups of London cases.—As has been seen, in the case of 24 of the 31 London retail sources of supply, and of those in Tottenham and Edmonton, the period of invasion of illness extended from 11th or 12th August for four or five weeks (g). In the case of the seven remaining sources of supply the period covered by the dates of onset of illness extended for four or five weeks from the beginning of September. In these later groups of cases it is important to note that the retail sources were distinct from those implicated in the previous groups. Among the seven groups now under consideration is a remarkable group in Hackney, deriving fish from two immediate (retail) sources, but possibly from one wholesale source, to which special reference must be made. A single case of typhoid was associated with each of two shops belonging to the retailer P, and this man supplied also two institutions, in one of which five cases of typhoid fever occurred. He supplied, moreover, another institution from which a single case of typhoid fever had been notified some weeks previously in fact at about the time of occurrence of the principal prevalence (that commencing in early August) already referred to. Coincidently with the cases among P's customers a group of seven cases occurred among persons who had brought fish from a vendor 0, whose shop was close to the institution yielding five cases. It was surmised that the cart which brought fish to P might possibly also have brought O's fish ; and that thus fish from one and the same source was supplied to 0 and P ; this was not conclusively demonstrated to have been the case, though there was evidence supporting the conjecture (h). (g) In a few cases the period was even longer (at furthest six weeks), but most of these later cases were from houses in which a previous case had occurred. (h) The facts concerning the cases in the Institution may be briefly summarized as follows:—Between 17th September and 18th October, four nurses and a dormitory maid developed typhoid fever. Three of the nurses had been working in typhoid wards, though in one case there was only just time for the incubation of the disease. The fourth nurse, though not regularly employed in the typhoid wards, had on exceptional occasions entered them. The dormitory maid had never been in typhoid wards, nor, so far as could be ascertained, had she been brought into contact with infected persons. Moreover, the ward maid, who was attacked early in August at the other Institution, had not been associated with typhoid patients. With regard to the incidence of the disease upon those working in typhoid wards, examination of the records as regards nurses and patients by the medical superintendent and myself, showed that at the time when the staff illnesses commenced it was roughly an even chance that any nurse selected at random in the hospital would be a " typhoid nurse." It cannot, therefore, be assumed without question that the cases among the nurses Were necessarily cases of direct infection. It was noted that no patient in the hospital had been attacked, and it further transpired that patients did not eat plaice ; this fish was consumed by nurses and ward maids. This circumstance, together with the fact that cases of typhoid fever had coincidently occurred among eaters of plaice in the neighbourhood of the hospital, undoubtedly arouses suspicion. There was, indeed, coincident attack of nine consumers of plaice, all living close to the Institution ; and, furthermore, as regards two of these persons there was the certainty, and as regards seven others the possibility, that this fish had been brought from Billingsgate by a particular van, and was all presumably, therefore, derived from one common source. 5176 H 106 Annual Report of the London County Council, 1910. It may here be noted that further cases occurred in association with these supplies. Thus six patients sickened in the last few days of October. Two in Hackney were customers of P ; two others also in Hackney, were costomers of O ; the remaining two were boys living in Tottenham, who had obtained fried fish from the shop customers of which had, at an earlier period, suffered coincidently with customers of O and P. It should be added that members of a household attacked in November had consumed fried fish obtained from O. The circumstances of these cases were very fully investigated by Drs. Goodall, Gordon, Warry and myself. In brief, of 11 members of the family eight developed typhoid fever between 11th November and 20th November; these eight had eaten fried fish obtained from O—the three members of the family escaping had not done so. Later, however (8th December), one of the latter developed the disease. Other groups of cases notified late in 1910 include three groups of multiple cases in houses in St. Pancras, Shoreditch and Finsbury, all the sufferers being fried fish eaters ; groups of cases in Gamberwell and Southwark, in the former borough there was some suspicion, and in the latter there was strong suspicion of fish infection; and a group of eight cases (four in one house) all fried fish eaters in Edmonton. The same source of fish supply was in question in the last instance as in the earlier group of Edmonton cases, and it is noteworthy that the later Edmonton group occurred at the time when the family group of eight cases occurred in Hackney among customers of the vendor O; thus both groups of Edmonton cases were affected coincidently with the customers of O. (See p. 105.) On the Extent to which Fish Infection has occurred in London in Recent Years. The circumstances of the present outbreak of typhoid fever raise question with regard to London typhoid fever generally. In Bethnal Green the occurrence of 50 cases in a limited area has enabled a close analysis of the facts in relation to possible causes to be made, with the result that a fried fish hypothesis emerges as the only obtainable explanation. In nine other boroughs of London, and in Tottenham and Edmonton, there were contemporaneous excessive prevalences of typhoid fever, and these prevalences also admit of explanation on a fish hypothesis. It is thus possible to proceed from an established case to other cases in which the proffered explanation must be felt to be a probable one. But coincidently with the excessive prevalence in the 12 named sanitary areas, there was the observed " normal " incidence in the rest of London. If analysis be made of the cases which make up this normal incidence it will be found that in addition to scattered or " sporadic " cases there were a few instances of grouping. Thus, three cases were notified from one house in Battersea. Dr. Lennane, the medical officer of health, made them the subject of full investigation, but no cause could be traced. The patients, he noted, were eaters of fried fish. A group of cases at Rushey Green was investigated by Dr. Wellesley Harris, the medical officer of health of Lewisham, with a like result. Bermondsey showed some excess of typhoid fever, though less than that exhibited in the 10 boroughs already named. Dr. Brown, the medical officer of health, could find no explanation of this incidence; but there was some suggestion of grouping, and it may be that fish sold by a coster from a barrow, and fish from a particular shop, one or other of which had been consumed by the sufferers, had infected a number of the patients. In Wandsworth a curious group of cases occurred, again at the particular time in question, but here there was an earlier case in the neighbourhood, and there is room, therefore, for more than one explanation of the prevalence. Lastly, just outside the County boundary in Acton, eight cases occurred in one house, all the patients sickening within a few days of one another. The eight sufferers had eaten fried plaice, and the one inmate of the house not attacked had not done so. Three cases simultaneously occurring in the near neighbourhood of this house were in all probability fish infected also. Curiously enough coincidently with these typhoid fever cases, three instances of " fish-poisoning," one of them involving a large number of persons, were reported from within or near London. Question necessarily arises as to whether or no some of these widely scattered groups, and further as to whether some of the sporadic cases occurring at this time, may not also be attributable to fish infection. In the Appendix to the Annual Report of the Medical Officer of Health of the County of London for 1903, a similar question was discussed at some length. It will, therefore, be sufficient here to refer to certain facts bearing upon the subject which have come to light since the occurrence of the prevalences of fish-borne typhoid of 1900 and 1903. The typhoid prevalence of 1906.—In 1906, between 1st and 20th June, 100 cases of typhoid fever occurred in seven areas in London and West Ham. The suddenness of the outbreak made it possible to exclude contact infection, rendering it practically certain that water, milk or other food was at fault. The evidence from all seven areas was to the effect that milk could be excluded and the areas were so scattered and so definitely localised that infection by water was rendered highly improbable. As regards other foods, 53 per cent. of the sufferers had eaten cockles during the month prior to attack. All save three of the London sufferers (92 per cent.) had eaten fried fish during the four weeks preceding attack. Despite the large number of cockle eaters, a cockle hypothesis was inadequate, for it left 40-50 cases unexplained. On the other hand a fried fish hypothesis received support from the following facts :— 1. The age-distribution of the sufferers was practically that which obtained in the Southwark outbreak of 1900. 2. In three of the seven areas most of the sufferers were supplied with fried fish from shops owned by the same man. Report of the Medical Officer of Health. 107 In West Ham there were two areas affected; in one there were some 50 cases, in the other 13. These outbreaks were believed to be due to cockles. (See Annual Report, Medical Officer, West Ham, 1906.) At the time there were felt to be difficulties with regard to the cockle hypothesis, for in West Ham, and this was the case in London also, only about half the sufferers gave a history of eating cockles. The London patients were all personally questioned by me with regard to this matter, and with reference also to fried fish. The argument was, however, used that 50 per cent. of cockle eaters is a larger percentage than obtains in a random sample of the population. If 50 per cent. admit having eaten cockles, it was urged, may not more have actually done so ? At the time this difficulty was not completely eliminated. Attack of seven persons in one family in Chelsea in May, 1907.—My attention was called to these cases by Dr. Parkes. These seven persons (five living in one house and two in another house) developed typhoid fever between 13th and 17th May. I made careful enquiry as to the food consumed by the seven sufferers. The two persons who lived away from the other five had some meals in common with them. The only food supply, among foods believed capable of transmitting the infection of typhoid fever, common to all seven persons, was found to be fried fish. The prevalence of 1908.—In 1908 an outbreak of typhoid fever occurred in Bethnal Green, which was studied in detail (Appendix I., Annual Report of the Medical Officer of Health of the County of London). In this outbreak, as in that of 1906, the question was narrowed down to one between fish and shellfish, the shellfish under suspicion being, however, now mussels not cockles. As in 1906, it was found that a fried fish hypothesis was adequate to explain the outbreak, for, making allowance for sporadic cases, all the sufferers were fried fish eaters. As regards mussels, out of 28 cases, only nine or ten patients gave a positive history—clearly, therefore, a mussel hypothesis was inadequate as a sole and sufficient explanation of the prevalence. There remained, however, the fact that the percentage of mussel eaters was considerable. Enquiry in a " control population " led to the conclusion that out of 28 sufferers, only five or six could be expected to be mussel eaters, and here among the 28 sufferers were nine or ten mussel eaters. This explanation, however, is really sufficiently obvious. The control population may be divided into two portions, a fried-fish-eating portion and a non-fried-fisheating portion. Clearly the habits of these two portions may differ as regards eating mussels and other shellfish. It might, perhaps, be anticipated that among the fried fish eaters there would be a higher proportion of shellfish eaters than among the non-fried-fish-eaters. Assuming, for the purpose of argument, that typhoid fever picked out in the prevalences of 1906 and 1908 the fried fish eaters, it might so chance that the outbreak was selecting a population containing in 1906 a somewhat higher percentage of cockle eaters, and again, in 1908 a somewhat higher percentage of mussel eaters than the control population. As a matter of fact, almost half the sufferers in 1906 had eaten cockles (the outbreak occurred in the cockle season), and nearly half the sufferers in 1908 and again in 1910 (outbreaks occurring in the mussel season) had eaten mussels. The percentages, of cockle eaters among the sufferers in 1906, and of mussel eaters in 1908 and 1910, were higher than those of control populations, because the suffering population was a selected population; the typhoid fever had, in fact, in selecting fried fish eaters, chosen populations having comparatively high percentages of shellfish eaters. The explanation is thus the obvious one-—that the fried fish eater is more fond of shellfish than the non-fried-fish-eater. The possibility may be mentioned that the fried fish eater is more partial also to other articles, such as watercress and ice cream, (i.) The prevalence occurring early in 1910.—One other prevalence must be referred to. Dr. Parkes, Medical Officer of Health of Chelsea, on 12th February, called the Council's Medical Officer's attention to three cases of typhoid fever. Dr. Parkes wrote : " I am inclined to think that these cases are due to something the boys buy in the streets." Enquiry yielded no feature common to the three cases, save consumption of fried fish. Coincidently with these cases there occurred six cases in Wandsworth. I conferred with Dr. Caldwell Smith with regard to these cases, and the result of our joint enquiries led me to suspect that they had the same origin as the Chelsea cases. One of the Wandsworth cases was that of a girl living in an institution in Wandsworth. A girl living in Fulham was a day scholar at this institution. The two girls developed typhoid fever at about the same time. The only meal partaken of in common by the two girls was dinner, and all the articles of food (other than fish) which have been credited with transmitting typhoid fever could be absolutely excluded. Six cases (five from one house) in Stepney occurred coincidently with the above cases. Here again, suspicion fell upon fish, and curiously enough fish from a source which again came under suspicion in 1910. Moreover, 15 cases occurred in members of three families living in the same neighbourhood in Camberwell, at about the same time. The facts regarding this group of cases admit of more than one interpretation; but in view of the time relations of this group and the other groups it is probable that they were also fish cases. These prevalances illustrate the difficulties associated with the question of infection by fish ; at the same time they point to the probability that fish infection is a not uncommon cause of occurrence of sporadic cases of typhoid fever in London. As to the Contamination of the Fish. There is a question with regard to the way in which fish become capable of transmitting infection which must now be briefly referred to. In the case of the outbreaks of fish typhoid of 1900 two points were already clear, (i) In this connection attention may be called to two outbreaks of typhoid fever in Hackney in 1903, and to a third prevalence there in 1904. The outbreaks had been attributed to watercress, but facts which have since come to light throw some suspicion upon fried fish. 5176 H 2 108 Annual Report of the London County Council. 1910. First.—That the kind of fish implicated was plaice (including in this term flounders and dabs); that small plaice were specially open to suspicion, and that there was a possibility that the question of failure to remove the gut (i.e., imperfect cleansing of the fish) was an important one in connection with communication of infection. Second—That the fish were already infected before reaching the retail vendor. This fact was already apparent in 1900, inasmuch as in that year at least three widely separated populations in different parts of London, obtaining fish from retail vendors having no association one with the other were involved in the typhoid prevalence. The experience of the last 10 years goes to confirm these conclusions. It was not found possible in 1900 or in 1903 to determine whether railway or steamer fish was in question. In the August and September prevalences of 1910, however, all the retail vendors implicated had received steamer fish. It does not, of course, follow that steamer fish is necessarily always at fault. It appears, indeed, that railway and steamer fish are apt to be derived in some instances from identical sources in the North Sea. It has been suggested to me that the possibility of contamination of small fish, in what are known as the " nursery grounds " in the North Sea, is not so remote as might at first sight be supposed. The publication of Reports on the Research Work of the Board of Agriculture and Fisheries has brought to light facts of great interest with reference to the distribution of small fish. The first of these Reports published in 1908, stated that " large quantities of small immature plaice were being swept up by the (North Sea) trawlers each year, especially in the summer months " ; and that the species (plaice), " was annually being caught in an immature state in vast numbers on certain grounds." The small fish abound at some seasons in shallow waters, but a particular shallow water area, known as A3, which with another area, B " formed the ' small plaice grounds' off the Danish Coast, is the only A area (i.e., the only shallow water area) in which an appreciable quantity of plaice was caught." Again in A;, the Danish inshore waters, and the so-called " small plaice grounds," 83 per cent. were small, while in B„ which is immediately outside this area, the percentage of small was 76. Reference to the map, published with the Report just referred to, shows the position of the area A , which comprises this offshore water, having a depth of 0-20 metres, bordering upon the German and Danish coasts. The area is described (Annual Report of Proceedings under Acts relating to Sea Fisheries, 1906) as being one in which " the 20 metre line extends to a much greater distance seawards than on the English and Dutch shores. . . the ground shelves gently into the deeper water of the B4 area without any marked change in depth or bottom." The area is shaped somewhat like a reversed letter L—thus J—the portion represented by the vertical stroke having its long axis north to south, and extending in places as much as 20 miles and more from the Danish and German coast line. This portion contains the important fishing grounds known as the Horn Reef, Sylt, etc. The horizontal portion borders upon the German coast, and is narrower as a rule, than the vertical portion; at the angle of the two portions is the mouth of the Elbe. The entire area comprises 4,750 square miles, but the fish are apparently derived mainly from certain " grounds " within it. The division of the North Sea into large areas, it is stated in Volume I. of the Plaice Fisheries Report, was one which was necessarily adopted because of the impossibility of obtaining statistics as to particular fishing grounds ; for to disclose " the quantity actually caught on each particular ground would be regarded as a breach of confidence by those who give the information. The ' areas' enclosing as they do a great number of grounds, do not disclose information of this kind." The published reports, therefore, contain no information as to the extent to which plaice are obtained from particular " nursery grounds " situated close inshore or within the estuaries of the big rivers. The question of the three-mile limit must not be overlooked ; but there is always a possibility that fish caught by foreign boats may find its way to the London market. The subject seems deserving of further study, bearing in mind the known ability of some of the small flatfish, e.g., the flounder (See Camb. Nat. Hist., Vol. V.) to ascend rivers; and the extent to which special attention has even been devoted to catching such fish in tidal waters. Thus, half a century or more ago, the Thames fishermen are stated by Professor H. G. Seeley to have used a " tuck net" for the capture of flounders between Deptford and Richmond. The plaice, like the flounder, is said to ascend slow rivers to some distance from the sea (Chambers' Encyclopaedia), and it has been found to thrive well in fresh water ponds. In recent years the distribution of small plaice in some of the Scotch estuaries has been precisely studied. (See British Marine Food Fishes. Mcintosh and Masterman.) It is desirable, therefore, that more knowledge should be available as to all the " nursery grounds " from which the smaller flatfish, particularly those of area A3 are obtained. The question of legislating, with a view to limiting the destruction of small plaice, has received much attention during the last six or seven years ; the fear being entertained that the North Sea would be depleted of its fish. The admissibility of small flatfish to market may, however, prove to have importance from an epidemiological point of-view as well as from its industrial aspect. Many vendors have assured me that the retail traders would welcome the imposition of a size limit. It is stated in the Plaice Fisheries Report that at Billingsgate a 20 centimetre limit is imposed. This limit is not a high one, but the rule at certain times of the year is clearly honoured in the breach as well as in the observance. It is worthy of note that during the period in which special attention has been directed to the subject of depletion of the North Sea, the amount of small plaice brought to Billingsgate has notably diminished. Typhoid fever in London has also shown a decline in this period. The fact has been noted in earlier reports, and is amply confirmed by experience gained in 1910, that some of the sufferers from typhoid fever have complained of a " gassy " and again of a " bitter " taste in the fish, to consumption of which they have attributed their illness. In a Report presented Report of the Medical Officer of Health. 109 by the Council's Medical Officer to the Committee four years ago, the following passage occurs : " The fish trade has its own inspectors, appointed by the Fishmongers' Company, and action in particular instances, more particularly as regards shellfish, has been taken by the City Corporation, but no systematic control by a sanitary authority, such as is now regarded as necessary in the case of other sorts of food, has hitherto been instituted. A considerable experience of the condition of fish arriving at shops in the poorer parts of London, acquired by officers of the London County Council, more particularly during recent years, shows that the inspection carried out at Billingsgate affords no sufficient security against the consumption of fish unfit for food." This report to the London County Council was considered by the Sanitary Committee of the Corporation, and that Committee, on 10th June, 1909, issued a report submitting a memorandum on a scheme, the acceptance of which it was believed by the Committee would render " persons sending unwholesome fish to the City Fish Markets " liable to " incur the same risk of prosecution as obtains in the case of the salesmen in the Meat and Provision Markets." No action appears to have yet been taken upon the Sanitary Committee's report. During the past summer there has again been evidence of the need of preventing the sale of unwholesome fish. Some of the retail vendors, in the areas affected by excessive prevalence of typhoid fever, have told me that they experienced special difficulty during last August with regard to small plaice. The Fish Trades Gazette records that on 9th August " small plaice was abundant at low figures," on 10th August such plaice " was exceptionally plentiful and cheap," and on the 11th August " heavy quantities of small plaice met a poor market at low figures." As has been pointed out, the evidence obtained in this investigation points to " steamer plaice " as having been at fault, and I, therefore, made special enquiries in this connection at Billingsgate. No steamer plaice, I was told, was condemned during August. It is the custom with many " friers " not to go to Billingsgate until the higher-priced fish has been disposed of. Numbers of men do not attempt to buy in the early morning. There is, therefore, special need of inspection in the case of this " late fish." In the Plaice Fisheries Report it is stated that at Ramsgate the " small stuff " is " given to the crew as a perquisite," or " sold to hawdcers and others on the open space outside the market." At Billingsgate the " late fish " falls largely into the hands of costers and small " friers," and, in the absence of a complete system of inspection at the market, the question as to whether the fish shall be sold or not is left to the discretion of the coster or " frier." Plaice is practically the only fish used by vendors of fried fish which is not gutted as a matter of course at sea. I was informed at Billingsgate that the nature of the food (shellfish, etc.), of the plaice makes it possible to retain the gut without injuring the fish ; whereas the character of the intestinal contents of fish consuming " softer " food necessitates removal of the gut forthwith. The practice of gutting plaice seems, however, to be coming steadily into favour as years go by, but the London steamer companies do not, as a rule, attempt to gut the small plaice. The extent to which the fish sold by fried fish vendors has been found to be imperfectly gutted has been referred to in previous reports (see page 10, Appendix to Report of Medical Officer of Health, 1903). In dealing with small " dabs," which are sold at times when there are " heavy quantities " available, at ½d. a pound, or say three or four a penny, cleansing is doubtless often left to be carried out by the purchaser, if performed at all. It is a suggestive fact that in the instances last summer, in which several members of one family were simultaneously attacked by typhoid fever, there was, generally speaking, a history of the consumption by all the sufferers in each family of small plaice or dabs. The fact that most, or all, of the consumers of these fish were attacked, points to a degree of infectiousness which requires some special explanation, and such explanation the absence of gutting of these small fish would possibly supply. It is clearly desirable, in the interest of the public health, as it appears to be admitted by many of those who are in a position to have an opinion, it also is in the interest of the fish trader, that no plaice which has not been gutted should be exposed for sale in the market. The collection of the information made use of in this report would, of course, have been an impossible undertaking had I not been largely indebted to others—to the Medical Officers of Health and Sanitary Inspectors of affected districts, to the Medical Officers of Metropolitan Asylum Board Hospitals (and in particular to Drs. E. W. Goodall and F. Thomson) and of hospitals and infirmaries, and to members of the staff of the Council's Public Health Department. II.—Report by Drs. J. M. Bernstein and W. H. Hamer on Glanders in Man. As a preliminary to the conduct of this investigation, it was thought necessary to enquire into the conditions existing in some large London stables in which equine glanders had recently been reported. Some of the stable workers themselves have voluntarily come to be examined under the impression that they were the subject of infection, but they were not infected. Other cases of stable workers have been sent also for examination. One case notified as glanders gave none of the diagnostic signs and was the subject of syphilis, from which he recovered. In all these bacteriological investigations were made and various ringworm fungi and bacteria were identified as associated with the lesions. These included such conditions as horse ringworm, boils, syphilis, and other inflammatory lesions of the skin. 110 Annual Report of the London County Council, 1910. It was obviously desirable to do more than merely investigate notified cases, and the attempt was indeed made, so far as this was practicable, to learn the facts concerning all hospital or infirmary cases with regard to which any sort of suspicion that the case was one of human glanders was entertained. It was further decided to make enquiry concerning the condition of health of employees in all stables from which cases of equine glanders were reported, and here we were fortunate in having the co-operation of the officers of the Public Control Department. Thanks to information supplied from that department, knowledge was obtained, during the early months of 1910, of 67 stables from which equine glanders had been notified, and a report was made upon each of these stables, and enquiry was instituted as to the health of the employees. So far as the question last named is concerned, the results of this investigation were entirely negative. Some particulars of interest with regard to the 67 stables were, however, forthcoming. First, as regards the character (size, sanitary condition, etc.) of the stables involved, it transpired that:— In 29 stables the number of horses did not exceed 10. „ 10 „ „ was from 11—20. „ 11 „ „ „ 21-40. „ 6 „ „ „ 41—60. „ 9 „ „ „ 61-150. „ 2 „ „ was over 150. We have no information showing the actual number of horses in London stables with differing numbers of horses. During last year, however, by direction of the Public Health Committee, the sanitary condition of some 300 London stables was investigated. When these 300 stables are divided into gr6ups—less than 10 horses, 11-20 horses, and so on, as above—it is found that the total horse population is approximately the same in each of these groups, viz., between five and six hundred horses. If cases of equine glanders were distributed at random throughout the London stables, it would follow—on the assumption that there were, roughly speaking, about the same horse populations in each group of stables—.that the glanders cases would be distributed more or less equally among the several groups. The actual figures given above, however, clearly show that, at the time of our enquiries, there was a markedly greater incidence of notified cases of glanders upon the stables with few horses, for while only 17 cases were reported from stables with over 40 horses, as many as 50 cases were reported from stables with less than 40. It will be seen that 29 cases were reported from stables with less than 10 horses. We are aware of the fact that our 300 stables are not altogether typical of London stables generally. On the whole, there was undoubtedly a tendency in selecting the 300 stables to select small rather than large stables. Again, we note the average number of horses in our 300 stables was only a little over 10, whereas reference to the reports of the Public Control Committee shows that the average number of horses per stable, in which outbreaks of glanders were reported, 1st September, 1905, to 31st August, 1906, was considerably over 90, and the same average for the year ending March, 31st, 1910, was considerably over 60. Clearly the figures just given relate to groups of stables containing quite a number of large stables, while our own figures as to the 300 stables relate to a group containing, on the other hand, many small stables. This fact, however, considerably emphasizes the disproportionate incidence of notified cases of glanders upon the small stables in the early months of 1910 ; for, in taking as the standard the grouping of stables obtaining in our 300 stables, we are clearly underestimating the number of large stables, and hence in actual fact, instead of finding glanders cases notified in almost uninterruptedly descending figures as we proceed from the groups of smaller to those of larger stables, the figures might have been expected, had the matter been one of mere chance, to have gone just the other way—increasing, in fact, as we proceeded from the groups containing the smaller to those containing the larger stables. It is necessary, of course, to point out that, when notification of glanders first came into force, it was less likely that cases of clinical glanders would be overlooked in larger than in smaller stables. It may be said, indeed, that there has been a tendency during the last few years for cases to be increasingly reported from the smaller stables, and this tendency, it may be urged, had become especially marked at the time when the 67 cases referred to above were notified. Making all allowances, however, we cannot fail to be struck with the markedly disproportionate incidence of equine glanders, during the period under review, upon the smaller stables. It may be that this incidence is really determined, in part at any rate, by the fact that horses which are diseased, or with respect to which suspicion of glanders is entertained, tend to gravitate to the stables which are small and ill kept, hurthermore, it may be that glanders is to some extent associated with bad conditions of stabling, and accommodation of horses, just as tuberculosis is associated with bad houses and poverty in man. With regard to overcrowding, the results are not, however, striking. The stables with glandered horses, it is true, only provide in rather more than one half the total number of cases, more than 800 cubic feet per horse ; but a similar statement may be made with regard to the stables without glandered horses. In three stables from which glanders was reported there was gross overcrowding, only 600 cubic feet per horse in two instances, and in one instance only 576 cubic feet per horse, being provided. Some extreme instances of overcrowding were, however, not infrequently noted in the stables without glandered horses. Speaking generally, there was much need for improvement Report of the Medical Officer of Health 111 of the ventilation of the stables visited, but it cannot be said that, comparing stables of approximately the same size, the ventilation of the stables from which glanders was reported was much more unsatisfactory than that of stables generally. Enquiry was made, moreover, as to the presence of vermin. As regards stables with cases of glanders, in 18 instances the presence of cobwebs was noted, and it was found that there was evidence of fly nuisance ; in eight instances there was evidence of the presence of mice, and in six of rats ; at one stable rats were said to be numbered by thousands, while at another a professional rat-catcher made periodical visits with a view to reducing the number of rats, The results yielded in stables without glanders do not, however, differ greatly from these. Generally speaking, approximately half the stables, both those with and those without clinical cases of glanders, show evidence of the presence of vermin of one kind or another. It must be noted that in the last two or three years there has been a reduction in the number of clinically recognisable cases of equine glanders. During that period much more attention has been devoted to the testing of horses in stables from which glanders was reported, and there has also been., of course, owing to the introduction of motor traffic, a very considerable reduction in the horse population of London. Horses in large studs, at least, ate not allowed to wander in a glandrous state, and very rarely in an advanced condition of disease, when the discharges from the nose and farcy buds would render them decidedly infectious, and so for this reason, for the time being, a lessened incidence in human cases might be expected ; this is, perhaps, aided to some extent by the growing knowledge amongst those working in stables of the infectivity of the disease for man. But though the larger studs have been in gr eat part rigidly depleted of their glandrous animals and are carefully watched by their owners for evidence of fresh infection, there still remains a large number of one-horse owners, who will endeavour to hide any evidence of disease in their animals so long as they can be worked. These horses, often badly fed and overworked, and so offering little resistance to infection, are still liable to constitute a serious source of infection, both to other horse.' and to man. These form so large a number as to be almost beyond the control of the authorities, under whose notice, indeed, they can only come when notified, and they are hence liable to be a menace and a focus from which fresh outbreaks can arise. It is from these cases at the present day that infection of human beings is to be expected, and here again the men who own these horses would be, and in fact are, if they suspect themselves to be suffering from any infectious disease, very loth to draw attention to themselves and interfere with their freedom. Recognising, then, the possibility of fresh outbreaks when attention is directed into other channels of prophylaxis—a condition not unknown in the past in connection with other diseases—also the fact that glanders in man is frequently overlooked and is commoner than hitherto thought, it will be advantageous to state briefly the main facts concerning the appearances presented by the disease in man, the means of diagnosis and methods of infection, with the object of facilitating the discovery of these cases—a condition that has, indeed, been brought about to some extent in recent years, and also to collect all the cases that have been reported as occurring in the county for some years past. As recently as 1906, in an exhaustive treatise on " Glanders in Man," up to which time the author (Dr. G. D. Robins, of Montreal) had only been able to collect 156 cases from all parts, there appeared the statement that " glanders in man is sufficiently rare to make it unlikely that any individual Anglo-Saxon observer should encounter more than a solitary case." That was then the generally accepted view, but a better knowledge of the varied forms the disease assumes in man, and, more important still, the introduction of bacteriological laboratories as adjuncts to all large hospitals, have made it evident that this is far from the truth. There can be little doubt that to the few cases of glanders in man reported in the past, when it is remembered that the disease was far more rife amongst horses and was allowed to run a far longer course than now, there should have been added many others which had been diagnosed, from clinical appearances and bacteriological ignorance, as abscesses, boils, ulcers, syphilis, tuberculosis, pyaemia, and even smallpox, etc. This is supported by the fact that in the past ten years, during which time equine glanders has been to an increasing extent under control, more human cases have been reported than in the previous years. Symptomatology.—Glanders in man may be a very acute or a very chronic disease, exhibiting most protean characters, including abscesses, single or multiple, in the skin or muscles ; chronic ulcers of skin or mucous membranes lasting months or years, and resisting treatment; chronic nasal discharge continuing for months and perhaps terminating with a sudden fatal acute outbreak ; acute febrile and sometimes rapidly fatal conditions ; pyaemia, associated with multiple abscesses, much malaise and pains in the limbs, etc. All these conditions have, at one time or another, been mistaken for better-known and commoner diseases, such as boils, tuberculosis, syphilis, pyaemia, septicaemia, acute rheumatism, smallpox, etc. It can only be said that if any of the conditions above enumerated occur in patients in any way associated with horses, they should be regarded with suspicion ; though at the present day, when it is becoming more common to diagnose abscesses and ulcers in the laboratory rather than on their clinical appearances alone, there is less likelihood of a mistake arising. Ætiology.—The occupation of almost all cases is in some way connected with horses. Occasionally infection has been reported as occurring from man to man, and once in a washerwoman, from infected clothes. Of the cases that are tabulated as occurring in London, 33 were thus occupied (stablemen, cab-proprietor, costermonger, carmen, horsekeepers, coachmen, tram-driver and conductor, 112 Annual Report of the London County Council, 1910. farriers and ostler); one was a carman's wife and lived adjoining the stables ; one, a greengrocer, had stables at the back of his premises ; one, a window cleaner, lodged with a carman ; one was a case of laboratory infection ; and one only had no connection with horses. But many men work amongst horses and comparatively few get glanders, and it is well known that knackers, who cut up, without any very special precautions, glandrous carcases, rarely get infected. Some species of animals are immune to glanders (e.g., sheep and ox), and indeed the disease especially affects the equine family; it is probable that man is much more immune to infection than the horse, but much less so than the sheep. Study of glanders clearly shows that marked contrasts are presented by the human and equine diseases, so-called. (i.) In origin. In the horse, cutaneous or subcutaneous inoculation is rarely mentioned in the literature; the rival theories, there mainly referred to, are those of ingestion and of inhalation. In human glanders inoculation from the skin of the exposed parts of the body occurs in more than half the cases (Robins). Sir John Macfadyean has remarked that if inhalation played any considerable part in transmission of the disease from horse to horse, it would have been expected to render the glandered horse a source of great danger to man, and yet there is " the comparative rarity of glanders among grooms and others working in badly infested glanders stables." Again, in equine glanders, as Sir John Macfadyean says, " the carcase in general, and the blood in particular, are usually not infective, the bacilli being almost entirely confined to the lesions and the discharges from them." Thus, he says, " The living glandered horse is far more dangerous than the dead one, and the most dangerous are those with profuse nasal discharge and the subjects of farcy." As he remarks, for many years 800—2,000 glandered carcases have been dealt with in London by Messrs. Harrison, Barber and Co., and during that period " no case of glanders has occurred among the men whom they employ in this work." On the other hand, Bulloch and Twort (Centralblatt fiir Bakt. Orig. Bd. xxxix. Heft. 1) insist upon the fact that serious risk is incurred by those who are brought in contact with human glanders, or with material of human origin, and they have been led to suggest " that the bacillus is probably much more virulent from human than from equine sources." (ii.) In the clinical course of the disease and in the nature of the lesions found post mortem. The subject cannot be here treated in detail, but we may allude to one point of special interest, viz., the occurrence of intra-muscular abscesses. Robins (" A Study of Chronic Glanders in Man ") says : " Subcutaneous or intra-muscular abscesses are by far the most constant of all lesions in chronic glanders." In the horse, we are told, such abscesses are rarely seen. We note, however (Lœffler and Schiitz) that they may occur in experimentally induced glanders in the horse. It is, of course, well known that diseases run very different courses in different animals, but the contrast presented in human and equine glanders is far more striking than is the contrast, say, between the anthrax, or the tuberculosis, of man and animals. A more or less parallel case to that of human and equine glanders is, perhaps, that afforded by the naturally acquired tuberculosis of man and some animals on the one hand, and experimentally produced tuberculosis on the other. Whatever the aetiology of glanders in the horse may be, human glanders is apparently in the majority of cases traceable to direct inoculation of infective material derived from the horse. Diagnosis.—Clinically , suspicion is aroused when conditions mentioned above are met with in people associated with horses, but the true diagnosis comes now within the province of the bacteriologist, and recent scientific researches have produced several methods of great accuracy. The methods adopted are as follows :— (1) Bacterioscopy, or the direct finding of typical bacilli in discharges from open abscesses or ulcers—a difficult and uncertain procedure—or, in closed abscesses, where they are very scanty. (2) Cultures, resulting in the obtaining of a pure growth of bacteria with typical characters on potato and glycerin-agar, in about 48 hours. (3) Animal inoculation (with material from the lesions) into a guinea-pig, with resulting typical glandrous lesions in a few days. This is of special value in open wounds, where there are too many contaminating germs to allow of isolation of the specific bacilli with certainty by the other methods (4) Mallein inoculation—the injection of mallein derived from pure cultures of B. mallei, into the patient. This is the method adopted throughout the country for diagnosing all cases of equine glanders, and particularly serviceable for detecting latent or occult cases. It is analogous to the method of detecting tuberculosis by inoculation with tuberculin. Where glandrous lesions exist, a definite reaction occurs within about 24 hours, consisting of a more or less local swelling and tenderness around the site of inoculation, and a rise of temperature through several degress with a return to normal in two or three days. The local reaction in man is not so constant a feature as in horses but in all cases where tried there has been a rise in temperature. On the other hand, in numerous cases (including several of tuberculosis giving a tuberculin reaction), which later turned out to be non-glanirous, mallein in doses of 10 to 15 minims was injected without producing any result, leading to the inference that the method of diagnosis is at least a harmless one (" Human Glanders, with a study of six cases." Bernstein and Carling, British Medical Journal, 1909). In doses of less than 113 Report of the Medical Officer of Health. the above amount, mallein does not appear to be so definite in its action. The following chart shows the temperature observations at intervals of four hours during five days, inoculation being made on the first and fourth days. Mallein reaction in human glanders — Temperature chart. (4a, 46) Cuti-reaction and "ophthalmo-reaction." These are modifications of the preceding test, in which a smaller amount of mallein is rubbed into a scarified surface of the skin, or a few drops are instilled into the eye. A local reaction is produced only in glandrous subjects. In horses these modifications have not been found universally satisfactory, but in a few human cases good results have been reported, whilst numerous controls on normal people have been negative. Still by analogy with the corresponding methods of diagnosing tuberculosis too much stress cannot be laid on these modified methods. (5) Agglutination. This is similar to the method now used for diagnosing typhoid fever. The serum of healthy men often agglutinates B. mallei in low dilutions, but the blood-serum of those cases, comparativey few in number, of human glanders which have been so tested give a reaction when diluted 100 fold. By analogy with horses, it is evident that it can be used as a diagnostic reaction. The blood serum of healthy horses will react when diluted many hundred times, but glandered horses react with the blood diluted 2,000 fold and more. In Prussia the reaction is made use of and all animals are killed as glandered whose blood reacts in 1,500 fold dilution and over. The technique has been much improved in recent times, and the reaction can be obtained within a few hours with stock emulsion of B. mallei and a centrifuge. (6) "Complement-deviation" method. The test is analagous to that now universally adopted for the diagnosis of syphilis, in which disease its value is indisputable. Briefly, the method depends on the fact that certain specific anti-bodies are formed in the system as a result of infection with bacteria. These anti-bodies will combine with the specific infecting bacteria in the presence of a third body, found in the blood of all animals and not specific, which is known as "complement." Further, if red blood corpuscles of one animal, e.g. a sheep, are injected into another animal, e.g. a rabbit, the blood serum of the rabbit has formed in it a substance known as hæmolysin, which will, outside the body, dissolve the specific corpuscles (namely, those of the sheep), but also only in the presence of complement. The technique is complicated but very accurate, and necessitates only the withdrawal of a little blood from the patient through a slight puncture of the skin. The blood serum is then heated to destroy its own complement, and mixed with an appropriate and standardised extract of glanders bacilli, and also some guinea-pig's blood serum to act as complement. This is allowed to stand at blood temperature for one hour, and then mixed with a standardised hæmolysin (contained in rabbits' blood serum also previously heated) and sheep's blood corpuscles, and again placed for one hour at blood temperature. If no solution of corpuscles occurs, so that they sink to the bottom of the test tube, it is then deduced that no complement remained, and that it must have previously combined with the glanders bacilli which could only occur in the presence of a serum from a glandrous patient, which would contain the appropriate anti-body, and so the serum which is in question must have been derived from a glandrous animal. There is some little divergence of opinion as to the practical usefulness of this method, but careful Continental workers have demonstrated its great value. In Berlin and Bromberg, etc., excellent 114 Annual Report of the London County Council, 1910. results have been obtained; in the latter place 95 per cent. of glandered horses were diagnosed and only 1 per cent. of healthy horses were wrongly diagnosed as glandrous. This method of diagnosis is perhaps the most scientific and accurate that we have at our disposal. Every stage can be accurately controlled, and the standardised reagents necessary for the test can be kept in a central laboratory to which place the blood could be sent. (7) Precipitin method. This, like the preceding two tests, depends on the formation of specific anti-bodies in the blood of infected animals, and these cause a turbidity or precipitate in suitable admixture with mallein. The test has not yet been widely tried. Summary of methods of diagnosis.—These fall into three groups:— (A) Bacteriological, resulting in the finding of the bacteria and proof positive, but only useful in cases with obvious external lesions, and useless in the many cases of internal or generalised or occult glanders. (B) Inoculation methods, necessitating the introduction of a virus into the system—an undoubtedly valuable method in the case of glanders, and the universal method adopted in this country. In experienced hands it is probable that no cases are missed, but it is possible that some cases of healthy animals react, and there is always the uncertainty arising from our ignorance of the effects of such inoculations. In man we have, as far as our experience goes, never met with any ill-effects from the use of mallein in fairly large doses, and in one case we think we have seen some improvement. It must always be remembered that an injection may cause a local focus of disease to flare up into a general infection, as was seen in the early days of tuberculin injections. (C) Methods directed to the finding of anti-bodies formed in response to infection. These are based on more scientific premises, and entail no interference with the patient beyond the withdrawal of a few drops of blood. The test is not affected by the general condition, such as pyrexia, of the patient, as is the mallein reaction. Analogy with other diseases, and the result of Continental investigations holds out promise that the complement-deviation method will ultimately replace the inoculation method. It is obvious that, other things being equal, methods which merely necessitate the withdrawal of a little blood for diagnosis must be given the preference over methods entailing the inoculation of toxic materials into the system. Attention might here with advantage be directed to the practice adopted at certain Continental centres where official sero-diagnostic institutes have been founded, and to these places blood from suspected cases of syphilis, glanders, etc., can be sent for diagnosis. Conclusions.—It is probable that the small, but increasing, number of diagnosed cases of human glanders does not include all the cases which occur, and that only the more severe varieties are reported. Man, not being a highly susceptible subject, is often affected, however, with a chronic form of the disease; such cases sometimes recover, but may terminate in the fatal acute form. The percentage of recoveries in the cases described is given varyingly from 20 to 50 per cent., but little importance can be attached to such statistics. We have at the present time under observation a patient who exhibits no glandrous lesions, but is suffering from advanced pulmonary tuberculosis. These chronic cases are often wrongly diagnosed, being mistaken for much commoner diseases. In recent years many cases in man have been reported in Continental and American literature, and it is evident that more cases are now correctly diagnosed than heretofore, but it seems probable that with more widespread knowledge of the varied symptomatology, and more readily accessible laboratories, other cases must be forthcoming. Much invaluable assistance has been rendered to us by Mr. Shaw, F.R.C.V.S., Inspector in the Public Control Department, and Mr. Simpson, F.R.C.V.S., of the London Parcels Delivery Company both of whom have put their wide knowledge of equine glanders at our disposal, and given us other facilities for following up the work. To them our thanks are due. We are also greatly indebted to the Chief Officer of the Public Control Department and members of his staff for help in this enquiry. Table 1.—Analysis of cases diagnosed in the County of London. Year. Year. Year. Year. 1893 1 1899 1 1904 4 1909 3 1894 1 1900 3 1905 7 1910 0 1897 1 1901 2 1907 4 Also 3 chronic cases merely mentioned by Bulloch. 1898 2 1902 3 1908 6 Table II.—Occupations of these. Stablemen 4 Coachmen 2 Farriers 2 Organ grinder 1 Cab proprietors 2 Cab driver 1 Ostler 1 Packer 1 Costermonger 1 Coal merchant's man 1 Horsedealer 1 Printer 1 Carmen 7 Tram conductor 1 Wife of carman 1 Window cleaner 1 Horsekeepers 9 Tram driver 1 Greengrocer 1 Laboratory worker 1 Unknown 1 Report of the Medical Officer of Health. 115 III.— Report by Dr. R. A. O'Brien (of the Lister Institute) on the Results of an Investigation into the Pathological Significance of an Infectious Quality in Certain Samples of Milk. The period covered by this report is a little more than twelve months from September, 1909, the total number of samples during this period being 2,520; but the figures given in some of the tables are derived from the whole material available in the records of the routine examination of milks for the presence of tubercle bacilli from August, 1908, to October, 1910. Details of the methods used in the examination of samples of milk for the presence of tubercle bacilli. On two days, or in some cases three days, in each week, the samples of milk in lots of 24 or 30 reach the laboratory during the afternoon. In a centrifuge running at about 4,000 revolutions per minute for a period of about twenty minutes, a quantity of 160 cubic centimetres from each sample is spun. After removal of the cream and the supernatant fluid, the deposit adhering to the bottom of the centrifuge glass is emulsified in eight to ten c.c. of sterile salt solution, and the emulsion pipetted into a sterile conical test-glass. The emulsion so prepared is injected subcutaneously on the inner side of the thigh into two guinea-pigs. The two animals corresponding to each sample are kept for 28 days in a metal cage, previously boiled in a lysol solution. During this period a certain number of the animals die, some few showing signs of tuberculosis. These latter are not dealt with in this report, which is concerned only with deaths from causes other than tuberculosis—the so-called "nontubercular mortality." On the 28th day the surviving animals are killed and examined for the presence of tuberculosis. Extent of the "non-tubercular mortality" amongst guinea-pigs inoculated with sediment of milk samples. Table showing Total Mortality from causes other than Tuberculosis. (i.) Number of cases in which both guinea-pigs inoculated with the deposit from a sample of milk, died in less than 28 days, from causes other than tuberculosis. The figures correspond to successive groups of 500 samples in which the examination for the presence of tubercle bacilli was completed. Group I. 170 Group V 133 II 208 „ VI 14 „ III 90 „ VII 14 „ IV 74 „ VIII 33 Total 736=16.3% of 4,508 samples (ii.) Number of cases in which one of the two guinea-pigs inoculated with the deposit from each sample of milk died before the 28th day=l,597. (iii.) Total number of guinea-pigs dying, "non-tubercular deaths" = (2 x 736) + 1,597 = 3,069. Total number inoculated = 9,016. 3,069 represents 33 per cent. of the total number. Of the above 3,069, 1,472 represents the animals from 736 samples, all of which, owing to death of both guinea-pigs before the 21st day, had to be collected a second time ("repeat" samples), since the possibility of tubercle bacilli being present in these samples could not be definitely excluded. Investigation into the actual causes of death of the inoculated animals. It is obvious that an enquiry of this nature is complicated by the great number of factors involved, the inter-relation of which it is not easy to define. The guinea-pig itself is not a constant factor, being subject to natural diseases of its own. For instance, in November, 1909, a severe epizootic occurred amongst the stock guinea-pigs at the Institute and affected some of the inoculated " milk guinea-pigs," greatly increasing the mortality amongst them. Further, the sediment injected introduces a complexity of factors, since it consists of a mass of foreign proteid and other bodies in the centrifugalised cells and deposits from the milk, as well as a varying number of various kinds of organisms. With the exception of a few instances in which the animal was examined after being killed on the 28th day, the guinea-pigs dying each day were opened and examined. The maximum period elapsing between the death and the examination of any given animal was thus usually about 18 to 20 hours. Post-mortem appearances.— Inflammatory exudates and hæmorrhagic conditions at the site of inoculation were found in the majority of animals dying during the first week, with occasional con gestion of the spleen, liver and suprarenal capsules. In those dying after the first week, these conditions were less often met with, though in a certain number of cases abscesses at the site of inoculation were found when the survivors were killed on the 28th day. Gas was never found in the subcutaneous tissue. During the winter of 1909-10—the "epizootic period" (see p. 119)—there were frequently found in the liver and spleen, hard round whitish-yellow nodules or points varying in size from tiny spots to nodes as large as a pea. The smaller spots in the liver and spleen were found mostly in cases where the B. aertryck was recovered in pure culture. The larger nodes in liver and spleen were found most often in association with enlarged mesenteric glands which on section were partly grumous or purulent. From these cases the B. pseudo-tuberculosis rodentium was almost always recovered. 116 Annual Report of the London County Council, 1910. Cultural methods.— Cultures were taken with the usual precautions against contamination, from the heart-blood, liver, spleen, the local lesion at the site of inoculation and sometimes from the mesenteric glands. Broth tubes and MacConkey lactose-bile-salt-neutral-red-agar plates were inoculated from each specimen and incubated at 37 deg. C. If colonies appeared on the plates, cultures were made for identification, one or more being used according to circumstances. If the plates when examined next morning showed no growth, the broth cultures were inoculated on MacConkey plates and then incubated. In the earlier part of the investigation, whenever these second plates showed no growth, the broths were inoculated on ordinary agar plates. In such cases it was found that cocci sometimes developed. Guinea-pigs are known to be very resistant to cocci, and the pathogenicity test confirmed this view for the strains of cocci isolated, so that these were considered to be accidental contaminations having no relation to the cause of death. Subsequently, therefore, MacConkey plates alone were used. Frequently both plates and broth showed no growth—in one series of 191 examinations this occurred 48 times ( = 25 per cent.). This suggested the possibility of the existence of toxins, or anaerobes in the milk as possible causes of death. The former possiblity is considered at p. 118. In order to see if anaerobes were present 14 tubes that showed no growth after incubation aerobically were incubated anaerobically. No growth occurred in any of them, and no further anaerobic cultures were made. The identification tests used were largely those elaborated by MacConkey in his various papers on intestinal organisms, for it became apparent early in the investigation that the predominating organisms isolated grew well on MacConkey's medium and were probably of intestinal origin. The media used in all cases were solutions in peptone water of lactose, mannite, dulcite, saccharose adonite, and inulin. Other carbohydrates as glucose, galactose, dextrin, maltose, sorbite, raffinose and arabinose were made use of in special cases. The reaction in Litmus milk was observed up to fifteen days; indol production was tested for after five days' incubation at 37 deg. C. by Ehrlich's test; and for the determination of motility six to eight hour broth cultures were used. Cultures on gelatin were made, and examined a month or more later, for the presence of liquefaction. Main lines of enquiry. For the sake of clearness, the main lines of enquiry are set forth here in order:— (i.) The possible occurence in the milk samples of bacilli pathogenic to man. (ii.) Identification of organisms isolated from the guinea-pigs on post-mortem examination. (iii.) Consideration of the number of organisms injected with the milk deposit. (iv.) The contribution of naturally occuring dieases amongst guinea-pigs to the observed mortality. (v.) Experiments with sour milk, injected (1) untreated, (2) after filtration, (3) after being boiled. (vi.) Attempts to correlate (1) the period of year and temperature, (2) the number of lactosefermenting organisms present in the milk samples, with the daily mortality and with the death-rate recorded in relation to the date of inoculation. (vii.) Results of inoculation of milk samples from single cows noted as "possibly diseased" on veterinary inspection. Search for occurrence in milk samples of bacilli pathogenic to man.—As this was a point of importance from the practical public health aspect, attention was directed throughout the investigation to the possible presence of such pathogenic organisms. The literature dealing with their occurrence in milk may first be briefly reviewed. The bacilli of typhoid fever in milk.—There are in the literature (j) more than 300 cases (many of them in Great Britain) in which the epidemiological evidence showed that certain milk supplies had almost undoubtedly been responsible for typhoid epidemics. I have made a search through the literature, but have found no case in which the B. typhosus was discovered in a milk supply in a routine examination, that is, without a previous suspicion that the given sample was infected. Reynolds, in 1902, stated that in eight years special search for this bacillus in Chicago milks had revealed it in three instances, but then only where local epidemics had directed suspicion to certain milk supplies. In the literature referring to the many epidemics, I have found only three instances (k) in which the typhoid bacillus was recovered from milk. In this investigation the methods were designed to yield as comprehensive results as possible, and the search for bacilli pathogenic to man, except in the case of the Gaertner group, was not specifically made. Yet it is interesting to find that no suggestion of the presence of the B. typhosus in the 2,520 milk samples received during the period under review has arisen either from an investigation of the effects of the deposits when injected into guinea-pigs, or of the results of direct inoculation of the milk on plates, in 111 instances in which this was done. Similar negative findings as regards London milks are recorded by Klein (I), and Hewlett (m). (j) Swithinbank and Newman; Bacteriology of milk, 1903, p. 316. Bulletin, 56, Hygienic Laboratory, U.S.A., 1909, p. 29. Sommerfeld ; Milchkunde, Berlin, 1909, p. 1901. Schϋder; Zeitschr. f. Hyg. u. Inf. Kr. Bd. 38, p. 343. (k) V. C. Vaughan; Ann. Rep. State Board of Health, Michigan, 1891, p. 216. Shoemaker; Journ. Amer. Med. Ass., 1907, p. 1748. Conradi; Cenlr. bl. f. Bakt. Abt. Bd. 40, p. 31. (I) Klein ; Journ of Hygiene, 1901, p. 85. (m) Hewlett and Barton; Journ. of Hygiene, 1907, p. 27, Report of the Medical Officer of Health. 117 B. diphtheriæ in milk.— The presence of B. diphtheriæ in milk has been responsible for many outbreaks of this disease in every civilised country and in this investigation the possibility of its occurrence was kept in mind. Many epidemics are reported where epidemiological evidence pointed strongly to a certain milk supply as the source of infection, but I have found only four instances in which the B. diphtheriae has been actually recovered from a suspected milk (n). In a routine examination of 100 samples of London milk in 1901, Klein (I) states that he isolated B. diphtheriae from an enlarged groin gland of a guinea-pig, which had been inoculated subcutaneously with milk sediment. This is the only instance I have found in which this bacillus had been stated to have been recovered during routine examination of milk samples which had not been suspected from epidemiological evidence of being infected. Hewlett (m) found bacilli morphologically resembling B. diphtheriae in one of twenty-six milk samples, but was unable to isolate them for confirmatory tests. In the present investigation smears from the glands of all guinea-pigs presenting an appearance similar to that described by Klein have been examined microscopically, but in none has any bacillus other than the B. tuberculosis, or the B. pseudo-tuberculosis rodentium been found. On two occasions cultures on serum were made from guinea-pigs that presented post-mortem appearances somewhat similar to those found in animals dying after the experimental inoculation of diphtheria toxin or cultures, but with negative results. Thus, as with B. typhosus, no evidence of the presence of B. diphtheriae had been found in the 2,520 samples of milk examined. Dysentery bacilli in milk.—Bacilli of the dysentery group have not, according to Weber (o), been found in milk. The bacilli of this group are not of very common occurrence in England, so that one would not expect to find them in milk here. No evidence of their presence has been found during this enquiry, either in cultures from the dead guinea-pigs or by direct cultural examination of 111 milk samples. Bacilli of the food-poisoning group.—(B. enteritidis Gaertner, B. paratyphosus, and B. aertryck). —Klein (I), in 1901, obtained cultures of the food-poisoning group in 10 of 39 instances from guineapigs that died after inoculation with London milk samples. Though milk has occasionally {e.g., by Wernicke) been suspected of causing symptoms associated with the presence of bacilli of this group, yet Uhlenhuth and Hubener (p) state that these bacilli have not yet been found in milk. Titze and Weichel (q) have recently (1910) examined twenty different samples of Berlin milk with negative results. Bacilli belonging to this group, and identified as B. aertryck were very frequently met with in the early stages of this enquiry, i.e., November and December, 1909, in guinea-pigs inoculated with milk sediment and they were occasionally found in them up to August, 1910. At first sight, this suggested that the bacilli were inoculated with the milk, but at this time this same bacillus was very frequently found in the guinea-pigs amongst the stock (i.e., non-inoculated animals) during an epizootic (discussed at p. 119). Further animals that survived the epizootic were shown to be excreting the bacillus in their faeces for some months afterwards, i.e., they were intermittent carriers of the bacillus. These facts make it clear that the B. aertryck, found in the guinea-pigs post-mortem, was not necessarily derived from the milk inoculated. However, in order to exclude definitely the possibility of these bacilli having been derived from the milk an examination of cultures from 111 milk sediments was made. In not a single instance was the bacillus found, although from artificially inoculated milk it could be easily recovered by the method (r) adopted. The non-lactose fermenters met with on plates inoculated from the sediments proved to be mostly B. faecalis alkaligenes, B. proteus or cocci. Identification of organisms isolated from the dead guinea-pigs.—The organisms isolated fall into the following groups:—Bacilli of the Gaertner group; B. pseudo-tuberculosis rodentium (s); lactosefermenting organisms of several kinds; bacilli of the Proteus group; and cocci. The bacilli of the Gaertner group and the B. pseudo-tuberculosis group are considered later (see p. 120). The lactose fermenting organisms found here have been compared with the tables of lactose fermenters isolated by MacConkey (t) from milk and the faeces of man, cows and other animals and by Orr (u) from milk, and it is found that almost all the lactose fermenters isolated during this investigation appear in those tables. This similarity strongly suggests that the lactose fermenting bacilli obtained in this investigation from dead guinea-pigs, and by Orr from milk, are originally derived from faecal sources. The bacilli belonging to this group most frequently found were:— No. 71 (MacConkey's list, obtained mostly from faeces of man, calf and horse) 55 times. B. coli communis 34 „ B. neapolitanus 15 „ B. griinthal 14 „ (I) Klein ; Journ. of Hygiene, 1901, p. 85. (n) Dean and Todd; Journ. of Hygiene, 1902, Vol. II., p. 194. Eyre; Brit. Med. Journ., 1899, II., p. 586. Bowhill ; Journ. of Stale Med., 1899, Vol. 7, p.705. (0) Weber ; Milchkunde, Berlin. 1909, p. 453. (p) Uhlenhuth and Hubener; Central bl. f. Bakt. Abt., I., Ref. Bd. 42, 1908. Beiheft, p. 127. (q) Titzer and Weichel. Arb. a. d. Kaiserlich, Oes. Bd. 33, p. 516. (r) The enrichment method of incubating in dulcite-bile-salt broth for 48 hours, before plating, gave the best results. This enrichment process was generally adopted for the examination of the sediments, but other methods were also used, e.g., spreading on MacConkey agar plates either directly or after preliminary incubation in broth or glucose bile-salt-broth. From the plates all bacili of the lactose non-fermenting groups (which include typhosus, dysentery and paratyphoid bacili) were picked off and examined. (s) This bacillus presents no resemblance to the tubercle bacillus. (t) MacConkey; Journ. of Hygiene, 1904, p. 94. (u) Orr; Report on contamination of milk (Yorkshire), 1908, p. 71. 118 Annual Report of the London County Council, 1910. In eleven cases portions of the milk samples were kept in the cold room, until after the death of the guinea-pigs injected with the deposits from the samples and the identification of the bacilli derived from the dead animals. From the milk so kept, in four instances, there was recovered the same organism as that found in the guinea-pigs' heart or spleen or in the inflamed tissue at the site of inoculation. The bacilli recovered in these instances were B. coli communis, B. griinthal, B. Friedlander, and No. 7 in MacConkey's list. Bacilli of the Proteus group were found occasionally but were probably post-mortem invaders of the organs from the intestine, since they are non-pathogenic to guinea-pigs. The cocci found were also not pathogenic and cannot be regarded as having any causal connection with the deaths. Consideration of the number of organisms injected with the milk deposits.—Having obtained some idea of the kind of organisms present in the deposits an estimate of the number would be of interest. Organisms lethal to guinea-pigs are present in the deposits, but it is not easy to ascertain if sufficient of them to constitute a fatal dose are present in any given deposit, by any other method than that of injecting it into the guinea-pigs—a method which is open to many fallacies (see Conclusions, p. 121). But even if it were possible to estimate the total number of each variety of pathogenic organism present in a given deposit, it would still be extremely difficult to ascertain the total effect of different doses of different bacilli, especially when we consider that the deposit contains in addition a large mass of foreign proteid matter in the form of cells, milk proteids and non-pathogenic organisms. Practically, the problem is an insoluble one on account of the technical difficulties. Pathogenicity tests.—In testing the pathogenicity of the organisms isolated, the question of dose is an important one. A number of pathogenicity tests were done with various bacilli isolated. The proteus organisms and cocci are not pathogenic, but all the lactose-fermenting organisms may be expected to kill a guinea-pig, if injected subcutaneously, in doses of 2 or 3 c.c. of a broth culture kept for two days at 37 deg. C. But, since we cannot actually count the numbers of each kind of bacillus present in any milk deposit, we cannot decide whether a lethal dose of a given organism, or a lethal dose of each of several organisms, was present in the deposit injected. One can at least be fairly certain that in some samples fatal doses of bacilli were injected, since the same bacillus was found in the milk and in the guinea-pig and belonged to the group of lactose fermenting organisms fatal to guinea-pigs in doses of 1 or 2 c.c. of a 24-hour broth culture. Experiments to determine the content of "lactose fermenting organisms" (indicating faecal pollution) in milk samples and its relation to the lethal effect of the injected sediment.—The number of lactose fermenters in the various milk samples can be roughly deduced by the fermentation test. Small quantities (.001 c.c. or .01 c.c.) of the various samples of milk were inoculated into glucose-bile-saltbroth, and those tubes in which fermentation, i.e., gas-formation, occurred were noted. This gas formation is roughly an evidence of the presence of lactose fermenting organisms in sufficient numbers in the amount stated to produce gas in 24 hours. In the course of these tests it seemed advisable to see if the absence of fermentation in the tubes showing no gas was due to the presence of a preservative in the milk. Tests for the presence of preservatives were carried out in the case of 54 samples by doing two parallel experiments. In one series, (a) a quantity of .01 c.c. of each milk sample was inoculated into glucose bile salt broth, and the whole set of tubes incubated at 37 deg. C. In the other, (b), 5 c.c. of each sample were inoculated into 3 c.c. of glucose bile salt broth, and to each tube a few drops of a dilute broth culture of an organism known to ferment glucose were added. If any considerable quantity of a preservative had been present in a milk sample, it would probably have killed, or at least have prevented the growth of, the added organisms, so that in such a case any tube that did not ferment in series (a), and that failed to ferment in series (b), would raise a strong suggestion of the presence of preservative in the corresponding milk sample. It was satisfactory to find that in not one of the 54 samples tested by this method was there any evidence of the presence of preservatives in amount sufficient to inhibit bacterial growth, so that the fermentation results recorded (see Diagram) can be accepted as a rough measure of the numbers of lactose fermenters present. With regard to the fate of the animals inoculated respectively with deposits from the "nonfermenting" and from the "fermenting" milks, the numbers are not very large, it is true, but it is somewhat striking that the proportion of deaths (34 in 322 and 6 in 60) is in each case practically the same—whereas one would have been inclined to expect the guinea-pigs, corresponding to the "gas" or "fermentation" milks, to show a larger death-rate than those inoculated from the "non-fermentation" milks. This is one of the many illustrations evident in this enquiry of the extrmee complexity of the various factors involved. Results of subcutaneous inoculation of sour milk.—(i.) Untreated; (ii.) after filtration; (iii.) after being boiled. The injection of a few cubic centimetres of milk which has become sour is usually fatal to guinea-pigs. The toxicity of the sour milk might conceivably be due (a) to the pathogenicity of some of the bacteria contained therein, or (b) to the poisonous qualities of the not inconsiderable amount of bacterial proteins contained in the bacilli injected, supposing the bacteria to be themselves incapable of surviving in the animals' tissues, and (c) to the presence of soluble toxins from the bacteria. Filtering the milk would remove all bacteria, and therefore factors number 1 and 2. Boiling the milk would kill the bacteria, but at the same time diminish or destroy the poisonous properties of the contained organisms and probably also any soluble toxin. The experiments eliminate the third factor above, namely, presence of soluble toxin as a cause of the mortality, but do not determine the relative importance of the other two factors in contributing to the death of the animals. Report of the Medical Officer of Health. 119 The lethal effect of different samples of milk.—A study was made of the records dealing with the number of animals dying on each of the first seven days after inoculation, and in each of the subsequent weeks, expressed as percentages of the total deaths. This study did not reveal any data of especial significance. Similarly there was no constancy in the period lived, even by those animals from which the same bacillus was recovered. The contribution of naturally occurring diseases amongst the guinea-pigs to the observed mortality.— A considerable proportion of the guinea-pigs upon the market are already infected with the germs of one or other of the diseases to which they are subject. In experimental work it is always advisable to submit the animals to a prolonged period of quarantine, but the serious shortage in the supply last year occasioned by the greatly increased demand for the work of public health authorities practically rendered this precaution impossible. Further, even when this segregation of animals destined for experiments has been carried out, some epizootic has broken out among them, due to the accidental introduction of an animal already suffering fom some disease in a latent form. An unfortunate instance of this sort occurred in November and December, 1909, when the segregated stock was smitten and nearly decimated by a disease associated (v) with the presence in the tissues of the animals affected of B. aertryck (=B. suipestifer). This organism is not uncommonly found in the intestine of the healthy pig and has been held responsible for outbreaks of food poisoning. Some of the animals used for the testing of milk had been taken from the stock just before the epizootic was discovered and the disease broke out amongst them, and spread to their companions. B. aertryck was never discovered in the milks injected, so that the inoculations were clearly not responsible for the high mortality at this period. B. aertryck vel suipestifer was also obtained 21 times post-mortem from the organs of guinea-pigs inoculated with milk between March and August, 1910, that is, during a period when no epizootic was present, and when the general "non-tubercular" mortality was low. In these 21 instances, though the two animals inoculated from each milk sample lived together in one pail, there were only two cases where the other animal died before the 28th day. The avilable evidence goes to show that this bacillus is an occasional inhabitant of healthy guinea-pigs' intestines, and is under normal circumstances not pathogenic. Should the animal suffer from any condition which lowers its resistance, e.g., the filter-passer referred to in the footnote below (v), or the injection of milk sediment (see p. 118), the bacillus migrates from the intestine into the organs and produces in some cases a septicaemia. The occurence of a septicaemia probably explains the finding of the bacillus in the local lesion in two cases. Another common disease of guinea-pigs, often of a chronic character, is due to B. pseudotuberculosis rodentium. During the first three months of 1910 the B. pseudo-tuberculosis redentium was frequently obtained from the dead guinea-pigs; it was also encountered occasionally up to June. This bacillus gives rise to a chronic disease in guinea-pigs, but occasional outbreaks of a more acute form are not uncommon. It is evident that the guinea pigs infected with the strains obtained during this enquiry did not readily communicate the infection to contacts, since in the 30 instances in which the bacillus was present, the companion animal in the cage was not affected by the bacillus, or at least not fatally, for in all cases it survived until the 28th day. Pathogenicity.—The strains isolated when injected subcutaneously or intraperitoneally were moderately lethal, 3 c.c. of a 24-hour broth culture killing a guinea-pig in 4 to 10 days. Only two feeding experiments were carried out, each of two guinea-pigs being fed on three successive days with an emulsified agar slope culture. One animal died in 10 days with no pathological appearances postmortem; the other died a month later with "psuedo-tuberculosis" in the organs, and from the mesenteric glands the bacillus of this disease was recovered. This bacillus was not found in the 111 samples of milk examined culturally during this investigation, nor has it, as far as I can find, been obtained by direct cultivation from milk by other observers. Consideration of charts showing mortality, temperature, &c.—A statistical survey of the facts bearing on the mortality was made and the data charted. A detailed chart (not reproduced) was prepared, in order to see if any correlation existed between temperature or season of the year, and the "non-tubercular" daily mortality, or the mortality amongst each batch of animals inoculated. The mortality curve did not show any close relation to the seasonal curve of temperature, even after making allowance for the epizootic, which occurred in November and December, 1909, and was responsible for the unusually high death-rate from causes other than tuberculosis. In Chart I. the percentages of different batches of samples, one hundredth of a cubic centimetre or less of which fermented glucose bile salt broth, are contrasted with the mortality resulting from the inoculation of those consignments of samples. The " fermentation percentages " curve follows the temperature curve fairly closely, the bacterial (v) For a time it seemed probable that this organism, which was highly pathogenic for guinea-pigs by subcutaneous injection, was actually responsible for the epizootic amongst the stock animals and also for the deaths amongst the inoculated "milk guinea-pigs." However, experiments by Petrie and O'Brien (Journal of Hygiene, 1910, p. 287), made to determine the mode of transmission of the bacillus, showed that it was of low pathogenicity when given with food and that the disease did not spread from one animal to another, when one of them was fed upon the bacillus, although kept together in close contact. This result was in so striking contradiction to what occurred in the natural epizootic, where 90 per cent. of the animals died, that it suggested an analogy with swine fever, in which disease the same bacillus is often found, but which disease has been proved to be due not to this bacillus but to an invisible virus which passes through a porcelain filter. The authors found that sterile filtrates of organs of guinea-pigs dying amongst the infected stock, when administered by different methods, frequently killed healthy experimental animals. They therefore conclude that B. aertryck was not the essential infecting agent in the epizootic, but that the disease was caused by a virus possessing similar characteristics to those of swine fever. 120 Annual Report of the London County Council, 1910. lactose-fermenting) content of the milk becoming greater in the hot weather as might be expected, but the mortality curve does not exhibit any correlation. For instance, the first week of July, 1910, shows a fairly high average temperature, and a very high percentage of "fermenters," and yet the mortality is below the average of the whole year and much below the average of June or August of the same summer. Chart II. gives the mean monthly temperature and the percentage mortality, and here again no close relationship is apparent between the mortality curve and the temperature. Results of subcutaneous injection of "single cow" milk samples.—To make this section clear, it is necessary to explain shortly the method of procedure, after a milk from a churn has been proved to contain tubercle bacilli by producing tuberculosis in a guinea-pig. The herd from which the milk in the corresponding churn comes is inspected by a veterinary expert, and any cow showing evidence of udder disease in any form, or of general illness, is carefully examined and its milk is forwarded for examination for the presence of tubercle bacilli. The total number of such samples in the period dealt with in this investigation was 193, of which 69 (= 35.75 per cent.) were proved to contain B. tuberculosis. These "single cow milks," coming thus from diseased or suspected cows, frequently contain pus and organisms associated with the disease, and it was of interest to enquire whether the milk from these cows produced a higher mortality than the ordinary "mixed milks" obtained from many cows the majority of which are presumably healthy. A comparison of the figures does not, however, show any great difference. The number of cases where both animals died, and a repeat specimen was necessary, is here 14 in 193 samples (= 7.2 per cent.), as compared with 736 in 4,508 (= 16.3 per cent.) while the total ''non-tubercular mortality" is here 24 per cent. and in the general samples 33 per cent. A comparison of the period lived after inoculation by the two groups does not reveal any notable differences. Consideration of cases in which both animals injected with the sediment of the same sample died —If the substances which cause the "non-tubercular mortality" were in the milk, and if they were the only factors present, one would expect the greater number of milk samples to cause the death of both animals, or of none, since each received an equal amount of the emulsified sediment. Yet this is not what we find, for (see table on page 115) in the first 4,508 samples of milk there were 2,333 (=736 + 1,597) instances, in which one or both of the injected guinea-pigs died, and there were only 736, i.e., less than one-third, in which both animals died. A consideration of those cases in which both the animals died did not suggest any ready explanation of this result, but suggested, on the contrary, that the lethal agent was in the milk. In analysing them, we find that the majority died within 24 hours of each other; e.g., in the last 72 instances, 52 of the pairs of animals died within 24 hours of each other. The majority of such "double deaths" occurred prior to the period of the present investigation, and of those recorded during the past year the greater number occurred during the "epizootic period" in November and December, 1909, the bacilli found in one or both of the dead animals being generally the B. aertryck, or, less frequently, the B. pseudo-tuberculosis rodentium. At this time the presence of a ''filter-passer" amongst both the stock and the inoculated animals was indicated as the probable cause of death. In some of the cases occurring since that time the plates inoculated from the organs of one or both of the dead animals remained sterile, but in a number of others the same bacillus was obtained from both animals at autopsy, the organism isolated being identical with, or closely allied to, the lactose fermenters common to MacConkey's table of faecal organisms and to Orr's table of milk organisms. We have seen that many of these organisms are lethal to guinea-pigs, when injected subcutaneously, so that the facts brought forward above raise a strong presumption that the infecting agent was often injected with the milk. Discussion of results. Since the intital problem was to ascertain the actual causes of the non-tubercular mortality the most obvious method of doing this was to see if the organisms isolated from the tissues of the dead animals were pathogenic to guinea-pigs when injected subcutaneously. If these organisms were found in the milk ejected, or had been shown by other observers to be commonly present in ordinary London milk, strong presumptive evidence would be afforded that such organisms were the real causes of the mortality. But difficulties arising out of this train of reasoning early presented themselves. From many of the animals dying during the early part of the investigation the B. aertryck was recovered, yet there were the strongest reasons for believing that this bacillus had not been injected with the milk sediment. Similarly the B. pseudo-tuberculosis rodentium was isolated from the dead animals, sometimes from the two animals of a pair dying on the same day, yet here again the evidence available strongly suggested that this bacillus was not derived from the milk. When dealing with the lactose fermenting organisms isolated, the chain of events at first seemed clearer. The bacilli isolated from the dead animals were faecal organisms of types found frequently in milk and were actually obtained from some of the samples of milk injected; they were, moreover, lethal to guinea-pigs when injected subcutaneously. One must not, however, conclude off hand that the presence in the milk sediments of organisms originally derived from faecal pollution was entirely responsible for the deaths. Many of these organisms have also been found in the intestine of the healthy guinea-pig. In the case of the guineapigs inoculated with milk they may have been so derived, as it is not uncommon for these intestinal Report of the Medical Officer of Health. 121 bacteria to invade the tissues shortly before death. Moreover, these organisms were more plentiful in milk in summer than in winter, and this increase should have been accompanied by a corresponding heavier summer mortality, yet Chart I. shows that this expectation was not borne out. Again, if the milk sediment was the only lethal agent, one would expect that if one animal died, its companion, injected with an equal quantity of the emulsified sediment, would also die. Yet the number of samples associated with the death of one animal is more than double that of those associated with the death of both, so that we must conclude that the milk sediment injected is not the only factor involved, but that it is often only a contributory cause of the mortality. The sediment contains cells from the milk and a very large number of bacteria, some pathogenic to guinea-pigs, some non-pathogenic; and we know from the results of the injection of dead cultures of organisms (vaccines) into man and animals that the bodies of bacteria contain constituents which may produce a great disturbance of health, accompanied by a lowered resistance to infection in general. Clinical evidence suggests that in consequence of disturbed conditions of general health, or of local disturbance, as in injury to the intestines, organisms normally present in the intestine may migrate therefrom and invade the tissues, producing severe or possibly fatal results. A careful review of the whole evidence suggests that a large part of the mortality amongst guinea-pigs inoculated with the sediment of milk is occasioned in a similar way, the milk injected so lowering the general health that a disease which is latent or chronic is able to progress to a fatal issue, or bacilli normally present in the intestine are enabled to escape into the circulation and cause death. In a paper which has recently appeared some experiments are described in which white mice were fed with cultures of various bacilli of the food-poisoning group—to which group the B. aertryck belongs. The observers, Zwick and Weichel (w) obtained results which led them to a similar conclusion. Some of their fed mice survived and were found to be execreting the bacillus with which they had been fed in their faeces for many days afterwards, although they appeared to be perfectly healthy. These animals when injected subcutaneously with a sterile emulsion of sausage meat died and the bacillus was isolated from their organs. The authors explain this by assuming that the inoculation lowered the animal's general health and its natural power of preventing the migration of the bacilli from the intestine, so that these bacilli invaded the organs and caused death. The presence of the fsecal or lactose fermenting organisms in the organs of the dead guinea-pigs seems, on the whole evidence, to be explicable only on a similar hypothesis. The toxic sediment lowers the animal's resistance so that the normal intestinal organisms of the guinea-pig rapidly leave the intestine, invade the organs and cause death. Thus, the source of these fsecal organisms found postmortem is not in all cases necessarily the dung of the cow-yard, but often probably the guinea-pig's intestine. Summary and conclusions. The object of the investigation was to determine the cause of the "non-tubercular mortality" amongst guinea-pigs and any bearing this might have on the general question of the purity of London milk. By "non-tubercular mortality" is meant the mortality from causes other than tuberculosis amongst guinea-pigs injected with the sediment from samples of milk. 1. A part of this "non-tubercular mortality" was due to infectious diseases which the animals were incubating at the time they were inoculated with the milk sediments, or with which they became infected during the month they were allowed to survive prior to examination for tuberculosis. This was notably the case during November and December, 1909. 2. Infection by bacilli identical with those derived from the faeces of cows and other animals contained in the milk inoculated is responsible for a certain amount of the "non-tubercular mortality," this amount being impossible to determine accurately. 3. The greater part of the mortality, however, appears to be occasioned by a combination of factors. A disturbance to the animal's economy is occasioned by the considerable dose of bacterial protein in the sediment, quite apart from the capacity of such bacteria to survive in the tissues. This may so lower the resistance of the animal that it succumbs either to an aggravation of an existing but hitherto indolent infection—e.g., pseudo-tubercle—or to the invasion of the organism by bacilli present in its intestine. 4. No evidence was obtained of the presence in the milk of bacilli causing common diseases in man, such as typhoid fever, diphtheria, dysentery, or " food-poisoning." (w) Zwick and Weichel ; Arb. aus. d. Kaiserlich. Oes. Bd. 32, 1910. 5176 I CHAPTER XXXIII. Public Health Reports (continued). Report of the Education Committee Submitting the Annual Report of the Medical Officer (Education) (Dr. J. Kerr) for the year 1910. In presenting the report of the medical officer (education) for the year ended 31st December, 1910, we would direct special attention to the great increase in the extent of the medical work which has engaged the most careful attention of the sub-committee concerned. In submitting the report for the year ended 31st December, 1909, attention was drawn to the great advance which had been made during that year in the matter of the health of children in public elementary schools. That advance has been well sustained during the year under review, owing in the main to the increased frequency of medical inspections and the steady development of the Council's scheme for the provision of medical treatment. The scheme of medical inspection has passed, during the period under review, through a transitional stage, the nature of which has to be borne in mind in considering statistics relative to the results of inspection during the year. During the earlier half of the year the school inspections included all the children in the school at the time of the doctor's visits. At a later stage the new entrants, the children about to leave, and those between the ages of 8 and 9 years were examined. The infants in these cases were only cursorily examined and medical record cards were not filled up in respect of infants unless there was urgent need for treatment. At the inspections held towards the end of the year, the new entrants, the children about to leave and those of between 8 and 9 years of age were all inspected and medical record cards were filled in for all the cases. The examination of children between the age of 8 and 9 years was in accord with the foreshadowing by the Board of Education of the examination of a third "age-group" as a likely code requirement. In May, 1910, the Board of Education expressed the opinion that the staff proposed was insufficient for the work to be undertaken. Naturally, the increased work undertaken has necessitated the augmentation of the medical staff engaged upon the work. Beginning with 40 quarter-time doctors, in 1908, this staff has been increased to 56 on 1st September, 1909, and to 72 on 1st September, 1910. The professional staff employed at the end of 1910 numbered 84 doctors (70 men and 14 women) giving time equivalent to the full-time of 24 medical officers. As from 1st January, 1911, this staff has been further increased to 114 doctors (96 men and 18 women) giving time equivalent to the full time of 32 medical officers The permanent staff at the end of 1910 comprised the medical officer (education), two assistant medical officers (full-time), two assistant medical officers (half-time), seven assistant medical officers (quarter-time), including specialists in mental, ophthalmic, aural, orthopaedic, and dental work, together with 72 medical inspectors (quarter-time). This staff has been increased as from 1st January, 1911, by two assistant medical officers (full time), and 28 medical inspectors (quarter-time). The Council's arrangements made four years ago for carrying out the statutory duties imposed by the Education (Administrative Provisions) Act, 1907, have now fully developed, and medical inspection is completely organised in all the schools. The medical officer (education) is therefore of opinion that the staff at present engaged will be sufficient to cope with the work and to comply with the requirements of the Board of Education. The following figures give a general idea of the results obtained during the year under review. Of the children examined in full detail there were recorded in last year's report (1909) the results of 37,420 examinations, with 12,656 or 33 per cent. requiring medical treatment. These represented chiefly children at all ages. Of the 172,619 children examined in 1910, and noted in detail, 52,954 or 32.6 per cent. received advice cards. The medical officer (education) states that the proportion of children who will be selected by the doctors after careful examination and given advice cards can now be fixed on the basis of the last two years as 65,610 out of 210,039, that is 32 per cent. or approximately one-third of those examined. Of the 172,619 children recorded, 81,151 were returned as normal, that is free from any definite organic defect. Bad defects of vision or eye diseases were recorded in 18,923. Defects of throat or nose were 29,927; of ears or hearing, 9,499; skin disease, 2,913, this includes 453 ringworm cases found by the doctors, ringworm cases being generally excluded by the nurses. Other diseases were recorded in 15,296 children. It is pointed out that considerable importance attaches to the estimate of the state of nutrition of individual children. This is usually done by ocular inspection, the general appearance of the child, his person and carriage, expression, signs of activity or listlessness, colour of the face and of the lips, roughness or otherwise of the skin, all being taken into consideration. The children so inspected are classified under three main headings, viz., (i.) those in good condition, (ii.) those in moderate condition, and (iii.) those in bad condition. The number falling under these headings during the year 1910 were 46.7 per cent. under (i.), 41.8 per cent. under (ii.), and 11.5 per cent. under (iii.), as compared with 46 per cent., 41.2 per cent., and 12.8 per cent. in 1909. Report of the Medical Officer (Education). 123 The physique of the children has been made the subject of considerable research, the results of which are presented in the form of charts. The various groups shown on the charts correspond very closely with the three classes distinguished by the British Association. The correspondence of the result with the predominant occupation of the parents [in 'each area is with a few exceptions remarkably close. The lower averages are found in the riverside districts, North Kensington, and in a central area extending from the Strand district to Bow and Bromley. The most unexpected figure is the weight recorded for Fulham, and here the majority of the children are tidy and come from apparently comfortable homes of the artisan and commercial class. The numbers at present available are, perhaps, too small and liable to chance error from exceptional children; whilst from the map, physique appears mainly correlated with social conditions, racial factors cannot be entirely excluded. In addition to the wider racial variations to be observed in large groups of children, there are individual differences which render comparison from one area to another somewhat uncertain during the years of rapid growth. During the winter of 1909-10 attention was called to the children at a school in Bethnal-green who showed obvious signs of abnormally poor nutrition. The school doctor reported that it was not hospital treatment but feeding that was necessary and 166 children were noted by him as requiring special feeding. All these children received a cupful of warm milk and a teaspoonful of cod liver oil during the morning interval, and at the end of the year it was found that a very marked physical improvement had occurred, only nine children remaining in statu quo ante. The Council's scheme for the provision of medical treatment in those cases where the parents are unable to provide suitable medical treatment themselves, has been steadily developed during the year, and while experience has been continuously accumulated, the application of the scheme has been extended to districts previously untouched. In October, a comprehensive report was prepared on the general question of dental treatment of children attending public elementary schools. In this report it was stated that it was undesirable to attempt an immediate and complete settlement of the problem, and the Council accordingly adopted the policy suggested in the report, viz., to enter into an agreement with the authorities of two institutions to provide treatment for 6,000 children for a period of one year, as from January, 1911, with a view to accumulating experience as to how best to deal with the matter. In connection with these two schemes, lectures on dental hygiene were given at five schools in the vicinity of each treatment centre by one of the assistant medical officers (education), and general information on the care of the teeth was disseminated among teachers, parents, and pupils by means of pamphlets, etc. A free dental clinic was also in January, 1910, opened as part of his dispensary work by Dr. Kirby of St. George's Dispensary, and 400 children of the "Blackfriars" school were treated during the year. At the Barrett-street school, which is situated in the centre of the hospital area, the attempt was made to get children requiring dental treatment to go to hospital. Ignorance is the chief cause of the neglect of dental hygiene, and the removal of this ignorance precedes any successful work in the school. So little have the public realised the value of dental treatment, that its development must of necessity be slow. Medical inspection is now carried out in all the Council's secondary schools, training colleges trade and technical schools. Each student is examined once a year, and each institution visited once in six weeks, so that the doctor can be consulted about pupils presenting any symptoms likely to affect their health or work. Every student has a medical record card showing, at a glance, the condition, so that they are continuously under observation, and if through illness or other cause students become unfit they are not permitted to continue at the institution. In the secondary schools special attention is given to curvature of the spine. Curvatures occurring during the years of most active growth are undoubtedly common in school children and generally of little importance, but some are serious, and all have, therefore, to be regarded from this possibility. Towards the end of 1909 the first steps were taken towards exercising the powers conferred upon the Council by the London County Council (General Powers) Act, 1907, in the matter of cleansing verminous children. Small experimental cleansing stations were established at the Pulteney, Chaucer, and Finch-street schools in October, 1909, the station at the Pulteney school being transferred to Bath-street school in September, 1910. The Bath-street station has already effected a considerable improvement in the children attending the schools in the neighbourhood, and one of the encouraging signs is the fact that on a second examination the same children are not always found to be verminous. There are a few who are always infected, but the greater number of children found verminous are new cases. The head teachers remark on the increasing cleanliness of the children. The working of the scheme has, however, been hindered to a considerable extent by the necessity for serving the statutory notice under the Children Act upon the fathers of the children, who are frequently not at home except at midnight. Among the various ailments and diseases dealt with in detail in the report may be mentioned adenoids, suppurating ears, and ringworm. Great difficulties are still experienced in the provision of proper educational treatment of epileptics, neither is there at present any special accommodation for children who are both mentally and physically defective. Those who are unable to walk to a mentally defective school have to be excluded altogether, though the number of such cases is small. One of the most important innovations of the year was the hard-of-hearing class at Ackmarroad school, which was started on 12th September, 1910, with six cases, others being added, so that at the end of 1910 the class numbered 17. Of these 17 cases, 7 were boys and 10 were girls. The primary cause of the defect in these cases was adenoids in 12 cases (4 catarrhal, 6 suppurative, 2 5176 I 2 124 Annual Report of the London County Council, 1910. suppurative and catarrhal), or 75.8 per cent., a high percentage, but, when the enormpus potency which these hypertrophies possess for causing ear diseases in children is taken into consideration, not higher than is to be expected. The medical officer (education) states that during the last three years a very pleasant form of education extensively used in German-speaking lands, and of a more real kind than the classroom can give, has been spreading steadily in the form of school journeys, and he is of opinion that these should be encouraged in every way possible and regarded as most serious and valuable methods of education. There may be some risks in subjecting ill-nourished or debilitated children to prolonged physical efforts, and for this reason a large number of journeys has been investigated by Dr. Clive Riviere, who has endeavoured to assess the conditions of the children before and after their excursion and to relate his findings to the various conditions of the journey. He finds that the boys looked the best who had spent a rambling seaside holiday; they gained in weight. A review of the past year reveals a striking diminution in the incidence of scarlet fever and diphtheria, both of which diseases appear to be passing through a stage of inactivity. Measles, on the contrary, has been unusually prevalent, the figures both for the spring and autumn showing an abnormal rate of incidence, the latter part of the year especially having been visited by an outbreak probably unprecedented for the time of year (when measles usually appears to be somewhat quiescent), which, as subsequent events have proved, was the beginning of an epidemic of almost unparalleled intensity and prevalence. As regards diphtheria, the number of notifications from teachers was 1,861, as compared with 2,212 in 1909. In all 81 schools were under observation; 999 cultures were taken in 17 schools and 35 children excluded as carriers. Report of the Medical Officer (Education) (Dr. J. Kerr) for the Year 1910. This series of reports on school hygiene in London, which were commenced voluntarily as an annual review of the duties of the medical officer to the Education Authority, have now become permanent in the form of statutory reports of the school medical officer which have to be submitted to the Board of Education annually. When the work of the year 1910 is surveyed, there is no great forward step to record nor any considerable addition to knowledge or practice to explain, but there is a sense of solid and substantial advance beyond the position attained when the year opened. The increase in extent and cost of medical work in the schools has naturally subjected it to much examination and criticism, but if it be considered that the changes of the last generation emphasise the importance of making capable and healthy citizens, it will be realised that the physical side of the children's life requires a proportional expenditure of thought and money to that spent on the mental side. The chief matters dealt with in this report may be briefly enumerated:— The Council's arrangements made four years ago for carrying out the statutory duties imposed by the Education (Administrative Provisions) Act, 1907, have now fully developed, and medical inspection is completely organised in all our schools. A scheme for the medical treatment of children has been slowly developed on a large scale; experience is being obtained, and when the scheme has grown efficient it will be a most valuable service. Some beginnings have been made with dental provision, but so little have the public realised the value of this service that its development must be slow. The services of the nurses have been most valuable, and this branch will probably best repay extension. Experiments of recent years in the matter of healthier environment for educational work, whether in the form of open-air schools, playground classes, school journeys, or special invalid schools, all appear to have been so much appreciated that they are being continued and in some cases extended. In several directions the Council's work is incomplete when divorced from that of other authorities. In the case of children coming from unclean homes and with verminous clothing, it has not been possible to apply the scheme drawn up some time ago to the whole of London. The general physique of children and their nutrition is another line of enquiry to which much attention has been directed. It largely depends on factors which can only be remotely and indirectly affected by the Education Authority. Elementary Schools. Staff The requirements of the Education (Administrative Provisions) Act, 1907, are that provision shall be made for the medical inspection of children entering and leaving school in each year. A complete scheme was drawn up early in 1908 for introducing this statutory medical inspection by arranging an increasing service to provide for gradual compliance with these requirements during three years. Beginning with 40 quarter time doctors in 1908, increasing them to 56 on September 1st, 1909, and to 72 on September 1st, 1910, this modified scheme was deemed ample to fulfil ultimately all requirements. The Board of Education accepted the modified scheme when put forward, but withheld judgment as to whether it would satisfy the requirements of the Act until they had an opportunity of observing the working of the scheme. Owing to this mode of gradual compliance, which was fully represented when the scheme was originally proposed and approved by the Council, the staff was not sufficient prior to September 1st, 1910, completely to fulfil the Code requirements. The professional Report of the Medical Officer (Education). 125 staff at the end of 1910 numbered 84 doctors, of whom 70 were men and 14 women, increased on January 1st, 1911, to 114 doctors, of whom 96 were men and 18 women. The numbers of the staff are as set out below:— The original scheme of 1908 as completed in September, 1910. Permanent Staff. Medical Officer (Education). Two Assistant Medical Officers (whole time). Two Assistant Medical Officers (half time). Seven Assistant Medical Officers (quarter time). (Including specialists in mental, ophthalmic, aural, orthopedic and dental work). Temporary Staff. 72 Medical Inspectors (quarter time). The scheme as extended in 1910 to take effect from January 1st, 1911. Permanent Staff. Medical Officer (Education) Four Assistant Medical Officers (whole time). One Assistant Medical Officer (half time). Eight Assistant Medical Officers (quarter time). (Including specialists in mental, ophthalmic, aural, orthopedic and dental work.) Temporary Staff. 100 Medical Inspectors (quarter time). All detailed enquiries in the way of important hygienic school work are carried out by the permanent staff, who are trained and skilled hygienists. The medical inspection is not technical work in this sense, but work which everyone qualified in medicine ought to be able to do. It presents no special features which cannot be learned in a few weeks, and being such routine work, and there being such an immense mass of it in London in comparison with the other medical work, it would always be difficult to get a good class of officer to give up all his time to do this work unless a comparatively high salary be offered. On the other hand the very highest type of medical practitioner can be secured who is willing to do it for a time early in his medical career, but this good type of officer will not do it always, and if these appointments were permanent the people who would retain such routine appointments would be those wanting in activity and originality, and the staff would gradually come to accumulate a large proportion of routine second rate workers content to go on in the groove. These officers once in possession could not fairly be displaced, but this result is avoided by the rota method, The criticisms which have been made in regard to medical inspection in London apply only to a time when the staff was insufficient to cover the area. In May, 1910, before the scheme was fully developed and when only 56 doctors were at work, a letter was received from the Board of Education in which the opinion was expressed that the staff as proposed was insufficient for the work. Suggestions for a further increase of "staff to do all that is likely to be required for the next three years" was asked for by the appropriate sub-committee. As the Board of Education had foreshadowed the examination of a third age group of children as likely to be required as a Code requirement, it was proposed that an additional age group of children between 8-9 years old should be inspected in addition to the entrants and leavers. It was pointed out, however, that the staff arranged a couple of years before to be completed in September, 1910, was sufficient to carry out all Code requirements. Finally it was decided to increase the staff as already shown as from January 1st, 1911. Such a staff is quite sufficient to do all the medical inspection likely to be required by the Code and the children of the extra age group in addition. In previous years a good deal of careful work was done on the methods of medical inspection especially with a view to ascertaining the points on which economies of time could be practised, for although a thorough clinical examination might be made of every child, the results to be obtained from such an examination would be quite incommensurate with the cost. For public health purposes it is necessary to devise a method which will result in all defects of importance being noticed, and yet will take up but little time, and consequently will not be unduly costly. Prior to the statutory medical inspections being required we carried out the "routine" examination, by which all children suspected of any defects were noted on special fists by the school teachers and were seen by the school doctors on their visits. The doctors also went through the department and picked out any children who seemed in need of examination. The simplest method was to "fall out" all noted by the teacher and then inspect the rest. It is obvious that the personal equation of the teacher is checked considerably by this method. Every child can be inspected, and if no time is lost in entering up forms and making unnecessary investigations it is easy to check one child a minute. This scheme is most effective in detecting children with ailments for treatment, and comparative tests show that very few cases are missed. The method now used ensures the finding of all the children with defects, but is much slower than the older method owing to the clerical work and the detailed examination of the healthy cases. The older method was temporarily retained during the year in the infants' departments; only selected children were examined in full detail. The time of examination is also decreased when the children are not stripped, and formerly when the staff for medical inspection was numerically insufficient, stripping was not encouraged, as it took one-third more time. When the children are stripped to the waist the examination gives a greater impression of thoroughness and utility, and the fuller the examination the better does it seem to be appreciated by the parents. There is no doubt of the influence which a first class examiner has on both parents and teachers. The grip of such an examiner cannot be described, but it is at once felt, and the effect of his work must outweigh any smaller considerations of office routine involved in the Medical Inspection. 126 Annual Report of the London County Council, 1910. employment of such part time officers. Again the surroundings of the medical inspection often condition its completeness. The draughts of a corridor will not permit of the same thoroughness as an examination in a teachers' room. Until the autumn of 1910 the medical inspection was so organised that there was latitude for special enquiries allowed to the inspectors, and leakage was avoided in the work. As each school came in turn to be inspected at the first visit the doctor and head teacher arranged locally for the subsequent visits at the most convenient times. Experience showed that this method gave the doctors a considerable interest in the work and that they averaged an excess of time spent in school over that due by them to the Council's service, besides writing extensive reports on many subjects of interest on which they made enquiries. It was probably these different methods, and a misunderstanding of this last arrangement, which gave rise to the criticism formerly applied to the medical inspection done by the part time school doctors. In the autumn it was suggested that fixed examination hours, if advertised some time before, would enable the care committees to make certain arrangements, and a rota was drawn up so that there could be no variation from the announced times, and no inspections were to be made except at these times, with the result that the doctors work at their allotted times only, and confine their work almost entirely to routine inspection. As the inspection is now carried out the days and times when the doctors will visit the schools for the purposes of medical inspection are published each week in the London County Council Gazette. The doctors are instructed that as the parents or guardians of the children about to be examined are invited to attend the school these times must be adhered to strictly. For this purpose all the schools are Visited once each term, the doctors have three fixed half-days (9.30 a.m. to 12 or 2.15 p.m. to 4.30 p.m.) weekly. The nurse arrives before the doctor to see that all is in readiness. She arranges the children and their record cards in order for examination, assists in dressing and undressing, and in testing vision, weighing and measuring. She also discusses the history of the child with the parents, and enters particulars of infectious disease on the cards. After the children are seen details are entered in the medical register at the school, and a form giving particulars of the inspection, numbers of children seen, defects noted and recommended for treatment, is transmitted to the head office. During the year 1911 the doctor inspects the entrants in the infants' school, the children born in 1903, that is the 8-9 age group, and those born in 1899; this last represents the group of leavers. Children of other ages are also examined by the doctor if he thinks fit, and any selected by the managers, care committee, teachers or nurses may be submitted as in urgent need of medical attention. The Model Schedule of the Board of Education is taken as indicating the scope of the inspection, but the returns hitherto have been noted on a simpler card to save clerical work. Where a child is in need of medical treatment this is explained to the parent, and an advice card is distributed, or if a parent is not present, the card is delivered later by the school nurse at the home. No individual is examined by a doctor alone, and undue privacy is always avoided. The inspection, and, indeed, all medical examinations are of a confidential nature, and as it is impossible to examine the children properly or to obtain the necessary information in regard to family history when strangers are present, no one except those qualified to aid the doctor, namely, the parent, teacher and nurse, is allowed at the medical inspection. This does not preclude a member of the School Care Committee being in the school and conferring with a doctor either before or after, but not during an examination. These medical inspections are not deemed sufficient for special school purposes and do not conform to the requirements of the Education (Defective and Epileptic Children) Act, 1899, so that doctors are instructed to advise the head teachers to nominate on forms prepared for the purpose all children who might require further examination as suitable for deaf, blind, mentally defective, invalid or other special schools. The objections to medical inspection are very few and appear to become fewer with time. Where objection is made either no action is taken or a record card is sent to the parent with an intimation that if this is filled up by their own medical attendant and returned to school that will be sufficient. So long as only one or two parents in a district object they can be neglected. In the Hampstead district at the end of the year numbers of letters came in from parents objecting to medical inspection on the ground that their children had already been seen by other doctors. It was evident from the similarity of the letters that they were the outcome of some organized arrangement. Enquiries were made and it was found that the Hampstead Council of Social Welfare were arranging to inspect annually the children connected with their dispensary, some 2,000 in number. Any extensive action of this sort would seriously diminish the value of the school work, and if the number of objectors to medical inspection became other than negligible it would probably be necessary to obtain powers to make the examination compulsory. Objections are raised more frequently to inspections of children by the nurses, but there the course is quite clear, for under both Section 36 of the London County Council (General Powers) Act, 1907, and Section 122 of the Children Act, 1908, the medical officer or any person provided with the authority in writing of the medical officer "may in any school within the county provided or maintained by the County Council as the local education authority examine the person or clothing of any child attending such school." In analysing the statistical returns of the medical inspection done during 1910, they may be arranged in three categories, but at the same time it is to be remembered that inspection only attained its full development with the appointment of the third instalment of the staff who began work in September, 1910. The three categories under which medical inspection is arranged are— (a) 140 schools, examined under the "old" scheme. All the children in the school were examined. This took place during the earlier half of the year, and was necessary to keep the treatment arrangements going. Report of the Medical Officer (Education). 127 (b) 123 schools, examined on an "intermediate" scheme. Entrants, leavers and the 8-9 age group. The infants here did not have cards filled up unless there was urgent need for treatment, they were "cursorily inspected." (c) 130 schools, examined in accordance with the scheme to be maintained during the present Code year (1910-11). The entrants, leavers and 8-9 group are all examined and have cards made out, but hitherto in the case of entrants only those examined in detail have the cards fully filled in. In the last two schemes in addition "urgent cases" at any age, presented by the teachers were examined. The figures are given in Appendix III. After this Code year it is proposed to examine in detail all the entrants, and fill up cards for both healthy and ailing children. The comparison of the work done under the three categories is shown in Appendix IV. As already stated these different groups vary in result according to the numbers of infants. Of the children examined in full detail there were recorded in last year's report (1909) the results of 37,420 examinations, with 12,656 or 33 per cent. requiring medical treatment. These represented chiefly children at all ages. In 1910 of the 172,619 children examined and noted in detail 52,954 or 32.6 per cent. had advice cards given. The proportion of children who will be selected by the doctors after careful examination and given advice cards can now be fixed on the basis of the last two years as 65,610 out of 210,039, that is 32 per cent. or approximately one third of those examined. Of the 172,619 children recorded, 81,151 were returned as normal, that is free from any definite organic defect. Bad defects of vision or eye diseases were recorded in 18,923. Defects of throat or nose were 29,927; of ears or hearing, 9,499; skin disease, 2,913, this includes 453 ringworm cases found by the doctors, ringworm cases being generally excluded by the nurses. Other diseases were recorded in 15,296. It will be seen that these are minimal numbers, and in the case of visual defects a comparatively low standard is taken, below Standard v. for instance, visual acuity of is taken as the beginning of what is called defect. The returns of each day's work are made on Form M.O. 190, a copy of which is given in Appendix V. A summary ot the work done in reporting on school buildings is given in Appendix V1. Considerable importance attaches to the estimate of the state of nutrition of the individual children. This is usually done by ocular inspection, the general appearance of the child, his person and carriage, expression, signs of activity or listlessness, colour of the face and of the lips, roughness or otherwise of the skin, being all taken into consideration. In addition by palpation the observer notes the firmness of the tissues and the extent of subcutaneous fat. The estimate has been recorded in numbers from 1 to 5 following the scheme used by Dr. Thomas (see Annual Report, for 1908, p. 17), the limit of the groups being defined as— School Buildings. Nutrition. 1. The pink of condition. 2. Very good muscular development with only fair general nutrition as indicated by subcutaneous fat, etc., or vice versa. 3. Fair all-round development. 4. Very poor muscular development with a fair amount of subcutaneous fat or moderate muscularity and little or no fat. 5. Very poor muscular development with little or no subcutaneous fat. At a later stage the classification was reduced to a threefold table of good, moderate and bad; good comprising 1 and 2 of the foregoing and bad 4 and 5. This reduced the number of border zones in which there was room for personal equation; the observer tending to set a standard by the children in the group actually under observation rather than from the whole in all types of schools. This equation affected results when a good type school was substituted for a poorer one and vice versa. The percentage distribution of nutrition has been— Group. 1909. 1910. 1 11.4 46.0 12.8 46.7 2 34.6 33.9 3 41.2 41.8 4 12.0 12.8 11.0 11.5 .8 .5 Some check or further method of estimation is desirable, but difficult to obtain. In adults the ratio of stature to weight is in general use and receives general acceptation and, since one factor, the stature, may be taken as stationary, the weight in the main varies with the nutrition. This is the more useful in cases where the weight is deficient. None the less, as spare and obese types exist, a wide variation must be allowed for within the limits of health. Apart from the influence of illness the weight varies with such conditions as food, sleep, general hygiene, character of occupation, temperament and race. In children the estimate must be of an even more complex nature since both stature and weight vary and not necessarily together, the increment at one time favouring the one more than the other. It is generally believed, following the investigations of Schmidt Monnard and Mailing Hansen, that the growth in stature is greatest in the spring and summer, when the weight is comparatively stationary while the chief weight increment occurs during the autumn months. This would seem largely confirmed by the observations made at open air schools. If the grams weight per centimetre of stature be used as an index it would be necessary to use a somewhat higher index as the 128 Annual Report of the London County Council, 1910. normal in winter than in summer. The following figures show, in round numbers, the average results obtained from the boys in some 28 schools:— Age. Grams per cm. Age. Grams per cm. 7 180 11 220 8 190 12 230 9 200 13 250 10 205 14 260 These numbers are a little lower than those obtained from the boys in the Council's secondary schools and trade schools given in last year's report (p.31), but they closely approximate to the figures given for urban elementary school children in Germany and Switzerland. The variation between heaviest and lightest in each group ranges from 80 to 200 grams, but generally a deficit of 50 grams from the average merits individual enquiry. The actual average values for the age groups generally examined may be compared with averages from the 1883 report of the Anthropometric Committee:— Grams per centimetre of stature. Boys. Girls. Age 8 12 8 12 London average 189 230 187 232 Anthropometric Committee average 195 236 190 230 This figure was applied as a test to a random selection of nutrition estimates taken from the medical record cards of children of the twelve year old group with results showing that a definite relation existed between the nutrition and the weight for a given stature. The following table shows the weight in grams per centimetre of stature in nutrition groups:— Nutrition Estimate. 1 2 3 4 Boys 253 252 222 204 Girls 284 249 226 210 A method of evaluation used on the Continent is a nutritional index derived from the percentage relation between the cube root of the weight in kilograms and the stature in centimetres. The average value of this index is said at all ordinary school ages (8-14) to be between 2.3 and 2.4 and to be independent of racial influences. Tested on a random sample of cards the following figures are obtained :— Index. Actual number. Percentage. 1.9 3 0.2 2.0 8 0.6 2.1 28 2.1 2.2 235 17.2 2.3 667 48.7 2.4 382 27.9 2.5 43 3.1 2.6 2 0.1 1,368 Adopting 2.3 as the mean value, the percentages above and below are 31.1 and 20.1 respectively, whereas the grouping of the same children on the threefold nutrition estimate were, good 29, moderate 45 and poor 26 per cent., a fairly similar result. Direct comparisons with the threefold nutrition estimate, however, showed that the index, though in the mass comparable with the ocular impression, differed in regard to individuals though a fairly high degree of correlation certainly exists. Percentage distribution of index for each estimate value:— Nutrition estimate. 1 2 3 Index 1.9 — — 2 2.0 — — 1.3 2.1 7 .4 61 2.2 10.7 27.7 35.1 2.3 50.7 52.5 47.2 2.4 33.2 18.7 10.1 2.5 4.7 .4 — 2.6 — .4 — % Report of the Medical Officer (Education). 129 It would appear that cases with an index of 2.1 or under need special investigation; they are somewhat more frequent than are the cases in the worst grade of the fivefold scale of ocular estimates. Oppenheim maintains that the relation between the girth of the empty chest and the maximum girth of the relaxed arm gives an indication of the nutrition of the individual which is superior to any Arm × 100 other measurable ratio. Chest = nutritional quotient. He finds the ratio to be practically independent of age and to present an average value of 29. A series of observations on the children attending London secondary schools gave an average of 29, while the same ratio calculated from the published measurements of boys at Marlborough College proved to be 28.6. A ratio below 26 might be taken to show bad nutrition, one over 29 good nutrition. Classifying the boys in a London secondary school by this means, 3 per cent. appeared as bad, 42 per cent. as medium, and 55 per cent. as good. Oppenheim's Nutritional Quotient. Age. London Secondary School. Marlborough College. 10 28.5 — 11 27.8 — 12 28.5 28.0 13 28.8 28.4 14 29.3 28.0 15 29.5 28.5 16 30.5 28.8 17 29.1 28.4 In the Council's secondary schools the results are definitely correlated with the ocular estimate, but no records having been made in elementary schools, a comparison with the former is impossible. The method merits further enquiry. Children in North Kensington.— Whilst the variation in physique of the children as shown in figures varies broadly over London, the examination of particular districts often shows a very patchy distribution in poverty and ill-health. The social conditions under which the children in North Kensington live vary considerably. At such schools as Portobello-road and Oxford-gardens they are fairly prosperous and comfortable, approaching the class found in secondary schools, only a few poor or neglected children being sprinkled through the classes. At Oxford-gardens the physique and nutrition of the children are very good, whereas at Edinburgh-road, a few streets away, the type of child is entirely different, many being dirty, ill-fed and neglected, and the numbers requiring medical treatment, or entered as necessitous being relatively high. At St. James' Norlands and St. John's, there are comparative comfort and well-being, while at Sirdar-road the mass of the pupils are suffering from poverty and bad home conditions, and at St. Francis in the adjacent street, the distress and destitution are very marked. At Wornington-road School during the last two years the prosperous child has gradually become more rare and the necessitous child more common; this is shown also by the increase in the number of meals provided and by the statement of the teachers that the neighbourhood is going down. In the Kensal-road district there are three schools, St. Andrew's, Bosworth-road, Middlerow, and St. Mary's Roman Catholic, East Row. Although the better class girls in the district prefer to attend St. Andrew's, there is a large percentage of malnutrition and poverty among the children there, while at Middle-row and St. Mary's these conditions are accentuated. A definite improvement has taken place during the last two years in the condition of the children attending Middle-row school. This is in part due to the medical inspection, to the work of the school nurse, the increased number of meals supplied, the improved quality of the food provided at the dinner centre, and in a great measure to the unremitting efforts of the teachers in all that concerns the physical welfare of the children. The Kensal-road district has become even poorer and more necessitous during the last two years and the home conditions also tend always to deteriorate. The amount of disease found among the North Kensington children is not very great. In the infants' department the children are on the whole healthy, the cases of organic disease and mental deficiency form only a small proportion of the whole. In the senior departments a larger number of cases of eye, throat, and ear trouble are met with, but the general impression obtained is that the material is fairly good, it is the conditions of life which are at fault. The great amount of anaemia and malnutrition among the children is attributable to poverty, with its resultant evils of dirt, ill-feeding and underfeeding, neglect and female labour. The necessity for buying cheap food results in the purchase of food-stuffs which are deficient in nutrient properties. The main articles of diet are indifferent bread and butter, the fag-ends of coarse meat, the outside leaves of green vegetables, and tea, with an occasional pennyworth of fried fish and potatoes. Children who are supplied with milk at school or who are given breakfast and dinner respond at once to the better feeding, and show distinct improvement in their class work. Dirt is one of the most potent factors in the production of malnutrition; large numbers of the children are verminous, and many more show evidence of the infested state of the houses and bedding. Infants are often drowsy and inclined to sleep all day because they have no proper quiet sleep at night. In one school on a roll of 392 girls, 208 were found to be dirty, and the examination of 1,670 children showed that 516 were dirty and 86 verminous. The unemployment among the men obliges the women to seek for work outside the home, and the underpayment of female labour has its effect upon the nutrition of the family. Investigation in the senior departments of one school showed that 144 children were being supported by their mothers only, 57 were living on their sisters, 68 upon the joint earnings of elder brothers and sisters, while 130 Annual Report of the London County Council, 1910. another 130 had mothers who went out to work in order to supplement the earnings of the lather. Approximately one-third of the children in this neighbourhood are supported by female labour. With the mother at work the children rapidly become neglected, the boys get out of control, they learn to play truant, to sleep out, and become known to the police while they are still in the junior mixed department. The maintenance of the home, the cooking and catering is done by an elder girl, who sometimes may not be more than ten years of age. The mother's earnings provide bread and tea for the family and pay the rent, but leave nothing over for clothing or boots. Many of the boys obtain employment out of school hours, for which they are paid and for which they may receive food; others learn to hang about the gasworks and similar places and get scraps of food and halfpence from the workmen. In consequence they may appear to be better nourished than the girls, who work beyond their strength at domestic work, step cleaning, baby minding, or carrying laundry bundles and running errands. For this labour they receive no remuneration since it is done for the family. It is not uncommon to find girls of ten doing a day's hard work outside their school work, they are the slaves of their mothers and grandmothers. There is a great difference between the physique of girls attending the Oxford-gardens school and those attending the Edinburgh-road school. In the former the development and deportment of the girls are excellent, but their leisure is spent in a recreative way on themselves, out of doors, taking music lessons, reading novels, while the girls at the latter are underfed and overworked from an early age. At this school there has been a definite inprovement in the girls during the last year, owing to the civilising efforts of the head-mistress. When medical treatment is recommended, the parents of the poorer class do not seem inclined to exert themselves to get it for the children. By personal effort some of the care committees have overcome all obstacles, and have succeeded in having the children attended to, but in chronic cases which require to attend hospital for long periods, and for quite young children, the difficulties are almost insuperable. Oil and Milk.—During the winter of 1909-10 Dr. Hawkes called attention to the children of one school in Bethnal Green. Most of them belonged to large families dwelling in small houses, in almost chronic destitution, the mothers often being the bread-winners and the fathers out of work. The food, generally being judged by quantity rather than quality, is usually insufficient. The impression gained of the children was that they were of poor nutrition; this was fully confirmed at the medical inspection. Their measurements were below the average for London, their clothing generally insufficient. The school doctor reported that it was not hospital treatment but feeding that was wanted. The surgeons at the Queen's Hospital had refused operation in many adenoid cases on account of the low state of the children's health. In many evident tubercular disease held a considerable place both in the personal and family histories. At the medical inspection a list was recommended to the School Care Committee as suitable for extra meals of milk and cod liver oil. The doctor marked the cards of those whose health he thought imperilled; 24 of the 57 boys and 61 of the 109 girls were so recommended. Of these tubercle was suspected in 12 boys and 26 girls. A teaspoonful of cod liver oil in a cupful of warm milk was given during the forenoon interval. Very few children showed repugnance, most of them actually enjoyed it. The nutrition which had been noted at the medical inspection was re-assessed at the end of the year as follows— Nutritional condition. Good. Average. Bad. (1) (2) (3) (4) 57 Boys Before 4 19 34 After 26 28 3 109 Girls Before 3 49 57 After 42 61 6 Almost all cases showed improvement, only three boys and six girls remaining in statu quo. Many showed improvement which was difficult to express on the cards, in that they showed more signs of alertness and activity, the faces were brighter and clearer, they held themselves more erect, but still many remained very anæmic, and this possibly is intimately related to housing and particularly small and badly ventilated sleeping rooms. When undressed, the improvement was still more marked in skin texture, the coarse rough quality improving. One boy who had been seen frequently with sores and pustules and bad eyes improved so that the skin became fresh and whole. A much greater improvement was noted in the cases where adenoids had been operated on than in those which had been left untreated; this despite the fact that children often lose weight for a few weeks after such operations. Cases with definite valvular disease did not markedly improve although those with functional murmurs cleared up most evidently. The five girls and four boys who showed signs of tubercle are mostly responsible for those marked as in statu quo. The actual numbers followed were too small to construct reliable curves of growth, especially as the times of feeding on oil and milk had varied. The gain in height and weight for both girls and boys was in excess of that determined some years ago as standards for London schools. Educationally the teachers noted improvement. The head mistress of the infants' department stated that prior to treatment many who were listless and with little power of sustaining attention gradually brightened and became more interested. The health gained and showed an attendance higher than that for previous years. The same result is Report of the Medical Officer (Education). 131 found in going through the individual notes of the other departments although these notes had not been made in regard to the effect of nutritional alterations, and were therefore unbiassed. Extra feeding on such a scale is only justified by results which, from the doctor's point of view, were good. Whilst indiscriminate feeding would be deprecated, yet, the provision of feeding is not only justified, but a duty, if the condition of the child and its home and the tendency towards disease or retardation of development are all considered and judgment is deliberately made that by feeding the child may attain a more normal development and have an increased resistance to the attacks of diseases which society practically thrusts upon it. Dr. Hawkes, who made these observations is also medical officer to a secondary school which receives a certain number of scholarship boys. He notes the inferior physique on admission of boys who mentally are on an equality with their better fed, housed and clothed fellows in the same school, and suggests that careful control, observations and a thorough investigation of the whole subject is urgently needed. Children requiring Feeding.—As already stated, it is extremely difficult to define any exact series of physical or mental conditions as caused by malnutrition. Dr. Guest, who has given some time to this subject, points out that malnutrition may only manifest itself as anaemia, and go on with apparently normal mental development or even exceptional mentality; whilst children from very poor homes may exhibit good physique and healthy blood, as judged by the colour of the mucousmembranes, and yet have mental dulness and inertia in a marked degree. In some of these cases improved diet certainly affects their mentality. In other cases malnutrition shows itself in the intractability of otherwise curable ailments. Discharging ears or chronic conditions of the surface of the eyes are often very difficult to deal with in badly nourished children. A child may be so lowered from malnutrition that it is almost constantly suffering from minor ailments, such as colds, bronchitis, diarrhoea, or slight febrile attacks, which in their cumulative effects may be serious. Both the social and physiological conditions of a child should be considered. If poverty is obvious, from the history of the children as known by the teachers, from the conditions of their clothes and skin, and from the facts known regarding the parents' work and wages and this evidence is reinforced by the existence of any medical defeot affected by the condition of nutrition, a clear case exists for feeding the child, which will need very strong evidence to the contrary before it can be put aside. On the other hand, in a child presenting marked anoemia or other defect ascribable if only partly to nutrition, without the existence of marked signs of poverty and without any obvious defect to account for it, then there is a case for careful medical investigation of the home environment. Respectable and threadbare poverty is often at the bottom of many such cases. If the school work is not to be affected substantial food should be provided for such cases. In many districts malnutrition is certainly one of the most serious and widespread conditions noticeable in the schools. The provision generally at cost price of school meals for all who choose to pay for them, would be a national economy, which would do much to improve the status of the feeding centres and the standard of feeding. This principle is applied most successfully in schools of a higher grade and might well be considered in connection with the ordinary elementary schools of the Council. Such a provision would probably be of the greatest benefit to the respectable but very poor, who are too proud to apply for charity meals and whose children are often penalised by want and the various avoidable defects or ailments that come in its train. The measurement of stature and weight made in the schools during the year enables an approximate picture to be formed of the distribution of physique in London elementary school children. This is indicated in the following maps, which show average results for children of 8 and 12 years at their last birthday. Physique. 132 Annual Report of the London County Council, 1910. Report of the Medical Officer (Education). 133 The averages for all London children obtained so far are shown on the accompanying table and compared with the averages given in the British Association Report of 1883:— L.C.C. schools and British Association Reports. Stature. Weight. Boys. Girls. Boys. Girls. 8 12 8 12 8 12 8 12 (l) (2) (3) (4) (5) (6) (7) (8) (9) L C.C. elementary schools (1906-1910) 120.0 138.2 119.8 139.9 23.0 32.0 22.5 32.8 L.C.C. secondary schools — 142.8 — 140.7 — 34.1 — 32.9 Industrial schools (town) 111.5 129.6 111.7 128.0 21.4 30.7 21.8 31.0 Artisan classes (town) 118.0 136.5 115.6 137.1 24.7 33.2 23.5 34.0 Commercial classes (town) 120.9 140.4 119.7 141.6 25.2 33.3 23.9 35.1 Professional classes - 145.5 - 145.8 - 38.6 23.9 36.2 When the averages of stature and weight of the boys in each London elementary school are arranged in groups and plotted out in map form, it may be seen that each group corresponds very closely with the three classes distinguished by the British Association. The correspondence of the result with the predominant occupation of the parents in each area is with a few exceptions remarkably closeThe lower averages are found in the riverside districts, North Kensington, and in a central area extending from the Strand district to Bow and Bromley. The most unexpected figure is the weight recorded for Fulham, and here the majority of the children are tidy and come from apparently comfortable homes of the artisan and commercial class. The numbers at present available are, perhaps, too small and liable to chance error from exceptional children; whilst, from the map, physique appears mainly correlated with social conditions, racial factors cannot be entirely excluded. The central areas, Central Hackney, Haggerston, Hoxton, Finsbury, Bethnal Green, Southwark and Lambeth, and outlying areas in North Kensington and along the banks of the Wandle were shown, in a report to the British Association in 1904, to present brunette traits to a greater extent than those of the rest of London, even when other obvious alien immigrants were excluded. This may correspond with the different basal elements of the population, one of which is supposed to have been tall, fair and stoutly built; another, shorter, slighter, and darker. There is also evidence that some racial strains attain a great proportion of adult dimensions in early life. The following table shows the percentage of adult stature attained at each age for several different races. Boys. Girls. 8 12 8 12 Russian Jews 73 84 78 92 Swedes 73 81 76 88 English (professional) 69 83 77 90 English (artisan) 69 80 74 87 134 Annual Report of the London County Council, 1910. In addition to the wider racial variations to be observed in large groups of children there are individual differences which render comparison from one area to another somewhat uncertain during the years of rapid growth. Physiological functions such as the cutting of teeth or attainment of puberty are acquired at periods differing markedly with individuals and yet closely correlated with general physique. It has been shown by Crampton, of New York, that of those children of the same age reckoned from birth, those who have the most teeth are taller and heavier. He, therefore, distinguishes between physiological age and age from birth. In one set of investigations on boys of 12 years of age, living under approximately similar conditions, he determined the physiological age by the number of canine teeth of the second dentition which had been cut, and found corresponding differences in physique. A variation between groups of individuals amounting to 11.7 centimetres and 4.8 kilos. (4½ in. and 10½ lbs.) was accounted for by difference in physiological age in the following table from Crampton's work:— Number of teeth cut 0 1 2 3 4 Stature in centimetres 135.1 143.2 143.2 143.9 146.8 Weight in kilograms 31.8 32.9 33.3 34.5 36.6 Similar differences are also noted in London children, but sufficient data have not yet been collected to justify publication. It has been shown that the average age at which these physiological events occur varies from one district to another, and this factor cannot therefore be ignored when comparisons are made between any small number of children at the same temporal age in one district and another, and accentuates the degree of difference which must be established to prove the action of any definite cause in the direction of physical deterioration. It has not been definitely shown that retardation in growth, which is ultimately made up, whether physical or mental is an evil. The relationship between physique and ability has been indicated in previous reports, and also in other cities. The New York records afford a certain explanation of this, the more advanced children in higher standards being physiologically the older, the others are found to make up much leeway after passing the period of puberty. A careful investigation of the problems of growth in relation to physiological estimation of age may probably furnish much valuable information in relation to educational work. In the schools in which the average stature and weight is low a certain number of children come from a small stock, but are proportionately up to their approximate level, there are others whose growth is retarded and a certain number whose dimensions appear deficient in one or other particulars, although not physiologically behind their age. In some cases these children come from homes where the conditions as to feeding, warmth, ventilation and sleep are often very defective. The conditions prevalent in areas in North Kensington and Bethnal Green are referred to on pages 129 to 131. In the Annual Report for 1905 it was shown that the relation of overcrowding to inferior physique was only clear when the numbers per room exceeded five, and in every case other factors came into play. Overcrowding chiefly depends on small income, and is associated with deficient or unsuitable feeding and clothing. The feature to which attention was then drawn of the superior physique of the children of widows has been often confirmed, as have the disadvantages suffered by families in which the parents go to work. Probably an undue share of food left for the mid-day meal is eaten by the first comers, and the rest suffer. A low average in stature and weight is not always associated with ill-health or with defects found at the medical inspection. The teeth in particular are often better in children from poorer homes, perhaps from use on rougher food materials, which leaves less debris to undergo fermentation. Children of poorer homes also often have the advantage of the fresh air of the streets, whilst the better-off child is kept indoors and becomes flabby and less resistant to minor ailments. The statistics of infantile mortality suggest that the children of the poorer schools have also gone through a more severe selection; disease weeding out by natural selection, and the less fit having succumbed before school age, the residue are of sturdier average type than in schools or classes where such selection has been less intense. Flat Foot.—The importance of flat foot in later life is considerable. According to an analysis presented at the Dresden Hygiene Exhibition this year the rejection of recruits from various European armies from this cause is very considerable. During the past decennium about 6 per cent. of the recruits in Great Britain have been rejected. Conditional rejections from full service in the German army for a similar reason were 25 per cent., Switzerland 33 per cent., France 7.5 per cent., and in the Austrian army it ranged from 20 to 30 per cent. according to districts and race, Croats being as low as 21 whilst Germans ran up to 36 per cent. Dr. Hawkes has noted the frequency of flat feet in 1,581 children, 770 boys and 811 girls, attending three schools of the poorer class. He has distinguished two groups— (1) Weak feet in which the leg muscles no longer support the arch of the foot, the strain falling upon the ligaments beneath the arch, the foot being slightly everted. In such cases the shape of the foot returns to the normal during the resting periods. (2) True flat feet in which the ligaments become stretched and the whole inner border of the foot touches the ground. The feet of 65.4 per cent. of boys and 64.9 per cent. of girls were affected to a greater or less degree. In 28.8 per cent. boys and 31.7 per cent. girls the second stage Report of the Medical Officer (Education). 135 of true flat feet had been reached. The distribution in age and sex is shown in the following diagram:— His conclusions are— 1. That children of either sex are equally affected. 2. That the condition becomes more marked during periods of sudden increase in stature and weight. 3. That where malnutrition is general a high percentage of deformity may be expected. 4. That where the surroundings are unfavourable a slight and curable degree of deformity tends to pass into a condition which is permanent. The effects of malnutrition are intensified by mechanical causes as excessive standing, walking or weight carrying and by the wearing of heavy rigid improperly shaped boots. Children under eight years of age can be found wearing boots which weigh from 2 to 2¼ lbs. Many of the boots worn by school children are made regardless of anatomical considerations so that the foot is forced to conform to the shape of the boot. The manufacturer of cheap boots appears to appeal to the vanity of the parents by reproducing fashionable shapes at a low price. Soft leather will in time conform to the shape of the foot, but if the pliant growing foot of a child is forced into a boot similar in shape, but made of unyielding leather and rendered unbendable by the nails and rivets used in the process of manufacture, the foot is cramped in the direction of least resistance and the end is deformity. The great toes of many children before the age of 14 are found to be already forced outwards from the middle line as a result of wearing improperly shaped boots; practically all these children are flat footed. Another important point is that these boots extend up the leg so that when laced the foot is nearly immovable at the ankle joint. In ordinary walking the child either shuffles along the street or, with an exaggerated movement at the knee joint, lifts the foot off the ground and carries it forward without any flexion at the ankle joint. When attempts are made to walk on the toes, as in dancing or drilling, the arch of the foot is forced downwards. Although the syllabus of physical exercises issued by the Board of Education warns teachers that such exercises as heel raising or jumping cannot be properly performed in badly fitting or unsuitable foot gear the caution is not always regarded, and it is a pathetic sight to see children with their toes crowded together in heavy rigid boots endeavouring to maintain their equilibrium. The results are likely to produce an opposite effect to that desired. Dancing is taught to give grace and ease of movement; freedom of action of the joints of the feet is necessary. With the children wearing heavy badly shaped boots the lesson is a travesty. The experiment of drilling in the hall without any boots at all was made in one school where the footgear was generally bad, and the teachers reported that the result was most satisfactory. The poison of rheumatism is widely distributed. One of its symptoms not infrequently noticed in schools is chorea or St. Vitus's dance, but the symptom of the most serious nature is the heart disease which is often found among the results of rheumatism. Profound anæmia, febrile disturbances and illnesses which come and go in children may all be due to this disease and probably overlooked rheumatism in childhood is one of the most fertile causes of debilitated health in adult life. Dr. Langmead has attempted to investigate the prevalence of rheumatism among 2,556 (844 boys, 838 girls, and 874 infants) of the children in schools at Baltic-street, Ann-street, St. Anne's (Dean-street) and Grafton-road. His proportions show the smallest possible results as he only noted those presenting definite evidence and omitted merely suspicious cases. Omitting 37 cases whose age was not noted, the numbers were at each age— Rheumatism. Age (1) 3 (2) 4 (3) 5 (4) 6 (5) 7 (6) 8 (7) 9 (8) 10 (9) 11 (10) 12 (11) 13 (12) 14 (13) Totals seen 54 164 290 297 281 231 241 217 247 222 246 29 Number of rheumatic cases 1 1 4 9 16 11 11 21 13 23 22 1 Percentage rheumatic — 0.60 1.37 3.03 5.68 4.76 4.56 9.67 5.26 10.60 8.94 — 136 Annual Report of the London County Council, 1910. The number of definitely rheumatic children was 133 (boys 59, girls 74), giving a percentage of 5.2 per cent. at all ages and 6.8 per cent. in senior departments. Taking representative schools the percentages of rheumatic cases were:— St. Anne's (Dean-street)—Good class, small shopkeeper, largely foreign Jews 6.9 Ann-street—Average class 7.2 Baltic-street—Very poor, much destitution .. .. .. 4"9 It has apparently no relation to social position, and, if anything, seems less common among the poor. It must, however, be remembered that a bad case of rheumatism has not the same chance of surviving among the very poor as among better classes socially. The 133 cases were carefully examined as to the throat conditions, the lymphatic tissues of the throat being particularly susceptible to the rheumatic poison and probably one of the main portals of entry. No signs of throat abnormality. 75 Tonsillotomy had been previously performed 3 Slight enlargement of tonsils 21 Considerable enlargement of tonsils 11 Great enlargement of tonsils 16 Adenoids only (producing signs of obstruction) 7 There was, therefore, abnormality in 58, or 43 6 per cent., of the rheumatic cases. The usual percentage requiring operation in school children is 7 per cent. according to Mr. Macleod Yearsley, and 8 per cent. according to the returns massed by the Board of Education from five million children. As far as obtainable the frequency of different rheumatic manifestations was— Numbers. Percentage of all children. Percentage amongst rheumatic cases only. Rheumatic fever 42 1.6 31.6 Chorea 18 .7 13.5 Rheumatic tonsilitis 32 1.2 24.1 Growing pains 35 1.4 26.3 Heart affections 115 4.5 86.5 Obvious valvular disease 74 2.9 55.7 No reliable data 10 — — The data of certain rheumatic affections as anaemia could not be determined. Chorea was noted twice as frequently in girls as boys. In about two-thirds of the 133 rheumatic cases there was something of a rheumatic nature in the family. There was noted— No rheumatic history in family 49 Doubtful rheumatism 25 Kheumatic history in mother 39 Rheumatic history in father 18 Rheumatic brother or sister 26 Rheumatic, more than one member (father, mother, brothers or sisters) 18 Report on an East End School. The following is condensed from a very full account of an East-End school as made by Dr. Hawkes, the school doctor, after careful enquiry and personal observation. Situation.— The School is surrounded except on the north-east by small, mean houses and gasometers. On the open ground to the north-east is the borough council depot for road metal and stores. A destructor there had to be abandoned on account of the smells and dust which it caused. The district so far back as 1848 is described as covered with foul drains and ditches, with cesspools and reservoirs for every conceivable kind of filth, so that "the odour given forth from this place is beyond conception disgusting. It spreads to a great distance and is complained of by all as an intolerable nuisance." Now it is not more remarkable than any other East-End district and better than many which might be selected elsewhere. Population.— The population is mostly London born, although such names as Dupuy, Dongray, Jacques, Chaitre, Lefevre, Dummett, Nadal, shown foreign descent; the "weavers lights" in many of the houses confirm this. There are very few Hebrews. The social grade of the parents is just clear of the submerged tenth. Very few are in permanent work. The woman is often the breadwinner, the man seeking work. Evidence of drink was forthcoming but not abundant. The public-houses visited on a Saturday night were mostly empty. Large families are common but the children are seldom all alive. Overcrowding at night does not depend on the number of rooms oc6upied. The paucity of bedclothes, want of fuel and necessity for conserving warmth being deemed more important than the need of fresh air. Much of the prevalent anaemia in Dr. Hawkes' opinion is due to this overcrowding. Report of the Medical Officer (Education). 137 Buildings.— The older part occupied by the infants runs east to west. The newer part runs from this north and south. It has recently been extended on the west side by assembly hall, lavatories and cloakrooms. The playground is inadequate. The boys have the west side and in fine weather have room for drill in the open air. The girls and infants have the rest of the playground and in wet weather access to the basement under the girls' hall It is not possible for girls and infants to be at play at the same time. The numbers on the roll are 300 boys, 292 girls, 321 infants. The two west classrooms of the infants' school are under the caretaker's house. In summer the heat is scarcely supportable, as no through draught is possible, and, if the windows are open, the noise of the traffic on the setts outside makes teaching difficult without voice strain. Next to these two rooms used for the youngest children are two rooms carried up to the roof. They are separated by folding doors so that the outer room is a thoroughfare for the inner. From the inner room access is obtained to the teachers' room—a poor room, where the teachers take their meals and all the cooking is done on an open gas stove. A door leads into a passage which communicates with an exit and another large classroom. This passage is used as a cloakroom and heated by a gas stove. There is another cloakroom and lavatory on the south side, but they are not heated except by a boiler used to supply hot water for washing the floors once a week. Wet garments have little chance of drying here. Under the girls' school is a large, well-lighted room, but very draughty. This was the room used for medical inspection, and it was either close and unpleasant or very cold. The boys' lavatory is properly arranged, but after an interval the floor is usually flooded. Supervision and discipline are needed to remedy this. The basement is open. The part used by the boys seems very unpleasant in winter; it faces east. The other part is quite satisfactory, and is used by the girls and infants. Lighting.—The lighting is generally good, artificially by upright incandescent burners. Their heat makes the rooms close and foul in winter, especially when a north-east wind necessitates closed windows. Heating.—Heating is by open fires and in one room hot pipes. Tobin's tubes are inserted, but were found closed by lids. The use of the windows for ventilation largely depends on the direction of the wind, as with open fire heating the children, often miserably clad, are too cold if near the windows. Nutrition.—The physique of the children in the school is below normal. A few children of a higher social status, publicans or small shopkeepers, just relieve the dull monotony of squalid poverty. This is probably due to underfeeding and overcrowding in the sleeping apartments as well as insufficient sleep and the irritation of vermin. In several cases the surgeons of the neighbouring Queen's Hospital have refused to remove adenoids or tonsils until the general health of the child had improved. The following table shows the estimated percentages of nutrition:— Department. (1) Bad or Very Bad. (2) Average. (3) Good. (4) Very Good. (5) Boys 33.1 42.0 19.1 5.8 Girls 37.5 46.3 14.7 1.4 Infants 27.3 45.7 23.5 3.5 Average of children 32.5 44.7 19.3 3.6 Cleanliness.—Cleanliness is a condition hard to assess. The older boys were trusted to bath themselves and the upper part of the body was generally attended to, but the rest was unclean. This, in the case of the feet, may have often been due to bad boots, as 23.5 per cent. had bad or very bad boots, although a considerable number of boots had recently been distributed by the head master. Of the 600 girls and infants, however, only 9 per cent. were classed as bad. This, in a district where facilities for bathing are scanty and bathrooms non-existent, may be considered satisfactory. If the medical inspection was made without notice the result would probably be very different. The presence of insect bites or tne scratching associated with vermin often makes one discount temporary cleanliness. Flea bites were common; 72 per cent. of the girls had infected hair. In 12 per cent. girls and 6 per cent. boys body lice were present. Among the infant girls 59 per cent. had pediculi and 13 per cent. body lice. In some of the younger children both skins and clothes were scrupulously clean. The chief sanitary inspector stated that many of the houses had been condemned several times, but the owners placed them in a state of habitable repair and they were re-occupied, probably still infested with vermin. To send these children to the cleansing station to have bodies washed and clothes disinfected is only a temporary solution. Re-infection occurs in a week. Clothing.—The clothing affords evidence of poverty and also of want of skill with the needle. The generally clean faces compared with dirty and ragged clothes gives an indication of the power of the school compared with the home. Some of the boys have only one shirt and wait at home when it is washed, or come to school without a shirt. The girls generally are better clad. Quite a collection of wire nails which were used as clothes fastenings has been made by the nurse. The assessment bf clothing, however, is not of very great value, as, having been officially warned, the children come in their own or in borrowed clothes better than those usually worn. 5176 K 138 Annual Report of the London County Council, 1910. Owing to the apparent malnutrition of 13 boys Dr. Hawkes had them weighed regularly every week from November, 1909, till May, 1910. Ages. Number of boy Commencing weight. Final weight. Gain kilos. Normal gain. Remarks. (1) (2) (3) (4) (5) (6) (7) 10—11 1 26.6 28.4 1.8 1.2 - 2a 30.6 31.4 .8 1.2 - 11—12 3a 24.6 24.4 .2 1.4 - 4 26.8 27.7 .9 1.4 - 5a 28.9 29.4 .5 1.4 - 6 23.1 24.0 .9 1.4 - 12-13 7a 29.1 31.0 1.9 1.75 - 8a 31.2 33.2 2.0 1.75 - 9 29.4 30.8 1.4 1.75 - 10 32.4 32.4 0.0 1.75 - 11 30.2 31.1 .9 1.75 - 13—14 12 34.4 35.1 .7 2.0 Left. 13a 26.5 27.2 .7 2.0 - Teeth.— Teeth were very good 13.6 per cent., good 65 3, per cent., average 9.1 per cent., bad and very bad 12.0 per cent. Those who had bad teeth were chiefly of the better class, so that probably coarse food and the absence of sweets had to do with good teeth. Adenoids and Tonsils.— Advice cards were given to 24 boys, 41 girls and 28 infants, though there were many other slight cases in which operative interference was not deemed necessary, but in which verbal advice was given to the parents. Dirt Diseases.— Vermin have been already referred to. Ho case of scabies was seen. Impetigo contagiosa was not uncommon; there was little ringworm and most cases of neglected dirt conditions seemed to be blepharitis of slight degree. Circulatory Conditions.— Many anaemic children presented functional cardiac murmurs. The numbers noted with anaemic or other circulatory defects were : Boys, 45 (15.4 per cent.); girls 111 (39 per cent.); infants, 109 (34.6 per cent.). Pulmonary Conditions.— Signs of catarrh or bronchitis were noted in 22 boys, 28 girls and 32 infants. The diagnosis of early pulmonary tuberculosis is most difficult. There were three doubtful cases. One boy of 13 with definite signs in the lungs was examined by the house physician at hospital, who wrote a somewhat sarcastic letter asking for details; these were furnished and elicited a more courteous reply, asking for the boy to be sent back. He was sent back, kept waiting for some hours and sent away without further examination. As he left school the case could not be followed up, but both parents were dead, and the mother was said to have died of chest disease. The next case, a small, miserable boy of 7, was sent away from the hospital, as having nothing wrong with him. He was put on oil and milk at school and for some weeks temperatures over 99.5 were registered in the afternoons, justifying the diagnosis. Ultimately the feverishness gradually diminished and disappeared. On the other hand a girl of 12 noted as merely anaemic broke down later and was treated at the hospital for tuberculosis. A family history of phthisis was often elicited from the parents of many quite healthy children. Only 17 out of 36 girls with such history could be even called delicate and only 7 out of 19 boys. On the other hand, 159 cases with good family histories seemed likely cases to develop tubercle later. Spinal Curvature.— In 100 of the girls there was some slight departure from normal, but no serious case of spinal deformity. Lordosis is however developed by false ideas of the teachers on the erect attitude. A flabby anaemic child standing incorrectly at attention tends to develop this deformity. Flat-Footedness.— Flat-footedness or weak feet were noticed in about 75 per cent. of the boys and 63 per cent, of the girls. They were mostly anæmic children and the condition seemed to remedy itself with better nutrition and exercise. Care of the Teeth. "The importance of this subject is not likely to be over-estimated." This was the first sentence on dental matters written in these reports some half-dozen years ago. It is not possible to add to the accounts of the terrible but common oral conditions reported on since then in the London schools. Five years ago, after visiting municipal dental surgeries in connection with schools in foreign towns, dental caries was reported as the most widespread affection among the population, and one which seriously affected the working capacity and even the earnings of large numbers of people." Dental hygiene must be taught in school, but the Continental experience shows that examinations and teaching are useless unless followed by the practical measures of inculcating and enforcing cleanliness among the children and providing remedial treatment. The affection is so insidious and so widespread that it should be met by public provision. There is no way of dealing with money in the interests of public health which will return so enormous a gain to the population for the same small expense required as this matter of school dentistry." There are now 80 towns in Germany with (a) Had an extra meal of milk and oil at 11 a.m. during winter. Nos. 2, 3, 6, 7, 8, 13 were marked as likely to become tubercular. Report of the Medical Officer (Education). 139 organised school dental care. In this country Cambridge has carried out a municipal service for the dental treatment of elementary school children for several years. At Bradford during the past year dentistry has been added to the activities of the school clinic managed by the municipality, and other towns are now appointing school dentists. London first moved in this matter when the Sub-Committee on the Medical Treatment of School Children, appointed by the Council, made the following recommendations as to teeth in 1907— 1. That in the opinion of this Sub-Committee there is a prevalence of dental caries among children attending public elementary schools and that the existing accommodation in the hospitals and dispensaries for even simple dental examination and treatment is wholly inadequate. 2. That in the opinion of the Sub-Committee it is desirable that provision should be made for simple dental treatment of school children. 3. That it is desirable that instruction in the hygiene of the teeth should be given to school children and to their parents or guardians. 4. That it is desirable that the daily use of the tooth brush by children in their homes be encouraged. 5. That it is desirable that from time to time children be examined as to the cleansing of their teeth. It was decided ultimately by the Council that the problem was one to be dealt with separately from medical treatment and whilst attention was turned to making arrangements with existing institutions such as hospitals for ordinary treatment, the consideration of dental provision was postponed, to be taken up during the past summer. As had been foreseen, with some small exceptions no arrangements could be made with any hospitals for the dental care of children. The professional dental associations refused to consider any co-operative arrangements for establishing dental surgeries on the lines of the medical treatment centres at Norwood and elsewhere. So far the work which has been done in the schools has chiefly been with a view of gaining some experience of the existing conditions, and towards establishing a kind of dental propaganda described below. During the winter of 1909-10 Mr. C. E. Wallis undertook the systematic dental examination of all the children at the "Blackfriars" School, recording the dental and dependent conditions on a chart for each child. Such careful work is only necessary in a pioneer investigation. The children were instructed and then took it in turn to speak to some of the younger children, so that a dental hygiene card hung on the waiting room wall was thoroughly appreciated by all. The teachers were also supplied with a circular on the care of the teeth and on "toothbrush clubs." This propaganda stirred up much interest in the school and prepared the way for the dentist's advice and for the attendance of the children at a dental centre. Centres for Dental Treatment. bt. George s Dispensary.— A free dental clinic was opened as a part of his dispensary work bv Dr. Kirby in January, 1910. No charges were made, and it is highly improbable that any could have been obtained in this very poor neighbourhood. The treatment was done apart from any of the Council's schemes. The honorary secretary of the school care committee at Blackfriars made all arrangements for the attendance of children, and a nurse attended on the appointed days at 4.15 p.m. and took from the school to the surgery a number of children whose parents had already consented to their receiving treatment. This course had to be adopted, as although the parents signed the consent form readily enough, they were generally unable or unwilling to accompany the children. The attendance of children on each of the two days weekly was thus kept at almost constant level. There was advantage in this particular case in having the children treated from 4.30 to 6.30 or 7 p.m., as it secured the services of an operator actually engaged in private practice, who had considerable experience with children. During the short time of attendance given weekly there were 400 children from the "Blackfriars" School treated during the year. There was no restriction as to age, and the following were the numbers recorded— Number of children seen 400 Number of visits 735 Temporary teeth or roots extracted 847 Permanent teeth or roots extracted 122 Number of stoppings done 837 Other operations, scaling, etc. 295 Number of anaesthetics (gas) 59 The gas was given on Saturdays only, and was perhaps resorted to more frequently than is usual, but this was to avoid any unpopularity that might have been caused during the early stage of the work from the infliction of pain. Nothing marred the uninterrupted success of this experiment, which terminated in December. It is to be recommenced on an extended scale this spring, and will now be subsidized by the Council at the usual hospital rate, no payment being required from any case sent. Barrett-street School.—At the Barrett-street School, which is situated in the centre of the hospital area, the attempt was made to get children requiring dental treatment to go to hospital. There was steady working up of interest by lectures to the teachers and lantern lectures on parents' evenings. All the children were examined and their dental conditions charted. A list of dental hospitals and dispensaries within a mile of the hospital was furnished to the secretary of the school care committee, who did her utmost to secure the attendance at the hospital of the children who had bad teeth and 5176 K 2 140 Annual Report of the London County Council, 1910. oven offered them pennies to have the teeth treated. The children were sent to the hospitals in twos and threes so as not to excite any hostility on the part of the authorities. At the end of 12 months, out of 71 boys marked as urgently in want of treatment, 17 had gone to an institution and not a boy had been sufficiently treated. No teeth had been stopped and only a few extractions carried out. A similar result held for the girls and infants. This shows that even in a school surrounded by hospitals and dispensaries, with dentists attached, it is practically impossible to obtain dental treatment without special arrangements. The Age for Commencing Treatment. It would scarcely be possible to treat all the children in the schools at once; the best way is to begin with one age group and then follow up. When it was proposed last summer to conduct medical inspection of an extra age group of children, between their eighth and ninth birthdays, this age was suggested as suitable also for dental work. It is not the ideal age, but was suggested as a compromise between medical and dental inspection. The results of medical inspection show that only one-eighth of the mouths are noted compared with the results obtained by a dentist, so that this inspection may be put on one side so far as dentistry is concerned. The utility of any first dental examination in the school is very doubtful, because as nine out of ten children in most schools will require treatment, they would probably be examined more effectively, cheaply, and with less disturbance to work, at the centre in the deptist's chair. This would have to be done in any case, so that examination for the first time in the school is superfluous. Examinations carried out at the "Michael Faraday" School, at the "Blackfriars," at schools in Deptford, and at the Stockwell College Practising School show that the group 8-9 is too late for the best preventative work. By that time a large number of the first permanent six-year-old molars are decayed beyond the reach of the treatment which could be afforded by any school clinic. Probably soon after the seventh birthday is the best time for most children to be seen by the dentist. The septic or necrosed remains of temporary teeth are then easily removed and incipient cavities or vulnerable points in the six-yearold molars can be treated without undue expenditure of time. The ideal plan seems to be to march all children in relays to the school dentistry about the time of their transfer from the infants' to the upper school. The care committee of the Stockwell College Practising School asked for an inspection of the teeth of the older girls in March. The results noted were as follows:— Standard. No. of girls. Perfect teeth. Satisfactory. No. requiring extraction only. No. requiring stoppings only. Requiring both extraction and stopping. (1) (2) (3) (4) (5) (6) (7) IV b 44 1 - 7 8 28 IV a 40 2 1 4 9 24 V b 32 1 — 2 6 23 V a 45 1 5 9 16 14 VI 52 — 2 3 22 25 L.C. 37 — — 3 17 17 Totals 250 5 8 28 78 131 Percentages — 2% 3% 11% 31% 53% The leaving class "L.C." in the above table refers to a class of backward delicate girls, who, being within a year of leaving school, have a special curriculum to make the most of their abilities. Though many are merely backward from previous ill-health some are of inferior mental calibre, and, although it does not appear numerically, the oral sepsis present and frequent hypoplastic enamel noticed pointed to conditions of ill-health in early life. Superior protrusion or projecting upper teeth, of the type associated with Continental caricatures of English women, was present in 13 of the 250. This is more than double the frequency of the ordinary elementary schools, and is scarcely likely to be due to error from small numbers. It was not explicable by nasal obstruction, and Mr. Wallis states that he had noticed a bad habit of keeping the upper teeth closed on the indrawn lower lip, which might account for it. The upper incisors, which in the manufacturing districts are so often affected in young girls, were only carious in seven cases, and none of these were less than 12 years of age. A similar observation has been noted in other London schools. Dental propaganda conducted here by lantern lectures to the teachers and students and to the parents caused numbers to become interested. Qualified and Unqualified Dental Treatment. Lists of qualified dentists in the district were drawn up to aid the parents, and a tactful notice, signed by the head mistress, caused many to seek treatment. Within six months 87 of the 237 cases found to need attention had obtained treatment. Qualified private dentists treated 48 per cent., the dental hospitals 12 per cent., and in spite of warnings unqualified practitioners treated 40 per cent. Careful notes were made when these cases were again inspected, and it was found that the treatment generally given had been unsatisfactory in the case of the unqualified practitioners. The fees charged were often excessive and frequently stoppings had been done and fallen out in a day or two. One girl paid £2 for five stoppings which had all fallen out within a week. Little or no attention had been paid to small cavities although it is on the treatment of these that permanent preservation of the teeth depends. Extractions which presented difficulty were either avoided or else the teeth were broken off and the roots left in the jaws. Several of the Report of the Medical Officer {Education). 141 girls were suffering from extensive oral sepsis as the result of the treatment, so that their mouths were worse than before. There is no branch of dentistry which requires better judgment than the treatment of school. children, but at any age properly sterilized instruments and careful asepsis are always a necessity. As a hospital house surgeon I have seen a young girl in the early stages of a most serious constitutional disease beginning in the cheek, and have also removed a large mass of loose and septic jaw bone with three dead teeth from a middle-aged woman. Both these cases had been damaged when they had teeth removed some weeks previously by an unqualified operator. Hitherto no steps have been taken beyond refusing the certificates of unregistered dentists. The time has come when the Council should issue warnings as to the risks incurred from dentistry at the hands of such unqualified or untrained persons, of dentists who advertise, or of persons who give themselves out as makers of artificial teeth without putting forward any pretensions as to dentistry. Suggestions have been made as to employment for dental treatment of school children of private dentists at their own surgeries. There would be great difficulty in efficient supervision. The objections better class dentists would have to the dirty feet of many children in their houses might limit the work to dentists of inferior professional rank. Friction with parents might occur at the dentists' surgeries and would be highly objectionable. The general lack of accommodation in the way of waiting rooms or recovery rooms for large numbers of children might also cause trouble. Arrangements necessary for a dental centre for treatment of elementary school children ought not to cost more than £35 a chair for equipment, at the most £50 for a single centre. Laboursaving devices are required and everything to avoid unnecessary work. There is also a need for avoidance of red tape and too much clerical work. The German Schulzahnkliniken err in excessively detailed records and unnecessary forms of all kinds. Their equipment is often very costly, including expensive mechanical chairs, costly engines, excess of nickel-plating and cut glass. These things are out of place in elementary school work. For the staff whole-time operators are not desirable. Whilst here and there an enthusiastic worker might be found they would, as a rule, be unambitious men who had given up hope of better things, the school work affording no experience of more interesting work, such as fitting dentures, crowning, or applying bridge work. Dentists are highly paid, assistants generally obtaining £300 per annum; the rule laid down by the School Dentists' Society of £1 for a school session is therefore a safe working guide. This corresponds to the salaries of medical inspectors. It is now possible to outline a scheme for dental provision towards which to work. Centres for school dentistry will be necessary, costing proportionately less if they can be combined with school treatment centres; the combination allowing of a greater number of centres and smaller distances to be travelled. Any charges to the parents means failure in efficiency of the results of the scheme as a public provision. In London it would be necessary to arrange for a first examination of about 80,000 annually with probably some treatment in 65-70,000 cases. In addition the majority would return twice or thrice in school life. Dental re-examination in school should take place at the ages 9-10 and 12-13. Allowing for a considerable diminution in cases of caries, through the teaching of dental hygiene and through the treatment, provision is urgently required for treatment of not less than 100,000 cases annually, and experience may show that ultimately a considerably greater number will have to be dealt with. Ignorance is the chief cause of the neglect of dental hygiene. The removal of this ignorance precedes any successful work in school. Knowledge may be instilled by talks, lectures, demonstrations, example, and by affording opportunity and materials for dental care. The first experiments were sanctioned about three years ago in the deaf schools. The heartiest co-operation was given by the teachers. Each deaf child has its tooth brush and is taught how to use it. Hard wooden racks with eye screws are used to put the brushes in, and these are hung outside the building. Toothbrush drill is taken regularly after dinner. The mouths of the children are much improved, and this is most noticeable to the teachers who have to instruct the children in speech., The teeth are also cleaner and the children appear to have realized the need of oral hygiene. The influence of the school appears also to have extended to the family. The success of this work has led to its adoption in the schools for the blind, as instruction in personal hygiene is perhaps more wanted among this class of children than among any others. In the ordinary schools a beginning has been made in departments in the neighbourhood of centres for dental treatment by lantern lectures to parents and others. It was found, however, at Barrett-street that without careful school arrangements for following up the treatment this propaganda was almost in vain (see page 139). Instructions have been published in the London County Council Gazette for teachers, and a special paragraph on teeth headed "As good as five shillings a week for life," is in the "Health Hints to Parents," which are distributed in large numbers. The ground has to be carefully prepared and the toothbrush clubs referred to in the last report are a most useful adjunct. Educational Propaganda for Dental Matters. Candidates taking up permanent appointments in the school service are examined in the Public Health department before commencing work. Candidates for scholarships are also required to be examined before the scholarship is finally awarded. The number of candidates submitting themselves for a first examination during the year was 6,294. They may be classified according as they are examined for the permanent service, under special references, or for the award of scholarships. Examination of Candidates. The first division includes all who work on the staff of the various educational institutions; these are teachers and instructors, matrons, nurses, school keepers and caretakers in all classes of educational establishments under the Council. Appendix VII. gives particulars of the various candidates examined and the conditions noted as present. The numbers medically examined will not coincide with the number of appointments, as candidates from the Council's training colleges having been under regular medical inspection therein are not further examined on entering the permanent service within the year after leaving college. Permanent Service. 142 Annual Report of the London County Council, 1910. Of the 240 referred candidates 10 (4 male and 6 female) were referred a second time owing to the conditions not having been remedied, viz., 3 (2 males and 1 female) to a dentist and 7 (2 male and 5 females) to an oculist. References. In addition to the first examinations 810 references were dealt with. These references relate to leave to be granted to employees absent owing to personal illness; to teachers returning to duty after extended leave of absence (a) owing to personal illness; (b) in order to visit educational institutions abroad or to study for degrees; (c) to married women under No. 93 of the regulations with regard to the Education Service; and to teachers about to be superannuated. Eighty-nine of these references related to claims made by teachers for payment of salaries for periods of absence owing to illnesses alleged to have been contracted in the course of school duties. The number of references under review compared with those for the preceding year shows an increase of 85 or 11.72 per cent. Scholarships and Training of Teachers. The scholarships and awards granted by the Council fall naturally into three divisions, each of which requires different treatment in so far as the medical examination of the candidates is concerned. These divisions are as follows— (a) County scholarships enabling candidates to proceed to institutions of university rank. (b) Technical scholarships enabling candidates to receive instruction in trades ; and special scholarships. (c) Awards enabling candidates to prepare for the teaching profession. County Scholarships.—These scholarships are of four grades (junior, supplementary junior, intermediate and senior) and provide a complete scheme by which a boy or girl may proceed by various stages from the public elementary schools to the highest grades of education, whether at a university, technical college or other institution, providing advanced training for a professional career. In medically examining these candidates the stage of the scholarship is carefully noted as the strain increases with the award, and it sometimes happens that a candidate who has been accepted for a junior county scholarship is rejected for the succeeding awards because attendance at higher institutions would be injurious to health. The main regulations as to junior county scholarships are that the head teachers of elementary schools in London are required to fill up nomination forms for the general examination for junior county scholarships for all boys and girls attending their schools, who (a) whilst not less than 11, will be less than 12 years of age on 31st July, and (b) who are working at the time of examination in the fifth or a higher standard. Head teachers are at liberty to nominate any other candidates who will not be working at the time of the examination in the standards as prescribed above, provided they are eligible in other respects. The medical officer (education) is required to certify that the scholar is in a fit state physically to take advantage of the scholarship. The medical examination practically gives the defects of the brightest children of the age group, 11 years old last birthday, and, as the children must, in any case, remain in school until 14 years of age, the rejections are few. Most useful work is done, however, by making it a condition of award that all remediable defects shall be treated before the children are allowed to take up the scholarships. Supplementary junior county scholarships are reserved for children of less than 15 and not less than 13 years of age who by reason of late development or other cause fail to obtain the junior county scholarships. The intermediate county scholarships are open to boys and girls who are not less than 15 and less than 17 years of age on 31st July in the year of competition, and are tenable at approved secondary schools or technical colleges until the end of the school year in which the scholar attains the age of 18, but may be renewed for a further period of one year. The senior county scholarships are intended to assist candidates, who must, as a rule, be less than 22 years of age on 31st July in the year of the award, to proceed to universities, university colleges, technical colleges or institutions of university rank. Appendix VIII. shows the number of candidates examined and the conditions found. Of the 839 junior scholars who were referred back for various defects, excluding those (38) whose scholarships were finally withdrawn, 29 (13 boys and 16 girls) were referred again owing to the conditions not having been remedied. A further analysis of these numbers shows that the causes of the second reference were— Sex. Want of cleanliness. (1) Vision. (2) Teeth. (3) Throat. (4) Ears. (5) Ringworm. (6) Boys 2 4 1 3 3 2 Girls 6 11 7 2 — — The 8 out of 839 finally rejected for want of cleanliness compares favourably with 50 out of 812 in the previous year. Of the 142 supplementary junior scholars who were referred back for various defects, 11 (4 boys and 7 girls) were referred again owing to the defects not having been remedied. The following table shows the nature of these defects— Sex. Want of cleanliness. (1) Vision. (2) Teeth. (3) Chest. (4) Throat. (5) Anæmia. (6) Skin. (7) Boys - 3 1 - - - 1 Girls 1 2 1 1 1 1 - Report of the Medical Officer (Education). 143 The following table shows the nature of the defects of 38 junior county scholars who were rejected— Sex. Want of cleanliness. l Vision. 2 Teeth. 3 Throat. 4 Spinal curvature. 5 Heart. 6 Chest. 7 Ears. 8 Boys - 1 1 1 1 - 1 - Girls 34 2 - 2 - 1 - 1 One supplementary junior county scholar was rejected owing to phthisis. Of the candidates passed as fit, 95 junior county scholars, 8 supplementary junior county scholars and 7 intermediate county scholars were accepted with defects that did not easily lend themselves to treatment but which would not interfere with their studies. Trade Scholarships.— The Council's scheme of trade scholarships is intended to encourage students to devote themselves to special branches of technical or industrial work. In medically examining the candidates the standard of examination is varied according to the trade that the scholar proposes to follow, because each trade has its peculiar effect upon the health of the workers. Appendix IX. shows the number of candidates examined in connection with each award, and the conditions found. Of the 175 who were referred. 10 (5 boys. 5 girls were referred a second time owing to the conditions not having been remedied. An analysis of these numbers is given in the following table— Scholarship. No. referred a second time. Referred for Want of cleanliness. Vision. Throat. Teeth. Sundry. l 2 8 4 5 6 7 M. F. M. F. M. F. M. F. M. F. M. F. Book production 1 ... ... ... 1 ... ... ... 1 ... ... ... Building and allied trades 2 ... ... ... 1 ... ... ... ... ... 1 ( ears) ... Dressmaking ... 1 ... ... ... 1 ... ... ... ... ... ... Engineering 1 ... ... ... 1 ... ... ... ... ... ... ... Furniture and cabinet making 1 ... ... ... 1 ... ... ... ... ... ... ... Millinery ... 1 ... l ... ... ... ... ... ... ... ... Photography ... 1 ... ... ... 1 ... ... ... ... ... ... Heady-made clothing, designing and making of ... 1 ... 1 ... ... ... ... ... ... ... ... Waistcoat making .. 1 ... l ... ... ... ... ... ... ... ... 17 candidates (15 boys, 2 girls) were rejected for reasons set out below. Some of the candidates were rejected for more than one defect— Scholarship. No. rejected. Reason of rejection. Want of cleanliness. Throat. Teeth. Vision. Chest. Sundry. l 2 3 4 5 6 7 8 M. F. M. F. M. F. M. F. M. F. M. F. M. F. Artificers, Boy 5 ... ... ... ... ... ... ... 3 ... ... ... 2 (Poor development) ... Beaufoy Institute 2 ... ... ... ... ... ... ... 1 ... ... ... 1 (General health) ... Book production 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... Borough Polytechnic 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... Cookery 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... Laundry work .. 1 ... 1 ... ... ... ... ... ... ... ... ... ... Mercantile marine 2 •• ... ... ... ... . ... 2 ... ... ... ... ... Photography ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... Woodcarving 2 ... ... ... ... ... 2 ... 1 ... ... ... ... ... Special Scholarships.— The Council has made provision for a number of awards which cannot well be classed as trade scholarships but which are of a special character. Appendix X. shows the number of candidates examined and the conditions found. 144 Annual Report of the London County Council, 1910. Of the 346 special scholarship candidates who were referred 14 (2 boys and 12 girls) were referred a second time owing to defects not having been remedied. An analysis of these numbers is given in the subjoined table— Scholarship. Number referred a second time. Referred for Want of cleanliness. Vision. Throat. Teeth. Sundry. l 2 3 4 5 6 7 M. F. M. F. M. F. M. F. M. F. M. F. Domestic economy, junior .. 12 .. .. .. 8 .. 3 .. 1 .. 3 (2 ears, 1 nasal obstruction). George Green's 1 .. .. .. 1 .. .. .. .. .. .. .. Trust Fund 1 .. .. .. 1 .. .. .. 1 .. .. .. Thirty-six girls were rejected for reasons set out below. Some of the candidates were rejected for more than one defect— Scholarship. Number rejected. Reason of rejection. Want of cleanliness. Throat. Teeth. Vision. Chest. Sundry. 1 2 3 4 5 6 7 8 Domestic economy, junior 35 24 3 9 2 .. 7 (anæmia 2, nose 3, ears 2) George Green's 1 .. .. .. .. 1 .. Teaching Profession.— The Council awards for the training of elementary school teachers provide a complete scheme by means of which a boy or girl may proceed by various stages from the public elementary school to a training college for teachers, and when conducting the examination the medical officer is required to certify that the candidates are in a fit state of health to take advantage of a scholarship, and that they are likely ultimately to satisfy the requirements of the Board of Education for recognition as certificated teachers. The ages of the candidates are as follows— Pupil teachers, 16 to 18 (pupil teachers of handicraft not less than 14 on the 31st July in the year of the award, pupil teachers of art, 17 to 21); bursars, 16 to 18; student teachers, not less than 17; training college students, not less than 18 on 1st August of the year of admission to a college; domestic economy training scholars, 18 to 30. The results of the medical examination are shown in Appendix XI. Of the 666 candidates who were referred 30 (5 males and 25 females) were referred more than once for reasons indicated below— Awards. Number referred a second time. Referred for Want of cleanliness. Throat and nose. Teeth. Vision. Anæmia. Sundry. l 2 3 4 5 6 7 8 M. F. M. F. M. F. M. F. M. F. M. F. M. F. Pupil teachers 1 6 .. .. .. .. .. .. 1 4 .. 2 .. .. Bursars 1 5 .. 2 .. 1 .. .. 1 2 .. .. .. .. Student teachers 1 7 .. .. .. 1 .. .. 1 5 .. 1 .. .. Training college students 2 7 1 2 .. .. •• .. 1 3 .. 2 .. 1 (eczema) Thirty candidates (2 males, 28 females) were rejected for the reasons given in the subjoined table— Awards. Number rejected. Cause of rejection. Want of cleanliness. Teeth. Vision. Heart and lungs. Sundry. 1 2 3 4 5 6 7 M. F. M. F. M. F. M. F. M. F. M. F. Pupil teachers .. 3 .. 2 .. .. .. .. .. 1 .. .. Bursars 1 8 .. 1 .. .. .. 1 .. 5 1 (undersized) 1 (wry neck) Student teachers .. 7 .. 1 .. .. .. 3 .. .. .. 3 (general health 1, anæmia 1, throat 1) Training college students 1 10 .. 1 1 3 .. 1 .. 2 .. 3 (general health and bronchial catarrh) Report of the Medical Officer (Education). 145 It will be observed that the examinations this year have continued to be of a stringent character in regard to personal cleanliness, the experience of past years having shown that candidates who will not attend to this matter are undesirable scholars and a source of annoyance and danger to other pupils and teachers in the institution. Training Colleges, Pupil Teacher Centres, Secondary and Trade Schools. Medical inspection is now carried out in all the Council's secondary schools, training colleges, trade and technical schools. It is just as important in these institutions as in the elementary schools, and, from the economical point of view, probably more important. Each student is examined once a year, and each institution visited once in six weeks, so that the doctor can be consulted about pupils presenting any symptoms likely to affect their health or work. Every student has a medical record card showing, at a glance, the condition, so that the students are continuously under observation, and if through illness or other causes become unfit they are not permitted to continue at the institution. Appendix XII. shows the defects noted. Medical Inspection. Personal Cleanliness.—The personal hygiene scheme in girls secondary schools and kindred institutions has continued in operation during the past year. The inspection is carried out by the two assistants to the superintendent of nurses, one working in institutions north and the other south of the Thames. At the beginning of each term a thorough inspection of each pupil is made and a card containing instructions for cleansing the hair is given to all unsatisfactory cases and they are excluded from the school. At an interval of a week the excluded cases are re-examined, and if again unsatisfactory they are excluded for a second period of one week. Few cases are unsatisfactory at the second visit, and a still smaller number at the third, but during the year 12 pupils were permanently excluded from the school either because the parents or guardians could not or would not cleanse them. The following table shows the conditions found during the past year:— Examination. No. of pupils. No. of verminous heads found. Percentage of unclean heads on number of pupils examined. (i) (2) (3) (4) Spring term 1910 2990 296 9.9 Summer term 1910 3471 211 6.0 Autumn term 1910 4085 335 8.2 The results of the personal influence of the teachers and the instruction of the doctors and nurses is making itself felt. The innovation of a lecture each term on hygiene by the school doctor at the training colleges has been warmly received both by the principals and students, several of whom have thanked the lecturer for practical hints on personal matters of health. In the secondary schools hygiene has as yet no definite place in the school curriculum. Occasionally an address is given by the headmistress to the girls. Seeing that this is the best school age at which to inculcate laws of health, there is a great need of more systematic teaching in this subject. That there is still room for improvement with regard to general knowledge of personal hygiene will be gathered from the following facts obtained by a show of hands at a secondary school in the course of a short talk on " Personal Hygiene " to the upper school:— (a) None have a cold bath or rub down daily, although all have a bath once a week. (b) Two-thirds have no bath room in the house. (c) None clean their teeth at night. (d) None go to bed by 9 p.m. (e) Two-thirds have supper immediately before going to bed. (/) One-half share beds; but none sleep with closed windows. It would probably be advantageous to institute in the secondary schools once a term or even once a year, regular talks on hygiene similar to those in the training colleges, accompanied by some questions eliciting defects; and it might be interesting to all concerned to keep a record of the answers, which could be compared from time to time. In certain areas, however, the application of the most elementary hygienic rules leaves much to be desired, and it is still uphill work to get these scholars to attend to personal hygiene. As an instance of the neglect of cleanliness one pupil stated that her mother objected to her washing more than her face and neck daily. In two known cases the only means of a daily wash was at a kitchen sink. During the year it has been necessary to exclude a few students for a compulsory bath, and this in spite of indefatigable efforts on the part of the head mistress in regard to hygienic matters. Cleanliness has been considered from a threefold standpoint, viz., unclean heads, neglected skins, and dirty underclothing—this last nearly always in those who sleep in their undergarments, and this habit continues largely in spite of continuous teaching to the contrary. Teeth.—There is a marked improvement in dental conditions both in regard to caries and cleanliness. All cases noted as defective are slight, or in students who have not been previously examined. Clothing.—The drill costume is worn compulsorily at drill and games, and special attention is paid by the drill mistresses to the presence of stays and similar unsuitable clothing. The comfort and convenience of this drill costume are so much appreciated that it is practically worn continuously, at any rate in school. Where this costume is adopted the underclothing as a rule is satisfactory, the enforced absence of heavy petticoats and the substitution of knickerbockers having a salutary effect and setting an example that will probably last throughout life. 146 Annual Report of the London County Council 1910. Feeding.— Many headmistresses are strongly of opinion that the scholarship holders are often badly in want of nourishing food, and they suggest that a portion of the maintenance grant allowed by the Council might, with advantage to the scholars, be diverted towards compulsory school dinners, thus ensuring at least one hot meal a day during the school term. The food that some of these children bring to school is often wanting in nutritive quality, especially fat. Where children are provided with food at the school or institution a marked improvement in general physique, tone and appetite is obtained after a few weeks' regular dinners. Games.—No cases of overstrain in the girls' secondary schools and training colleges have been noted, due no doubt to the precautions taken to regulate the amount and nature of play in cardiac and ancemic conditions. In these and in every doubtful case medical opinon is asked before the pupil is allowed to take part. It would be an advantage if the playing ground was always of easy access from the school; Moorfields Training College is at a great disadvantage in this respect. Homework and Nerve Strain.—Enquiries have been made into the amount of homework undertaken. In some cases it appeared as if there were some overpressure, but this seems to be due, not to the amount of home-work actually set but to additional work unconnected with the school. At one secondary school the head mistress has arranged the work so that each class has no special homework given on one evening in the week which necessarily involves slightly more on the other evenings. There is apparently no overpressure in the lower school. In the upper school the time taken at homework ranged between averages of 1¼ hours for a class of average age 13 years 11 months, and 3¼ hours for a class of average age 16 years 4 months, four nights weekly. In addition it appears that more than half these girls practise music for half an hour or more daily and assist in home duties such as washing up, minding the baby, etc., for more than another half an hour. As a consequence the girls have not only to do a corresponding amount of homework to the boys but have, in addition, accessory occupations which, however diSerent from school work, have not the recreative effect of the boys' play. In many cases girls seem to work harder and more conscientiously over their homework than boys, and are proportionately fatigued. With regard to music, it is perhaps only excessive practising, say over half an hour daily, to which exception can be taken. The amount of outside engagements also formed the subject of enquiry. Of the upper school (Form V. and upwards) only five girls out of 124 had regular engagements more than once weekly and in some cases these were music lessons. The pupils do not leave school till 4 o'clock, many do not reach home till 5 and cannot commence their homework for perhaps another hour. As a result the average bed hour is late. In a class of 28 girls of average age 15 years 8 months, nine go to bed at 9.30; ten at 9.3010; four at 10-10.30; one at 10.30-11; four at 11 and later. There is the further difficulty that an enormous proportion of girls have to do their homework in a room where everyone is talking around them and where the delay due to distraction must be very considerable. In some schools an arrangement is made whereby a certain proportion of the preparation can be undertaken at the school and in many instances this would seem the preferable system. Certain cases where excessive homework had been complained of by the parents were investigated at the request of the head mistresses and it appeared that in all there were complicating factors such as music practice, domestic duties or regular outside engagements, which formed additional causes of stress. Many parents of the scholars do not look on domestic duties as work and expect the girls to be useful at home and also to prepare for a scholastic career, while in the case of the boys the need for play and recreation would be conceded. Spinal Curvature in Secondary Schools. Curvatures of the spine occurring during the years of most active growth are undoubtedly common in school children, and generally of little importance, but some are serious, and all have, therefore, to be regarded from this possibility. They have recently aroused much interest in connection with their treatment in school by remedial exercises; it is important, therefore, that their frequence, variety and importance in after life should be understood, and that the possibilities and limitations of school treatment should be known. Boys and girls are, according to previous observers about equally affected. In orthopaedic clinics the proportion of boys to girls attending for treatment of spinal curvatures is from 1.4 to 1.7. The variety of curve found is also very different in examinations in school and in orthopaedic clinics. Scholder found in school:— Single curves to L., 70.3 per cent. of the whole. Single curves to R., 21.1 per cent. Double curves, 8.6 per cent. Whitman in a New York Orthopaedic Clinic found amongst 180 cases— Single curves, 39. Double curves, 117. Triple curves, 24. It seems evident that there is a considerable variation in the standard adopted in looking for spinal curvature and that the common school types of curve are not those usually seen in orthopaedic clinics. For these reasons it seemed advisable that in any investigation all cases of alleged curvature should be seen indepently by two observers and that one of these should be an orthopaedic surgeon. The boys in one secondary school were examined by Dr. Clive Riviere and the girls in two secondary schools were examined by Dr. Annie Gowdey. Card records were made of all children considered to have spinal curvature; these were then examined subsequently by Mr. Elmslie. The results were as follows:— Total examined Antero-posterior Lateral curve curve only. Boys 166 2 28 Girls 459 13 49 The percentages with lateral curves are, therefore, Boys, 16.9 per cent., Girls, 10.9 per cent. Report of the Medical Officer (Education). 147 The total numbers examined were not sufficient to give an accurate percentage, but it is clear that the number of cases of curvature found was considerably lower than that usually recorded amongst school children. This may mean that the children in these secondary schools have straighter backs than those examined by other recorders, but it is more likely that it is due to a difference of standard. This is rendered specially probable by the large number of comparatively slight cases of curvature found. The cases were classified into the following varieties:— Girls. Boys. Totals. Kyphosis 10 1 11 Kypho-lordosis 3 1 4 Lateral curve— Single to Left 31 8 39 Single to Right 6 13 19 Double R. Dorsal L. lumbar 9 5 14 Double other varieties 3 2 5 With the exceptions of three boys and six girls all the children showed comparatively slight deformities easily corrected by regulation of posture, and nearly all came into four classes— 1. Kyphosis. 2. Single curves to left. 3. Single curves to right. 4. Double curves, right dorsal, left lumbar. The first three of these classes constitute the common varieties of school postural curves and deserve a little further consideration. Kyphosis.—By this is meant an excess of the normal backward dorsal convexity. This convexity varies a great deal in different individuals; it is often comparatively great in those of unusual muscular power. To lay down an absolute standard is therefore impossible. It may be considered, however, that a child is kyphotic if with a strong dorsal curve the head is poked forward, the chest flat, the abdomen prominent and the scapulae placed further forward than natural on the chest wall. These children, if told to hold themselves up are apt to correct the kyphosis by strongly arching the lumbar spine throwing the shoulders back but leaving the chest as flat as ever and making the abdomen more prominent. If this mode of correction goes on throughout the period of growth the dorsal convexity becomes fixed, a definite lumbar lordosis arises and the condition changes into the more unsightly and less treatable kypho-lordosis. If proper postures are taught in the early stages kyphosis in children is, however, easily cured. Single curves to left.—This is the commonest variety of school curve. Scholder found that 70 per cent. of curvatures in the children he examined belonged to this class. In the present series just 50 per cent. of the lateral curvatures were left sigle curves. In 20 out of the 39 cases there was an associated kyphosis. The usual appearance of the child with a left single curve is that in addition to bis kyphosis the whole spine tilts in a long curve to the left, the right hip being thus rendered more prominent and the left shoulder raised. This posture is a common one in many users of the right hand below the shoulder level. It is one of the common postures of the spine in writing. These cases are easilv corrected and in fact probably often correct themselves during growth, for this long curve to the left is not commonly seen among adults. 148 Annual Report of the London County Council, 1910. Single curves to right.— These are not uncommon in school children; they were specially numerous in this series amongst the boys. The curvature is rather different from the left single curve. The curve to the right is slight and is situated high up in the dorsal region, the scapula on the right is raised out of proportion to the spinal curvature. There being no curvature in the lumbar region neither hip is unduly prominent. This elevation of the right scapula is another common writing attitude. These cases in school are nearly all very slight and easily corrected by regulation of posture. Double Curves.—The double curves with the exception of those already mentioned, were all very slight, in fact they scarcely required treatment, but inasmuch as it is these double curves which develop occasionally into the really bad forms of scoliosis it is important that they should be noted and the children who suffer from them kept under observation. In all varieties of lateral curvature slight rotation of the vertebral bodies towards the convex side of the curve occurs. Severe rotation only occurs, however, in the double curves and is the exception in school curves; such rotation was only detectable in one case besides those already described as severe curvatures. In a hospital exercise clinic a large majority of the children or adolescents attending suffer from the more severe types of curvatures, viz.:— Double curvatures with rotation. Kypho-lordosis. Severe instances of single curve. The slighter cases such as are seen in school are in the minority and usually are cured after two to three months attendance. Of the 92 children suffering from curvatures 33 had weak or flat feet, 5 had slight knock-knee. In 4 cases a lateral curvature was partly due to shortness of one leg. Conclusions.—(1) The investigation of school children for spinal curvatures is important, but it must be carried out without bias and is valueless unless the variety, severity and possibility of correction of the deformity is noted. (2) Conditions to which the curvature is secondary must be looked for carefully. In six cases in this series the curvature was secondary to other conditions (short leg, torticollis) and the vision was not enquired into; defective vision is a frequent cause of kyphosis. (3) The slighter cases of curvature should be treated by exercises in school for the following reasons— (a) Daily exercises are required. (b) Attendance at a hospital or clinic necessitates expensive journeys and absence from school. (c) The treatment can be carried out in classes, exercises being arranged for— 1. Kyphosis. 2. Left single curves. 3. Right single curves. (4) Proper posture is the first essential in all exercises. It is to be feared that the persistence of many cases of kyphosis and kypho-lordosis is due to a failure in the elementary school to inculcate a proper erect posture by teaching or example. (5) Cases of severe curvature, specially double curves unless very slight, and kypho-lordosis, require special individual exercises which occupy much of the instructor's time. They can only be done by a teacher who has had training in remedial exercises, and the children should be seen at intervals by a doctor. Unless these conditions can be complied with in school these cases should be sent to a hospital or clinic for treatment. Regular orthopaedic courses are now taken in many German towns for children in ordinary elementary schools, and the Turnsaal is provided with apparatus so that children may be supported by the heads, and by the arms fully extended over the head, whilst others are exercised crawling round on the floor, excellent results being obtained in the slighter cases. Anthropometry in Secondary Schools, Trade Schools and Training Colleges. In the annual report for last year statistics were given relative to the heights and weights of boys in secondary schools, etc. The following table gives similar information in regard to the girls in some of the Council's secondary schools, trade schools, and training colleges. The pupils have been grouped according to age last birthday. The probable errors, standard deviations, and degree of variation have been calculated and are exactly comparable with the tables on p. 10 of the Annual Report for 1907, in which the procedure adopted for their calculation is explained. Age last birthday. 1 Heights in centimetres. Weights in kilograms. Age last birthday. 12 Number examined. 2 Average height in cm. 3 Probable error + - 4 Standard deviation. 5 Coefficient of variation. 6 Number examined. 7 Average weight in kilos. 8 Probable error + 9 Standard deviation. 10 Coefficient of variation. 11 12 45 140.7 .70 7.0541 5.01 44 32.9 .41 4.0657 12.37 12 13 90 148.7 .47 6.6626 4.48 72 38.9 .47 6.9971 17.98 13 14 98 151.8 .44 6.5788 4.33 109 41.9 .43 6.7022 15.99 14 15 157 155.1 .34 6.2290 4.01 187 45.2 .31 6.3016 13.94 15 16 168 156.9 .33 6.3380 404 157 48.3 .35 6.6558 13.78 16 17 57 158.6 .55 6.2064 3.91 74 49.6 .41 5.3954 10.88 17 18 25 159.1 .65 4.8980 3.08 58 52.9 .52 5.9110 11.11 18 19 98 160.1 .35 5.2038 3.25 106 54.4 .45 6.9275 12.72 19 20 42 160.6 .66 6.4187 4.00 40 53.9 .78 7.4142 13.75 20 Report of the Medical Officer (Education). 149 Comparison with other Countries.—In the annual report for last year was shown a comparison of the boys in secondary schools in London with those elsewhere in this country and abroad, which indicated that the Council's scholar compares favourably in physique with any other. The following are similar tables for girls. Here unfortunately it appears that both in stature and weight the scholars in the Council's secondary schools for girls are somewhat behind the standard of the other econdary schools. Average Stature in Centimetres. Age. L.C.C. Secondary Schools. North London Collegiate School. Worcester U.S.A. Berlin (Rietz). Stockholm (Key). Russia (Michaeloff) Turin (Pagliani). 1 2 3 4 5 6 7 8 12 140.7 147.3 144.7 147.8 143 132.9 139.4 13 148.7 151.3 147.9 152.1 148 138.3 146.4 14 151.8 154.4 153.7 156.6 153 145.8 152.1 15 155.1 158.9 156.7 — — 146.4 - 16 156.9 159.9 159.3 — — 150.3 — Average Weight in Kilos. Age. L.C.C. Secondary Schools. North London Collegiate School. Worcester U.S.A. Berlin (Rietz). Stockholm (Key). Russia (Michaeloff). Turin (Pagliani). l 2 3 4 5 6 7 8 12 32.9 39.1 36.1 40.5 35.9 30.3 31.8 13 38.9 43.0 39.7 43.1 39.6 36.5 37.6 14 41.9 47.8 44.9 49.7 44.8 40.5 43.0 15 45.2 50.5 47.1 51.2 48.9 42.6 45.6 16 48.3 52.8 51.2 — 51.6 — 45.7 Personal Hygiene Schemes. There are 90 school nurses with a superintendent and two assistants to the superintendent. Their duties consist chiefly in assisting at the medical examination of school children; making systematic visits under the direction of the Council's medical officer to the schools allotted to them, paying due regard in all such work to the necessity of using as much tact as possible with teachers, parents and children, and causing as little disturbance of school routine as possible; examining children for all forms of obvious uncleanliness and disease; advising the teachers in regard to the exclusion from school of doubtful cases; applying the schemes for cleansing the heads, bodies and clothing of the children; visiting the children's homes and advising the parents in regard to treatment. An average of 3.4 sessions a week is given to assisting the school doctors in medical inspection. In this connection, the nurses arrive before the doctors at the schools where examinations are to be held, and make the necessary preparations for the examination, arrange for the expeditious arrival of the children in the examination room, undress and dress them or assist the parents to do so. The nurses also, when required by the school doctor, examine the children in regard to the cleanliness and condition of the skin; make the preliminary test of vision; take the weights and measurements; obtain from the parents particulars in regard to the family history and details of previous illnesses, referring any particular case to the doctor; enter from the doctor's dictation the results of the examination on the medical record cards and the names of children requiring treatment, in the medical register. When the parents are present at the examination the nurses hand to them advice cards in each case where the school doctor is of opinion that medical treatment (including vision) would be beneficial to the child; when the parents do not attend the examination the nurses visit the homes and leave advice cards explaining the nature of the trouble from which the child is suffering and the necessity for obtaining treatment. The nurse's knowledge of the children and their home conditions proves helpful to the doctor, and the knowledge gained at the examination enables the nurse to deal more effectively with the children in her routine work, and to interview and advise the parents and assist the School Care Committee in regard to treatment. Staff of Nurses. For the purpose of carrying out the schemes for personal cleanliness each nurse is placed in charge of a district containing from 7 to 15 schools, according to the condition of the neighbourhood. A rota showing the order in which schools must be visited and the dates of proposed visits is drawn up and is so arranged that every school is visited at least once a month. At the rota visit the children in one department are thoroughly inspected and if any time remains a short visit is paid to the other departments. The departments are visited in cyclic order, beginning with the girls' department, then the infants' and finally the boys' department, with necessary variations where there are mixed and junior mixed departments. At these visits the nurse examines the children in school for any unsatisfactory condition of person (heads, bodies and clothing) and applies the cleansing schemes. Her attendance at the police court is necessary to obtain a conviction against parents of children excluded for Organisation 150 Annual Report of the London County Council, 1910. prosecution under the cleansing schemes. The homes of children with verminous bodies and clothing are visited, and, if found to be unclean, the Medical Officer of Health for the district is asked to deal with them under the London County Council (General Powers) Act, 1904, Part IV. Reports are made in respect of children found in circumstances which may render it desirable that they should be dealt with under the Children Act, 1908, with a view to action being taken for their safety and protection and the punishment of the parent or guardian. The nurse also assists the head teachers generally with her knowledge and experience by suggesting temporary procedure in cases of suspected outbreaks of infectious or contagious disease, affections of the skin, ophthalmia, offensive discharge, etc.; by dealing with parents who attend at the schools to seek advice or to complain of action taken; by advising in regard to the many small and doubtful points concerning school hygiene that may be submitted to her. The nurse also examines children going to the country through the Children's Country Holiday Fund. The school nurse is thus a most valuable agent for co-ordinating all the influences affecting the child's health. She is the essential link between the school, the teachers, the doctor and the home in matters directly affecting health and sanitation. With the initiation of the cleansing arrangements now being entered into with borough councils or for Council cleansing stations, additional nurses will be used, one attached to each cleansing centre, to arrange the supply of children to the centre, to follow up cases in regard to any necessary proceedings required by statute and to attend police courts, if necessary. With the extension of treatment "following up" nurses will be required to feed treatment centres. The use of nurses for the organization of all processes where the individual children and their parents have to be dealt with is to be recommended because the nurses have all had good experience in dealing with this very class, their tact and judgments are generally good, their uniform respected, and it may be said generally that it is scarcely possible to get a higher quality of service for the price paid, than that of nurses. Heads. Personal cleanliness is not merely an educational measure of great importance; it is the very foundation of any general effort to improve public health. In respect of personal cleanliness among school children, too, there has been on the one hand great success, and on the other hand years of retardation from want of administrative foresight in legislation. When I first visited the London schools nine years ago they presented a very large number, larger than seen elsewhere, of children with neglected and verminous heads, which often meant prolonged absences. It was possible in the course of a single afternoon to visit a number of girls' departments in each of which were several children with masses of scabs and vermin on their heads. At the present time one would search in vain for a child in a comparable condition. In the original cleansing scheme the policy of warning the parents and later excluding unclean children and then prosecuting for non-attendance was adopted. The success of this scheme was marked, and it must have paid the cost of its working many times over in increased attendance grants. In working the scheme the school nurse examines all the children at a school, noting the condition of their heads and using strict precautions against contagion. The head teacher is then supplied with a white card for each child requiring cleansing. The card is enclosed in a sealed envelope and sent home by the child. At the end of the first week all cases not treated are separated from the other children, and a red card with full details is filled up by the nurse for each child still offensive. This is forwarded to the divisional superintendent who has the card delivered at the home by the attendance officer. At the end of the second week the assistant to the superintendent of school nurses visits the school and examines the children proposed for exclusion. After exclusion the divisional superintendent takes out a summons, but if any child is properly cleansed before the hearing it is readmitted to school, examined by the nurse, and the summons is not pressed, the circumstances being explained to the magistrate. About one in four hundred cases seen by the nurses is fined. This scheme is therefore a simple mechanism which secures cleansing of the heads by the parents in over 99 per cent, at a comparatively trivial cost and without any unwieldy organisation. The following table shows the result of the cleansing scheme as applied to heads (1910):— Departments Number of Children Examined Number Clean. Number with very few nits Number Verminous Number of White Cards served [First Notice) Number of Red Cards served (Final Warning) Number Proposed by Nurse for Exclusion Number Excluded for Prosecution (1) (2) (3) (4) (5) (6) (7) (8) (9) Boys 2,072 1,918 55 99 99 23 18 5 Girls 36,523 25,980 3,560 6,983 6,983 4,521 3,212 2,227 Infants 16,980 14,405 970 1,605 1,605 863 566 316 Mixed 6,728 6,080 167 481 481 365 284 211 Special 1,491 1,108 43 340 340 254 168 83 Totals 63,794 49,491 4,795 9,508 9,508 6,026 4,248 2,842 Bodies and Clothing. The parents of 265 children were prosecuted and fines varying from 1s. to £1 imposed. The percentages of children found to be verminous to children examined was 22.4 in 1910, as compared with 20.9 in 1909. The increase may be due to a somewhat stricter standard. It was pointed out, when the cleansing scheme was first proposed, that it was applicable to verminous heads which could be cleansed by the parents in a week, but that it would not be applicable to children whose bodies or clothes were affected and whose homes were also presumably unclean. These cases were beyond the range of the Education Authority and it was Report of the Medical Officer (Education). 151 suggested that legislation should be obtained which would make it the duty of the sanitary authorities, as soon as a child was excluded from school on account of the verminous condition, of body or clothing, to take it in hand and effect cleansing of the clothing, person and home. The London County Council (General Powers) Act, 1907, confers power to examine the clothing or person of any child attending a school provided or maintained by the Council, and gives the Council power to cleanse such a child. It was left to the Council and sanitary authorities to arrange between themselves as to the use of premises or appliances, and this has led to delay in arriving at any general scheme of even a tentative nature which would be satisfactory to the Education Authority. Somewhat similar powers are also conferred in Section 122 of the Children Act, 1908. Under these powers small experimental stations were established by the Council in October, 1909, at the Pulteney (Strand), the Chaucer (Bermondsey), and in December at Finch Street (Whitechapel) School where the Favus School had been. The Pulteney station was transferred in September, 1910 to Bath-street (Finsbury). The method of utilizing these stations is a modification of the earlier cleansing scheme. The nurse notes all the children in school with verminous bodies or clothing and supplies to the head teacher for each child a card drawing attention to the condition and containing directions for cleansing. These cards are sent home in sealed envelopes to give the parent an opportunity of effecting cleansing. After 48 hours the nurse again visits the school. All cases not cleansed are separated and their names, together with the days and times when children can attend the cleansing station are forwarded to the divisional superintendent. A statutory notice is then served upon the parents requiring them to cleanse their children; containing directions for cleansing; stating the stations and times at which cleansing can be effected; and warning them that proceedings will be taken if the children are not cleansed. The divisional superintendent informs the nurse of the time of service of the notice, and after 24 hours the nurse visits the school, examines the children, and if not cleansed takes them to the cleansing station. She then furnishes the divisional superintendent and Medical Officer (Education) with names and addresses of the children and the date on which they were cleansed by the Council. The medical officer of health is informed with a view to following up by cleansing in the home, and the parents are warned that the need for another cleansing by the Council will involve police court proceedings. Should the child have to be compulsorily cleansed again police court proceedings are taken against the parents. At the Council's cleansing stations three children can be cleansed each hour and the work of the bathing woman is supervised by the nurse. Boys attend in the mornings, girls in the afternoons, or vice versa. The child's head is carefully combed, cleansed with soft soap, rinsed and again combed, the comb being dipped in paraffin. Where permission is given the worst part of the hair, if covered with nits, is cut away. The work of these experimental stations can be followed from the tables given below. Cleansing Stations. The cleansing scheme was applied at 23 schools from 1st January to 30th September, 1910, with the following results— Department. Number examined. Number clean. Number verminous. Number of cards M.O. 24 served. Number returned clean. Number on whom statutory notices were served. Number cleansed at L.C.C. stations. (1) (2) (3) (4) (5) (6) (7) (8) Boys' 6,505 6,226 279 279 165 114 50 Girls' 6,583 6,298 285 285 171 114 44 Infants' 6,019 5,823 196 196 139 57 8 Mixed 490 481 9 9 7 2 2 Special 140 114 26 26 15 11 8 Totals 19,737 18,942 795 795 497 298 112 The "Pulteney." The percentage of verminous to clean children attending schools in the neighbourhood of the " Pulteney " centre as shown by the nurses examinations was as follows— First examination on opening cleansing station, 6.4 per cent. Last examination before the closing of station, 2.7 per cent. Examination three months after closing the station, 1.5 per cent. The following table shows the results obtained at the "Chaucer" station during the twelve months ended 31st December, 1910:— Department. Number examined. Number clean. Number verminous. Number of cards M.O. 24 served. Number returned clean. Number of statutory notices served. Number cleansed at station. Number prosecuted. 1 2 3 4 5 6 7 8 9 Boys' 25,741 23,777 1,964 1,964 772 1,192 641 5 Girls' 26,299 24,617 1,682 1,682 726 956 369 5 Infants' 24,084 22,810 1,274 1,274 614 660 191 2 Mixed 3,850 3,547 303 303 159 144 60 1 Special 864 761 103 103 33 70 44 — Totals 80,838 75,512 5,326 5,326 2,304 3,022 1,305 13 The "Chaucer." 152 Annual Report of the London County Council, 1910. The cleansing scheme (bodies and clothing) was applied in 43 schools, and the parents of 13 children were prosecuted. Fines varying from 2s. 6d. with 2s. costs to 8s. with 2s. costs were imposed in 12 cases and one case was withdrawn. This centre has done a good year's work and has been the means of effecting general improvement in the clothing and condition of the children attending the schools in the neighbourhood. The children are neglected and verminous, the parents poor and the homes squalid, and as an instance of the improved conditions attention may be drawn to the case of a parent who gave as a reason for keeping her child away from school that the child had not been able to have the usual wash in the previous week. The mother stated also that formerly it was sufficient to send the child to school in a clean pinafore, but now she must be sent clean right down to the skin, because she might be examined by the nurse at any time. The teachers have shown appreciation of the scheme and assist the nurses by sending the children to be cleansed, instead of excluding them indefinitely, with the prospect of remaining out of school until sent back by the attendance officers with little improvement in their condition. The "black sheep" of the schools become familiar to the nurse in charge of the station, who works in conjunction with the nurses whose districts surround the station. The area covered by the centre is therefore a wide one, and parents who try to evade the nurse by removing and sending their children to other schools are impressed with the fact that escape is practically impossible and that some improvement in the condition of the children must be made. One of the results of the work in this district is the light constantly thrown on the verminous conditions of the homes. Finch-street The following table shows the results obtained at the Finch-street station during the twelve months ended 31st December, 1910:— Department. Number examined Number clean. Number verminous. Number of cards M.O. 24 served. Number returned clean. Number of statutory notices served. Number cleansed at station. Number prosecuted. (1) (2) (3) (4) (5) (6) (7) (8) (9) Boys' 16,955 15,571 1,384 1,384 376 1,008 688 3 Girls' 17,213 16,374 839 839 214 625 431 2 Infants' 8,629 8,244 385 385 110 275 145 — Mixed 2,558 2,439 119 119 27 92 48 — Special 601 523 78 78 7 71 57 — Totals 45,956 43,151 2,805 2,805 734 2,071 1,369 5 The cleansing scheme (bodies and clothing) was applied in 48 schools and the parents of five children were prosecuted and fines varying from 5s. with 2s. costs to 10s. or seven days were imposed. In one case the father went to prison. » A greater number of children has been cleaned during the year at this station than at any other. Although there is not such poverty in the district, the verminous conditions are worse than in the poorer neighbourhoods. Jewish parents are, as a rule, excellent in looking after the amount of clothing and feeding of their children, but often the clothes are verminous. They live so crowded together that cleanliness cannot be studied and remonstrance is useless. In many instances in this quarter there is a separate number on each door in a house showing that whole families are living in each room. In one case a school nurse found a mentally deficient child living with its mother and a brother in a deplorably filthy room. The mother could scarcely understand a word of English and the brother, who was 12 years of age, was an imbecile. There was one bed for the three, and at 12 o'clock the two children were still undressed. The woman maintained herself and the children by going out washing, and the little girl might be cleansed over and over again and never be clean; yet prosecution in such a case means imprisonment and the loss of what little means the parent has of earning a livelihood. There are not many troublesome parents in the neighbourhood, as foreign parents take or send their children for voluntary baths. In very few instances is it necessary to prosecute. Bath-street. The Bath-street station, transferred from the Pulteney, was opened on the 3rd October, and the table shows the results obtained up to 31st December, 1910:— Department. Number examined. Number clean. Number verminous. Number of cards M.O. 24 served. Number returned clean. Number of statutory notices served. Number cleansed at station. Number prosecuted. (1) (2) (3) (4) (5) (6) (7) (8) (9) Boys' 2,999 2,553 446 446 72 374 180 2 Girls' 3,200 2,813 387 387 97 290 156 3 Infants' 3,362 3,075 287 287 76 211 79 — Mixed 1,621 1,518 103 103 12 91 31 — Special 306 258 48 48 14 34 14 — Totals 11,488 10,217 1,271 1,271 271 1,000 460 5 The cleansing scheme (bodies and clothing) was applied in 24 schools and the parents of five children were prosecuted. One parent was fined 5s. in respect of each of two children and another parent was fined 10s. Two cases were dismissed, as the magistrate refused to convict unless the hair was cut and the head freed from nits. Report of the Medical Officer (Education). 153 This station has already effected a considerable improvement in the children attending the schools in the neighbourhood, and one of the encouraging signs is the fact that on a second examination the same children are not always found to be verminous. There are a few who are always infected, but the greater number of children found verminous are new cases. The head teachers remark on the increasing cleanliness of the children. The working of the scheme has, however, been hindered to a considerable extent by the necessity for serving the statutory notice under the Children Act upon the fathers of the children, who are frequently not at home except at midnight. The custom has grown up prior to the powers obtained under the London County Council (General Powers) Act, 1907, of having school children cleansed at borough cleansing stations when the local authorities were willing to assist. In the borough of Camberwell, which maintains a station under the Cleansing of Persons Act, 1897, the cleansing of school children has always been well attended to, as indeed it has been in several boroughs. Sanitary Authorities. The question of providing means for cleansing children with verminous clothing or bodies has been under almost continuous consideration, and in December, 1910, the Council decided that some provision should be made for the whole of London. A scheme was therefore devised by which children will be picked out in school by the school nurse and, if not cleansed by their parents, will, after due warning, be taken by a nurse acting under the Children Act to one of 23 cleansing centres. There the child's clothing will be removed and exposed for ten minutes to boiling temperature moist steam, then thoroughly dried and brushed. Meanwhile the child will be washed with soft soap and hot water and given a hot bath. The hair will also be treated with paraffin and if necessary portions cut. Arrangements for one year have been made to use the cleansing stations of thirteen borough councils on payment by the Council. The boroughs which have made such arrangements are Battersea, Bermondsey, Camberwell, Greenwich, Hackney, Hampstead, Poplar, St. Marylebone, St. Pancras, Southwark, Stoke Newington, Woolwich, and the City of Westminster. The City of London has made arrangements for the cleansing of its own school children without payment from the Council. Certain districts are not served by these centres and it is therefore proposed to establish centres to be worked by the Council in the vicinity of Fountain-road (Wandsworth), Frankham-street (Deptford), Hackford-road (Brixton), Halford-road (Fulham), Lauriston-road (Hackney, S.), Pakeman-street (Islington, E.), and Sirdar-road (Kensington, N.), in addition to the already existing centres. Each centre will serve a district within a mile radius. The cleansing of the child at a centre is ineffective whilst the home is untouched and so a mechanism is arranged whereby the unclean child in the school will be followed up in its home by the sanitary authorities and cleansing of the home achieved. The borough ocuncils will be paid two shillings a head for cleansing the children. The cleansings will be as many as are required, but only one payment will be made for any number of cleansings up to the end of the month following that in which the first cleansing is done. The arrangement of cleansing stations has justified itself in the work as set out above. Neither the existing stations nor those projected should be looked on as other than temporary measures till the cleansing scheme for verminous bodies and clothing is fully developed. The present provision is merely for the treatment of a most obtrusive symptom, but when the relations of this symptom to the conditions of the houses and the want of domestic opportunity for ordinary cleansing are considered, the whole question of school baths as a sanitary and educational requirement will have to be gone into and provision may prove to be necessary on a larger and more substantial scale than any cleansing which has yet been considered. Following the practice of former years the school nurses assisted the Committee of this fund by examining for the detection of any infectious disease (e.g., ringworm) or any form of uncleanliness the children whom it was proposed to send to the country so soon as the summer vacation began. These children were examined on two occasions. The parents of children found to be in an unsatisfactory condition at the first examination were warned that, if the condition were not remedied, the children would not be sent on the holiday; and cases found to be unsatisfactory at the second examination were rejected. There appears to have been a lack of co-operation on the part of the voluntary workers in carrying out the scheme for the examination of these children, but much good work was done and in many instances the school nurses, in their leisure time, assisted the voluntary workers by visiting the parents and advising as to the steps to be taken for the relief of unclean conditions. Children's Country Holidays Fund. Mr. Harman has investigated cases where "blight" has appeared in the Ackmar-road, Canal-road, and "Dockhead" schools. So far as his experience goes the teachers are competent to detect true "blight" and the description already given in the rules for their guidance is sufficient. On the appearance of cases in a school the use of towels should be suspended immediately, any washing that is considered necessary should be done under direct supervision of a teacher and washing of the face at school must be forbidden. The school doctor, on being advised of the cases, should make enquiry with a view to ascertaining the out of school causes contributing to the spread of disease and the steps necessary to combat any such causes. Some system of treatment should be undertaken in these cases as with efficient treatment they can be cured in a very short time and much loss of attendance thereby obviated. In a recent outbreak 27 children were absent for various periods exceeding a fortnight, 17 of them with an aggregate of 144 weeks or an average of two months apiece. As an alternative to excluding these cases an experiment might be tried of allocating certain desks apart in the class to such cases and expecting the children ten minutes after the others and dismissing them ten minutes earlier. It is evident that the disease which is a particular infection can only be dealt with by official supervision. The recording of all such cases on a suitable card index, and the following up of each case to recovery is highly desirable. The cases could be safely diagnosed in the first instance by the school nurses. 5716 L Ophthalmia. 154 Annual Report of the London County Council, 1910. Scabies. Another disease which might be dealt with on similar lines is scabies or itch. Last autumn an enquiry showed 520 children absent from this disease and having an average loss of attendance of seven weeks equal to grant loss of £122. This represents the children absent in one selected week so that there is probably a loss of grant approximating to £1,000 annually from this cause. Practically all these cases can be cured in a week and yet a single family will sometimes offend for months. The card index should also be followed out with this disease, and no mercy shown to people who neglect the disease and suffer it to persist. Medical Treatment. The Council was the first educational authority to move in the matter of medical treatment for school children. This was done before legislation had enacted the medical inspection which has brought the provision of medical treatment into such prominent position as a question of the day. Treatment is not a statutory obligation, but has been introduced voluntarily by the Council in the public interest. It is all done outside the Council's own service by arrangement with various institutions of a charitable or semi-public nature. The administration has hitherto been done in the Education Officer's department. The general routine by which a child comes to be treated under the Council's scheme is that the child, having been inspected by the doctor at the school and noted as having some defect, has a white medical advice card filled in with its name and the nature of the defect. The card informs the parents that the child has been found to have a certain defect, and advises that medical treatment should be procured. It also states that the card itself gives no claim to treatment at any hospital. If the parents are present at the time of the medical inspection the doctor generally gives some advice to them and delivers the card at the time. A representative of the school care committee often also attends and interviews parents as to their intentions in regard to treatment, or whether their means are such that they intend to take advantage of the Council's scheme. When parents are not present, the school nurse visits at the child's home and gives advice to the parent to seek treatment and personally delivers the advice card. After each session given to medical inspection a form is sent to the Medical Officer (Education), giving a complete return of the defects found in the children examined, set out in accordance with the detailed schedule suggested by the Board of Education. Another form is also filled in with the names of all the defective children and the nature of the defects where medical treatment is advisable. This last list is gone through and the cases taken out where the defect is included in the Council's scheme which provides for disorders of the eyes, throat and nose, ears or skin. This selected list is then forwarded to the Education Officer, who makes further arrangements. When the case has been given a sufficient time, it is further investigated, and if arrangements are made by the school care committee for attendance at hospital, a voucher card is sent to the parents which gives them the right to attend at a certain hospital at a determined hour, and obtain treatment, for which they pay at a rate agreed upon by the school care committee. Revision of Treatment. During the course of the medical inspection the school doctors have re-visited certain schools to ascertain the results of the treatment received by the children found defective at former visits. At such visits the doctors looked through the medical registers and record cards, made enquiries of the children and teachers as to any step which might have been taken, and inspected the children to ascertain if the defect had been remedied or if it still needed attention. A note of the present state was made in the medical register, and on the record card. Returns were forwarded to the office indicating the children seen and whether or not they were still in need of treatment; a separate entry being made for each defect. Such enquiries into the history of 5,093 children, presenting 5,576 defects, showed the results given in Appendix XIII. Of the 5,576 defects, medical treatment or advice had been obtained for 2,741 and home treatment not under medical supervision for 81, leaving 2,267 who had not been treated of whom 138 are known to be no longer in need of treatment. Of those entered as not yet treated, treatment had been arranged for in 312, while in 21 instances it had been arranged but refused. 415 children presented two separate defects needing treatment; of these neither had been treated in 186, one in 89, and both in 140. 24 children presented three such defects of which none had been treated in 19, one in 8, two in 4, and all three in 3. In revising the vision of children previously defective it was noted that spectacles had been obtained but were not used in 55 cases, while in 36 the spectacles, though recently obtained, were already lost or broken. Out of the total of 5,093 children three have been reported to have died prior to the revision; this corresponds closely with the average death rate at the school age. Of the children who had received medical advice and treatment, 2,183 were stated to have been treated at hospitals, dispensaries or similar institutions, 329 by private practitioners, while in 229 instances it was uncertain where the treatment had been obtained. Tonsils and Adenoids. Attention has frequently been drawn to the treatment of children suffering from enlarged tonsils or adenoids in complaints more particularly of children having been allowed to leave hospital too soon. For most of these cases treatment at hospital other than by surgical operation may be dismissed as unavailable. The usual method of treatment in London, however, is for the child to attend at the out-patient room of the hospital on a fixed day, and for directions to be given to the parent to ensure that the child does not attend after a heavy meal. These directions are not always carried out. The operation, which consists generally of scraping off the adenoid growths in the vault and sides of the pharynx and slicing off the greater part of the tonsils is then performed. Report of the Medical Officer (Education). 155 For one or two minutes there is in almost all cases very profuse haemorrhage. This continues less freely for some hours, and the child is often sick. The child should be kept under observation for five or six hours at least and, if possible, should be retained in hospital for at least 18 hours. Children suffering from enlarged tonsils and adenoids are liable to many future troubles, e.g., discharging ears with a certain proportion of fatalities; slowly progressing deafness in later life; stupidity and indecision of character. It is to avoid these results that the cost, inconvenience, and in a few cases the risks of operation, have to be balanced. Actual statistics to make an effective comparison are not obtainable, but the impression exists and appears reasonable that exposure to the cold and dust of the streets and often it must be added the condition of many homes, during the period of depression following the shock of the operation and the anaesthesia, lead to a higher incidence of serious accidents than occurs in cases which are kept in rest and warmth in hospital until this period of depression is over. Every care is taken, but the time available under the present conditions does not permit of long detention in hospital. Many thousands of children are operated on without experiencing the slightest inconvenience after the first hour or so after operation is passed, and as the unpleasant cases only are heard of they may considerably bias the judgment. On the other hand, whilst it may be expected that the retention by the hospital of every child operated on, for the night following the operation, would improve the results obtained, the improvement would be verv costlv. The Council decided to continue until the 31st March, 1910, the arrangements made during 1909 with the Queen Victoria Jubilee Institute for Nurses for the treatment of children suffering from suppurating ears in the nursing districts of (1) Hackney and (2) Shoreditch and Bethnal Green. The mode of procedure, of which the following is a brief summary, was similar to that outlined in the annual report for the twelve months ended 31st December, 1909. Cards were given to children found by the school doctors to be suffering from suppurating ears giving advice to the parents and disclaiming responsibility on the part of the Council for treatment prescribed or given; the homes of such children were then visited by the nurses, but no treatment was given on the first visit, and any subsequent treatment was provided only under the direction of a medical practitioner. Suppurating Ears. The difficulties referred to in the last report were encountered in dealing with the cases now under review. In discharging ears, medical examination is a necessary preliminary to any treatment by the nurse. For instance, many cases of discharging ears are kept up by the presence of adenoids. Operation on the adenoids may be all that is wanted for spontaneous recovery of the aural condition, whilst without this operation treatment may be in vain. In many instances, however, the parents refused to take their children to a doctor and as many as six visits were paid to some of the homes before obtaining a doctor's prescription. Even after a prescription had been obtained there was often extreme difficulty in attending to the children of parents who were continually changing their addresses. During the period from 1st January to 31st March, 1910, cards were issued in 16 schools for 226 children. An analysis of these cards shows that:— (a) Treatment was unnecessary and no action was taken in eight cases. (b) The parents of 54 children refused to see a doctor, but in 16 of these cases treatment was given by the parents. (c) Treatment was obtained at hospital or by private doctor in 8 cases, of these 1 was cured and 7 were not cured. (d) The nurses attended 156 cases and treated 52 of whom 16 were reported to be cured, and 2 could not be traced. The Superintendent of School Nurses was asked to examine all the cases and report with a view to ascertaining the actual results of the experiment. She found that:— Nurse not required— (a) Treatment was unnecessary in 8 cases. (b) 122 were treated by parents; 20 were cured and 102 not cured. (c) 48 obtained treatment at hospital or by private doctor; 11 were cured and 37 not cured. (d) In 7 cases reasons for non-treatment were not given and in 14 cases the children had either left the school or were absent. Work done by nurses. (e) The nurses treated 52 cases and effected 11 cures. (f) 9 cases reported cured were found to be suppurating again. (g) 7 cases were not seen by the Superintendent and in 25 cases treatment by nurse was stopped by the parents who continued treatment. The nurses paid 2,610 visits to the homes. The cost of the experiment for the first three months was £45, when 20 cures were effected by the nurses (£2 5s. a case); during the second period of three months the cost was £45 when 11 cures were effected by the nurses (£4 2s. a case). During the whole of the experiment (six months) the nurses effected 31 cures at a cost of £90 (£2 18s. a case. In addition 44 children were cured by hospital, private doctor or parents, and 18 of these 44 .. were visited by nurses, who, however, gave no treatment. These 44 cures are as a result of the scheme although not as a result of the nurses' treatment. If they are included the cost per case cured becomes £1 4s. The experiment also had some effect on the parents. During the first three months 25 per cent. and during the second three months 54 per cent. of the parents undertook the treatment of the disease. L2 156 Annual Report of the London County Council, 1910. Owing to the lack of hospitals and dispensaries in the Hackney and Shoreditch areas it was not considered that the experiment in this district was a fair test of the scheme, and the Council decided, as a further experiment for six months, to enter into arrangements during 1911 with the Paddington and Marylebone Nursing Association to treat children suffering from suppurating ears; the Paddington Green Children's Hospital and the St. Mary's Hospital, Paddington, are both situated in the district served by this association, and with several good dispensaries there should be little difficulty in obtaining medical prescriptions. Ringworm. Kingworm still continues to be a source of trouble in the schools, and there appears to be but slight diminution in the incidence of the disease in spite of the arrangements made in regard to treatment by means of X-Rays. It is estimated that only about one-fifth of the cases are treated by X-Rays, and until this form of treatment is generally adopted it is unlikely that there will be any material diminution in the prevalence of the disease. Ringworm is usually a very chronic complaint if not drastically dealt with in the early stages and is responsible for considerable losses in school attendance. Proper treatment should therefore be carried out both in the interests of economy and the benefit of the children. Any expenditure of public money in this connection would be to a large extent repaid by additional receipts in government grants through increased school attendance. Frequently where medical certificates are furnished stating that children who have been excluded from school owing to ringworm are not suffering from the disease, microscopical examination of the hair stumps has revealed the presence of ringworm fungus, and it is somewhat difficult to reconcile in the minds of parents the action of the Council in excluding the children from school and the testimony of their own medical attendant that there is no necessity for exclusion. Microscopical examination, however, is the only sure test for diagnosis in doubtful cases and a strong stand has to be taken in such cases in spite of protest from the parents. The following figures show the number of fresh cases of ringworm reported by school nurses during the year, together with the results of the microscopical examination of hair stumps. Number of fresh cases reported. Number of specimens of hair stumps examined. Found to be forms of ringworm. No fungus found. Favus. Suspicious 5,766 3,116 2,400 709 4 3 Special Schools. The differentiation of children from the ordinary elementary school class is leading to more specialised types of schools. The school at Kensal House for tuberculous children is, however, the only new type actually organised in the past year. New regulations and the maintenance of the card record now established in the schools for mentally defective children, as well as the physically defective already done, have thrown a considerable amount of additional work on the staff. The results of the medical examinations of children nominated as suitable for admission to special schools may be classified as follows:— M.D. MD and P.D. P.D. Blind. Blind and M.D. Myopes. Deaf. Deaf aad M.D. Hard of Hearing. Industrial School. Elementary School. Imbeciles. Invalids or Epileptics. Total. 1962 3 1098 118 8 46 125 6 41 31 2,642 160 2,015 8,255a Schools for Physically Defective Children. The school buildings are good, but often are provided with insufficient ground space. It probably would now be an advantage if the lessons of the open air schools could be applied to them. Mr. Elmslie has put forward the suggestion that there should be an increase in playground space. There was, from the first, a tendency to stint them in this respect under the impression that physically defective children are not very active, and do not therefore need much room for play, but probably the invalid child requires if anything more space and air than the normal child. Some of the tiny playgrounds at present existing are so close and stuffy in hot weather as to be of little use. Easy access to the playground, by wide French windows opening directly from hall or classroom and without steps (steps should not exist in these schools) would aid the formation of open air classes. The furniture should be adapted to the same end by using deck chairs and the light couches at present provided. Some shaded areas in the playground either in the form of a verandah, or light transportable canvas shade would also be useful. With provision of this kind the school hours could be lengthened with much advantage and a midday rest introduced after lunch. Longer hours are necessary educationally if good work is to be obtained from the children. At present many do little in the afternoons but after a midday rest might be expected to work well. Longer hours would also keep the children out of their homes the greater part of the day, and this would probably be a considerable advantage. Some of the children get home soon after 3.30 p.m., and are often set to work, which is quite harmful to them. With a rest between 1 p.m. and 3 p.m. the children need not leave school before 4.30 p.m. (a) Some of the hard of hearing cases and myopes in these figures are also included under elementary schools and invalids. The total number of children examined was 8,233. Report of the Medical Officer (Education). 157 The length of the ambulance rounds has been the hindrance hitherto in lengthening the school hours, but as the centres are multiplied and the districts get smaller this is a gradually vanishing difficulty. Other improvements which might be suggested are school baths for such children as the doctor certifies as suitable. There are considerable difficulties in maintaining some of these children in a clean condition and verminous clothes may need consideration. Some children with discharging wounds are kept out of school for lengthy periods, in many of these cases this could be avoided if the nurse was permitted to change dressings by arrangement with the doctor who has the child under his care. Possibly this will become feasible as the new treatment scheme for co-ordinating school and hosnital work is develoDed. The provision of suitable education for epileptic children continues to present great difficulties. The voluntary institutions restrict their accommodation to children of the least troublesome type. These are the very children with whom parents and guardians are often unwilling to part. For the remainder of cases for whom provision is more urgently needed on account of the distress caused by their presence in poor families, no possibility of educational and colonial treatment is found. Such children are placed in the Council's schedules as "Invalid" but this term merely denotes that they are unfit for any existing educational institutions. During the year 196 epileptic children have been scheduled during the course of medical examinations; of these 1 was considered imbecile, 4 were found fit for special (M.D.) schools, 7 were capable of attending ordinary day schools, 67 were certified as fit for epileptic colonies (i.e., falling within the limits set forth in the prospectuses of voluntary agencies) and 117 were regarded as unfit for any existing educational institution. Certificates were furnished on behalf of 31 of the children who were suitable for colonies but the number actually sent thereto was only 19. To illustrate the difficulty in securing proper educational treatment for these children and the restriction of the limits insisted upon at present it may be remarked that of the children considered fit for colonial treatment and upon whose behalf certificates were filled in five were refused admission into Chalfont. Epileptics. There is at present no special accommodation for children who are both mentally and physically defective. Those who are unable to walk to an M.D. school have to be excluded altogether. The number so excluded is, however, very low. In the report for 1906-7 a table showing the backwardness of children in the P.D. schools was included and showed that most of these children are from 1 to 5 or 6 years behind their proper standard and that about 20 per cent, are, in the opinion of the teachers, of exceptionally low mental ability. Yet the number of children transferred from physically defective to mentally defective schools or excluded for combined defect is not large. Including 89 mentally defectives mentioned in the table of children leaving the P.D. schools last year and 92 who have left during 1910 or are still in the schools, the following distribution of combined mental and physical defect is found:— Combined Mental and Physical Defect. Tubercle of the spine and joints 16 Infantile paralysis 7 Spastic paralysis 73 Rickets 19 Congenital talipes 6 Various other deformities 5 Heart disease 9 Various diseases 17 Mentally defective only 29 Total 181 amongst 4,272 children. These were disposed of as follows:— Transferred to M.D. schools or excluded 131 Left 9 Still in P.D. schools 41 Of the 41 left in the P.D. schools 22 suffer from spastic paralysis, are so crippled as to be incapable of getting to an M.D. school and are being given a further trial. The other 19 belong to various groups and if there is no marked mental improvement a physical improvement will probably shortly permit their transfer to an M.D. centre. Apart from the cases of spastic paralysis the only groups which show an abnormal proportion of mental defect are— Rickets—19 out of 163 children. Congenital club foot—6 out of 74 children. Excluding these three groups the proportion of mentally defectives is probably no higher amongst physically defectives than among the healthier children. But as already mentioned, backwardness amounting to mental stagnation is very common and it is extremely difficult, during the first years of attendance, to determine whether these children are strictly speaking mentally defective. It is quite common for a child to come into school at 7 or 8 knowing nothing and apparently for the first year incapable of learning anything. Yet many of these children, after progressing very slowly for several years, suddenly make a start and reach a level of Standard IV. or V. in ordinary work, and in addition learn to do very good handwork. This is probably due to the fact that previous to admission to school these children were chronic invalids and had not been taught 158 Annual Report of the London County Council, 1910. anything, so that their educational attainments are nil and they have not even acquired the faculty for learning. Two points in the education of physically defective children seem to arise from this— 1. That these children must not be hastily classed as mentally defective until they have been under observation for some considerable time. 2. That they ought in some cases to be given the advantage of special education after their physical defect is well, in order that they may make up the great educational loss they have suffered earlier. Referring to the special classes already alluded to, rickety children are admitted to the special schools on account of (1) severe deformities; (2) active rickets. The former should soon be cured by surgical means, the latter by proper hygiene and feeding. Club foot can be cured up to a certain stage by surgical measures, after this the child should walk well enough in instruments to be able to get to an M.D. centre. Thus mentally defective children belonging to these classes need only remain at the special P.D. schools for a short period during which the remedial measures are being carried out. Children suffering from spastic paralysis form a difficult educational problem. The number of cases amongst 3,244 children was— Total. M.D. Very Dull. Epileptic. Hemiplegia 104 19 36 20 Paraplegia 53 15 30 1 Diplegia 37 10 24 0 194 44 90 21 This gives the number attending the schools during 1910 or leaving during that year; in addition 56 children had left or been excluded from school previous to 1910 (Hemiplegia, 27; Paraplegia, 15; Diplegia, 14); of these 29 were mentally defective (Hemiplegia, 13; Paraplegia, 6; Diplegia, 10), so that the proportion who are mentally defective is very high. Epilepsy is common amongst children with hemiplegia, the proportion represented in the table is much too low. Some authorities give the percentage as high as 70 per cent., in many cases the fact that the child is an epileptic is concealed by the parents, in many others the epileptic fits only commence in later childhood. A large number of children with diplegia have defective speech (12 out of 37); this is rare in the other forms of paralysis. In hemiplegia a certain amount of improvement may take place in the physical condition largely as a result of re-education of the paralysed muscles and of their motor centres in the brain. In paraplegia and diplegia little improvement can be expected. Surgical treatment in these cerebral paralyses has proved to be of only very limited use. In suitable cases the division of tendons and use of appropriate instruments leads to improvement in walking, but operative measures on the upper limb seldom end in any permanent benefit. When the large proportion of mental defect or dullness, the difficulty in walking, the loss of use of one arm in hemiplegia or of both in diplegia, and the speech dofect in the last class, are considered, it must be clear that the majority of these children can never become self-supporting. Segregation in suitable homes in which they may carry out a considerable amount of work under supervision seems to be the onlv reasonable method of providing for such children among the poor. Remediable Physical Defect. Routine examination in the special P.D. schools may lead to considerable improvement in individual scholars. The best results are obtained where an active manager (often a representative of the Invalid Children's Aid Association or Ragged School Union) undertakes personally to urge the treatment necessary upon the parents and to follow up the case. For example, many of the children with bad rickety deformities have been sent to hospital and have had these corrected by osteotomy. The failure to secure treatment of this sort is often due to parental indifference or obstinacy. Amongst the cases of club foot there were four which had never been treated, and four completely relapsed. In these eight cases the children were walking upon pads situated upon the tops of the feet. In four out of the eight successful treatment was ultimately obtained after much trouble. G. D., set. 7, with double club foot had been treated in infancy, but the after-treatment had not been continued and the feet had completely relapsed. Efforts were made from February to November, 1909, to persuade the parents to take the child to the hospital. At the latter date the mother attended the school at a medical visit and was shown a child who had been successfully treated. She thereupon took the child to the Orthopaedic Hospital, where the feet were successfully treated last year and the child is now walking flat upon both feet. Such success cannot always be obtained. D. V., set. 6, attending a South London special school, has untreated club feet. The parents have been repeatedly seen and urged to secure treatment between December, 1908, and the present time, but they absolutely refuse to permit any operation. This was suggested as a suitable case for prosecution under the Children Act, but so far it has not been considered advisable to take proceedings. It seems clear, however, that the child is being rendered a permanent cripple owing to the parents' obstinacy. Many instances of remediable defect are seen among the children with infantile paralysis; out of 496 children with this disease 139 had both lower limbs affected and 32 of these had never walked up to the time of admission to school. As a result of suggestions for treatment 13 of these have subsequently been enabled to walk with or without crutches, 5 others were still under treatment when last seen, and 5 are still under observation in school before treatment is recommended. In 9 cases treatment suggested is not yet being carried out by the parents. Very few even of the most severely paralysed children should be given up as hopeless. Nearly all can be enabled to get about in some Report of the Medical Officer (Education). 159 way or other. In many cases suggestions have been made for treatment of a single paralysed limb, for the improvement of some deformity, and for treatment of the children with tuberculous disease, in the event of a recrudescence of the disease or development of an abscess. Dr. Branson has summarised notes from 100 cases of organic heart disease in certain physically defective schools. On the question of diagnosis he notes that it is seldom difficult to differentiate organic from functional manifestations in the heart unless the physical signs consist of a systolic apical murmur only. In this case it may be impossible to say with certainty whether the murmur is due to organic disease or not. Soft systolic apical murmurs, often transitory, are very frequently met with in childhood, especially, but not always, in weakly children, and since experience shows that these murmurs generally prove to be not organic, all such equivocal cases have been eliminated from this series. With regard to the diagnosis between congenital and acquired lesions there is again seldom any difficulty, though the identification of the actual congenital lesion present in a given case must often be more or less a matter of guess work. Leaving aside the typical cases of congenital pulmonary stenosis about which there can be no mistake, the common murmur significant of a congenital defect is a loud harsh systolic murmur heard widely over the praecardial area and of maximum intensity either towards the middle of the sternum, or in the region of the aortic valve. In the latter case it may be impossible to be sure that the lesion is not an acquired roughening or stenosis of the aortic valve, but in the absence of a history of rheumatism and of physical signs of incompetency of the valve the probabilities are in favour of a congenital lesion. The ratio of congenital to acquired heart disease is shown by the fact that of the 100 cases 86 were acquired and 14 congenital. Heart Disease in Physically Defective Schools. I. Acquired Heart Disease.—The sex incidence was as follows—Girls 52, Boys 34. It would appear, therefore, that acquired heart disease is decidedly commoner among girls than boys. The following table shows the numerical relations of the various lesions:— Mitral regurgitation 58 Double mitral disease 14 Double mitral disease with aortic regurgitation 2 Double mitral and double aortic disease 2 Double aortic disease 2 Aortic regurgitation 1 Mitral stenosis 1 Adherent pericardium without valvular lesion 1 (?) Aortic stenosis without regurgitation 1 Various combinations of valvular lesions 4 86 The prognosis of chronic acquired heart disease in childhood is, in Dr. Branson's opinioD, governed by the following considerations:— (i.) The mechanical disability.—In lesions of any standing, provided that compensation is maintained (as is commonly the case among children well enough to attend school) the degree of mechanical disability existing in a heart is accurately measured by the degree of resulting hypertrophy. The position of the apex beat, combined with the sense of force imparted to the hand laid flat against the chest over the heart, gives prognostic indications of far greater significance than any consideration of the lesions alone, provided these are chronic and quiescent. For example aortic regurgitation with little hypertrophy is more favourable than mitral regurgitation with much. (ii.) The risk of recurrent rheumatism or chorea.—This risk can only be appraised in general terms. The more remote the original attack the less likely is a recurrence, and the younger the child at the time of its first attack the more likely is it to be subject to recurrences. (iii.) The life's work.—It is obvious that the prospects of health for a rheumatic subject with a damaged heart turn largely upon the choice of occupation, for exposure and strain may lead to the early ending of a life which in sheltered and sedentary surroundings might well have attained the average expectancy. In the case of school children the first of these three elements of prognosis is the only one which can be estimated. Upon it is based the following statement of the prognosis in the 86 cases under consideration. The term "Good" is taken to signify that the individual, given good fortune as regards the items (ii.) and (iii.) above mentioned, may look forward to a practically normal existence; the term "Moderate," that both life and usefulness will be seriously curtailed and that existence must be one of semi-invalidism; the term "Bad" that the prospects of the individual are chronic invalidism and early death. Prognosis— Good 47 Moderate 17 Bad 21 Doubtful 1 (Disease apparently active). 160 Annual Report of the London County Council, 1910. The cases admitting of a "Good" prognosis were all examples of uncomplicated mitral regurgitation, with four exceptions, viz:— Slight mitral stenosis 1 Slight aortic regurgitation 1 Adherent pericardium (probably) without valvular lesion 1 Slight double mitral disease 1 Mr. Elmslie has recorded (b) that more than half the deaths at the schools for physically defective children are due to heart disease. An investigation by Dr. Branson of 343 consecutive autopsies at the East London Hospital for Children (c) went to show that heart disease is the most fatal of all chronic diseases for children between the ages of 8 and 15, not excepting tuberculosis. The evil is therefore a grave one. There is some evidence of a relation between rheumatic affections on the one hand and "tonsils and adenoids" on the other. In a recent detailed examination of some 500 girls at Maidstone-street School, Dr. Branson met with 13 cases of acquired valvular disease. Of these 13 no fewer than 10 were subjects of enlarged tonsils or adenoids or both. (It may be mentioned that the concurrence was not being looked for at the time the records were made.) If this conjunction could be established as one of any constancy it would afford a valuable prophylactic indication. Experience in a children's hospital, and in schools, has convinced him that in predisposed children the factor exciting an attack of rheumatism is often the swimming bath, which he considers should be strictly and permanently interdicted for children who exhibit the least rheumatic tendency. In early childhood the apex-beat is commonly in the fourth intercostal space and in the nipple line, moving downwards and inwards as growth advances. Examination of 50 consecutive girls in Standards I. and II. gave the following results— Apex beat in 4th space. Apex beat in 5th space. In nipple line 8 Just without nipple line 1 Just within nipple line 4 In nipple line 8 J inch „ „ 1 Just within nipple line 11 h inch „ „ 3 ¼ inch „ „ 5 i inch „ „ 1 ½inch „ „ 5 ¾inch „ „ 2 1 ½inch „ „ 1 17 33 Average height of 17 children with apex beat in 4th space 115.5 cm. Average height of 33 children with apex beat in 5th space 118.3 cm. Average weight of 17 children with apex beat in 4th space 20.9 kg. Average weight of 33 children with apex beat in 5th space 21.7 kg. II. Congenital Heart Disease.— Of the 14 cases of congenital heart disease there were: Boys 8, Girls 6. Of the total, 7 were probably examples of congenital pulmonary stenosis. These, it is well known, are uniformly unfavourable. The remainder are probably to be regarded as cases of patency in the interventricular or interauricular septa. With regard to cases of this type it is probably true to say that if the lesion is not severe enough to produce symptoms, it may, from a prognostic point of view, be placed on a par with favourable mitral regurgitation. But if symptoms are present the prognosis is bad. Of the 14 cases here considered, two only admitted of a good prognosis. The limited possibilities of happiness for these unfortunates are greatly extended by permitting them to continue at the special schools, even when there is no likelihood of their surviving to become useful citizens. the Deaf. Education of the Deaf under the Act of 1893 is carried out in 10 schools, of which 7 are day schools and 3 residential schools; one of the latter (Homerton) is for children who are deaf and also otherwise defective. The number of deaf on the rolls is 655. There are also 11 evening continuation classes for the deaf, and this year an experimental class for semi-deaf children has been opened. Each centre is regularly visited and a complete card index of all the cases maintained. Mr. Macleod Yearsley is making an exhaustive examination of the conditions of each child, but this is slow and can be done only in intervals of other work. His reports on educational results will be spread necessarily over several years' work. The other matters he deals with are the cases seen at the Head Office, the hard of hearing class and the teaching of lip-reading and articulation. Cases Seen at the Head Office, 1910.—Examinations were held at the Head Office at which children were submitted as requiring exceptional educational treatment on account of deafness. The number of examinations held was 32 and 562 children reported upon. Some of them were seen on several occasions. Their educational disposal was as follows:— Number. (1) Educational Treatment. E.S. (2) E.S. (front row). (3) Hard of Hearing. (4) Deaf. (5) M.D. (6) Imbecile. (7) Invalided. (8) P.D. (8) 562 181 142 64 123 18 5 28 1 (b) L.C.C. Report of Medical Officer (Education), 1909, page 86. (c) British Medical Journal, January 14th 1905, page 72. Report of the Medical Officer (Education). 161 Of the invalided, thirteen were seen again after treatment had been obtained; six of these returned to the elementary school unconditionally, three to the elementary school to sit in the front row in class, three were reported as suitable for a hard of hearing class, and one was sent to a deaf centre. Any scheme for the proper education of the deaf should be contrived to include all who show any signs of deafness, from the slightly deaf to the mentally defective or blind deaf-mute, and their educational treatment should range from those who are able to receive benefit from the ordinary elementary school for hearing children to those who are obliged to obtain special instruction in a residential institution for blind and mentally defective deaf-mutes. By using the voice test, every child who is examined can be drafted provisionally to a suitable school. During the present year, those who can hear the voice beyond six feet are recorded as fit for an elementary school, those who can hear it at from six to three feet are fit for an elementary school if they are placed in the front row, those whose voice hearing is from three feet to one foot are classed as "hard of hearing" and suitable for a special class, whilst those whose acuity is below one foot require to be taught in a deaf centre. This rough classification works very well. Cases classified under it can, moreover, be revised if necessary. Those children who hear the voice at the full distance of the room of 17 feet can be tested further with the whisper, by which means a number of cases of very early deafness can be detected and parents advised as to treatment before it is too late. In middle ear deafness it is the acuity for whispered speech which is the first to go, and this loss is present some time before there is any noticeable deterioration in ordinary voice hearing. The detection of this loss for the whisper and the taking of immediate action upon it would lead to a very considerable lessening of the number of cases of chronic deafness in adult life. Another important symptom in this connection is the occurrence of transient attacks of earache, not necessarily followed by discharge, in childhood. Such complaint calls for investigation and treatment; many cases of chronic adult deafness give histories of these attacks in early life. All cases returned to the elementary school, whether for front row or not, require watching as regards the future of the hearing. Of the children seen at the Head Office 123 were classified as "deaf" and drafted to a deaf centre for special instruction. Four of these were scholars already in deaf schools who were seen before transference to Anerley or Oak Lodge residential schools, or for other purposes. One was too old for admission and was exempted from further schooling, having already received special instruction in the country. Four cases were sent either to evening lip-reading classes or to a deaf school for special lessons in articulation. Altogether there were 115 cases—56 boys and 59 girls—who were drafted to special deaf schools because they were too deaf to be taught elsewhere. The following table analyses these cases according to the causation of their deafness and according to the amount of hearing they possessed, a certain number being doubtful in both respects:— Causation of Deafness. Condition of Hearing. Total. Totals. Totally Deaf. Semi-Deaf. Doubtful. B. G. B. G. B. G. B. G. l 2 3 4 5 6 7 8 9 Congenital 13 12 4 2 - 2 17 16 33 Acquired— Brain Diseases. Meningitis simple 1 1 1 - - - 2 1 3 „ tuberculous — - 1 - - - 1 - 1 Acute Infectious Diseases Cerebro-spinal meningitis 1 — — - - — 1 — 1 Measles 3 — 2 2 - — 5 2 7 Scarlatina 1 — 1 1 - 1 2 2 4 Diphtheria — 2 — — - — — 2 2 Whooping cough — — — 1 - 1 — 2 2 Constitutional Diseases. Pneumonia 1 - — - - — 1 - 1 Chorea — - 1 - - — 1 - 1 Tubercle — - 1 - - — 1 - 1 Congenital syphilis — 1 1 2 - 1 1 4 5 Primary Ear Diseases. Mid. ear suppuration(d) 2 1 4 4 - 1 6 6 12 Mid. ear catarrh — — 3 3 - — 3 3 6 Other influences, undoubted. Fright — — — 1 — — 1 1 Injury to head 2 3 — 1 1 — 3 4 7 Do., followed by meningitis 1 — — — - — 1 — 1 Concussion of brain 1 - - — - — 1 — 1 Problematical. Shock from burns 1 - - — - — 1 — 1 Not yet decided 1 4 2 2 1 3 4 9 13 Do. probably congenital 2 5 2 1 2 — 6 6 12 Totals 30 29 23 20 4 9 57 58 115 (d) Not including suppuration due to the exanthemata. 162 Annual Report of the London County Council, 1910. Speaking generally, these statistics conform to those given in the Annual Report for 1909, p. 76, the number of congenital cases is, however, less. Last year in 500 cases, there was no instance of the occurrence of cerebro-spinal meningitis as a cause of deaf-mutism, a cause which is very common in the United States' statistics. This year one case was met with. The history was undoubted. The long continued prevalence of a very mild type of scarlet fever, and the absence of any serious epidemic during the last decennium is showing in the deafness returns. Measles continues to give rise to nearly twice as many cases of deafness as scarlatina, 8.2 per cent. as compared with 3.4 per cent., which is the reverse of proportions found in older records. In the 115 cases here analysed, the percentage of those due to congenital syphilis was 6.25, as against 7.5 per cent. in last year's analysis of 500 cases; the latter is a much higher percentage than occurs in other places, Kerr Love giving that for Glasgow as 1.8 per cent. and Castex for Paris as 2.5 per cent. Last year the percentage of this cause among the acquired cases was 7.5 per cent., so that it is seen that its occurrence among the additional cases this year is practically the same. Hard of Hearing.—One of the most important innovations of the year was the hard of hearing class at Ackmar-road which was started on September 12th, 1910, with six cases, others being added, so that at the end of 1910 the class numbered 17. Of these 17 cases, 7 were boys and 10 were girls. Nature of the cases.—The children who would be fit for a hard of hearing class will not be found among the congenital partially deaf cases nor among those semi-deaf who have acquired their defect from such causes as meningitis, mumps, or injuries affecting the internal ear. Such cases have not usually sufficient hearing for any form of education but that provided in the deaf centres. It is essentially the middle ear cases which are suited to the hard of hearing classes, in whom deafness is due to suppuration or catarrh, especially those in whom it has been induced by the presence of adenoids. A few may show a limited amount of secondary involvement of the internal ear. Those are the children who are distinctly unfit for a deaf school and the necessary association there with deaf mutes. At the same time they are unable to obtain any benefit at an ordinary hearing school. An analysis of the 17 children gives the causation of the deafness as follows:— Middle ear catarrh 5 Secondary internal ear involvement in 1 „ „ suppuration 9 „ „ „ „ 1 , „ „ and catarrh 3 „ „ „ „ 1 Total 17 „ „ „ „ 3 The primary cause was adenoids in 12 cases (4 catarrhal, 6 suppurative, 2 suppurative and catarrhal), or 75.8 per cent. a high percentage, but, when the enormous potency which these hypertrophies possess for causing ear disease in children is taken into consideration, not higher than is to be expected. Taking the 5 catarrhal cases, 4 were undoubtedly due to adenoids and one was doubtfully so. One showed moderate secondary internal ear involvement. Of the 9 suppurative cases, 6 were undoubtedly due to adenoids. Of the remaining three one was caused by scarlet fever the other two giving no history. One showed secondary internal ear involvement. It will also be noted that several of these cases were in need of active treatment. Three cases showed a combination of the two conditions, suppurative and catarrhal; in two of these the right and in one the left ear was suppurating. The radical mastoid operation had been performed in three cases, in one case, on both sides. The question of the hearing of these children is a very interesting one. In an experimental class of this kind it is a little difficult to fix at first the amount of hearing which should qualify for admission. Two of the cases who showed a hearing acuity, one for six inches for the voice and one for the raised voice only, at the initial examination at the Head Office, subsequently were found to hear 48 in. and 120 ins. in the one, and 8 ins. and 84 ins. in the other, and were transferred to the front row of an elementary school. A third, who appeared to hear the raised voice at 24 ins., it has been found necessary to transfer to a deaf school. There are several factors which come into play in estimating accurately the fitness of a given case for the various forms of deaf education. Such are shyness, individual variations in mentality, and the listlessness engendered by a sojourn in a large hearing class where the inability to hear has residted in what may be termed chronic inattention. Deducting the three cases mentioned above and taking the amount of hearing in the remaining 14, it will be found that they average a hearing distance of about 16.3 ins. in the right and 14.5 ins. in the left ear or for both ears 15.4 ins. This would, in dealing with such small numbers, be a very fallacious figure upon which to base any conclusions and it would probably be best to fix the amount of hearing which should qualify for a hard of hearing class at about 4 feet. This is, of course, an entirely empirical estimate. The amount of hearing which decides the question whether a given child is to be classified as fit for hearing class, hearing class in the front row, hard of hearing class, or deaf school can only be arrived at after prolonged observation and experiment. Careful examination by a skilled otologist is needed in every case. Probably given normal mentality, a comparatively small amount of hearing is sufficient to enable a child with acquired deafness to be instructed in a hard of hearing class. Speech was defective in two cases, one was the child subsequently transferred to a deaf centre, in whom it was doubtful whether there was any defect of mentality or mere backwardness. The other was a boy with pronounced deafness and speech defect was but slight. In the remaining fourteen cases, speech was natural. In almost every instance, however, unless educational measures had been taken to obviate it, speech would have tended to become defective. Results.— Of the seventeen scholars forming the class at the end of December, 1910, one left with sufficient facility in lip reading to obviate her defective sense of hearing in after life, two were 163 Report of the Medical Officer (Education). transferred to the front desks in a hearing school, and one was found to be too deaf to benefit by the class and was transferred to a deaf centre. Although the class has only been at work a comparatively short time the increased industry and happiness of the children, the difference in their bearing, and the new confidence due to their finding a means of following the meaning of their teacher, show that it is a success. The care of the teacher has had much to do with the ease with which the children seem to acquire lip reading, and those who have most hearing seem to have learned the lip reading best. The nearer they approach deaf mutism the longer they seem to take to learn it and the more practice they require to become thoroughly proficient. However carefully the hard of hearing children are segregated from the very deaf, it is a mistake to place a hard of hearing class in a deaf centre. It should be in a hearing school so as to prevent the undesirable system of mingling hard of hearing children with deaf mutes, whose mode of thought is different from that of the former and detrimental to them. At Ackmar-road to prevent this mixing the hard of hearing children arrive at nine in the morning and proceed straight to their class-room instead of assembling in the hall. Thoy have prayers in their own room. Their play hours are different, they have their dinners in a separate building, and they are dismissed before the deaf children. It would be better to have the class in a hearing school. In some cases a few months of the special teaching in the hard of hearing class will be sufficient to enable these scholars to resume their places in hearing schools. The contrast is marked between the alertness and ability displayed by the children in the Ackmar-road experimental class before they joined, and that now shown after only a few weeks' attendance; marked also is the eagerness with which the children, handicapped hitherto by their loss of auditory acuity, grasp at lip-reading as a new method of communication with their teachers and fellows. Classes of this nature should be arranged in every large school district and into them should be drafted suitable children from the districts they are designed to serve either as permanent classes, held daily, or temporary classes, held on certain specified days of the week. Such classes would be under certificated teachers of the deaf, but in the case of temporary classes these teachers would be visiting. Under the first plan, suitable children would be members of the class until such time as they were fit, in the opinion of their teacher and the doctor, to be returned to their ordinary classes. In the second case the scholars would have instruction in lip-reading exclusively whilst in the class, rejoining their hearing classes on other days to receive the ordinary teaching of the school curriculum. In the ordinary hearing class a child, unless it has sufficient hearing to enable it to benefit largely from a position in the front row desks, must necessarily lose a good deal from his inability to watch the teacher's face and lips properly and continuously. The child cannot lip-read the teacher whilst bending over a book or an exercise, or whilst the latter has his back turned, as when writing on the blackboard. If the scholar has considerable residual hearing, however, he can benefit largely by the mutual assistance of hearing and lip-reading. The precise method of education of particular deaf children is a very difficult one to decide at once. It is probable that the best plan may be to educate all those who cannot hear the whisper below 6 feet, save the very deaf, partly in the front row of a hearing class, partly in the temporary hard of hearing class, under a visiting teacher, and that the present experimental hard of hearing class shall be a class for the semi-deaf and semi-mute. Lesser defects of hearing than the 6 feet whisper would do perfectly well in the front row of a hearing class. But the whole matter requires very careful working out. Another point in which difficulty arises is that of age and standard. The number of children who can be taught adequately in a hard of hearing class, such as that with which this report deals, is small. One containing 17 to 20 children of all ages and degrees of mental quickness is too unwieldy for a single teacher. The largest number, for the instruction given to be adequate, is from 10 to 15, the former being probably nearer to efficiency. In a class of about 16 children of ages varying from 7 to 14 and representing all standards, it is not practicable to teach all together, as the language and ideas of the older scholars are much in advance of those of the younger ones, and with the aim in view of their return to a hearing class, a certain amount of teaching, with practice in lip-reading, of such subjects as Geography and History appears advisable, besides giving an added interest to the school work. A considerable amount of time must be spent in keeping the younger children usefully employed, and in training them to work by themselves whilst the others are having lessons. The little ones also require instruction in reading and writing. When the class is small, some of the children can advantageously be set to practise lip-reading with each other, whilst the teacher is giving special attention to the more backward and those with speech defects. Some of these difficulties could be obviated by the organisation of classes under visiting teachers. Two classes in each district containing at most 15 children on the roll, one class for children aged from 5 to 10, the other for those from 10 to 14, would perhaps be the best solution of the problom. This experimental class has succeeded so well, that further classes should be formed, otherwise the " hard of hearing " child for whom the Ackmar-road class is impracticable by reason of its distance, has to go either to a deaf centre or to the front row of an elementary school. 64 cases suitable for hard of hearing classes were found daring the year, but only some 15 or 17 have been accommodated at the class started at Ackmar-road, leaving nearly 50 cases noted but unprovided with suitable education. These are, of course, only a fraction of the number of such cases. To educate the whole of our deaf children on a rational and scientific basis, which will provide for the exact educational want of every class of deaf child will mean enormously better results at less cost and with an expenditure of less labour. This is what the experiment of a hard of hearing class promises and its success is now assured although the exact form may not yet be fixed. 164 Annual Report of the London County Council, 1910. Lip-reading and Articulation.—Mr. Yearsley has been noting the accomplishments of the children by a method which consists in taking the articulation, lip-reading and general capacity and assigning to each a value denoted by the terms "Very good" (V.G.), "Good" (G.), "Sufficient" (S.), or "Insufficient" (I.). This test has been applied to 548 children in deaf schools, and the results as regards articulation and lip-reading alone are shown in the following table:— Mentality. Normal. Poor, Subnormal, or M.D. Speech at commencement of education. None. Residual. Natural. Not specified. 1 2 3 4 5 V.G. 17 23 42 2 G. 67 29 13 5 Articulation S. 53 5 1 12 I. 60 0 — 61 V.G. 26 26 24 1 G. 87 20 14 4 Lip reading S. 54 9 7 13 I. 30 2 11 62 Not marked 120 15 5 18 These results apply only to 390 of the scholars (203 boys and 187 girls), as 158 (96 boys and 62 girls) were too young or had been too short a time under instruction to permit of their being judged with justice to themselves or the system. They have, however, been included in the table as "not marked." The table classifies the children primarily on a basis of mentality. In order to be quite fair, the 98 placed under the column "poor, subnormal, or mentally defective," may be left out of consideration altogether. The remaining 450 of normal mentality are further grouped, according to the amount of speech which they possessed at the commencement of their education, into those who started with no speech at all (inclusive of a few children in whom residual speech has been lost by neglect), those with residual speech, and those with natural speech. 140 of these children were too young or had been an insufficient time at school to allow of their being marked, leaving 310 scholars whose progress could be judged fairly accurately by this method of marking. Taking first the powers of lip-reading of 197 children who had never had any speech, 113, or 57.3 per cent., were "very good" or "good," whilst 84, or 42'6 per cent. were "sufficient" or "insufficient," whilst of the 113 who were lucky enough to be left with residual or natural speech, 84, or 74.3 per cent., were "very good" or "good," and only 29, or 25.6 per cent., were "sufficient" or "insufficient." This tends to show how much the retention of speech, which means largely the retention of motor memories of speech, helps in the acquirement of lip-reading, that is to say, in the appreciation of speech movements in others. It will be noted further that 30 of the no-speech children, or 15'2 per cent., were "insufficient," that is to say, absolute failures at lip-reading, against 13, or 6.6 per cent., of those who had residual or natural speech. Deaf education is not satisfactory in which at least a quarter of the scholars in whom speech was originally absent, but who are normal mentally, are "insufficient" in their knowledge of lip-reading, "insufficient" meaning that they are incapable of reading other people's lips sufficiently to gather what they are saying. The teaching of lip-reading is, however, only one part of the aim of deaf education. It has also to give speech to the dumb, that is to say, it must so teach them articulation as to make their speech intelligible. If we now take the results of this system of marking we shall see how this side of the education works out. Of 197 boys and girls who had no speech on admission, only 84, or 42'6 per cent., had articulation which could be marked "very good" or "good," and only 17 of these, or 20.2 per cent. (8.6 per cent. of the whole 197) belonged to the former category. Of those marked "sufficient" or "insufficient" (and the majority of the former would, probably, be understood only with difficulty by anyone who was unused to conversing with the deaf), there were 113, or 57.3 per cent., and of these 60, or 53.09 per cent. (30.4 per cent. of the whole 197), were "insufficient," that is to say, oral failures—children to whom the present system of deaf education had failed to give speech. In strong contrast are the results with the 113 children who had residual or natural speech on admission. Of these, 107, or 94.6 per cent., were "very good" or "good" (the former, as is seen by the table, being in excess), whilst only 6, or 5.3 per cent., were "sufficient" and none were " insufficient." Here the oral system had succeeded in the great majority of its pupils in preserving to them the speech which they had retained in greater or less degree when they had become deaf. These figures show that the present system of deaf education does not produce a sufficiently high percentage of successes under existing conditions. The reasons are to be sought in the conditions under which the teachers have to work; they are wholly unconnected with the capacity of the teachers themselves. The teachers are too severely handicapped by the present state of legislation, and classification. They receive their pupils too late in life to enable them to turn out finished products. The majority of the children do not commence their education until they are 7, when brain and larynx are no longer sufficiently plastic. We should begin to educate the deaf child at the age of three, instead of denying to him the physiological education which his hearing fellow is getting from his earliest years. In extra-urban districts, there may be difficulties in the way of getting the child at an early age, but the urban deaf child should not be allowed to suffer. By early education, articulation could 165 Report of the Medical Officer (Education). be made more natural and speech more automatic. The absence of a properly worked out scientific classification of deaf children is another hindrance, but not as important as the neglect of the plastic period of speech development. On the 10th October, 1910, the occurrence of a series of cases of appendicitis came under observation on the report of the managing committee of the Mayford Industrial School. Appendicitis at Mayford Industrial School. On the 16th September, S. Y. (1876) was taken ill with definite symptoms which within 24 hours became those of general septic peritonitis. Immediate operation was performed, a loose and gangrenous appendix being found, and the boy dying next day. Three other cases were recognised very early with mild symptoms, and were immediately operated on with good results. In each case inflammatory bands and signs of old appendicitis were noted. The boys and dates of operation were J. H. (1897), September 18th; T. S. (1906). October 5th; and A. F. (1897), October 7th. Enquiry was made and certain improvements suggested in the school arrangements, but no definite reason for the rapid sequence of cases could be assigned beyond the fact that careful observation of abdominal symptoms had been kept up after the first alarming case. Of the 13 boys admitted to the school during the year 4 were so delicate that it was suggested longer hours of rest and sleep, shorter hours of educational and manual work, and a lighter diet would be desirable. Application was ultimately made to the Home Office under Section 53 of the Children Act to board out these four boys. By the end of the year three more mild cases had been operated on, but further action was deemed unnecessary. As, however, three further cases had occurred by the 19th January, an exhaustive enquiry was commenced at the school by Dr. C. J. Thomas, and Professor G. F. Still, of King's College Hospital, was invited by the Council to investigate and report on the whole matter. An outbreak of sickness occurred in 13 boys on the 22nd and 23rd January, 1911, and one of these boys was operated on on the 26th January, making a total of ten cases of appendicitis needing operative interference. Careful consideration of the individual cases showed that except in the fatal case there was definite evidence of old standing inflammation of the vermiform appendix. The problem was not one of appendicitis in previously healthy boys but of a series of recurrent attacks. Any question of infection or contagion could therefore be set aside. This is borne out by the spacing of the attacks in time, and by the conditions found on operation. It must be remembered that many attacks of pains and stomachache in children are manifestations of appendix trouble, and it seems a possibility that the alarm of the first fatal case and the consequent expectancy and anxiety of the officials resulted in even the slightest attacks being detected. This must not be taken as an adverse criticism of the treatment, for in light of the first case once the diagnosis was established any other treatment would have been unjustifiable. It was well for these boys to be operated on and freed from a condition which presented a constant menace to life. Attacks could not be traced to the dietary, but the stores were put out of use till all the materials had been analysed. Some of the materials were found to be not of the purity or standard arranged for, the sugar for instance was tinted with an aniline yellow. The milk was unexceptional, although one cow when tested was found to be tuberculous and has been removed. The water, although hard, is pure. Some of the boys were found to have eaten vegetables and fruits immoderately in the fields; two, indeed, had gorged with blackberries immediately before the attack, and two had gorged themselves at table by swallowing their neighbour's porridge or soup in addition to their own share. The conclusions were that food irritatation was the probable cause of the recurrences, although the particular irritant could not, in all cases, be determined. The material removed by operation in the two last cases was thoroughly tested by the Clinical Research Association and a Gaertner-like bacillus which was isolated from one of the cases was used for agglutination tests. Three boys who had been sick on the 22nd January, three boys who had not been sick then but who had been operated on for appendicitis, and three boys who had remained in good health were tested, but the reactions were generally negative or inconclusive. Summarising the facts, the occurrence of such a series of cases is almost inexplicable. Except the first case, the symptoms were generally mild, and excepting in this case Dr. Lawrie found in all the results of old-standing appendicitis. The attacks appear, therefore, to have been recurrences and no infection or any common cause could be traced. Food irritation due to irregular feeding on indigestible material in the fields often indulged in by healthy country boys may have acted as an irritant in these boys previously disposed to attacks of appendicitis. There have been no further cases during the first quarter of 1911. Following up the experience of the previous year, playground classes were again instituted. These are of various characters, distinguished as follows :— Playground Classes. A.—Classes of delicate boys of equal educational standing chosen from neighbouring schools by the school doctors. B.—Classes of delicate girls of varying educational standing selected (but not by the school doctor) from one school. C.—Classes of children in the same standard of one school only, the same class being taken out each day of the week. D.—The various standards in the school are taken in the playground in rotation. It has now been decided that five playground classes of type A, one class of type B, and 50 classes of type C and D (as many as possible of type D) shall be held during the year 1911. The classes of type A (central classes) were held at "The Lawrence," Daniel-street, Turinstreet, and Cator-street. The selection of children aged between 9 and 13 was by the school doctors, who made a choice from the contributory schools of such weakly or debilitated children 166 Annual Report of the London County Council, 1910. as would permit a class of about 30 being formed, but allowance was made for those children whose parents might object to attendance at the classes. For Cator-street, 78 Standard III. boys were chosen. In the Bethnal Green district boys and girls were selected, but ultimately the classes were restricted to boys, the youngest group going to " The Lawrence," the eldest to Turin-street and the others to Daniel-street. 162 children were selected in the contributory schools. No special provision had been made for the medical supervision of these classes, but the school doctors, Dr. Clarke, for Cator-street, and Dr. Branson, in the Bethnal Green district, relinquished part of the ordinary school work to keep these classes under close observation. The Bethnal Green district is a very poor one, and the selected children represent the poorest stratum of the population. Without presenting definite disease they were ill-nourished, ill-clad, pallid and inert. The time-table was varied with different classes and the weather. On wet days the classes were under cover but not indoors. Physical education, including correction of attitudes, breathing and exercise was particularly looked after. The children were carefully examined in June and October. Measurements were taken on the second examination at Daniel-street only. The medical examination left no doubt as to the beneficial effect of the outdoor regime. Dr. Branson states that at his second visit, three weeks after the inception of the class, he felt momentarily doubtful in many cases whether particular children were the individuals he had selected. The difference was partly in complexion, but also in high degree in demeanour and expression, which was more alert and spirited. The haemoglobin estimations of the blood gave somewhat higher readings at the final examination, and although the school doctor felt that too much weight should not be placed on these alone, there was no doubt that both mental and physical vigour had been improved by the outdoor life. Many children regarded as apathetic and morose had become bright, energetic and interested in their occupation. The Daniel-street class of 25 had 22 children present at both examinations on July 1st and October 12th, the results of which were as follows :— Age last birthday. Number examined. Heights in centimetres. Weights in kilograms. Average on admission. Average gain in 3 months Standard for L.C.C. schools, 1906. Average on admission. Average gain in 3 months. Standard for L.C.C. schools, 1906. 1 2 3 4 5 6 7 8 9 1 120.0 1.0 125.2 21.9 .90 25.4 10 5 123.2 .9 129.8 23.8 1.46 27.6 11 14 124.3 1.0 134.3 24.0 1.39 29.9 12 2 128.7 .3 138.7 26.4 1.60 32.4 Although the numbers are too small for any detailed analysis, it is noticeable how far these Daniel-street children fall short of the standards determined for L.C.C. schools generally, and at " The Lawrence " conditions were even worse, for 13 children of 9 years of age only averaged 118.2 centimetres in height and weighed 21.6 kilograms. The Cator-street Class, which was open from 20th May to 28th October, was composed of boys of Standard III. varying from 8 to 13 years of age. They were all below normal health and most were anaemic or had enlarged cervical glands. Twice a week the boys had nature study in the park. On cold days they had more than usual exercise, and on wet days the work was done under the playground shed which is open on both sides. Dr. J. T. Clarke kept the class under close observation. Whilst there was steady proportionate increase in weight and in amounts of haemoglobin, the height appeared to remain stationary, and during the two hot months of July and August the height appeared to increase whilst the other measurements remained steady. Continuous records were obtained of 34 boys, the results being as follows :— Age last birthday. Number measured. Heights in centimetres. Weights in kilograms. Average height 30.6.10. Average increase in four months. Standard for L.C.C. schools, 1906. Averageweight 30.6.10. Average increase in four months Standard for L.C.C. schools, 1906. 1 2 3 4 5 6 7 8 9 22 124.9 2.00 125.2 24.0 2.32 25.4 10 8 126.9 1.75 129.8 24.8 1.61 27.6 11 4 129.4 2.12 134.3 24.6 2.80 29.9 In the youngest group of delicate boys they were nearest to normal on admission, but four months later their measurements were better than the standard. From the amount of benefit received it appears as if the youngest group should have the preference for admission to these classes. The improvement in colour was very marked, the pallid aDaemic children being much improved. The hæmoglobinometer measurements showed the average blood colour a little over 70 per cent. of normal at admission, and a little over 90 per cent. of normal four months later. In this class there was also 167 Report of the Medical Officer (Education). noted the general improvement, listlessness giving place to brightness and alertness which were maintained till the close. Excepting one tuberculous boy, who had to be removed to hospital, each child showed improvement both in health and measurements, although the enlarged glands generally remained, but as they were chiefly due to dental irritation nothing had been done from which improvement in this respect might be expected. A control comparison between the children in the open-air class and those in the ordinary Standard III. was intended, but could not be made partly owing to lack of facilities in the schools and partly to pressure on the doctor's time. The Cator-street children were originally of better physique than those at Daniel-street and they improved to a much greater extent. The conclusions formed after last year's experience of playground classes are thus borne out, viz., that such classes are very suitable for the milder conditions of debility but that for extreme cases the full open-air school treatment is required with its regime of feeding and provision for rest. The open-air school is now beyond the experimental stage. In 1907 one was opened at Bostall Open-Air Woods on the model of establishments already existing at Charlottenburg, Miilhausen and München Gladbach. Three such schools were carried on in 1908 and 1909. This year only the two schools in South London were continued owing to difficulty of finding other sites. The Birley House School was kept open until December 31st. Shrewsbury House.—123 children were admitted to Shrewsbury House, which is on the top of Shooter's Hill. The separate conditions noted in these children were :— Anaemia 79 Malnutrition, general weakness, etc. 68 Chest troubles and deformities, liability to bronchitis (excluding phthisis) 44 Quiescent phthisis 2 Family history and suspicions of phthisis 4 Doubtful phthisis 2 Well-marked phthisis 1 Throat and nose (adenoids, tonsils, etc.) 20 Discharging ears; 3 Enlarged glands (24), tubercular (3) 27 Heart disease 4 Rickets 6 Blepharitis etc. 8 Sundry other troubles 6 A detailed examination of the teeth of each child was conducted, and a list was made showing the treatment necessary. The teachers were highly successful in making the children keep their teeth clean, but only one child had a perfect set of teeth. In 88 cases, extraction of roots was necessary, 51 being urgent, 49 needed stoppings to save permanent teeth. A local dentist having volunteered, small batches of children were taken by the school nurse to his surgery, but after treating 59 by extractions and 10 with stoppings he was unable to continue the work gratuitously. A sum of money was raised and 60 more teeth extracted and 75 stopped at a charge of 6d. for extraction and 2s. 6d. for stopping. The general health of the children throughout the summer left nothing to be desired. The child with active phthisis had to be sent away almost as soon as admitted and rapidly became worse. One boy was discovered in the first few days of the school to be in the peeling stage of scarlet fever, and was removed and notified. His brother was also temporarily excluded, but both were readmitted some weeks later and did well. No other cases of any infectious disease occurred. The other reports are in complete accord with previous years. Birley House.—95 children were admitted to Birley House in an extremely poor condition. They maintained their average weekly gain in health and physique uninterruptedly right up to the end of December. The increase in measurements was a little above double the average for London children. The children in these schools did not contract colds, and except in one case of a boy who was reported in February as having subacute rheumatism there was no complaint as to any illness. The Education Officer endeavoured by enquiry to ascertain the opinion of the teachers as to whether the improvement in physical condition of the children who had been in these schools in 1908 or 1909 had been maintained. Replies were obtained regarding about three-quarters of the children, and in at least 95 per cent. of the cases the teachers had thought permanent benefit was received. The usual statement of parents at the admission examinations to the open-air schools was to the effect that the child obtained much benefit during its stay at the school but had fallen away again since leaving. In a few cases children who passed through the open air schools in a former year have been considered too good for the open air schools at a succeeding admission examination. The physical measurements show that generally the same type of children was admitted in 1910 and that satisfactory improvement was attained during the school session; the smaller percentage weekly increases in height and weight recorded as compared with former years are to be explained by 168 Annual Report of the London County Council, 1910. the considerably longer time the schools were kept open. The following tables show the average heights and weights of the boys and girls at the schools; the number of children in each age group is given in brackets. Average Heights in Centimetres. BOYS. GIRLS. Age last birthday. Birley House, 1910. Shrewsbury House, 1910, Open Air Schools, 1907-8. London Elementary Schools, 1906. Birley House, 1910. Shrewsbury House, 1910. Open Air Schools, 1907-8. London Elementary Schools, 1906. 7 (4) 117.5 115.2 116 (2) 119.5 (2) 111.8 114.0 115.4 8 (8) 118.3 (11) 120.4 119.5 120.5 (5) 111.8 (9) 121.0 118.6 120.2 9 (5) 119.4 (13) 122.0 123.1 125.2 (9) 120.5 (4) 128.2 121.8 124.7 10 (9) 127 (9) 127.8 124.3 129.8 (16) 126.0 (15) 129.2 130.0 129.9 11 (9) 128.2 (7) 133 134.5 134.3 (9) 132.0 (10) 132.1 134.1 135.0 12 (4) 133.0 (7) 139 137.8 138.7 (10) 135.7 (7) 133.2 137.0 140.6 13 (3) 138.0 (5) 142.6 137.0 143.1 (4) 141.0 (8) 143 142.0 146.8 Average Weights in Kilograms. Average Weight at Entrance. Average Weekly Increase -Percentage of Body Weight. Sex. Age last birthday. Birley House, 1910. Shrewsbury House. 1910. Open Air Schools, 1907-8. London Elementary Schools. 1906. Birley House, 1910. Shrewsbury House, 1910. Open Air Schools, 1907-8. London Elementary Schools. 1906. Boys 7 - (4) 21.7 - - - 38 - _ 8 (8) 21.7 (11) 21.8 22.8 23.4 .38 .38 .42 .139 9 (5) 22.0 (13) 22.9 23.8 25.4 .22 .33 .36 .159 10 (9) 25.8 (9) 25.3 24.6 27.6 .22 .27 .46 .164 11 (9) 26.2 (7) 26.6 28.4 29.9 .28 .21 .37 .147 12 (4) 28.6 (7) 31.4 29.9 32.4 .40 .25 .38 .183 13 (3) 30.0 (5) 32.9 31.5 36.4 .24 .32 .31 .174 Girls 7 (2) 22.0 (2) 18.5 20.4 21.2 .28 .55 .60 .145 8 (5) 19.4 (9) 22 21.5 22.9 .39 .35 .48 .160 9 (9) 22.9 (4) 26.3 23.0 25.0 .43 .12 .51 .156 10 (16) 24.9 (15) 25.7 25.9 27.1 .31 .28 .52 .173 11 (9) 27.4 (8) 32.6 27.8 29.8 .34 .34 .49 .192 12 (10) 29.8 (7) 27.3 28.7 33.3 .44 .26 .55 .225 13 (4) 33.1 (10) 27.4 32.2 37.7 .40 .28 .54 .217 Open-Air Residential Schools. During the careful sifting of all classes of defects in our London schools during the last decennium the debilitated child and chronic convalescent handicapped by environment has often been referred to. Doubtless proper provision for such children will eventually be secured by state care in suitable institutions. "Children should be taken there and kept till healthy, not merely relieved from the most urgent symptoms and sent out again to drag away months till urgent symptoms again supervene as is the common history of such cases at present." (Annual Report, 1906.) Their conditions were brought before the Sub-Committee on Medical Treatment of School Children in 1907, who reported that in the large majority of cases of general debility a stay in a home intermediate between the hospital and the special school provides the only prospect of real recovery. In dealing with the provision of medical treatment the Sub-Committee divided children into three classes: Class I. being "those requiring care in an institution and outdoor life, i.e., (a) debilitated children; (b) children convalescent from tuberculosis treated surgically; (c) children suffering from subacute or early tubercular disease." "A large number of the children of this class can only be effectively treated by segregation in institutions intermediate between the hospital and the special schools situated in the country, but in order adequately to provide for these children whose physical debilitation constitutes a grave national danger a number of residential schools will be necessary." Such residential open-air schools for this class of children would probably be more profitable for State expenditure than are industrial schools, but as yet no attempt has been made to deal with this problem in practice. A little progress in this direction has been made by the utilisation of play grounds in the summer and by the establishment of two open-air schools; but the intermittent character of these efforts has made organisation very troublesome and for the same reason and from the fact that London land is held at such high prices, such schools, instead of being cheaper as they ought to be, have cost three to four times as much as the ordinary schools. Legislative uncertainties at present hinder any serious developments, and permanent provision is only likely to be possible when powers are obtained to establish residential schools in suitable localities beyond the metropolitan area. The arrangements for a residential open-air school will depend entirely on the type of child for whom it is intended. There are two classes of cases which, although they may merge into each other, or overlap, are yet quite distinct from the aspect of treatment. 169 Report of the Medical Officer (Education). The first type of children is roughly represented by those now sent to the existing open-air school. It would include sufferers from anaemia, malnutrition, and general ill-health, as well as many suffering from early stages of tuberculosis of glands or lungs. The latter group of lung cases would not include those who cough or expectorate, who, if such symptoms appear, would be deemed to be infectious, and therefore would be removed from school as invalid. The second type are children definitely proved to have tuberculosis, but at such a stage that residence not exceeding a year might be expected to result in a "permanent cure." This group would include all forms of tuberculosis not calling for such medical treatment as would exclude schooling under special conditions. Some would have early or temporarily arrested joint or bone diseases, others glandular or pulmonary disease in quiescent forms. It would be impossible to assume that the last would remain without cough or expectoration, or discharges which might contain infective bacilli, so that for this class of child it would be necessary to provide all the routine for avoiding infection and means for facilitating sterilisation of materials and constantly watching all sources of risk. The provision for tubercular children would depend on how the groups as shown above were defined. The first-class—A residential open-air school for say 120 children of the type now admitted to the existing open-air schools.—It is assumed that any child showing signs of disease involving risk of infection would be sent home at once. A moderate-sized site, of two or three acres, would suffice if in the neighbourhood of common or other accessible open spaces. Adequate space for outdoor classes and partly covered, in case of wet weather, would be necessary; Doecker sheds would suit. For teaching certain subjects and for use in constantly wet weather some well-lighted and fully ventilated classrooms should be available, but used as little as possible. The classrooms should be so desked that they can be used for recreation on long dark winter afternoons or in the evenings. A portable type of school desk available for in or out door is to be recommended. A separate dining hall is necessary both on hygienic and administrative grounds. An assembly hall, available also for recreation, will probably be required. A suitable boot room near the entrance and apart from the cloakroom and a place for drying wet clothes must not be overlooked; this will save labour in cleaning and reduce dust. The bedrooms could be on upper floors, should be large and well ventilated. Sanitary accommodation, accessible at night, is required, and spray or other baths. The staff bedrooms may be placed where most convenient for supervision of the children, as there will be no risk of infection. The resident staff would probably comprise teachers, domestics, needlewoman, and at least one trained nurse. Questions of water supply, lighting, heating, sewage and provision of a laundry depend on local considerations. Steam heating has been found the most dependable and simplest in sanatoria. Sick room accommodation for the instant isolation of any infectious case must be provided. The medical inspection could be carried out weekly by arrangement of the Council's permanent staff, whilst urgent calls might be dealt with by a local doctor. Provision of a residential school for the second class of definitely tuberculous children.—When a community is to consist entirely of tuberculous children the question of infection and of the care of the individual becomes urgent and requires modification of the plans required for ordinary open-air schools, residential or not. (i.) Infection.—The risk is solely in discharges from the patient. Dressings would have to be collected and burned, the vessels in which they are received being subsequently sterilised. Children with cough and expectoration would have to use spitting flasks, which must be collected, cleansed and sterilised twice or thrice daily. The contents must be sterilised before being discharged into the drains. Sterilisation of linen, bedclothes, and handkerchiefs would be necessary. The need for sterilisation is imperative, but its cost is not great if steam heating for cooking or the laundry is provided. The local authority may be expected to intervene if sputum or washing water from linen is discharged unsterilised into the drains. (ii.) Individual care.—These patients are liable to sudden relapses or complications. These may be avoided often by instant attention to the first trivial signs. These cases, in a day school, would be kept at home for a time, and not become obvious, but in a residential school, especially in pulmonary cases, they must be provided for and guarded against. During the earlier part of their stay temperatures ought to be taken, at least four times daily. Few children would be likely to be affected acutely at one time, but in their earlier weeks all should have the most constant medical and nursing supervision. (iii.) Site and Structure.—The grounds should be twice to thrice as large as in a school for the other group, say, at least six acres for 120 children, as supervision is less easy outside, and naturally objections to "consumptive" children will be raised in the neighbourhood of the school. Provision, which may not be required often, must, however, be made for a few children to be in bed all day; this involves special sanitary arrangements. These particular bedrooms should be readily washable and on the ground floor, or have balconies so that the cots could be wheeled into the open. More nurses would be needed, and the staff might require quarters apart from the children, as generally they are well impressed with the risks of infection. Daily supervision by a medical officer with special experience of the management of tuberculosis would be necessary, and all his directions as to rest or play, and the amount of activity allowed each child should be implicitly followed. It might indeed be advisable to have the superintendent a medical man. 5176 M 170 Annual Report of the London County Council, 1910. An intermediate scheme.—Even if it were decided to limit admission to initially non-infectious cases provision for care and disinfection would still be required, since any one might develop a cough or become infectious. The increased space would still be required, daily inspection would be advisable till the trend of the experiment was evident, and at least two nurses would be required. The curriculum would have to be susceptible of modification to fit the individual child and his daily changes and to be subordinated to medical requirements. If all the children were tuberculous greater demands would undoubtedly be made by the Board of Education. Local authorities and neighbouring interests would be keener in their restrictions. With such a carefully selected type of child, although tuberculous, the risk of infection may be reduced to a minimum. If it were understood that any child would be removed on becoming infectious the provision for sterilising materials could be materially reduced and no special attendant be necessary. The buildings could be simpler and the nursing staff reduced. Regular medical inspection would be required almost daily, at least until the experimental stage was passed. In the early days of the school all the arrangements would require to be elastic and subject to constant revision under medical advice. Such an experimental school might be started first on a small scale, with adapted premises on a rented site, not too far from the county, and with initially non-infective cases, to gain data for a later and permanent school, in a more suitable situation. A multitude of unsuspected factors are constantly being revealed in relation to sanatoria, and it is probable that equally valuable lessons will be found in the tuberculosis school. No children's sanatorium on the proposed scale exists in this country, so that on many points in regard to work, play, rest and medical arrangements the data are insufficient, and conclusions formed in advance might be found later to be erroneous. Kensal House Tuberculosis School. The school known as Kensal House School for Tuberculous Children has now been organised. It originated with a proposal made to the Council by the Paddington and Kensington Dispensary for the Prevention of Consumption. The original scheme was a school in which children coming from a tuberculous environment might be educated in the particular hygienic precautions needed to avoid danger. Perhaps this is rather an elaborate idea and one in which the result is scarcely attainable. It was not, however, possible to put it to test, as under the Act of 1899 the Board of Education required to be satisfied that every child admitted was actually suffering from tuberculosis. The Paddington Dispensary Committee suggested a day school in the district rather than a residential country school as being more likely to influence the parents and the homes in regard to the principles of open air, and to show that open windows and fresh air are as applicable in London as in the distant country. The Dispensary deals with whole families, not merely with individuals. Having found one member of a family tuberculous they examine all the others. The doctor and nurse visit the home of every patient, and having supervised the patient's surroundings the further control of the children in school is being attempted. The Kensal House School is intended to do more for a child with tubercle than the ordinary open-air school; by the co-ordination of the Council and Dispensary the child will be under continuous observation by a doctor who knows the circumstances of its family, home and school. Beyond this observation and the open-air methods it was intended that the school should not depart materially from the ordinary school. The strenuous inculcation. of the need of cleanliness, of plenty of fresh air, and of the avoidance of fatigue are the main novelties of the school. The Dispensary did not wish school feeding, as part of their campaign is to educate the members of affected families to proper home feeding. The visiting members of the Dispensary are always ready to give advice as to choice and preparation of suitable food. It is, however, likely that it will be necessary to institute regular meals if the school is to attain its full usefulness. Suitable clothing is necessary for a phthisical child, and yet from the nature of the case it is to be expected that many of these children will come from slums, where warm clothing is scarce. At the Dispensary it is made known that only well-clothed and well-fed children will be admitted; parents who could not so provide for their children are handed over to the Charity Organisation Society so that the family may be dealt with as a whole. The children were selected entirely from the patients of the Dispensary. They live within walking distance of the school and are able to go home for the mid-day meal. The factors taken into account in their selection are, in addition to definite evidence of pulmonary tuberculosis, the clothing and cleanliness of the child, the apparent possibility of its receiving sufficient food, and the keenness and earnestness of its parent. Kensal House is in the Queen's Park district lying between the Canal and Harrow-road. It is a private house with a big garden space around. The ground floor forms three classrooms, a head teacher's room and offices. There is a large kitchen and a workroom on the same floor. The second floor, reached by a broad stone staircase, has two school rooms. Above this are various rooms for the teachers, nurse, doctor and caretaker, but none are used for teaching. Ordinary windows are provided, the educational effect of ordinary open windows being greater than any special ventilating arrangements. For the same reason heating is entirely by open fireplaces. Electric light is used throughout. Curriculum.—The school hours are 9 to 12 and 1.30 to 4 p.m. There is a rest period before going home to dinner and again on returning. The school work is light and well broken up by intervals in which breathing and other physical exercises are taken, or free play or organised games. The classes are held outdoors as far as this can possibly be done. For wet weather a lean-to shelter has been placed in one corner of the garden. The children are taught to take an interest in gardening and given a small plot to care for. The school was opened early in 1911, and it is impossible as yet to state any results such as the gain in weight at the open-air schools. 171 Report of the Medical Officer (Education). Functional Nervous Trouble. Allusion has been nede previously to functional disorders among school children. Epidemics of shakings, faintings, hiccuping, or other disorders are occasionally recorded in continental schools, Some years ago there was a small outbreak of paralysed left arms in a class in Hackney, but such school outbreaks are very rare in England. There are, however, other forms of functional disease which are not uncommon in individual cases, and they are cases which need investigation carefully as part of the school work, but for which some special observation school is required. There are very many educational problems in which there will be little advance till careful study of individual cases can be made under suitable conditions. Children are especially liable to suggestion, and cases of long standing disorder are seen which could be cured in a half an hour by one who thoroughly understood the treatment, but which often continue neglected. An illustrative case is given below of a boy's writing. 1. The boy's attempt on arrival. 2. Written after suggestion to do better. 3. After a few minutes repeated suggestion that he could write without any tremor. These were all written within the samo quarter of an hour. The boy had been frightened some weeks previously by a dog, and this may have originated the condition noticed by the head master, who called attention to " the onset of a nervous disease " and submitted copybooks written by the boy during a period of about a month, in which the gradual onset of tremulous writing was shown. From the character of the alterations in writing the nature of the disorder appeared to be hysterical, and for safety in diagnosis the boy was sent up to the head office. His writing in my room was quite tremulous and characteristic. By impressing the boy, laying one's hand on his head and repeatedly saying " In a few minutes you will write as well as ever " he wrote the word required without a shake. He was directed to return to school and write an exercise that afternoon and another next day, and send them up to the office. The writing of these two exercises probably suggested a contrast to him, for the one written that afternoon was perfect whilst next day it was as bad as ever, and an exercise written a fortnight later was even worse. This case could be permanently cured in a very short time by appropriate means. In the case of stammering the majority of the cases are of a functional nature, and there is little doubt that the equally good results obtained by all kinds of methods and treatments from comparatively untrained teachers owe their success to the common element of the teacher's complete faith in his method as the best, and its suggestive influence on the stammerer. A stammerer can sometimes be cured in a quarter of an hour. For this reason, and looking to the facts recorded in the last Annual Report that 1.3 per cent, of all children have some obvious speech defect, and that about 3 per cent. Standard VI. boys and about 4 per cent. of Standard VII. boys present defects, it has been suggested that an experimental class for the educational treatment of stammerers should be opened. The argument commonly used against such work is that we must not experiment with children, but if this is not to be done, schools might as well be closed, for all education is experimental, and without experiments no progress is possible. If stammering is not to be wholly neglected, as it has been hitherto, careful enquiry into its educational and physiological aspects is necessary, and there is little doubt that a class for stammerers would speedily bring the whole matter within regular lines of treatment. It has been proposed to institute such a class so that the children can attend it on several halfdays a week, and be treated whilst still continuing their ordinary school work at other times. Teachers' Health in relation to Ventilation and Heating of Schools. Attention having been called to the ventilation of Culloden-street School (Plenum ventilation), enquiries were made during the year into the health of teachers in the nine schools ventilated on the Plenum system, and also in nine schools warmed by open fires and nine warmed by radiators, the last two groups being ventilated by the so-called "natural" means. One department only of each Stammering. 5176 M 2 172 Annual Report of the London County Council, 1910. school was taken. The schools had been so selected that it could be assumed that the conditions were equal except in the matter of heating and ventilation. The facts regarding each teacher were recorded:— (i.) not absent; (ii.) absent owing to an illness which might arise from school surrounding, (iii.) absent owing to causes which cannot in any way be related to school surroundings. The number of separate attacks of each disease was noted and the number of whole days absent from duty. The conditions of school life which were particularly concerned and which might deleteriously affect the health of teachers are:— (i.) Infection of the respiratory system from impurity of the air, deficiency of moisture or the presence of dust, and includes such illnesses as common catarrhal colds, influenza, fever, acute rheumatism, bronchitis, pulmonary catarrh, pneumonia, tonsilitis and various varieties of ulcerated, relaxed, or sore throat. (ii.) Conditions arising from deficiency of heat and moisture in the air breathed and predisposing to chills and the various infections above noted. (iii.) Conditions associated with overheating of the atmosphere and insufficiency of humidity. These are chiefly local catarrhal conditions of throat, nose and larynx, and also the more acute toxic symptoms, from disturbance of metabolism, showing itself in subjective feelings of languor, exhaustion, or in headaches. Headache has always been noted unless definitely stated to be due to gastro-intestinal trouble. All other causes of absence (neuralgia, toothache, accident, heart disease, nervous debility, or breakdown, operations or family bereavement) have been summarised as showing what an important factor thev form in explaining absence from school. The following table shows the causes of absence of 521 teachers in Schools under various systems of Heating and Ventilation :— Causes of absence. Nine Plenum schools. Nine heated with radiators. Nine heated by open fires. Culloden-street. Percentage of teachers absent. Average number of days absent. Percentage absent. Days absent. Percentage absent. Days absent. Percentage absent. Days absent. (1) (2) (3) (4) (5) (6) (7) (8) (9) All associated causes.. 39 2 44 3.5 45 2.7 52 5.2 Simple colds 23 3.6 40 2.3 31 1.9 50 1.8 Influenza 10 8 5.9 12.3 11.1 6.5 2.0 3.4 Bronchitis 3.7 12 7.7 12.0 4.0 14.0 8.3 5.5 Tonsilitis 6.2 6.0 9.1 5.0 11.1 5.5 12.5 6.3 Headaches 9.1 1.2 16.6 1.0 11.1 1.0 12.5 1.0 This table shows that in spite of alleged drawbacks the schools with the Plenum system are the healthiest. The conditions of Culloden-street were, however, very much worse than those at any of the other schools, and there must, therefore, be some special cause at work. On going into the question at the school it appeared that the ventilation was not being given a fair trial. The teachers showed considerable ignorance of the most elementary requirements of ventilation. Windows had been broken, thereby short-circuiting other parts of the building, and doors were kept open or shut at random. The only other defect found was that whilst the air was pure and of the right temperature it was too dry. Further enquiries are to be made as to the ventilation of school rooms. There is little doubt that, whilst ventilation under the conditions of our English climate can be maintained tolerable by the so-called natural ventilation, this requires extensive opening of windows, practically the whole side of a classroom, and also very considerable provision of heat. Mechanical ventilation gives by far the purest air. The best system of mechanical ventilation would be a combined system of pull and push, so that the average pressure in the building would equal that of the outer air. The great evil of the Plenum, and indeed all ffiechanical systems, is that the air is used for the convection of heat. Heat should be supplied separately to the classrooms by means of low-pressure pipes or radiators and the air supplied at a considerably lower temperature than the room (say 50 deg. F.). Only by this means will the sense of fatigue and headache be kept clear with a supply as low as 1,000 cubic feet per head per hour. School Journeys, During the last three years a very pleasant form of education, extensively used in Germanspeaking lands, and of a more real kind than the classroom can give, has been spreading steadily in the form of school journeys. These should be encouraged in every way possible and regarded as most serious and valuable methods of education. There may be some risks in subjecting ill-nourished or debilitated children to prolonged physical efforts, and for this reason a large number of journeys has been investigated by Dr. Clive Riviere, who has endeavoured to assess the conditions of the children before and after their excursion and to relate his findings to the various conditions of the journey. He finds that the boys looked the best who had spent a rambling seaside holiday; they gained in weight. This year the excursions were less strenuous than on previous occasions, and there was but little dilatation of the heart of any consequence. It appears that a moderate enlargement of the heart (as measured by a half or three-quarters inch increase in the breadth of the surface dulness) is common and harmless as the result of these holidays. The size of the heart is determined by deep percussion over it and by the 0 173 Report of the Medical Officer (Education). alteration in position of the point where the apex beat is noted. This dilation seems to be directly related to increased nutrition, good feeding, and physical exertion. On the other hand, in many cases there is an actual decrease in the size of the heart (even to the extent of three-quarters of an inch in the dulness). This decrease is more evident in the seaside journeys than in inland expeditions. The final result on the heart appears to be the outcome of various factors, exertion and high feeding tending to enlargement, whilst on the other hand skin stimulation from sea air, bathing, the open-air, etc., tends to increase the tone of the heart and cause some diminution in size. The boys from Holbeach-road (Lewisham), a school in a good suburban neighbourhood, were in a very fit condition before beginning the journey and presented practically no heart changes. Examination of the pulse did not give material information. Among the girls considerable numbers showed hearts larger than normal. Want of condition and flabbiness of tissues are the predisposing causes of cardiac strain in many cases. The girls are often soft and out of condition, and exertion is liable to lead to strain. The average need of the elementary school child is mainly physical. As the social scale is ascended the physical requirement may be overlooked and mental and moral considerations chiefly regarded. Dr. Riviere, therefore, takes it that physical considerations should be the chief for the ordinary school except in suburban schools where the class approaches, say, the secondary school type of children. Two types of journey are thus differentiated. A.—The holiday journey with special regard to the physical needs of the ordinary school child. Abundant skin stimulation being useful as a nervous tonic, and as increasing appetite and digestion, and the tone of the heart muscle. For these requirements the seaside is most suitable. An ideal holiday of this kind was spent by the scholars from St. Mary Magdalene's Schools (Paddington, North), at a farm close to the seashore at Dymchurch. They spent time on the farm and the seashore. Lessons on farm animals and their feeding, poultry, kitchen gardens and the meadows, alternated with shells and seaweeds, fishing and the geography of the coast. The feeding was admirable and there was a good rule restricting drinks to the end of meals. B.—Holidays for sightseeing and long excursions. The children should be carefully selected. Boys who are flabby or out of condition or with malnutrition should be excluded. Boys of somewhat similar age and physique should be taken on the same excursion so as to avoid unnatural competition. In such holidays a stimulating climate lessens risk of cardiac strain, but it is to be remembered that fatigue may be less easily felt and the boys worked to exhaustion. The boys appear to do best with short spells and short rests. Frequent small drinks probably act well through their stimulation of the heart. Adequate meals are required, but large meals must be avoided especially when tired. Lunch should be carried and a good meal taken in the evening after a short rest. Plenty of sleep, probably 10 hours, is necessary. Private Study of Hebrew. In this connection some enquiries were made by Dr. Chaikin into the hygienic aspects of the religious instruction given out of school to many children among the Jewish population in the EastEnd. Some of the texts used are of comparatively small print, but generally speaking Hebrew is printed in large enough characters. The work of 95 boys of the ages of 8 to 14 in Council elementary school was analysed. Of the 32 who did not study Hebrew the majority were over 13 years of age; the remainder studied Hebrew by reading, writing and oral methods. Reading was the chief subject. In 50 of these the work was not excessive, averaging not more than 10 hours weekly. A few worked excessively. One boy, for instance, was found who worked at Hebrew four evenings a week, five mornings from 7.30 to 8 a.m., five days between 12 and 2 p.m., on Saturdays and on Sundays nearly all day. Three-quarters of the work is evening study, but some also work in the day either at home or in small classes. Fatigue symptoms were only marked in five cases, and there was an average for all of 10 sleeping hours. On the whole, it may be taken that from this work there is only serious strain in very exceptional cases. Disinfectants and Cleansing. In June, 1910, the Council decided to accept the offer of the Poplar Borough Council to supply disinfectant for the purpose of cleansing the floors of six L.C.C. schools in the borough, as an experiment for six months. As a concurrent experiment the floors of the infants' departments of six neighbouring Council schools were to be cleansed thoroughly every week with soap and water for a similar period. The chosen schools for the disinfecting fluid were : Alton-street, Knapp-road, Marner-street, Bromley Hall-road, Culloden-street and Ricardo-street. Those for the soap and water were : Broad-street, Dalgleish-street, Gill-street, Heckford-street, Northey-street and the Highway. Disinfection.—Disinfection with the electrolytic disinfecting fluid was carried out in accordance with the instructions given to the schoolkeepers to soak with the fluid the sawdust used for sweeping purposes, to sprinkle the floors with the fluid, in the proportion of 2 to 1 water, by means of an ordinary galvanised iron watering can with a large rose, and to add the fluid to the water when scrubbing floors. The amount of fluid required varied from 20 to 30 gallons weekly. Careful observations were made at the schools. This disinfecting fluid being somewhat sticky appears suitable for allaying dust which tends to form into little balls. It has a further quality of materially sweetening the air immediately after spraying, but to be effective as a deodoriser it would be necessary to spray every hour. The disinfecting properties of the fluid may be effective if used undiluted, as was done for the offices; it is doubtful, however, whether by spraying occasionally in such 174 Annual Report of the London County Council, 1910. quantities as not to wet the floor or by sweeping with sawdust damped with the fluid its action as a germicide is efficient. There are objectionable properties which may be attributed to this particular disinfectant, and these should be taken into consideration. It is hygroscopic, and for this reason dirt is trodden into the floors. It is claimed for the fluid that it bleaches and thereby improves the colour of the floors, but in every case it was observed that there was more discoloration after use, and in time the floors appeared quite dark and dirty. A further disadvantage is that it rapidly oxidises metals, coating them with rust or verdigris; this moist rust coming into contact with clothing produces permanent stains, with the result that the teachers complained of their clothing being "burnt." With regard to the cleansing power of the fluid when used in dilution for the purpose of scrubbing the floors, the schoolkeepers agree that it is beneficial, but it was observed that if the dilution was above a certain strength the soap did not lather well and the cleansing and disinfecting power of the soap was impaired. Some schoolkeepers state that the disinfectant is corrosive and destructive to clothing, scrubbing brushes, brooms, etc., and that it irritates the skin and eyes. If ordinary care is taken and the fluid is properly diluted such complaints can scarcely be justified. The teachers were not wholly favourable to its use; complaints being that the floors remained damp and had a stained appearance, producing a depressing effect, and the preparation caused the floors to be slippery, causing minor accidents aniong the children. On the other hand there was a noticeable diminution in the amount of vermin found and that the air of the classrooms was sweeter. With regard to the incidence of measles it cannot be said that the use of the disinfectant had any effect in controlling its spread, as in these schools there were altogether 166 cases as compared with 170 cases in six exactly similar schools in the immediate neighbourhood. Washing.—The schools selected were in a particularly poor and crowded neighbourhood and in most cases rather antiquated, thereby rendering more difficult the process of cleansing. At these schools the floors and furniture of the classrooms, corridors, etc., were thoroughly cleansed once a week with soap and water. A review of the experiment shows that the practice of weekly cleansing carried out in a thorough manner is highly successful from a hygienic point of view. The floors of the class rooms, halls, corridors and cloakrooms looked clean and white, and all the rooms had a bright and healthful appearance. The air was sweet, cool, and free from dust, and even at the end of the session there was a complete absence of stuffiness or human odour so frequently detected in naturally but poorly ventilated schools in these districts. A further and highly satisfactory effect of the cleansing was its action in allaying dust. When objects in the rooms, including the upper portion of pictureframes, were touched, the hand showed no trace of dirt or dust, as is too commonly the case. The schoolkeepers and teachers were thoroughly satisfied with the experiment, and attention was drawn to the marked diminution of vermin. It was noted that in the selected schools there were only 129 cases of measles as compared with 245 in six similar schools previously chosen in the immediate neighbourhood, —i.e., Lower Chapman-street and Blakesley-street (St. George's-in-the-East), Senrab-street (Stepney), Cayley-street, Thomas-street and Farrance-street (Limehouse), but both here and in the other schools the numbers are comparatively small, and too much weight should not be assigned to them. Comparative Incidence. Infectious Disease. A review of the past year reveals a striking diminution in the incidence of scarlet fever and diphtheria, both of which diseases appear to be passing through a stage of inactivity. Measles, on the contrary, has been unusually prevalent, the figures both for the spring and autumn showing an abnormal rate of incidence, the latter part of the year especially having been visited by an outbreak probably unprecedented for the time of year (when measles usually appears to be somewhat quiescent), which, as subsequent events have proved, was the beginning of an epidemic of almost unparalleled intensity and prevalence. The following table shows the number of cases of scarlet fever, diphtheria and measles for the past five years, the incidence among school children being compared with the total number of cases occurring among persom of all agjs in the metropolitan area. Total number notified. Weekly mean. Per cent. of school Disease. Year. Children Children children to persons All ages. attending public All agei. attending public of all ages. elementary elementary schools. schools. (1) (2) (3) (4) (5) (6) (7) per cent. Scarlet fever 1903 20,333 8,371 391 161 41 1907 25,923 12,307 498 237 48 1908 21,648 10,291 416 198 48 1909 17,389 7,716 335 148 44 1910 10,513 4,700 202 90 45 Diphtheria 1903 7,934 2,549 153 49 32 1907 8,597 3,170 167 61 37 1908 7,671 2,809 148 54 36 1909 6,617 2,212 127 43 34 1910 5,391 1,861 104 36 35 Measles 1906 18,899 — 365 — 1907 Non- 26,179 — 503 — 1908 notifiable 19,385 — 373 — 1909 20,145 — 387 — 1910 25,677 — 494 — A X mangaia SCARLET FEVER. A Diagram X. B Y margaia Diagram Y SCARLET FEVER. B. MEAN NOTIFICATIONS MEAN NOTIFICATIONS C Diagram Z. DIPHTHERIA. C. a Diagram AA. DIPHTHERIA. D. MEAN NOTIFICATIONS MEAN NOTIFICATIONS E Diagram BB. MEASLES. E. 175 Report of'the Medical Officer (Education). Diagrams X, Y, Z and AA, illustrating the deviation of scarlet fever and diphtheria above and below the weekly mean, and tracing by means of curves the course of these diseases for the past year will be found at the end of this chapter. The measles diagram (BB) shows the rise and fall of the disease for the past five years. The number of schools under observation for the above diseases were : measles fever 239, and diphtheria 81. The departmental distribution was as follows:— 749, scarlet Schools under Special Observation. Disease. Boys. Girls. Mixed. Infants. Special. (1) (2) (3) (4) (5) (6) Diphtheria 9 14 4 60 - Scarlet fever 30 63 24 197 1 (P.D.) Measles 2 8 9 746 3 (P.D.) 1 Blind 1 Deaf Although as a general policy in the prevention of infection school closure has been practically abandoned, it has been considered desirable on certain occasions, where other and more detailed methods have been attempted but have failed to elucidate the sources of infection, or where the coexistence of two diseases has complicated investigations, temporarily to close departments or classrooms. School Closure. The following table shows the numbers of such closures:— Scarlet Fever. Diphtheria. Measles. Mumps. Scarlet Fever and Measles. Diphtheria and Measles. Measles and Mumps. Dept. Depts. Rooms. Depts. Rooms. Depts. Rooms. Depts. Rooms. Depts. Rooms. Depts. Rooms. Depts. Rooms. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) Boys - 1 - - - - - - - - - - - - Girls - 1 - - - - - - - - - - - - Mixed 1 - - - - - - - - - - - - - Infants — 3 — — 12e 34/ - — — 2 1 2 1 — Mentally - - - - - - 1 - - - - - - - tive In addition to the closures specified in the above table one infants' department was closed one day for disinfection. The policy of excluding for varying periods unprotected children from infant classes and Exclusion of Unprotected Children (Measles). departments in which measles has occurred has been rigorously carried out. The subjoined table shows the number of occasions on which these exclusions were ordered. Exclusion of unprotected Exclusion of all children from unprotected children under individual classes. live years of age. Departments 279 Classrooms 12 On certain occasions it has been considered desirable during the prevalence of measles or whooping cough to exclude temporarily all children under the age of five years, and this procedure has been adopted at 16 schools (9 by order of the local sanitary authority) on account of measles and from two schools (by order of the local sanitary authority) on account of whooping cough. Exclusion of all Children undor Five. The schools have been remarkably free from this disease during the year. The number of notifications from teachers was 1,861, as compared with 2,212 in 1909. In all 81 schools were under observation; 999 cultures were taken in 17 schools and 35 children excluded as carriers. The general source of trouble was the occurrence of two or three cases in a department in children associated together in school. The detection and exclusion of carriers in each instance was successful in arresting the outbreak. In only one school was more than one visit necessary for this purpose, and as it illustrates the ineffectiveness of school closure in arresting the spread of diphtheria, the following details are given: Isolated cases in which the children last attended school on May 27th, June 15th and 28th, and July 1st, occurred at St. John's School, Greenwich. It became apparent later that the disease was extending in the district, and on July 9th cultures were taken from 42 infants at the school. In one of these a growth of Klebs Lœr bacilli was found, and the child was excluded. No fresh cases occurred in the department before the end of the term. During the summer holidays, however, the attention of Dr. Annis, the medical officer of health, was drawn to the fact that the disease continued to spread, chiefly among children in the girls' department, four of whom were notified during the holidays on various dates. A visit was, therefore, made on August 22nd, the first day of term, and cultures taken from 62 girls, amongst whom two carriers were found. Subsequently another girl was notified whose last attendance at school prior to her illness was August 26th, and two infants who were last at school on August 25th. On 1st September cultures were taken from 55 infants, of whom one (e) 3 departments closed by order of the local sanitary authority. (f)11 classrooms closed by order of the local sanitary authority. Diphtheria. 176 Annual Report of the London County Council, 1910. was found to be a carrier and excluded. Four further cases were notified from the infants' department, the affected children having last attended school on 1st September (two), 2nd September and 8th September. A final visit was made on 13th September, and cultures were taken from 28 girls and 50 infants; amongst the former of whom another carrier was detected, and with her exclusion the outbreak ceased. In this instance, school closure, i.e., the long summer holiday, had no effect in arresting the spread of the disease or in limiting its area. Rather was the area extended, for while before the holiday infants alone were attacked, both girls and infants were involved subsequently. It was not until all the children had been bacteriologically examined and the carriers excluded that the outbreak ceased. Garman Measles. During the past year the difficulty of controlling the spread of measles in London schools has been increased owing to the frequent admixture of cases of German measles in the course of the outbreak. As school outbreaks of German measles are infrequent, it is not easy to obtain reliable information, but in a few schools the outbreaks have been almost entirely of the German variety, and have been specially investigated by Dr. Hogarth and Dr. Letitia Fairfield. Apart from clinical evidence, and so far as schools are concerned, it appears possible to differentiate ail outbreak of German measles from ordinary measles by the following circumstances. In an infants' department the elder classes are attacked as frequently as the younger, and classes well protected by a previous outbreak of ordinary measles are quite as liable to be attacked as classes not so well protected. The disease does not tend to spread rapidly or even constantly throughout the school or department, and isolated cases repeatedly occur in classrooms, whilst few secondary cases follow. Ordinary measles does not produce an immunity against German measles and vice versa, and thus, during the recent cpidemic, many cases have been reported by teachers and parents as " second attacks " of ordinary measles. The symptoms shown in school are different in the two diseases; in the case of ordinary measles there are signs of catarrh, bad cold, sneezing, coughing, while in the case of German measles facial rash, feverishness, sore throat, headache are the symptoms which generally attract the teacher's attention. Another important indication is the mildness of the attacks in many cases. The result is that the parents, not having sought medical advice, deny that it is measles of any kind, and attribute the rash to the consumption of water, ice, fish, and to other causes. In the case of German measles this attitude of the parents is not unreasonable, and during the year, in some instances, the regulations have been so relaxed as to allow children certified to have suffered from German measles to return to school after 14 days' absence if certified by a doctor to be free from infection. Continuation School Work in Hygiene, Etc. The spread of knowledge of hygiene and the inculcation of a natural health conscience can be carried on in the following ways:— Elementary Schools. In the ordinary elementary schools by direct instruction to the children, but even more perhaps by the example of the teachers and the steady moral pressure in the direction of cleanliness and the correction of faults. Evening Schools, In the evening schools the courses on health, home nursing, and infant care all have a direct bearing on the hygiene of the community and show incidentally the great importance of correcting such defects in children as may be revealed in the course of the medical inspection. The courses reach students from the age of 16 and include a few of the younger married women. Clubs. Other courses, though usually of shorter duration, are held in many clubs, mothers' welcomes and similar institutions. These, being held in the afternoons, are very well attended by mothers, who are able to bring their infants with them. In many institutions provision is made in another room for the entertainment, during the lecture, of the children below school age. This provision and the fact that the classes are held during school time when the elder children are from home is an essential factor for success. A mother who has to leave children at home unattended naturally will not attend any form of lecture, free or otherwise. These lectures have impressed on the mothers in the poorer districts the importance of treating so-called minor ailments and have greatly facilitated the work of medical inspection by inducing larger numbers of mothers to attend to receive advice. Special Club Classes at Elemental y Schools. Teachers. In some elementary schools special club classes of six lectures have been held soon after medical inspections and these have been well attended and have rendered equally valuable aid. Although such classes have increased and are widespread the task of impressing the parents falls largely on the teachers in the schools, who are consulted privately by parents as to advice given by the school doctor or care committee, and even on that given by their own doctor or by the medical officers of hospitals or dispensaries. With a view to aiding teachers in dealing with such problems arising out of medical inspection special courses of lectures have been given on the care of the eyes, ears, teeth, etc., which were, however, only moderately attended. Training Colleges. In connection with the medical inspection of students in training colleges arrangements were made for medical officers to give three lectures on personal hygiene and the care of the body. These lectures proved of personal interest and advantage to the students, and were the means of giving information which will be of future use to them as teachers, as they have a more direct practical and personal bearing and are quite distinct from the routine lectures in hygiene embodied in the educational syllabus. Syllabuses. The following are examples of the syllabuses which were used in connection with some of the foregoing classes:— Clubs.—Infant care—six lectures on baths, clothing, food, infantile ailments, training of babies care of the mother's own health. 177 Report of the Medical Officer (Education). Health. Six lectures. Air, light and warmth. The house—points to avoid; darkness, damp ness, disorder, defective drainage, dust and dirt. How to keep the body in health—rest and sleep, exercise and work. Cleanliness—habits good and bad. How to dress. What to eat. Special club classes at elementary schools.—Six lectures on early life. Motherhood—simple hints on the care of the health of the mother and child; infant clothing- Childhood—training of infants; common ailments of childhood. Early youth—training and precautions of girls and boys at this time. Consumption—its cause, forms and how to avoid it. Lantern lectures. Six lectures about children. The functions of the body—digestion and indigestion; foodstuffs required at different stages of development. The development—needs and slight ailments of the infant. The growth—needs and slight ailments of children. Before the school age—rickets. The care of the child during school years—food, sleep, play, work, clothing, and cleanliness. Common ailments—infection. Training colleges.—Lecture I.—Personal hygiene; care of the skin and clothing. Lecture II. —The eye and ear. Lecture III.—The teeth, nose, and throat. If time permits a few words on fatigue might be appended. The general lectures on hygiene and physiology under the Board of Education syllabus cover details as to the structure of the organs, so that the special lectures deal mainly with questions of general and personal hygiene from the medical aspect in such a manner as to appeal personally to the students. The syllabus is intended for general guidance and is not necessarily to be rigidly followed as if for examination purposes; the aim of the course being to arouse general interest and an appreciation of the importance of early attention to any defects. Personal hygiene.—The importance of cleanliness, not only of skin, but of hair, teeth, nails, clothing, and in all our habits. Skin.—Structure, function. Dirt.—What it is. How it interferes with function of skin; results of this; how best removed. Soap.—Composition; necessary to remove oily matter. Baths.—Cold, warm and hot; uses of each and temperature. Necessity for daily bath or daily all-over sponge; warm bath at least twice weekly; washing of hands before each meal. Hair.—Washed once a fortnight with soap and water. Pediculi.—How to avoid it; how to get rid of; applications. How to care for; use brush and comb night and morning regularly; younger children to wear hair plaited in school; separate hat pegs; avoid contact of heads. Nails.—How to clean; keep short; dirt and germs; remember toe nails need to be clean. Clothing.—Materials; relative warmth; wool next the skin; why; undergarments to be changed at least once a week; no garment worn during day to be slept in at night, but hung out to air; remember dirt is in dark garments even though it does not show, and these need cleaning too; clothing to be loose; why; ill effects of tight clothing, e.g., bands, stays, tight sleeves, garters; boots and deformities. Illustrate nature's chest; chest of tight clothing; ditto feet. Suggest proper garments for children. Suggest proper garments for adults. Good habits.—Rest; sleep; how to encourage; amount necessary; exercise necessary to health; good effects of exercise; bad effects of too little; suitable exercise at different ages; effects of exercise on heat regulation. Constipation—what it is; how avoided; importance of daily regular action. Menstruation—personal care; fallacies. Value of fresh air; windows to be open night and day; effect of living and sleeping in badly ventilated rooms. Eye and ear.—Eye.—Structure; signs of defective sight (a) attitude, (b) objective signs, (c) effect on work, (d) headache. Long sight; short sight. Accommodation (ciliary muscles; elasticity of lens). Eye strain; spectacles. Convergence. Sore eyes.—Relation to bad hygienic conditions and malnutrition. Need of fresh air and good food; precautions against spread; need of separate towel. Care of the eyes.—Light. Avoid working in dim light. Test of lighting; see diamond print in darkest corner at 10 inches. Direction of light; colour of walls. Fine work to be eschewed in infants' schools. Working distance at least 1 foot. Books to have large clear type. Child's eyes compared with adults; vision testing. Ears.—Structure briefly; connection with the throat. Deafness.—Causes; frequency; how to test; foreign bodies; leave alone; refer to doctor. Discharging ears.—Causes; dangers; should be medically treated. Adenoids.—Mouth breathing; appearance; results. Teeth, throat, and nose.—Teeth.—Structure of a tooth; use of teeth; how and when to clean; apparatus; early use of tooth brush; each child should have a separate brush. The importance of sound teeth; mastication; digestion. The results of neglect (a) Local—foul breath, abscess, toothache; (b) General—-on health, decay. How caused. The importance of immediate attention. Consult properly qualified dentist. Age at which teeth, especially those of the second dentition, are cut. Much trouble arises from thinking the early teeth of the second dentition belong to the first, with the result that they are neglected. Throat and nose.—Structure very briefly; importance of breathing through the nose; tonsils and adenoids, their effects and importance. Use of handkerchief; value of handkerchief drill. Infection through the throat; glands in the neck. Fatigue.—Nature, stages and symptoms of fatigue; importance of ample sleep; evils of overpressure during period of growth. 178 Annual Report of the London Couty Council, 1910. Physiology of Adolescent Girls. At a special course for mistresses of girls' schools on the personal hygiene and physiology of adolescent girls given by Dr. Murrell the attendance was over three hundred. The importance of this subject and the need for the extension of knowledge is obvious. The following is an outline of the syllabus of these lectures, which could with advantage be repeated in every district in London:— I.—Life. Reproduction and death. Methods of reproduction found in all forms of living organisms from the lowest to the highest. II.—Adolescence, with its special problems; (a) Physical; (b) Mental and moral. Evils to which it is particularly liable with their results. Best method of prevention and cure and the enormous importance of the former as compared with the latter. III.—The teacher; her part as mother substitute; how best to deal with the queries of the growing child. The intimate connection between health of mind and body. The qualities of tiue citizenship are self-resDect and clean, healthv living. Teeth. A special course of lectures on the care of the teeth was given by Dr. C. E. Wallis to the parents of elementary school children at each of six schools in the neighbourhood of the Deptford and Poplar Dental Treatment Centres. The syllabus is subjoined. Two sets of teeth :— 1. Temporary or milk teeth. 2. Second or permanent teeth. What the teeth are for. How the upper and lower teeth ought to meet together. If the teeth do not properly meet the food cannot be chewed and indigestion follows. Why the upper teeth sometimes project. The harm that is done by the " rubber comforter," and by allowing babies to suck their thumbs. Burn all comforters. Why teeth decay. Importance of keeping the teeth clean, especially at night. Why vinegar and pickles are bad for the teeth. Why some sweets make the teeth decay. How to clean the teeth; common whitening and a piece of clean rag or a toothbrush and precipated chalk; a separate brush for each person. Results of bad teeth; the body becomes poisoned, bad complexion and skin diseases, bad breath, poorness of blood (anaemia), indigestion, rheumatic pains and general bad health. How to make the mouth healthy; teeth that can be saved ought to be stopped; teeth that cannot be saved ought to be extracted, as they poison the body, especially when they do not ache. Advanced ambulance classes in relation to voluntary aid detachments. Voluntary Aid Detachments. Daring the year the possibility of arranging classes of a more advanced nature in First Aid has been considered and a provisional syllabus approved, but as yet the scheme has not been put in practice. A considerable portion of the instruction required for Red Cross Detachments is covered by the lectures already available, which must have been taken by all who join these detachments. In the case of women they must have obtained certificates in Home Nursing and First Aid. In the case of men the First Aid certificate alone appears to qualify for membership. Although it is improbable that men in th3 voluntary aid detachments would have any specific nursing duties in the case of war, the regulations of the Red Cro33 Society require training in nursing. If the members of the detachment have taken the Home Nursing certificate, this instruction will in part have been received, and this is more completsly coverel with the present syllabus in Home Nursing, which excludes infant care. The attention of orgmissrs of m3n's voluntary aid detachments should be drawn to the existence of these classes for man, as the syllabus covers most of the ground required under the heading "Training in Nursing Duties." In classes where most of the pupils are members of a voluntary aid detachment it is possible for the lecturer to treat the various topics from the standpoint of field nursing and to draw special attention to the possibilities of improvisation of materials and apparatus. Although some of the stretoher exercises can be carried out in evening schools, most of the drill has to be done by the detachmente misting apart from school facilities. The essential preliminary work for women is dealt with in the ordinary First Aid and Horns Nursing Classes. An elaborate equipment is unnecessary and perhaps would be a mistake. Additional requirements are small. There would be needed some form of improvised st3rili33r (fish kettle), improvised dressing trays (photographic dishes), culture tubes similar to those supplied to the maternity classes and empty biscuit and coffee tins to hold sterilised dressings and serve as sterilisers. A good supply of absorbent and non-absorbent wool and other dressings is desirable, as the routiue of dressing wounds must be thoroughly taught. A more extensive equipment of poles, bits of boxee, cardboard and tow than exists in the schools at present is necessary, but would no doubt be provided locally by the students, who, if members of a detachment, should take more interest than in ordinary classes and be more ready to assist, especially if they are made to realise that ingenuity in improvisation is one of their objects. From the medical aspect, aid is given to the movement by the ordinary first aid and home nursing classes under the present regulations, and this can be supplemented by special classes in advanced first aid and sanitation. Syllabuses have been prepared for such classes; they need not be given in full here, but embrace a course for men's detachments, an advanced course for woman's detachments, and in cookery for the sick, and also the care of soldiers' clothing. Chapter XXXIV. Public Health. (i.) The Public Health (London) Act, 1891, by which the Council is authorised to make orders adding to the list of offensive businesses, and regulating the establishment anew of offensive businesses, or the enlargement of premises on which such businesses are being carried on; to make orders adding to the list of notifiable infectious diseases, and to extend any of the provisions of sections 59 to 74 of the Public Health (London) Act, 1891, to other dangerous infectious diseases than those specified in that Act; to require weekly returns of infectious diseases from the Metropolitan Asylums Board; to license slaughterhouses, cowhouses, and knackers's yards; to take proceedings with respect to nuisance caused by sanitary authorities in removing, treating or disposing of house or street refuse; to act in default in cases where local authorities fail to carry out their statutory duties, including the enforcement of by-laws made by the Council; to make by-laws for regulating (a) the conduct of offensive businesses, and the structure of the premises on which they are being carried on, etc.; (b) for regulating the removal or carriage of offensive or noxious matter or liquid and as to the removal and disposal of refuse and (c) as to water-closets, earth-closets, privies, cesspools, and receptacles for dung. Powers and duties of the Council. The Council is also required under this Act to pay half the salaries of local medical officers of health and sanitary inspectors; and may make representations to the Local Government Board as to the number of sanitary inspectors appointed. Copies of all periodical reports of medical officers of health must be given to the Council, and in the event of any medical officer failing to carry out this requirement the Council may refuse to contribute towards his salary. (ii.) The Common Lodging Houses Acts, 1851 and 1853, part IX. of the London County Council (General Powers) Act, 1902, and part V. and section 79 of the London County Council (General Powers) Act, 1907, by which the Council is authorised to license common lodging houses; to require the names of all deputies to be submitted to the Council for approval; to make by-laws for regulating the conduct of such houses and to cause any inmates thereof who may be verminous to be cleansed compulsorily, if necessary. (iii.) The licensing of seamen's lodging houses and the enforcement of by-laws made by the Council under the provisions of section 214 of the Merchant Shipping Act, 1894. (iv.) Part VIII. of the London County Council (General Powers) Act, 1903, authorising the Council to license premises for receiving horses for slaughter or dead horses. (v.) Part Y. of the London County Council (General Powers) Act, 1904, which authorises the Council to seize and slaughter, on payment of compensation to the owner, any cow in a London cowshed suspected of tuberculosis of the udder. (vi.) Part IV. of the London County Council (General Powers) Act, 1907, by which the Council is authorised to take and examine samples of milk entering London, to proceed to the place from which any sample proving tuberculous was sent to London, to examine the cows thereat, and, if any are found to be affected with tuberculosis of the udder, to prohibit the supply, within the county, of further milk from the animal so affected. (vii.) The approval of dairies and cowsheds and the examination of cows under the Dairies, Cowsheds and Milkshops Orders, 1885, 1886 and 1899. (viii.) Section 9 of the London County Council (General Powers) Act, 1908, authorising the Council to make by-laws for regulating the conduct of a fish curer, a vendor of fried fish, and a rag and bone dealer. (ix.) Section 6 of the London County Council (General Powers) Act, 1908, provides that the Council may contribute any sum towards the salary of each health visitor appointed by a Metropolitan Borough Council not exceeding one half of the salary. (x.) Part IV. of the London County Council (General Powers) Act, 1904, and Part III. of the London County Council (General Powers) Act, 1909, authorising the Council to represent to the Local Government Board when a sanitary authority has made default in carrying out its duties in regard to the purifying and cleansing of articles and premises, and to accommodation for the storage of food. All by-laws are, however, subject to approval by the Council and no proceedings can be instituted against, or representation made to the Local Government Board as to default of, a local sanitary authority until the proposal has been approved by the Council. The total number of cases of small-pox notified during the year was 7. Of these cases 5 were subsequently verified to be small-pox. Small-pox. Investigation was during the year made into certain localised prevalences of typhoid fever in London in 1910. An area in Bethnal-green was especially affected, but study was also made of a number of localised prevalences of typhoid fever in other parts of London and in Edmonton and Tottenham. Examination of the facts failed to show in each instance that any ordinarily accepted cause of typhoid fever had been operative, but it was found that all sufferers had partaken of fish (usually fried fish), and that in every instance in which information on this head could be obtained, small plaice belonging to the category described by fried fish vendors as "late steamer fish" had been used for food. As many of the small plaice sold at Billingsgate come from an area in which are situated certain "nursery grounds" not far from the mouth of the Elbe, it was suggested as a possibility that estuary fish might be in auestion, and tVn of the City Corporation was directed to the matter. Typhoid fever. 180 Annual Report of the London County Council, 1910. Cerebrospinal fever. On 8th February, 1910, the Council made an order under section 56 of the Public Health (London) Act, 1891, extending for a further period of 12 months from 13th March, 1910, the notification of all cases of cerebro-spinal fever (epidemic cerebro-spinal meningitis) occurring within the county of London. It has been arranged with the medical officers of health of the sanitary districts for particulars of all cases of the disease notified in London to be furnished to the Council. This information is communicated to every medical officer, who is thus at once put into possession of all available information as to cases occuring in other districts, and facilities are afforded for observation in the event of the disease showing any tendency to spread. The services of Dr. Wanklyn, the assistant medical officer of health, are also available with a view to the investigation of cases in association with medical practitioners in London, should they so desire. The number of cases notified up to 31st December, 1909, was 318, and during the year ended 31st December, 1910, 108 additional cases were notified, making a total of 426 cases since notification became compulsory in 1907. Ophthalmia neonatorum. The Council is, by section 56 (6) of the Public Health (London) Act, 1891, authorised to extend by order to any infectious disease the provisions contained in section 55 of the Act. The section contains a list of the infectious diseases made notifiable by the Act and prescribes the course to be taken for notifying the occurrence of a case of one of these diseases to the medical officer of health of the London sanitary area in which the case has occurred. It appeared desirable that steps should be taken with a view to the more effectual prevention of blindness or impairment of vision caused by the want of prompt and efficient medical treatment among newly-born infants, and that the provisions of the section referred to above should be applied to all cases of ophthalmia neonatorum and thus render it possible to make arrangements for securing continuous and efficient treatment of the child. The Council accordingly made an order and fixed 13th March, 1911, as the date on which the order should come into operation. Phthisis. The Committee considered it desirable the Council should have information as to the administrative measures in force in the County of London for the control of phthisis, and with this view instructed the medical officer to inquire and report what action was being taken in each of the districts of London with regard to cases of phthisis coming to the knowledge of the sanitary authorities by means of the voluntary notification of the disease. The medical officer prepared a report submitting a report by Dr. Wanklyn as to the action taken by the London sanitary authorities in the matter. The report showed to what extent such measures as voluntary notification, disinfection, the appointment of health visitors, the co-operation of health societies, the circulation of pamphlets, etc., have been adopted by the various sanitary authorities in the County of London, and is a useful record of the work which is being done at the present time for the limitation of this disease. The report was printed and placed on sale. Census of homeless persons. In 1904, 1905, 1907 and 1909 censuses were taken of homeless persons in the county of London by the medical officer in order to ascertain the use made of common lodging-houses, and the provision existing for the accommodation of persons of the poorest class. A further census was made on the night of 18th February, 1910, and the medical officer submitted a report showing the number of persons found homeless on that night in the streets, on staircases or under arches, the number and sex of persons who might reasonably be regarded as homeless on the ground of not being able to pay for a bed and the arrangements made for the shelter of persons of this description, and other information bearing on the question. It is worthy of note that on the night of the census there was vacant accommodation for 7,680 persons in common lodging-houses and for 685 persons in casual wards. Following the practice adopted in previous years, the Committee gave instructions for the report to be printed and placed on sale. Transmigrants. In April, 1910, the attention of the Committee was directed to the accommodation provided for transmigrants during their stay in London. It appeared that as the result of the institution of an especially cheap service by a shipping company a large number of intending emigrants to America were brought from Rotterdam to London for re-shipment. Arrangements were made by the persons who had undertaken this duty for finding accommodation for these transmigrants during their stay in London in common lodging-houses and elsewhere, but great difficulty was experienced in doing this, and also in making provision for feeding so large a number of persons. A number of emigrants in a house in the Borough had nothing but bread and water from 3rd to 5th April. A fire which broke out on the s.s. "Cairnrona," on which some 700 or 800 aliens had embarked, necessitated the return to London of a large number. In the emergency the Council's inspectors made every effort to assist in placing transmigrants in suitable houses. The Council has no responsibility in the matter of providing accommodation, but had previously pointed out to the Home Secretary the objections to the course which was formerly adopted by the shipping agents of accommodating the transmigrants in tenement houses in Whitechapel. As a result of this representation it was arranged that these persons should be received into certain common lodging-houses specially set aside for this purpose. This accommodation, though sufficient for a small number, entirely failed in respect of the large number brought over in the early part of the year and for whom practically no provision was made. The Council decided to call the attention of the Secretary of State to the matter, as he had power under the Aliens Act to require shipping companies to give security that transmigrants would be properly maintained and controlled during their transit. Milk. During the year under review the Committee presented to the Council four reports showing the progress made with the administration of Part IV. of the London County Council (General Powers) Act, 1907. These reports showed that between the date of the coming into operation of the Act and 31st December, 1910, some 5,713 samples of milk had been taken, the examination of 4,938 of which 181 Public Health. had been completed, with the result that 034, or 108 per cent., proved tuberculous. The milk came from some 27 different counties. During the year 2,766 samples were taken, of which 268 were found to be tuberculous. The Council's veterinary inspector visited for inspection purposes, since the Act came into operation, 1,119 farms and inspected 28,797 cows, of which number 483, or 17 per cent., were found to be affected with tuberculosis of the udder. The owners of the animals affected undertook that the use for human consumption of the milk should be discontinued immediately. During the year 490 farms were visited and 12,875 cows were examined, of which 117 were found with tuberculous udders. Under the provisions of the London County Council (General Powers) Act, 1904, by which the Council is authorised to seize and slaughter any cow suspected to be suffering from tuberculosis of the udder, the cows in London cowsheds are examined about six times in the year by a veterinary inspector appointed by the Council. During the year under review 27 animals have been seized and slaughtered under the Act, and compensation amounting to £263 12s. 6d. has been paid, the post-mortem examination showing in each case that the udder of the animal was tuberculous. The Council administers (except in the City of London) Part I. of the Children Act, 1908, which re-enacted most of the provisions of the Infant Life Protection Act, 1897, but amended in important respects the law relating to the protection of infant life. The Council has delegated its powers under Part I. of the Act to the Public Control Committee, and a staff, consisting of 2 male and 7 female inspectors, is employed under the direction of the chief officer of the public control department in administering the provisions of the Act. Infant Life Protection, The duties of the local authority under the Act include the institution of inquiries as to persons who undertake the nursing and maintenance of infants, and the appointment of infant protection visitors to inspect places where infants are kept. The local authority is also required to satisfy itself as to the proper maintenance of the infants. Notice has to be given to the local authority in cases where one infant is received, instead of two or more, as was provided in the Infant Life Protection Act, 1897, and the age limit of infants is raised from 5 to 7 years. The Act also contains a provision making void any policy of insurance on the life of an infant when taken out by any person who shall have the custody of such infant for reward, and making it an offence for any such person to insure or attempt to insure the life of such infant. Under the Act the local authority is empowered to fix the number of infants which may be kept in a dwelling as to which notice has been given, and to arrange for the removal from a notified house of an infant improperly kept. Persons guilty of an offence under Part I. of the Act are liable on summary conviction to imprisonment for a term not exceeding six months, or to a fine not exceeding £25. Any such fines are to be paid to the local authority. The extension of the law to all homes in which nurse infants taken for hire or reward are kept has increased very largely the number of homes and infants coming under the supervision of the Council. On 31st March, 1909, the number of homes under inspection by the Council's officers was 268, containing 668 infants, and on 31st March, 1910, these numbers had risen to 1,792 and 2,413 respectively. Section 2 (2) of the Act provides, inter alia, that where any infants have been placed out to nurse by any philanthropic society the local authority may, if satisfied that the interests of the infants are properly safeguarded, authorise the society to exercise the powers of infant protection visitors in respect of such infants, subject, however, to the obligation to furnish periodical reports to the local authority. Under this provision the Council approved 17 societies for the purpose of undertaking the powers in question, but during the year one of these societies was, at its own request, relieved of the obligations which it had undertaken in the matter. Powers and duties oi the Council under the M idwives Act, 1902. By Section 8 of the Midwives Act, 1902, every council of a county or county borough in England and Wales is constituted a local supervising authority over midwives with in its area. The duties of a local supervising authority are :—(1) to exercise general supervision over all midwives practising within the county or county borough; (2) to investigate charges of malpractice, negligence or misconduct on the part of any practising midwife; (3) to suspend from practice any midwife if such suspension appears necessary in order to prevent the spread of infection; (4) to report at once to the Central Midwives Board the name of any midwife convicted of an offence; (5) during the month of January in each year to send to the Central Midwives Board a list of all midwives who during the preceding year had notified their intention to practise within the county; (6) to keep a current copy of the roll of midwives accessible at all times for public inspection; (7) to report at once to the Central Midwives Board the death of any midwife or any change in the name or address of any midwife; and (8) to give due notice of the effect of the provisions of the Act to all persons using the title of midwife. In addition to these duties, every local supervising authority is by Section 5 of the Act compelled to pay its proportion of any deficit which may occur in the expenses of the Central Midwives Board, provided such deficit is approved by the Privy Council. i In order to carry out its duties of general supervision, the Council has appointed two women inspectors, who are duly qualified medical practitioners, to pay visits of inspection to midwives practising within the county, as well as to make special investigation into any case of puerperal fever occurring in the practice of a midwife, and to attend if possible any inquest held upon the body of a woman or infant upon whom a midwife had been in attendance. During the year 1910 there were 90 cases of puerperal fever in the practice of midwives, and 83 inquests were held in which midwives were concerned, 14 being on the bodies of women, and 69 on the bodies of children. Supervision of midwivee. 182 Annual Report of the London County Council, 1910. Investigation of charges against mi Charges of malpractice, negligence or misconduct on the part of two midwives were investigated during the year, with the result that the Central Midwives Board were informed that in one instance a prima facie case of negligence and misconduct, and in the other of misconduct, had been established, but the Board had not during the period covered by this report, announced its decision with regard to the charges. Suspensions—con victions. Number of midwives practising in the administrative county of London. Notification of provisions of the Midwives Act. It was not found necessary during the year to suspend any midwife from practice nor was any midwife in the county convicted of an offence. During the year ended 31st December, 1910, 529 midwives notified to the Council their intention of practising within the county during the year; and, in addition to these, 10 notices were received from persons who had acted as midwives on specific occasions, and 32 notices from midwives who intended to practise within the county during periods shorter than a year. A list of these notices was in due course sent to the Central Midwives Board. Before 1st April, 1910, a woman who was not certified under the Midwives Act, 1902, was not prohibited from attending cases of childbirth, providing she did not take or use the title of midwife or any title of a similar nature; but on that date sub-section 2 of section 1 of the Act came into operation. This sub-section prohibits a woman who is not certified under the Act from habitually and for gain attending women in childbirth, legally qualified medical practitioners and persons rendering assistance in cases of emergency being exempted from the operation of the section. It appeared desirable that the provisions of the sub-section should be known as widely as possible, and with this intention the Council on 8th February, 1910, decided to give notice by public advertisement of the altered state of the law. Deficit of Central Midwives Board. Enrolment of untrained women. The accounts of the Central Midwives Board showed an adverse balance for the year 1909, and the Council was called upon in June, 1910, to pay a sum of £73 17s. lid. as its proportion of this deficit. Health visitors. From the evidence given before the Departmental Committee appointed by the Lord President of the Council to consider the working of the Midwives Act, it appeared probable that in the county generally there would in certain districts be an insufficient number of certified midwives to fill the vacancies caused by the withdrawal from practice of uncertificated persons in consequence of the provisions of sub-section 2 of section 1 of the Act. In these circumstances an Order in Council was issued on 14th March, 1910, authorising the Central Midwives Board to enrol without examination women who had been in practice for a year before the passing of the Act, provided they made application before 30th September, 1910. In the opinion of the Council there was no necessity for the admission of untrained women to the roll so far as the administrative county of London was concerned, and a communication to this effect was made to the Central Midwives Board. Eleven metropolitan borough councils, viz., Battersea, Bermondsey, Finsbury, Hammersmith, Hampstead, Kensington, Poplar, Shoreditch, Stepney, Stoke Newington and Woolwich, made application to the Council for a contribution of one-half of the salaries of health visitors appointed by them. The Council decided in each case to make the contribution asked for subject to the following condition, among others, viz., that the contributions are dependent on there being sufficient surplus on the exchequer contribution account to enablep ayments to be made after making provision for the discharge of the existing statutory charges on that account in full. Common lodginghouses. Applications were received for licences to keep and use, as common lodging houses, 308 premises in the County of London, and licences were granted in respect of 307 of these premises, the application for the remaining licence being withdrawn. One person was convicted for having kept an unlicensed common lodging-house and was fined £5 Is. with £10 12s. costs, and two licensed keepers were fined £5 15s. with £1 9s. costs for having infringed the Council's by-laws. Seamen's lodginghouses. On 3rd January, 1910, the Board of Trade gave its confirmation to the new series of by-laws which the Council had made for regulating the conduct of seamen's lodging-houses. An order in Council was issued on 19th February, 1910, prohibiting the keeping of a seamen's lodging-house in the administrative county of London by any person who was not licensed by the Council. During the year licences have been granted in respect of 58 premises and in 7 instances the Council has refused to licence premises. The use, as seamen's lodging-houses, of 10 licensed premises was subsequently discontinued. Legal proceedings were instituted in 10 instances on account of breaches of the by-laws, with the result that 9 convictions were obtained, fines amounting to a total of £49 16s. being inflicted, with £7 4s. costs. Prosecutions were also undertaken against 5 persons for keeping unlicensed seamen's lodging-houses. In each case a conviction followed and fines amounting to £27, with £6 9s. costs, were inflicted. Nuisance?. During the year 298 complaints were made to the Council under the Public Health (London) Act, 1891, as to insanitary conditions or failures in sanitary administration. Of these complaints 178 were anonymous. Flies and vermin. During the summer months of 1907 and 1908 investigations were made into the extent to which nuisance from flies is caused by accumulations of offensive matter, and reports as to the results were submitted to the Council. These investigations were continued in 1909 and the results embodied in a further report. This report also contained particulars as to the prevalence of vermin in common lodging houses. Offensive businesses— knackers' yards, slaughter houses, cow houses and dairies. In pursuance of the authority conferred upon the Council by section 19 of the Public Health (London) Act, 1891, sanction was on 22nd February, 1910, given to the establishment anew of the business of a fat melter, and on 1st November, 1910, certain premises were removed from the register, the right to carry on fat melting thereat having lapsed. During the year the Council also took proceedings,* under the provisions of section 100 of the Public Health (London) Act, 1891, in default of a metropolitan borough council, against a person for having established anew the business of a fellmonger 183 Public Health. without obtaining the Council's sanction to such establishment, but the case was dismissed and the Council ordered to pay £5 5s. as costs. The number of slaughterhouses, cowhouses and knackers' yards licensed during the year was 254 slaughterhouses, 201 cowhouses, and 5 knackers' yards. An appeal against the decision of the Committee not to grant a renewal of the licence in respect of a cowhouse was allowed. An application for sanction to establish anew the business of a slaughterer of cattle at Bostall Farm, Abbey Wood, was granted. Ice crcam. Draft by-laws relating to the businesses of a vendor of fried fish, fish curer and rag and bone dealer were submitted to the Local Government Board and the Secretary of State for the Home Department for approval, and the observations of the Board thereon are now under consideration. Part VIII. of the London County Council (General Powers) Act, 1902, requires (inter alia) every ice-cream barrow to bear the name and address of the maker of the cream. An itinerant vendor of ice-cream was summoned at the instance of the Greenwich Borough Council for neglecting to exhibit his name and address on his barrow. The proceedings failed, as the evidence showed that the defendant had removed the wheels from his barrow and was selling the commodity from a tub (part of the body of the barrow), and the magistrate held that the defendant was not selling from a barrow. The borough council, therefore, asked the Council to seek an amendment of the provisions of the Act so that they should be made to apply to stalls. The Holborn and Battersea metropolitan borough councils asked in addition that the provisions should be made to apply to all materials used in the preparation of ice cream. The Council considered the suggested amendments desirable and decided to seek authority to amend Part VIII. of the Act accordingly. Maw Drainag e. The Council is charged by statute with the responsibility for the provision and maintenance of an efficient main drainage system for the whole County of London. Its powers and duties in this respect are derived mainly from the Metropolis Management Acts, 1855, 1858 and 1862, and under these Acts the Council is specifically required to provide and maintain the necessary sewers and works for preventing as far as may be practicable, the sewage of the Metropolis, collected by the local sewers, from passing, into the river Thames within the county. The treatment and disposal of the crude sewage also forms an important part of the Council's work. In addition to the County of London, several neightouring districts make use of the London main drainage system; the necessary powers to enable the Council to receive and deal with the drainage of these out-county areas having been conferred by Parliament from time to time. In every case in which the sewage is received and dealt with, each out-county authority is required to make to the Council an annual payment, the amount of which varies in the several districts. The districts concerned, and the statutes dealing with the disposal of their drainage, are as follows :— (i.) Hornsev, under the Hornsey Local Board Act, 1871, the Metropolitan Streets Improvement Act, 1872, and the London County Council (General Powers) Act, 1906. (ii.) Tottenham ^ under the Tottenham and Wood Green Sewerage Act, 1891, and (iii.) Wood Green J the London County Council (General Powers) Act, 1908. (iv.) West Ham, under the West Ham Corporation Act, 1893. (v.) East Ham (part of), under the London County Council (General Powers) Act, 1897. a(vi.) Willesden (part of) under the Willesden Sewerage Act, 1896. (vii.) Acton, under the London County Council (Acton Sewage) Act, 1898, and the Acton Sewage Act, 1905. (viii.) Penge, under the Penge Scheme, 1900. (ix.) Beckenham (part of), under the Beckenham Sewerage Act, 1873, and (x.) Upper Norwood, under the London County Council (General Powers) Act, 1903. Small parts of Ealing, Chiswick, and Mitcham also drain into the metropolitan system. A joint application from the Urban District Councils of Edmonton, Enfield, Leyton, Southgate and Walthamstow, that the sewage of those districts may be received into the metropolitan main drainage system, has been under consideration for some time, but there are so many important details requiring to be settled, that it has not been possible up to the present to arrive at an agreement in the matter. The area drained by the system and the resident population thereof (1901) are approximately as follows gq. miles. Persons. North—County of London 50 2,789,510 Out-county districts 24 581,140 South—County of London 67 1,746,762 Out-county districts 2¾ 39,874 143¾ 5,157,286 Although, as stated above, the whole of the sewage of the County of London is dealt with by the Council, power is reserved to the Council in the West Kent Main Sewerage Act, 1875, to connect any of its sewers with the West Kent sewer, which passes through the southern portion of the metropolitan boroughs of Lewisham and Woolwich. This power has not been exercised. (a) Under the London County Council (General Powers) Act, 1908, the Council will, when certain works authorised by the Act have been completed, receive into the metropolitan main drainage system the sewage from the whole of the Willesden district. Powers and duties of tle Council. Metropolitan main drainage area. 184 Annual Report of the London County Council, 1910. Treatment and disposal of sewage. The sewage collected by the local sewers, which are vested in the local authorities, and by main and branch sewers under the control of the Council, is conveyed by means of large intercepting sewers to the outfall works. These are situated at Barking on the north side of the Thames, and at Crossness on the south, and are respectively 11 and 13 miles below London-bridge. The sewage on its arrival at the outfalls is subjected to chemical treatment—i.e., about one grain of proto-sulphate of iron and four grains of lime are added to every gallon of crude sewage. The sewage is then discharged into, and allowed to pass slowly through, large reservoirs or precipitation channels, where the suspended or solid matters subside and the liquid or effluent passes over a weir into channels leading into the river Thames. The residue in the precipitation channels, which is called sludge, is cleared out and pumped into other channels, where the solids are allowed to settle still further. The resultant sediment, which contains about 92 per cent. of moisture, is pumped into the Council's sludge steamers and conveyed to the Black Deep in the Thames Estuary. The following table shows the quantity of crude sewage treated, chemicals used in precipitation, and sludge sent to sea, together with the quantity of refuse intercepted at the gratings at the outfall works at Barking and Crossness respectively during the year 1910:— Barking. Crossness. Total. Sewage treated gallons 57,826,161,520 49,305,450,176 107,131,611,696 „ daily average „ 158,427,840 135,083,425 293,511,265 Lime used tons, cwt., etc. 15,396.55 10,761.60 26,158.15 Proto-sulphate of iron used „ 3,333.65 2,914.25 6,247.90 Sludge sent to sea „ 1,720,000 953,000 2,673,000 Sludge weekly average „ 33,077 18,327 51,404 Refuse intercepted at gratings „ 3,322 1,172.25 4.494.25 From the above figures it will be seen that at the Barking outfall one ton of sludge was extracted from an average of 33,620 gallons of sewage treated, as compared with 33,815 gallons in the preceding year, while at the Crossness outfall the average quantity of sewage treated to produce one ton of sludge was about 51,737 gallons, as compared with 48,967 gallons in the preceding year. The total quantity of sewage treated at the outfalls was more, by 5,660,977,592 gallons, than the flow in the previous year, while the quantity cf sludge sent to sea was more by 37,000 tons, or about 712 tons a week on an average. At the Barking outfall there is a one-acre coke bed which has been maintained in action for over seventeen years for the bacterial treatment of the effluent produced after chemical precipitation, and the purification continues to be satisfactory, although the filtering capacity of the bed has diminished. The refuse intercepted at the gratings of each outfall is taken away for agricultural purposes, with the exception of a small quantity which is dug into the ground or used as manure on the garden plots attached to the workmen's cottages. In addition to this refuse, large quantities of sand and fine gravel are brought down by the sewers, in times of rain, and deposited in the precipitation channels, from which the deposits are removed from time to time. The sludge is taken to sea by the Council's sludge vessels, which are six in number, viz., the "Barking," "Barrow," "Bazalgette," "Belvedere," "Binnie," and "Burns," and each is manned by a staff of officers and crew numbering 24. Each vessel carries a load of about 1,000 tons. During the year under review, the vessels made 2,673 trips to and from the deposit area in the Black Deep; the distance travelled being about 267,300 miles. The vessels are insured for £108,000. Main drainage extension scheme. On 5th December, 1899, the Council approved in principle a scheme of main drainage extension works necessitated by the increasing strain imposed upon the existing system owing to the growth of the population. This scheme, the estimated cost of which is roughly £3,772,550, comprises the undermentioned works :— North of the Thames. Barking to Old Ford—Two new sewers (Northern outfall sewer enlargement) and extra works at Barking. New sewer between high-level and middle-level sewers (Middle-level sewer No. 2). New sewer between middle-level and low-level sewers (Northern low-level sewer No. 2). Extension of middle-level sewer No. 1 to Scrubs-lane. Enlargement of the Abbey-mills Pumping Station. South of the Thames New sewer from Crossness to Deptford (Southern outfall sewer No. 2) and extra works at both stations. New sewer from Crossness to Catford (Southern high-level sewer No. 2). New sewer from Deptford to Battersea (Southern low-level sewer No. 2). Practically all these works are now completed with the exception of the enlargement of the Abbey-mills pumping station and the construction of the southern low-level sewer No. 2, and sections 3, 4 and 5 of the northern low-level sewer No. 2, and these are in course of execution. During the year the erection of a new engine house at Abbey-mills pumping station was entrusted to Perry and Company (Bow), Ltd., the amount of their contract being £58,362 3s. 4d. The gas engines for this pumping station are in course of construction by the Premier Gas Engine Company, Ltd., at the contract price of £23,558 5s. The centrifugal and other pumps are being supplied by Mr. John Cochrane for £8,400; the hydraulic penstocks and valves by Messrs. J. Blakeborough and Sons for £2,205; and the travelling crane by Messrs. T. Smith and Sons, for £475. 185 Public Health. There are certain works which, while not specifically provided for in the scheme, are so closely connected therewith as practically to form part of it, and although their cost was not included when the rough estimate of £3,772,550 was prepared, it is anticipated that their inclusion in the scheme will not cause this estimate to be exceeded. The preliminary arrangements in connection with two of these works were put in hand during the year. They are (i.) the enlargement of the Crossness pumping station, roughly estimated to cost £120,000; and (2) the extension of the southern high-level sewer No. 2 from Catford to Nunhead at an estimated cost of £105,000. Storm relief. There is no separate system of sewers in London for dealing with the surface water apart from the sewage, but large storm-water sewers have been constructed to relieve the main and intercepting sewers in times of heavy rainfall, and at various points on both banks of the Thames there are storm overflows which can be utilised at certain states of the tide. Pumping stations have also been erected for the sole purpose of pumping storm water into the river and, in addition, arrangements are made for discharging storm water by means of auxiliary engines at the Western and North Woolwich sewage pumping stations. The disposal of storm water is a matter to which the Council has always given most careful consideration, and on 16th February, 1904. the Council decided that the time had arrived when large additional flood-relief works should be undertaken. The undermentioned works are included in the scheme, and the estimated expenditure involved is £795,000. North of the Thames. Storm-relief sewer from Holloway-road to the Thames. Storm-relief sewer along Stroud-green-road and Tollington-park (Stroud Green and Hornsey relief sewer). Extension of the Hackney-wick to Abbey-mills relief sewer. New sewer from the middle-level sewer No. 1 to the Counter's-creek sewer (North Kensington relief sewer.) South of the Thames. New pumping stations, and sewers in connection therewith, in or near Wandsworth and Southwark. (Falcon Brook pumping station in connection with the Wandsworth and Battersea relief sewer, and the Shad Thames pumping station in connection with the Bermondsey and Southwark relief sewer). Certain other works, not specially mentioned were also provided for in the estimate. All the works specifically referred to above, have been completed with the exception of the sewer from Hollowayroad to the Thames. It was originally proposed that the outlet of this sewer should be at the Tower of London, but it has since been thought that it would be more advantageous if the outlet were situated further eastward at Shadwell, and preliminary work in connection with the making of borings and preparations of plans of the new route was undertaken during the year. The payments on capital account up to 31st March, 1910, in connection with main drainage extension works and flood relief works amounted to £3,003,382 9s. 5d. Cost of new works. Section 9 of the London County Council (General Powers) Act, 1894, prohibits the discharge into any sewer of the Council, or any sewer or drain communicating therewith, of any chemical or manufacturing or trade or other liquid refuse, or any waste steam, condensing water, heated water, or other liquid of a temperature exceeding 110 deg. F., which either alone, or in combination with other matters or liquid in a sewer, may cause a nuisance, or involve danger or risk of injury to the health of persons entering the sewers, or be injurious to the structure or materials of the sewers or works of the Council. It was not found necessary during the year to institute legal proceedings in any case in respect of the contravention of this Act. Illegal discharges into sewers. Unless great care be exercised at places where petrol or similar liquids are used, there is a possibility of matter of a dangerous nature finding its way into drains and sewers, and it was thought desirable to issue a warning as to the danger of allowing this to happen, and the liability attaching thereto. Copies of an Order made by the Council on 20th December, 1898, under section 10 of the Act above referred to, prohibiting the discharge of dangerous substances into sewers, were therefore served during the year upon a number of persons licensed under the Petroleum Acts, and carrying on businesses such as might produce residues which would be dangerous if discharged into sewers. Building over sewers. By Sections 204 and 68 of the Metropolis Management Acts of 1855 and 1862 respectively, the erection in, on, over, or under any sewer of a building, wall, bridge, fence, etc., without the previous consent of the Council is prohibited. During the year 20 licences to build over sewers were granted, and one licence was refused. The principal works of repair, etc., undertaken during the year, and the expenditure sanctioned therefor in each case were as follows:— Repairs etc. Barking Outfall.—Alteration to effluent discharging channel and provision of sewage recording gauges, £2,000; repair of gas-mains, etc., £650; painting sludge tanks, £500. Crossness Outfall.—Repair of entablature in engine house, £610. Sewers repaired.—Upper Grange-road, £1,800; Ranelagh, £1,250; Southwark-bridgeroad, £1,075; Fleet (Argyle-street branch), Limekiln dock, Ratcliff Highway, Regent-street, and Victoria-street, £1,000 each; Ranelagh relief, £500. Sludqe vessels.—£1,993 15s. 6176 N 186 Annual Report of the London County Council, 1910. Works completed or in progress. The following is a statement of works or contracts connected with the main drainage and flood relief scheme, which have been completed, or are in progress. North of the Thames. Main Drainage Extension Scheme. £ s. d. Northern outfall sewer enlargement—Completed at cost of .. .. 569,465 15 4 Northern low-level sewer, No. 2— Section 1—Completed at cost of 78,785 0 3 ,, 2 „ „ 82,775 13 11 „ 3—Contract price 261,599 0 0 „ 4 (and extension)—Contract price 85,158 0 0 „ 5—Contract price 172,630 12 6 Middle-level sewer, No. 2—Completed at cost of 315,045 5 9 Extension of middle-level sewer No. 1 to Scrubs-lane—Completed at cost of 13,126 11 6 Abbey Mills pumping station enlargement—Erection of engine-house— Contract price 58,362 3 4 Flood Relief Scheme. Stroud Green and Hornsey relief sewer—Completed at cost of .. .. 21,254 14 0 Hackney Wick to Abbey Mills relief sewer extension—Completed at cost of 62,751 15 4 North Kensington relief sewer—Completed at cost of .. .. .. 27,727 5 1 South of the Thames. Main Drainage Extension Scheme. Southern outfall sewer enlargement and Southern high-level sewer No. 2 £ s. d. Sections A-D—Completed at cost of 723,309 17 10 Greenwich-road Branch— Section 1—Completed at cost of 12,808 10 1 Section 2—Contract Price 22,796 6 3 Southern high-level sewer No. 2— Section E—Completed at cost of 361,223 5 4 Deptford pumping station— Erection of engine house (exclusive of machinery)—Completed at cost of 46,330 0 0 Machinery, etc 29,380 10 0 Flood Relief Scheme. Wandsworth and Battersea relief sewer—Completed at cost of 38,452 19 11 Falcon Brook pumping station—Completed at cost of 20,695 5 0 Bermondsey and Southwark relief sewer—Completed at cost of 99,330 17 6 Shad Thames pumping station—Completed at cost of 39,740 7 10 The figures quoted above do not include the cost of purchasing property required, of settling claims for compensation payable by the Council, of purchasing and fixing machinery, etc., or of employing the necessary supervising staff, etc. Local sewers. Section 69 of the Metropolis Management Act, 1855, provides that no new local sewer shall be made without the previous approval of the Council. The subjoined table shows the total length and sizes of the local sewers, the construction of which were sanctioned by the Council during the year. Size. North of Thames. South of Thames. Total length. feet. feet. feet. 4 ft. by 2 ft. 6 in 85 — 85 15 inches — 110 110 12 inches 1,849 11,198 13,047 9 inches 5,946 7,247 13,193 6 inches 250 823 1,073 ½ round pipe invert 876 — 876 Total 9,006 19,378 28,384 The London Hydraulic Power Company, under the Wharves and Warehouses Steam Power and Hydraulic Pressure Company's Act, 1871, had power to carry out its works in a portion of the County of London. This limited area was extended to the whole county by a further Act obtained by the company in 1884, under which Act it is necessary for the company to obtain the Council's consent to any works in the County of London, outside the City area, beyond those carried out in an 187 Public Health. area specified in the Act. This power is vested in the Council with special reference to the protection of its drains and sewers. The consent of the local authorities (the City Corporation and the metropolitan borough councils) has also to be obtained to work proposed by the company. By Section 13 of the company's Act of 1893 it is provided that the company shall, if required by the Council, supply copies of any maps, plans or sections in its possession showing any mains or pipes laid down. During the year 16 applications from the company to lay extensions of mains were considered by the Public Control Committee, and, after examination the Council's consent was given in each case. Appeals. It is the duty of the Appeal Committee to hear and decide any appeals made under the undermentioned Acts— (1) Section 211 of the Metropolis Management Act, 1855, which allows an appeal against an order of any metropolitan borough council in relation to the level of any building or any order or act of the borough council in relation to the construction, repair, alteration, stopping or filling up or demolition of any building, sewer, or drain. (2) Sections 37, 41 and 43 of the Public Health (London) Act, 1891, which provides for an appeal against any notice or act of a metropolitan borough council in relation to the provision or alteration of water closets, ashpits, earth-closets, privies or cesspools and also in relation to the construction, covering, filling up or other alteration of a drain. Three appeals under section 211 of the Metropolis Management Act, 1855, were considered during the year. The first appeal was against a notice of the Hampstead Metropolitan Borough Council in regard to repairs to drains at No. 226, Finchley-road. A preliminary objection was raised on behalf of the borough council. The objection was allowed and the appeal accordingly dismissed. The second appeal was against the refusal of the Hampstead Metropolitan Borough Council to approve a plan for the re-drainage of No. 105, South-hill-park. The appeal was dismissed. The third appeal was against an order of the Hampstead Metropolitan Borough Council in regard to the drainage of No. 226, Finchley-road, referred to above. As the appellant had not supplied the necessary plans and did not appear in support of the appeal, the appeal was dismissed. Diseases of Animals, The Diseases of Animals Acts, 1894 to 1903, make provision for the prevention, diminution and suppression of contagious diseases in animals, and are enforced in London partly by the Board of Agriculture and Fisheries and partly by the Council and the City Corporation. The Acts are supplemented by Orders made by the Board of Agriculture and Fisheries, dealing with infectious disease among animals and the areas in which such disease exists. The Acts and Orders are administered in London outside the City by the Council, and in the City by the Corporation, which body is also responsible, as port sanitary authority, for enforcing the provisions of the Acts relating to foreign animals. The powers of the Council are exercised by the Public Control Committee as the executive committee. The Council's outdoor staff for the administration of the Acts consists of four veterinary inspectors, and certain other inspectors, who devote their whole time to the work. The prevalence of contagious disease in animals in London during the year 1910 and certain preceding years is shown by the following statement— Number of animals attacked by disease. Disease. 1903-4. 1904-5. 1905-6. 1906-7. 1907-8. 1908-9. 1910. Glanders, including farcy 2,055 1,718 1,382 1,332 1,490 1,704 597 Typhoid in swine 5 11 36 9 35 3 4 Pleuro-pneumonia — — — — — — — Sheep-scab - — — — — — Anthrax 3 4 3 9 13 63 35 Rabies — - — — — - - (a)Epizootic lymphangitis — 126 10 — — — — (b)Parasitic mange - — — — — — 384 During the year the Council has had under consideration the general results of its administration of the Glanders or Farcy Order of 1907, and the question of the desirability of additional powers being conferred upon local authorities to facilitate the efforts made with a view to the extirpation of the disease. The two most serious difficulties with which the Council has had to contend in connection with the extirpation of glanders have been the very large number of latent cases of the disease disclosed in some studs, and the recurrence of disease in a few studs. Experience proves that the spread of glanders has been largely due to the failure of horse owners to take adequate measures for the protection of their horses, and to the neglect of one of the most important precautions advocated by the Council, namely the malleining of all newly purchased horses. The latter cause has led to the introduction of glandered animals into stables where previously the disease was non-existent, and its re-introduction into stables where the disease had been previously eradicated at considerable expense. (а) This disease was scheduled in 1904. (б) This disease was scheduled as regards London in 1909, the Order coming into force on 1st June, 1909. 5176 n 2 188 Annual Report of the London County Council, 1910. The Council on 1st February, 1910, passed a resolution to the effect that, in its opinion, the Order of 1907 should be amended so as to provide— (i.) That the local authority be empowered to collect and destroy infected or suspected nosebags or other articles not easily capable of disinfection and used in connection with glandered horses. (ii.) That the local authority in all cases be empowered to re-test after a period of a month or six weeks from the first test, a stud of horses in which there has been disease. (iii.) That the proprietors of horse repositories be required to disclose to the local authority the name and address of any vendor of a horse if the animal is subsequently found to be glandered together with the names and addresses of the purchasers of any other animals then sold from the same stud. (iv.) That the control of the local authority be maintained over any horse which has been tested with mallein so long as a definite result is not obtained from the test, provided that such control should not extend beyond a maximum period of three months. It was, at the same time, decided to ask the Board of Agriculture and Fisheries to amend the Order of 1907 accordingly, and representations to this effect have been made to the Board. The following table shows the number of animals attacked by glanders in London and the adjoining counties, together with the total cases for Great Britain, during each of the past ten years— Year. London. Middlesex. Essex. Kent. Surrey. Great Britain. Percentage of London cases. 1901 1,828 93 119 54 17 2,370 77 1902 1,604 58 85 36 39 2,073 77 1903 1,915 118 102 18 52 2,499 76½ 1804 1,869 123 132 26 77 2,658 70 1905 1,387 97 80 14 48 2,068 67 1906 1,382 84 92 47 28 2,012 68½ 1907 1,365 33 44 21 32 1,921 71 1908 1,730 144 97 18 36 2,421 71 1909 1,272 92 90 29 84 1,753 72½ 1910 597 26 64 33 24 1,014 58½ Total 14,949 868 905 296 437 20,789 72 Compensation amounting to £7,143 19s. 3d. was paid by the Council in respect of horses slaughtered during the year. 20 infringements of the Order were detected, but in no case were legal proceedings taken. The Animals (Notification of Diseases) Order, 1910, which came into operation on 1st April, 1910, requires veterinary surgeons or veterinary practitioners in private practice to notify the local authority of any case of pleuro-pneumonia, foot-and-mouth disease, sheep-pox, sheep-scab, swine fever, anthrax, epizootic lymphangitis, or glanders or farcy which may come to their knowledge in the course of their practice, and provides for the payment of a fee of 2s. 6d. by the local authority in respect of each notification. The occurrence of the diseases above-mentioned, other than glanders, is rare in London, and the amount for which the Council will be liable in respect of such fees is likely to be small. Exportation of Horses Order, 1910. The Board of Agriculture and Fisheries has issued an Order, known as the Exportation of Horses Order 1910, the object of which is to ensure that no decrepit or injured horse, or any horse intended for slaughter abroad, shall be shipped from Great Britain to a port in Belgium or the Netherlands without first being subjected to the inspection of a veterinary inspector of the local authority. The Order requires that any person intending to ship a horse for conveyance from any port in Great Britain to the above-mentioned countries shall give notice of his intention to the clerk of the local authority of the district where the horse is intended to be shipped, or to some person appointed by the local authority to receive such notices. The notice must state (a) the number of horses intended to be shipped and the port of shipment; (6) the date and the approximate time at which the horses will arrive at the port of shipment; (c) the name and address of the owner and of the foreign consignee (if any), and the name of the port to which the horses are to be shipped; (d) particulars of the purpose for which the horses are exported, and whether they are intended to be slaughtered or worked on arrival in the foreign country; and (e) the estimated value of each horse. The Order provides for a veterinary examination of every horse intended to be shipped unless the local authority is satisfied that such examination is unnecessary, and the veterinary inspector is em powered to serve a notice prohibiting the shipment of any horse which, in his opinion, cannot undergo the intended voyage without unnecessary suffering owing to age, infirmity, illness, injury, fatigue or any other reason. The Order also prohibits the shipment of any horse unless authorised by permit of the local authority, and the officer granting the permit may label each horse for the purpose of identification. Heavy penalties are provided for breaches of the Order. The Council is the local authority under the Order so far as it relates to that part of the river Thames and the docks within the County of London, excepting the portion within, or abutting on, the City of London. The provisions of the Order will prevent the shipment of any horse the value of which is below £5, and so possibly put an end to some of the worst features of the export trade in horses. 189 Public Health. The Board of Agriculture and Fisheries has issued an Order, known as the Anthrax Order, 1910, to come into force on 1st January, 1911. The Order revokes the Anthrax Order, 1899, and provides that every person having in his possession, or under his charge, a diseased or suspected animal or carcase, shall with all practicable speed, give notice of the fact to the police, who shall at once report the matter to the local authority, and the latter's inspector is required to inform the medical officer of health for the district. Upon the receipt of the notification the veterinary inspector must at once examine the animal or carcase. If he is of opinion that the animal or carcase is not diseased, a notice, giving the result of his examination, must be served upon the owner and no further steps taken. If the inspector forms the conclusion that there is good reason to suspect that the animal or carcase is affected with anthrax, he must—(a) serve a notice prohibiting the access of other animals to such animal or carcase and detaining any contact animals; (b) take steps to ensure that the carcase is at once removed and destroyed; (c) see that the place where the carcase was found is disinfected; and (d) forward such material from the carcase of the animal to the laboratory of the Board of Agriculture as may enable the Board's veterinary officers to decide whether the case is one of anthrax. If the result of the Board's examination shows anthrax to exist, the veterinary inspector is required to serve notice upon the occupier of the premises where the diseased animal was kept declaring the premises to be an infected place and requiring the detention of all animals which had been in contact with the diseased animal. Provision is made in the Order for the cleansing and disinfection, at the local authority's expense of infected places and things which may have come into contact with or been used in connection with an affected animal, but in the event of the cost of disinfection being increased by any wilful act or negligence on the part of the owner of the animal, the local authority is given power to recover the additional cost so caused. The local authority is also empowered to remove and destroy any litter, dung or broken fodder which appear to the inspector likely to spread the disease. The essential points of difference between the new Order and the Order of 1899 are that the existence of the disease must be confirmed by the Board of Agriculture, and that restrictions are placed on the movement of animals from the infected premises. Anthrax Order, 1910. Chapter XXXV. Housing of the Working Classes. Housing of the Working Classes. ,g The powers of the Council with respect to the housing of the working classes are derived from the Housing of the Working Classes Acts, 1890 to 1909, and questions relating thereto are considered by the Housing of the Working Classes Committee. Part I. of the Housing of the Working Classes Act, 1890, as amended by the Acts of 1903 and 1909, places upon the Council the duty of preparing and carrying into effect (after confirmation by the Local Government Board) schemes for the re-arrangement and reconstruction of the streets and houses within insanitary areas which are of such size as to be of general importance to the whole county of London. Any scheme for dealing with such an area must provide for the demolition of the old houses, and the re-arrangement, so far as is necessary for purposes of health, of the streets and alleys comprised therein, and must also provide for the accommodation of at least half the number of persons of the working-class displaced, in suitable dwellings, which, unless there are any special reasons to the contrary, must be situated either on the particular area of displacement or within its immediate vicinity. Part II. of the Act empowers the Council and the metropolitan borough councils, either jointly or separately, to undertake schemes for the re-arrangement and reconstruction of insanitary areas which are too small to be of general importance to the whole county. In any such schemes it is not essential that new accommodation for the persons displaced should be provided, but the Local Government Board may order such provision to be made as may appear to be required by the circumstances. Provision is also made in this Part of the Act for the removal of buildings which obstruct the acces of light and air to other houses. The Housing, Town Planning, etc., Act, 1909, empowers the metropolitan borough councils to order the closing and demolition of individual insanitary houses, a right of appeal to the Local Government Board being reserved to the owner of the property. The Council has power to take action in default of a borough council, both as regards obstructive buildings and closing and demolition orders. Part III. of the Act of 1890, as extended by the Acts of 1900 and 1909, empowers the Council to acquire land, either within or without the county, and to provide thereon accommodation for persons of the working class, apart altogether from any displacements that may have taken place. The Act of 1903 provides that where dwellings occupied by 30 or more persons of the workingclass are acquired under statutory powers other than the Housing Acts, e.g., in connection with the carrying out of public improvements, etc., the dwellings shall not be entered on until the Local Government Board has approved a scheme for rehousing the persons to be displaced, or has decided that such scheme is unnecessary. The late Metropolitan Board of Works in the exercise of its powers and duties under the Artizans' and Labourers' Dwellings Improvement Acts, 1875 to 1882, and the Artizans' and Labourers' Dwellings Acts, 1868 to 1882 (known as Cross's and Torrens' Acts respectively), carried out 16 schemes for the clearance of insanitary areas in various parts of London at a total net cost of £1,323,370. These areas comprised about 42 acres, and the displaced working-class population numbered 22,872 persons. It was the practice of the Board always to cease executive operations with the clearance of areas or the provision of rehousing sites, and then to offer the land thus prepared to artizans' dwellings trusts and companies with a view to their erecting and managing the dwellings which had to be built. In this way rehousing accommodation for 27,180 persons was provided on the several sites. The Board also initiated schemes for the clearance of six other areas of some 15½ acres in extent, involving the displacement of 6,188 persons of the working class. When the Council succeeded the Board in March, 1889, the areas had been cleared and efforts were made to follow the previous practice of selling the building sites subject to the obligation to provide working-class dwellings upon them, but, except for two small plots of land, without success. The Council therefore determined itself to undertake the erection and management of the necessary dwellings, and this policy has since been pursued in every instance. For rehousing the persons of the working class displaced by these latter schemes, dwellings were erected by the Council on the cleared sites with accommodation for 2,707 persons. Under the Hughes-fields, Deptford, scheme, accommodation for 240 persons was provided by the Provident Association. Under Part I. of the Housing of the Working Classes Act, 1890, the Council has completed nine schemes involving the displacement of 14,784 persons of the working class. One of the schemes was carried into effect with the co-operation of the freeholder, who has repaid the Council the cost incurred in acquiring the various interests in the property and has erected working-class dwellings on the cleared site with accommodation for 630 persons. Under Part II. of the Act the Council has completed four schemes, in each case with the aid of a contribution from the local authority concerned. The number of persons of the working class displaced was 1,855. For the purpose of rehousing persons of the working class displaced in connection with schemes under Parts I. and II. of the Act, the Council has provided new dwellings capable of accommodating 15,010 persons. (a) Webber-rowetc., scheme. In connection with the Webber-row, etc., Southwark, scheme, which is included in the schemes (a) See Insanitary areae before and after clearance and cost of clearance and rehousing. 191 Housing of the Working Classes. above referred to, the Council decided, on 3rd May, 1910, to abandon the proposal agreed to in 1905 to form a new 40 feet road alongside the railway viaduct between Friar-street and King James-straet. Certain premises in Upper Green-street used for storage purposes which it would have been necessary to demolish for the proposed new road, were no longer required for the purposes of the scheme; and the scheme was accordingly modified, pursuant to an Order of the Local Government Board of 3rd November, 1910, so as to exclude the premises from the operation of the scheme. Tabard- street scheme. During the year the Council decided to proceed with an important scheme for the clearance of three unhealthy areas known as the Tabard-street and Grotto-place areas Southwark, and the Crosbyrow area Bermondsey, which were the subject of official representations under Part I. of the Act of 1890 by the district medical officers of health. The areas, which comprise about 16| acres, are larger than the area dealt with under any clearance scheme yet undertaken by the Council or the late Metropolitan Board of Works. Tabardstreet area. The Tabard-street area as represented is about 13½ acres in extent, contains 649 houses, and has a population of 3,552 persons, nearly all of whom are persons of the working class. The area is situated between Long-lane and Great Dover-street and is in two detached sections lying north and south of the London County Council school in Westcott-street. The characteristic feature of the area is the narrowness of the streets and the bad arrangement of both streets and houses. George-court is, in parts, only 3 ft. wide; Little Britain 5 ft.; Wickham-court, 7½ ft.; and several other streets do not exceed 10 ft. in width including the footways. Out of 32 streets in the area no less than 13 are culs de sac. The houses in Tabard-street are three storeys in height, but nearly all the other houses on the area consist of two storeys and contain either two or four rooms. The houses generally are worn out; the walls of many of the ground floor rooms present evidence of dampness or have been matchboarded in such a way as to conceal the dampness; and the staircases are, in a number of instances, narrow, dark and dangerous. The yards of some of the houses are at a much lower level than the houses themselves and are approached by narrow, dark staircases. These yards are very small and very little sunlight and fresh air can reach them. The whole of the area is populated by a very poor class, many of the inhabitants occupying cheap furnished rooms. Grotto-place area. The Grotto-place area, which comprises some 1½ acres, lies to the west of Southwark-bridge-road, and includes a number of badly-arranged courts most of which are culs de sac, and some houses in Great Suffolk-street. The area contains 138 houses, all of which, except those fronting on Great Suffolkstreet, are one or two storeys in height. The houses with few exceptions are quite worn out, and the inhabitants, who number 567, are of the poorer class. Crosby-row area. The Crosby-row area, which is situated on the eastern side of Crosby-row between Snow'sfields and Long-lane, Bermondsey, is about one acre in extent and contains 88 houses occupied by 474 persons, most of whom are very poor. The houses in Crosby-row are two and three storeys in height and a few have basements. Nearly all the other houses on the area are two storeys in height and contain two, three and four rooms. These latter houses are situated in courts approached either by narrow archways or passageways from Crosby-row. The courts are some feet below the level of the pavement of Crosby-row. The houses generally are worn out, are surrounded by high buildings, and have insufficient space about them. Many of them show signs of dampness or are matchboarded in such a way as to conceal the dampness. Death rates The average yearly death rate from all causes of mortality in the Tabard-street area during the five years 1904-8 was 36.8 per thousand or more than twice that of the metropolitan borough of Southwark, which was, in the same period, considerably above that of London as a whole. The death rate from phthisis in the area was nearly twice that of the borough and nearly three times that of London. The death rate from the principal epidemic diseases was more than two and a-half times that of the borough and more than three and a-half times that of London. The Grotto-place and Crosby-row areas are small for the calculation of reliable death rates, but the figures obtained show that in the former area the death rate from all causes was more than twice, that from phthisis more than three times, and that from the principal epidemic diseases nearly one and a-half times that of Southwark. The death rate from all causes in the Crosby-row area was more than one and a-half times, and that from phthisis nearly one and a-half times, and that from epidemic diseases more than two-and-a-half times the corresponding death rate of Bermondsey. Scheme. The Council was greatly impressed with the necessity for drastic action being taken to remedy the evil conditions prevailing, and on 8th November, 1910, it decided to make an improvement scheme under Part I. of the Housing of the Working Classes Act, 1890, in respect of all three areas. The Grotto-place and Crosby-row areas were the subject of official representations in 1899 and 1904, and although the Council hfd then felt a difficulty in dealing with these areas separately on account of their limited size, it was thought that if a scheme was proceeded with for the clearance of the larger (Tabardstreet) area the opportunity should be taken of reconstructing the two smaller areas at the same time. As regards the limits of the scheme, the only departure which it was found necessary to make from the exact areas described in the official representations was the inclusion of certain property on the north side of Staple-street to enable that thoroughfare to be widened to 40 ft. This had the effect of increasing the population of the Tabard-street area to 3,596 persons. The numbers of persons of the working class occupying the houses on the three areas are as follows—Tabard-street, 3,517; Grottoplace, 567; Crosby-row, 468; or 4,552 in all. Rehousing. In order to decide the amount of accommodation which the Council should provide on the areas themselves for rehousing the persons who would be displaced, inquiries were made to ascertain the number of vacant working-class rooms in the neighbourhood. These inquiries were made within a 192 Annual Report of the London County Council, 1910. radius of approximately one mile from Tabard-street on the south side of the Thames, the district covered including the whole of the metropolitan borough of Southwark and about one-half of the metropolitan borough of Bermondsey. The total number of houses and tenements found to let in the whole area was 1,784, containing 5,977 rooms, of which 1,807 may be described as in good condition and 3,707 as in fair condition. The total number of empty rooms, viz., 4,764 in Southwark, and 1,213 in Bermondsey, is equivalent to about 5 per cent. and 3.5 per cent. of empties respectively, and there is apparently vacant accommodation in the vicintiy of Tabard-street for a larger number of persons than will be displaced from the represented areas. The demand for accommodation in block dwellings in London is decreasing, and there is no very great demand for tenements in the ordinary block dwellings in the neighbourhood of the Tabardstreet area. This, no doubt, is largely due to the general outward movement of London population, and with increasing facilities for cheap and rapid locomotion, this migration from the crowded central districts is likely to continue. It is now quite possible for a working man to obtain more and better accommodation in the suburbs at rents which are low enough to enable him to bear the cost of travelling to and from his work at no greater, or very little additional, expense for house accommodation and travelling together, than he would have to pay for house accommodation alone in or near the commercial centres. In all the circumstances, and particularly in view of the large amount of vacant accommodation in Southwark and Bermondsey, the Council thought that it would be inadvisable to erect new dwellings on the cleared sites sufficient to rehouse all the people who would be displaced, as a building scheme in this district on such a large scale would probably be attended with unfavourable financial results owing to the difficulty in letting the tenements. The Council considered it desirable however, that accommodation for a substantialn umber should be provided on the area of displacement; and in determining the amount of such accommodation regard was paid to the number of persons whose occupations rendered it unlikely that they could remove to any great distance from their present homes. Having considered the question from all points of view, the Council arrived at the conclusion that the requirements of the case would be met by erecting dwellings on the Tabard-street are a to accommodate 2,450 persons. Open space. There is great need for additional public open space in the locality, and it was therefore decided that the central portion of the Tabard-street area, about 5 acres in extent, should be laid out as a public open space, and that the requisite rehousing accommodation should be provided in fivestorey balcony block dwellings overlooking the open space which would, however, be open to the road on two sides. It is anticipated that dwellings so favourably situated will readily let. The remainder of the Tabard-street area, comprising about 3 acres, and the whole of the two smaller are as will be utilised for commercial purposes. Street widenings The street widenings and extensions tor which provision has been made in the scheme may briefly be described as follows:—Roads will be formed on each side of the open space; two of these will be new streets, and two will consist of widenings of Tabard-street and Pardoner-street. The road on the north side of the open space will be continued in an easterly direction so as to provide through communication between Long-lane and Tabard-street. Staple-street will be widened, and Globestreet will also be widened between Tabard-street and Violet-place. On the detached (southern) portion of the Tabard-street area, Little Hunter-street, Tabard-street, Law-street and Lansdowne-place will be widened, and the last mentioned thoroughfare will be continued to meet Little Hunter-street. On the Grotto-place area a new road will be constructed so as to form a continuation of Lant-street and emerging into Great Suffolk-street at King's-court, about 50 yards north of Sturge-street. On the Crosby-row area, Crosby-row and Snowsfields will be widened within the limits of the area, and a new road will be formed from Crosby-row on the site of Porlock-place. All the new streets will be made 40 feet wide and the existing roads, where widened, will be made of the same width. Cost The gross cost of the scheme is estimated at £473,300, and the net cost, after deducting the estimated value of the surplus lands and rehousing sites, at £387,700. The erection of new dwellings to accommodate 2,450 persons as proposed will involve additional expenditure approximately estimated at £116,375. The date fixed for the holding of the Local Government Board inquiry into the scheme was 26th April, 1911. Bangorstreet area. During the year a complaint, signed by t velve ratepayers in the county was made to the Council's medical officer of health under section 5 (2) of the Housing of the Working Classes Act, 1890, with regard to the alleged unhealthiness of an area in the Royal Borough of Kensington, comprising Bangor-street, Crescent-street, and those parts of Sirdar-road and St. Anne's-road which lie between Bangor-street and Crescent-street. In accordance with the provisions of the above-mentioned section the medical officer made to the Council an official representation, stating the facts of the case, and giving his opinion that neither the said area nor any part thereof was an unhealthy area; and notification to this effect was sent bv him to the signatories. Part II. schemes. Apart from schemes which the Council has itself undertaken under Part II. of the Act of 1890, the Council co-operates with metropolitan borough councils in dealing with small insanitary areas. Generally speaking, the Council contributes a fixed proportion, one-half or one-third, of the net cost of carrying the schemes into effect and has the power of approving the plans of any new dwellings which are to be erected on the cleared areas. Ten schemes have been undertaken, eight of which have been completed. Schemes for the clearance of two areas known as the Chapel-grove and Eastnor-place areas, St. Pancras, have been sanctioned by the Local Government Board, and confirmed by Parliament, but no steps have yet been taken by the local authority for carrying out the schemes. 193 Housing of the Working Classes. The amount expended on capital account by the late Metropolitan Board of Works and the Council up to 31st March, 1911, in respect of the clearance of insanitary areas (exclusive of the cost of erecting new buildings), amounted to £3,420,255 7s. 5d., while the receipts derived from rents and sales of land, including the amounts charged against the accounts of the dwellings for the housing values of sites appropriated for that purpose, together with the contributions from local authorities towards the cost of carrying out Part II. schemes, amounted to £906,740 Is. Id., thus leaving the net expenditure at £2,513,515 6s. 4d. Rehousing in connection with improvements, etc. In carrying out public improvements other than schemes under the Housing Acts, involving a statutory obligation to rehouse, the Council has displaced 12,313 persons of the working class, and has provided accommodation in new dwellings for 12,895 persons in lieu of that destroyed. The construction of Rotherhithe Tunnel involved the displacement of 2,842 persons of the working class. Rehousing accommodation for 1,990 persons has already been provided, leaving an obligation outstanding to erect further dwellings on two sites on the south side of the Thames in Albionstreet and Clarence-street, Rotherhithe, and on a site on the north side of the river at London-street, Ratcliff. Having regard to the large number of empty tenements, not only in private ownership, but also in some of the Council's dwellings in the vicinity, it was considered that the provision of further dwellings in these districts would probably be attended with unfavourable financial results, and the Council therefore decided on 19th April and 12th July, 1910, to ask the Local Government Board for release from the obligation to erect further working-class dwellings on these sites (6). In two cases the Council has, in the exercise of its powers under Part III of the Act of 1890, fulfilled rehousing obligations incurred by other authorities. The late School Board for London was required to provide accommodation for 1,030 persons displaced from properties which it had acquired in various parts of the county, and in consideration of a payment of £10,359, the Council provided this accommodation at Preston's-road and Norfolk-street, Poplar. Under the Green-street and Gunstreet schemes, two insanitary areas were dealt with by the late Vestry of St. George-the-Martyr, Southwark, and after the sites had been cleared the Council purchased the land and erected upon it dwellings with accommodation for 418 persons. The acquisition of property by the Council for various purposes does not always necessitate the provision of rehousing accommodation for the persons of the working class displaced. In the case of 2,675 persons occupying houses demolished by the Council from time to time in connection with street improvements, construction of bridges and tunnels, provision of new schools, etc., there was no statutory obligation to rehouse. As regards 2,198 persons of the working class similarly displaced in various parts of the county, the Council was required to submit rehousing schemes for the approval of the Home Secretary or the Local Government Board, but in view of the large number of vacant wroking-class tenements in the vicinity of the various sites, the confirming authority decided in each case that it was unnecessary to provide new dwellings under a special scheme for rehousing the persons displaced. During the year the Local Government Board released the Council from rehousing obligations as regards 106 persons displaced from properties over which compulsory powers of acquisition had been obtained for purposes of the education service. Common lodging houses. The Council has provided three model lodging-houses for men containing altogether 1,849 cubicles, viz. : Parker-street House and Bruce House, Drury-lane, and Carrington House, Deptford. The charge for accommodation is 6d. and 7d. a night for each lodger, which includes the use of the dining, reading and recreation rooms, cooking utensils, crockery, etc., lavatory, feet-washing room, wash-house, boot-cleaning and dressing rooms, etc. For a hot bath one penny is charged and a nominal charge is made for the use of lockers in which the lodgers may store their personal belongings At each house there is a shop at which lodgers can obtain food either cooked or uncooked and facilities are provided for lodgers to cook their own food if they so desire. At Bruce House and Carrington House a few cubicles, specially furnished, are let at Is. a night or 5s. a week. Part III., estates. Although committed to the policy of itself undertaking the erection and management of dwellings when under specific obligations to secure re-housing accommodation for persons displaced by clearance and improvement schemes, the Council hesitated for some time to embark on undertakings involving the provision of accommodation for persons of the working-class apart from such obligations. H wever, on account of the deficiency of such accommodation existing at the time, the Council decided, on 6th December, 1898, to extend its housing operations by taking action under Part III. of the Housing of the Working Classes Act, 1890. Since that date the Council has voluntarily provided in various parts of the county a number of tenement dwellings capable of accommodating 4,068 persons; and, in addition, it has acquired four suburban estates at Tottenham, Tooting, Norbury and Hammersmith comprising nearly 340 acres, upon which cottages are being erected. Up to 31st December, 1910, 2,054 cottages, with accommodation for 15,363 persons, had been completed on these estates, making a total accommodation for 19,431 persons provided under Part III. of the Act, exclusive of certain dwellings and lodging houses, which, although erected under Part III., were provided to fulfil statutory rehousing obligations. During the year under review the Council had under consideration the question of the policy to be pursued in regard to the land which it had acquired under Part III. of the Act of 1890. In 1909 the Council, having formed the opinion that it held more land for housing purposes than it was likely to require for some time to come, applied to the Local Government Board for its (b) The Local Government Board has since intimated that it is prepared to comply with the Council's application ag regards all three sites. 194 Annual Report of the London County Council, 1910. consent to the sale of about 12 acres of the Norbury estate and about 180 acres of the White Hartlane Estate, Tottenham, on the understanding that a sum of money equivalent to that received from any such sale should be expended on the housing of the working classes under Part III. of the Housing of the Working Classes Act, 1890. In reply to the application the Board stated that in its opinion the Council had no power to apply the sale proceeds otherwise than in or towards the purchase of other lands under Part III. of the Act, and that as the Council apparently contemplated applying the money not in this way but for some other purpose of Part III., the application as it stood seemed to be one to which effect could not be given. Having regard to the view taken by the Board the Council felt that it could not take any further action as regards the proposed sale as the law then stood; but the circumstances have since altered owing to the passing of the Housing, Town Planning, etc., Act, 1809, and the Board's objection no longer applies. Section 32 of the new Act provides that where any land vested in a local authority for the purposes of Part III. of the Act of 1890 is sold under section 60 of that Act (which relates to the sale and exchange of lands), the proceeds may be applied not only as provided in that section, but also for any purpose, including repayment of borrowed money for which capital money may be applied and which is approved by the Local Government Board. The Council reviewed the whole situation on 26th July, 1910, and, while still of opinion that some of its bousing estates were too extensive to admit of their being developed within a reasonable period, came to the conclusion that it would be unwise to endeavour to sell such a large proportion of the land, especially as it was doubtful whether a purchaser could be found for so large an estate as the White Hart-lane estate, who would be prepared to pay a reasonable price. Norbury estate. The Council was advised that the conditions as regards the Norbury estate had altered somewhat during the preceding year or two and that the prospects of the estate had distinctly improved. Whereas during the financial year 1908-9 the loss by "empties" amounted to 30 per cent., and the result of the year's working of the dwellings was a deficiency of more than 18 per cent. of the gross rent, during the year 1910-11 there was a slight surplus. The increased travelling facilities afforded by the linking up of the Council's tramway service with that of the Croydon Corporation will materially assist the development of the district generally, and will tend to ensure the letting of the cottages which are being erected on the Council's estate. In all the circumstances the Council thought it well that the whole of the estate, which comprises altogether about 28½ acres, should be retained for housing purposes. White Hartlane estate. The White Hart-lane estate is not so well situated, and the Council formed the opinion that it would be best to dispose of a substantial proportion of the land. The estate consists of two detached sections, of which the northern contains about 49 acres and is about 440 yards distant from the southern portion which is now in course of development. The development of the estate has not proceeded so rapidly as was anticipated, and it is evident that it will not be possible for the Council to build upon the northern portion for many years. For this reason, and in view of the fact that meanwhile the rates have to bear the interest and sinking fund charges on the capital cost of the land, the Council thought it would be well advised to dispose of the freehold of this portion of the estate with the least possible delay. The main (southern) section of the estate, which is about 179 acres in extent, is situated in a district where the working-class population already largely predominates; and the Council felt that it would be impolitic to cover such a large area with cheap rented dwellings, and that it would be to the advantage of the district generally if a substantial proportion of better-class property could be erected on the land. The estate is suitable for development on the lines of a garden suburb, which would comprise many different types of houses, including small cottages at a moderate rental, and houses suitable for middle-class occupation. The provisions of the Housing Acts, however, do not permit of the erection of dwellings for any other than the working classes on land which the Council holds under Part III. of the Act of 1890, and the Council decided, therefore, to promote legislation in the session of Parliament of 1911 to enable it to develop or to lease for development any part of the estate on the lines indicated. The Council thought, however, that it should endeavour to sell the western portion of the estate, consisting of about 44 acres and situated almost entirely in the urban district of Wood Green. The remainder of the undeveloped land immediately surrounding the portions already built upon, the Council decided to retain, with a view to its possible development for bousing purposes, due regard being paid to the demand for working-class accommodation in the district. If successful in obtaining the proposed additional statutory powers the Council would be in a position to lease portions of this land for development on the lines of a garden suburb, and the portions of the estate which the Council desired to sell could also be leased on similar terms as an alternative to disposing of the freehold, if the land was not sold in the meantime. In order to facilitate the development of the land, it was felt to be very desirable to provide through communication over the Council's estate from Lordship-lane to White Hart-lane, and in order that this might be done the Council approved of arrangements being made with a view to the construction at an early date of two new roads, the first in continuation of Waltheof-avenue, and the other commencing from Hatherley-road and joining White Hart-lane to the east of Snakes'-lane. In accordance with the resolution passed by the Council on the date mentioned, application was made to the Local Government Board for its consent to the sale of about 90 acres of the White Hart-lane estate, and to the proceeds of any such sale being utilised in or towards the development of other lands under Part III. of the Housing of the Working Classes Act, 1890. A public inquiry into 195 Housing of the Working Classes. the subject of the Council's application was held by one of the Board's inspectors on 7th, 11th and 12th November, 1910 (c). The development of the White Hart-lane estate was proceeded with during the year. Roads and sewers have been constructed on a part of the estate adjoining Lordship-lane, sufficient to enable about 48¾ acres to be developed. Cottages have been erected on about 23 acres, and 3⅓ acres have been laid out as an estate garden. About 28 acres have been laid out as allotments for the benefit of the tenants of the cottages. On sections A and B (101/2 acres), 304 cottages, containing accommodation for 2,454 persons, have been erected. Lord Swaythling's gift. In 1903 the late Lord Swaythling (then Sir Samuel Montagu, Bt.), gave to the Council £10,000 to be applied towards the development of about 25 acres of the White Hart-lane estate. After taking into account the interest which had accrued, the gift amounted to £11,841 0s. 3d. on 31st March, 1911, up to which date a sum of £7,587 5s. 3d. had been applied to the purposes of the gift. The portion of the estate to which the gift has been allocated is known as the Tower-gardens section. The construction of roads and sewers on the whole of this section has been completed and a considerable proportion of the roads have been finished and the footways paved, the remainder of the work being carried out as the cottages are completed. About 3⅓ acres have, by arrangement with the donor, been laid out as an estate garden, the cost being defrayed out of the gift. On 31st December, 1910, 314 cottages, capable of accommodating 2,548 persons, had been completed on this section, and a number of others were in course of erection. During the year the question of educational facilities for the children of the tenants on this estate was again before the Council. An offer was received from the Tottenham Urban District Council to purchase a site of 2 acres for £2,555, for the purpose of erecting a public elementary school, subject to the Council constructing certain adjoining roads. The Council accepted this offer and the sale was completed after the necessary consent of the Local Government Board had been obtained. Totterdown fields estate. The development of the Totterdown-fields estate, Tooting (383/4 acres), is rapidly approaching completion. The total number of cottages to be erected on the estate is 1,229 in addition to four shops. Up to 31st December, 1910, accommodation for 7,698 persons in 1,097 cottages had been provided, and the four shops had also been completed and were occupied. Contracts for the remaining cottages have been let and it is anticipated that the building work will have been finished before the end of 1911. The work of finishing the roads and paving the footways on the remainder of the estate is being carried out by the Wandsworth Metropolitan Borough Council as the cottages are completed. Norbury estate. Further progress has been made with the development of the Norbury estate, Croydon (281/2 acres). Roads and sewers have been constructed on about 18 acres of the estate, and the cottages already built cover about 12 acres. The work of finishing the roads on this estate is being carried out by the Croydon Corporation. Up to 31st December, 1910, accommodation for 2,559 persons had been provided in 339 cottages. Further cottages are in course of erection on the portion of the estate on which roads have been formed, and the Local Government Board has given its consent to the erection of four shops. The development of the remainder of the estate is under consideration. Brickmaking One of the conditions of purchase of the Norbury estate was that the brickmaking plant which had been used by the vendor should be purchased by the Council. The Council decided to continue the manufacture of bricks to be used in the construction of cottages on the estate, and the work was carried on up to the end of the season 1906-7 by the direct employment of labour. The bricks have been used for the construction of cottages on the Norbury estate, and have been charged to the capital account of the cottages at cost price. A few have been otherwise disposed of. All the bricks having been appropriated, the brickfield account was closed at 31st March, 1911. Old Oak estate. The Old Oak estate, Hammersmith, was purchased by the Council in 1905, and then comprised about 54J acres, but about 8 acres have been acquired by the Great Western Railway Company for the construction of a branch line. A scheme for the development of the western section of the estate, comprising about 14 acres, has been approved by the Council. The scheme provides for the erection of 333 cottages and cottage flats, and 5 shops. The cottages will comprise 42 of five rooms, 27 of four rooms and boxroom, 92 of four rooms, 23 of three rooms and boxroom, 101 of three rooms, 6 of two rooms and boxroom, and 16 of two rooms. It is proposed to provide 26 cottage flats, 12 with two rooms and the remainder with one room. Each of the cottages and flats will have a scullery and the usual offices, and the cottages of five and four rooms and 14 of three-roomed cottages will be fitted with baths. Contracts have been let for the construction of roads and sewers on the western section and for the widening of Ducane-road in front of Wormwood-scrubs prison and the extension of the widened road along the southern boundary of the estate to Old Oak Common-lane. The work was in progress at the end of the year and contract particulars for cottages to be erected on the first part of the western section were almost completed. The north-eastern boundary of the estate where it adjoins Wormwood-scrubs is irregular, and with a view to making the building site more suitable for development, the Council decided, with the consent of the War Department and the Local Government Board, to appropriate a portion of the open space, about 21/2 acres in extent, for housing purposes, in exchange for portions of the housing estate of equal area to be added to the open space. A 40 feet road will be constructed along the new boundary line, half the land required for the purpose (c) The Board has since decided to comply with the Council's application as regards the northern (detached) portion, but the Board is of opinion that sufficient grounds have not been adduced for the sale at the present time of any part of the main (southern) portion of the estate and is not prepared, therefore, to accede to the Council's application in this respect. 196 Annual Report of the London County Council, 1910. being taken from the open space and half from the housing estate. The question of providing schoo accommodation on the estate is under consideration. Accommodation destroyed and provided With a view to the Council being kept informed as to the provision of working-class accommodation in London and the adjoining districts, a return (d) is prepared each year showing the amount of new accommodation provided and old accommodation destroyed. The return, which has been prepared for the years 1902 to 1909 inclusive, gives the number of working-class tenements and rooms provided in each borough or district and the average rents at which they are let or to be let; and particulars of the demolitions which have taken place in each district are also given separately. The return for 1909 shows that during the year the number of rooms in new dwellings in the County of London was 5,711, the number of rooms in dwellings demolished 4,569, and that the net addition to the number of rooms was therefore 1,142. The figures in respect of the adjoining districts were 21,150, 232 and 20,918 respectively. The average rents per room at which the new dwellings were let or to be let were during 1909, 2s. 10d. in the central districts of London, 2 s. 7d. in the outer districts of London and 2s. 11/3d. in the extra-London districts. Average rents. The task of managing the Council's dwellings, which on 31st December, 1910, contained accommodation for 51,396 persons, is one of considerable magnitude, and a special department has been established for the purpose. Dwellings completed during the year. Dwellings capable of accommodating 3,344 persons were completed during the year 1910 at an approximate cost for buildings and plans of £105,125. New buildings designed to accommodate 2,320 persons and other works incidental to the development of the various estates were undertaken during the year, and the total cost thereof is estimated at £83,732. The standing orders of the Council require that all dwellings shall be so designed that the cost of erection may not exceed a sum which will enable all outgoings, interest, and sinking fund charges, to be paid without placing a charge upon the county rate, and the rents to be charged are not to exceed those ruling in the neighbourhood. Some of thedwellingrs erected by the Council do not fulfil these requirements; but this is mainly due to the fact that the Council was obliged to build on sites which were so unsuitable as to be unsaleable for the purpose. Aocounts. The accounts of the Council s working-class dwellings for the year 1910-11 are given in Appendix XIII. Parts I., II. and III. of the Housing of the Working Classes Act, 1890, are shown entirely distinct from dwellings provided for rehousing persons of the working-class displaced by the Council in connection with the carrying out of public improvements, separate balance sheets being given under each head. The gross rent for the year of all the buildings open on 31st March, 1911, was £202,985 17s. Id., of which £146,750 lis. lOd. was in respect of dwellings provided under the Act of 1890. The accounts show that, after making full provision for all outgoings, including debt charges, there was a surplus for the year of £4,428 2s. 5d. on all dwellings in occupation, as compared with a surplus of £1,107 lis. Id. for 1909-10. This result was arrived at after taking into account the deficiency, amounting to £2,045 12s. 10d., in respect of dwellings on sites compulsorily appropriated for rehousing, upon the working of which a deficiency was anticipated from the first owing to the character or situation of the site. The net deficiency for the year in respect of estates in course of development under Part III. of the Housing Act, 1890, consisting mainly of debt charges amounted to £5,826 2s. 6d. The total financial result on all dwellings and estates from the date of the opening of the first block in April, 1894, up to 31st March, 1911, shows that a sum of £110,111 8s. lOd. has been temporarily defrayed out of the rates, and £922 18s. 2d. has been contributed from the tramways account. A sum of £50,678 15s. 8d. has already been repaid out of revenue from the dwellings, leaving a net contribution of £60,355 lis. 4d. up to 31st March, 1911. Of the sum temporarily provided out of the rates £71,336 16s. 3d. has been required to meet the deficiency in respect of estates in course of development under Part III. of the Housing Act, 1890. The total amount remaining to the credit of the repairs and renewals account on 31st March, 1911, after paying for all repairs and renewals required up to date, was £59,037 lis. 8d., while the sums annually set aside for sinking fund purposes, together with accumulation of interest thereon, amounted to £177,973 14s. 3d. By the operation of this sinking fund the ratepayers at the expiration of the loan period of 60 years will come into possession of an unencumbered freehold property yielding a large profit income. The net expenditure on capital account up to 31st March, 1911, in connection with the provision of dwellings under the Housing of the Working Classes Act, 1890, amounted to £2,136,075 13s. Id., and under Improvement Acts to £743,646 0s. 6d. The Council has published an account of its housing work up to the year 1900 (e). (a) New working-class accommodation, 1902, 1903, 1904, 1905, 1906, 1907, 1908, 1909. (e) The Housing Question in London, 1855-1900 (No. 503.) Chapter XXXVI. Housing Accounts and Statistics. Housing Accounts. These accounts (see Appendix XIV.) are issued, subject to audit, in advance of the Annua] Accounts of the Council for the year ending 31st March, 1911. They comprise all the dwellings and lodging houses erected or owned by the Council. These dwellings are provided either (a) under the Housing of the Working Classes Act, 1890 (Parts I., *II. and III.), or (b) under Improvement Acts. Memorandum by the Comptroller. Considering the operations as a whole, the results of the year 1910-11, after interest and sinking fund charges have been met, as shown by the Revenue Accounts, are as follows— Summary of results of year. Surplus ( + ) Deficiency (—) Dwellings— £ s. d. Housing of the Working Classes Act, 1890 +1,876 2 6 Improvement Acts +2,551 19 11 Net surplus on dwellings +4,428 2 5 Estates in Course of Development — 5,826 2 6 Net deficiency on all dwellings and estates —1,398 - 1 The surplus on dwellings for 1909-10 was £1,107 11s. 1d., and the deficiency on estates in course of development £7,224 10s. 5d. The deficiency shown was met to the extent of £181 3s. Id. out of the Tramways Account in respect of a proportion of the deficiency on Hughes Fields Dwellings (Greenwich Generating Station rehousing), the remainder being met out of the rates. Owing, however, to balances in hand at the beginning of the year the contribution to the rates was actually in excess of the contribution from the rates. Housing Act 1890. Housing of the Working Classes Act, 1890. The Council's operations under the Housing Act comprise (a) dwellings erected under Parts I. and II. of the Act to provide rehousing accommodation for persons displaced by schemes for the clearance of insanitary areas, and (b) dwellings erected under Part III. of the Act to provide accommodation for persons of the working class, apart from any displacements. Dwellings erected under Parts I. and II. represent, therefore, compulsory provision for rehousing under statutory obligations, whereas dwellings under Part III. represent housing accommodation voluntarily provided by the Council. In certain instances of compulsory rehousing it has been necessary to erect dwellings on sites, on the working of which, owing to their character or situation, an unfavourable financial result was anticipated from the first. These cases are separately shown in the accounts. The account under Part III. is sub-divided to show the results of the dwellings apart from the debt charges on estates in course of development, which are referred to in a subsequent paragraph. The results of the year's working under the Housing of the Working Classes Act, 1890, are as follows :— Results of year 1910 11 Surplus (+ ) Deficiency (—). £ s. d. Part I. +4,505 - 7 „ II + 163 2 11 + 4,668 3 6 „ III.—Dwellings —2,792 1 - Net result on dwellings +1,876 2 6 Part III.—Estates in course of development —5,826 2 6 Net result for Housing Act — 3,950 - - The deficiency on dwellings under Part III. includes £1,404 17s. 6d. in respect of Carrington House, a lodging-house erected under Part III. but in fulfilment of rehousing obligations in connection with the Mill-lane, Deptford, scheme under Part II. Income. The gross rental for the year from dwellings under the Housing Act was £146,750 11s. 10d. Deducting therefrom allowances for empties, caretakers' quarters and amounts irrecoverable, the net rental amounted to £130,362 15s. 2d., exclusive of £597 10s. 8d. for interest on cash balances. The amount of rent irrecoverable was £223 18s. 6d., or only 015 per cent. of the gross rental. The total loss of income due to "empties" was £15,133 14s. 7d., or 10.32 per cent. of the gross rental, as against 10 32 per cent. in 19C9-10. The greater part of this loss occurred on five estates, viz.: 198 Annual Report of the London County Council, 1910. Carrington House (£3,278, or 42.75 per cent. of gross rental), Hughes Fields Dwellings (£498, or 38 98 per cent.), Hughes Fields Cottages (£747, or 36 35 per cent.), Preston's-road Estate (£1,255, or 3143 per cent.), White Hart-lane Estate (£2,786, or 25.45 per cent.), which account for £8,564. On five other dwellings the loss from empties was more than 10 per cent. of the gross rental. Expenditure. The total expenditure on dwellings was £129,084. Per cent. of Per cent. of 1909-10. gross rental. 1910-11. gross rental. £ Working Expenses— £ 8,782 6.50 Supervision and collection of rent 8,984 6.12 (o)23,392 17'31 Rates and taxes (less tax on interest on debt recovered) 21,689 14.78 7,889 5 "84 Lighting, heating, water and insurance 7,972 5.43 289 0'21 Stores and incidentals 246 0.17 13,321 9'85 Repairs and renewals (transfers to fund) 14,125 9.63 53,673 3971 53,016 36.13 Debt Charges— Interest (gross) Land £11,023 Buildings 52,595 (6)55,455 41.03 63,618 43.35 Sinking Fund— Land 2,134 Buildings 10,316 11,630 8 60 12,450 8.48 120,758 89.34 Total Expenditure 129,084 87.96 15,222 11.26 Net deductions from gross rental (empties, etc.) 16,388 11.17 Surplus on dwellings (excluding interest on cash balances) — 813 -0-60 page xxxv 1,279 0.87 135,167 100 00 Gross rental 146,751 100 00 A statement is appended showing the percentages on gross rental of the several items of income and expenditure for each estate. Repairs and renewals fund. The repairs and renewals fund has been established with the view of equalising the charges against revenue under this head between one year and another, as the expenditure in future years will naturally be larger than at present, when many of the buildings are new. The sums charged to revenue account and carried to this fund are based on the estimated cost of all repairs and renewals during the loan period, after deducting interest earned on the investments of the fund. The credits to this fund during the year exceeded the expenditure thereout by £3,702 10s. lOd. The amount standing to the credit of the fund on 31st March, 1911, was £39,595 3s. 10d., of which £37,297 5s. lOd. was invested. Estates in course of development. The interest and sinking fund charges, less receipts in aid, in respect of the capital outlay on lands acquired under Part III. of the Housing of the Working Classes Act, 1890, and still in course of development, are included in a separate account. The charge on the rates in respect of the deficiency under this head for the year 1910-11 was £5,826 2s. 6d., and the aggregate amount raised in the rates to 31st March, 1911, is £69,946 7s. 9d. This amount includes the annual instalments of sinking fund to redeem debt. Norbury Brickfield. The Norbury Brickfield formed part of the estate at Norbury, which the Council in February 1901, acquired under Part III. of the Housing of the Working Classes Act, 1890. It was subsequently decided to continue the manufacture of bricks to be used in the construction of the cottages on the estate. Brickmaking operations ceased, however, in October, 1907. The bricks have been used for the construction of the cottages on the Norbury Estate, being charged to the capital account of the cottages at cost price. A few have been otherwise disposed of. All the bricks having been appropriated, the Brickfield Account was closed at 31st March, 1911. The following statement shows, as nearly as may be, the financial results of the brickfield— Total Expenditure— Manufacture £22,323 Central office charges 627 Interest on outlay 3,011 -£25,961 Less —Sales (including ballast, etc., not yet disposed of, valued at £403 15s.) 4,458 21,503 Less —Estimated credits on basis of prices quoted by accepted contractors (c) 14,381 Deficiency 7,122 i Deduct—Estimated saving in capital expenditure effected by using the clay in manufacturing bricks instead of digging, loading and carting it away to shoot (c) 3,770 Net deficiency 3,352 (a) Before deducting tax on interest. (b) Less tax. (c) These figures do not appear in the accounts. 199 Housing of the Working Classes—Accounts. The gift of £10,000 received from Sir Samuel Montagu on 5th August, 1903, for improving the White Hart-lane estate, amounted, with the interest thereon, on 31st March, 1911, to £11,841 -s. 3d., of which £2,906 5s. -d. was invested in India Bills, maturing 8th April, 1911. A sum of £7,587 5s. 3d. had up to 31st March, 1911, been applied to the purposes of the gift. Sir Samuel Montagu (Lord Swaythling) gift fund. The Council purchased Millbank Prison site under Part III. of the Act and when the Council decided, with the sanction of the Home Secretary, to utilise a portion of this land for the purpose of rehousing persons displaced in connection with the Thames Embankment Extension and Improvements at Westminster, carried out under the London County Council (Improvements) Act, 1900, it was arranged that the Westminster Improvement Account should be charged, and the Part III. Account credited with a sum of £50,000, which has under the Statute to be applied towards "the cost of the acquisitions by the Council of other lands for the purposes of Part III. of the Housing of the Working Classes Act, 1890." After defraying certain expenditure on the Millbank Site Account, the fund amounted, with interest, on 31st March, 1911, to £51,798 17s. 9d. The London County Council (General Powers) Act, 1908, empowers the Council to apply this money in the "improvement and development of estates already acquired by them under and for the purposes of Part III." The Council has decided to utilise the fund in connection with the development of the Old Oak estate, and £4,313 13s. 7d. has been applied to meet expenditure on this estate during the year. The balance available for future expenditure on this estate is thus £47,485 4s. 2d. Special fund for the acquisition of lands under Part III. of the Housing of the Working Classes Act, 1890. The balance sheet shows that the total expenditure on capital account on the dwellings and estates up to the 31st March, 1911, amounted to £2,136,075 13s. Id. The Summary of Financial Results shows the apportionment of this figure as between land and buildings. The capital expenditure during the year 1910-11 amounted to £86,478 13s. 7d. Capital expenditure dwellings and estates. With regard to dwellings erected to rehouse persons displaced by clearance schemes under Parts I. and II. of the Act, the Council's practice is to charge the capital account of the dwellings with the value of the site as earmarked for housing purposes, the account of the clearance scheme being credited with this value. The latter account, which is charged with the cost of clearance and laying out (less sales), is thus placed in the same position as it would have been if the Council had disposed of the land for the erection of dwellings. In the case of dwellings erected under Part III. of the Act the total cost of the land and of its development for building is chargeable against the dwellings. The estimated commercial value and housing value are given on pages xxxviii. and xxxix. in respect of all sites utilised for the erection of working class dwellings under Parts I. and II. of the Act, whether the dwellings have been erected by Dwellings Companies or by the Council. As regards sites sold to Dwellings Companies, the aggregate commercial value at the time of disposal is estimated at £472,100, and the aggregate housing value as represented by cash received from Dwellings Companies is £198,915, the difference of £273,185 being charged against the clearance schemes. The aggregate commercial value on the same basis of sites acquired or appropriated by the Council is estimated at £465,803, and the housing value charged to dwellings accounts to £163,361, the difference of £302,442 being charged against the clearance schemes. The statement on page xxxvii. shows the capital expenditure on the clearance of insanitary areas under Parts I. and II. of the Housing of the Working Classes Act, 1890, as distinct from the expenditure on dwellings. The net capital expenditure to 31st March, 1911, under both parts of the Act for clearance schemes, amounted to £2,513,515 6s. 4d. The capital expenditure during the year 1910-11 amounted to £2,353 15s. 2d. Capital expenditure on clearance schemes. Dwellings under Improvement Acts. These dwellings were erected in pursuance of statutory obligations to provide rehousing accommodation for persons displaced by improvements, etc., under various Acts of Parliament. Certain dwellings were erected on sites on which, owing to their character or situation, an unfavourable financial result was from the first anticipated; these are shown under a separate head. Results of year 1910-11 The result of the year's working of Dwellings under Improvement Acts is a net surplus of £2,551 19s. 11d., as compared with £1,560 15s. -d. in 1909-10. Income. The gross rental for the year from dwellings was £56,235 5s. 3d. Deducting therefrom allowances for empties, caretakers' quarters, and amounts irrecoverable, the net rental amounted to £52,712 -s. 6d., exclusive of £315 16s. 2d. for interest on cash balances. The amount of rent irrecoverable was £39 4s. 2d., or only 0'07 per cent. of the gross rental. The total loss of income due to "empties" was £2,920 11s. 8d., or 519 per cent. of the gross rental, as against 6 90 per cent, in 1909-10. The greater part of this loss occurred on three estates, viz. : Hughes Fields Dwellings (£249, or 38'98 per cent. of gross rental), Brightlingsea Buildings (£264, or 24.27 per cent.), and Swanlane Dwellings (£959, or 23 28 per cent.), which account for £1,472. On three other dwellings the loss from empties was more than 10 per cent. of the gross rental. 200 Annual Report of the London County Council, 1910. Expenditure. The total expenditure on dwellings was £50,476. Per cent. of Per cent. of 1909-10. gross rental. 1910-11. gross rental. £ Working Expenses— £ 4,296 7.66 Supervision and collection of rent 4,254 7.56 (c)10,022 17.88 Rates and taxes (less tax on interest on debt recovered) 8,857 15.75 2,546 4.54 Lighting, heating, water and insurance 2,584 4.60 68 .12 Stores and incidentals 78 .14 5,465 9.75 Repairs and renewals ("transfers to fund) 5,428 9.65 22,397 3995 21,201 37.70 Debt Charges— Interest (gross)— Land £3,515 Buildings 21,002 (d)23,045 41.11 24,517 43.60 Sinking Fund— Land 657 Buildings 4,101 4,730 8.44 4,758 8.46 50,172 89.50 Total Expenditure 50,476 89.76 4,523 8.07 Net deductions from gross rental (empties, etc.) 3,523 6'26 Surplus on dwellings (excluding interest on cash bal- 1,365 2.43 ances) 2,236 3.98 56,060 100.00 Gross rental 56,235 100.00 Repairs and renewals fund. The amount standing to the credit of this fund on 31st March, 1911, was £19,442 7s. 10d., of which £18,702 14s. 2d. was invested. The credits to this fund during the year exceeded the expenditure thereout by £1,345 1s. 8d. Capital expenditure on dwellings. The balance sheet shows that the total expenditure on capital account up to .51st March, 1911, in respect of Dwellings under Improvement Acts amounted to £743,646 -s. 6d. The Summary of Financial Results shows the apportionment of this figure as between land and buildings. The capital expenditure during the year 1910-11 amounted to £387 15s. 6d. The practice with regard to the charge to the capital account of the dwellings in respect of the value of the site is the same as for dwellings erected to rehouse persons displaced by clearance schemes under Parts I. and II. of the Housing Act. The estimated commercial value and housing value are given on pages xxxviii and xxxix. in respect of all sites utilised for the erection of working class dwellings under Improvement Acts, whether the dwellings have been erected by Dwellings Companies or by the Council. As regards sites sold to Dwellings Companies, the aggregate commercial value at the time of disposal is estimated at £255,435, and the aggregate housing value as mainly represented by cash received from Dwellings Companies is £131,007, the difference of £124,428 being charged against the accounts of the improvements. The aggregate commercial value on the same basis of sites acquired or appropriated by the Council is estimated at £416,277, and the housing value charged to Dwellings accounts at £108,213, the difference of £308,064 being charged against the accounts of the improvements. Financial results to 31st March, 1911. The total financial results on all dwellings and estates from April, 1894 (the date of the opening of the first block) to 31st March, 1911, apart from contributions from or to rates, are as follows— Housing of the Working Classes Act, 1890— £ s. d. Part I surplus 28,782 5 - Part II surplus 2,702 16 4 Part III. deficiency 27,687 13 9 surplus 3,797 7 7 Estates in course of development deficiency 69,946 7 9 Total under Housing Act deficiency 66,149 - 2 Dwellings— Improvement Acts surplus 5,793 8 10 Net aggregate deficiency 60,355 11 4 Contributions from Tramways Account 922 18 2 Net contributions from Rates 59,432 13 2 60,365 11 4 These results are arrived at after (i.) charging interest on capital outlay, (ii.) making full provision for repairs and renewals, and (iii.) setting aside a sinking fund sufficient to replace the capital outlay on land and buildings and estates in course of development within a period of 60 years. The accumulations of the sinking fund on 31st March, 1911, amounted to £177,973 14s. 3d. (exclusive of £13,642, proceeds of sales). (c) Before deducting tax on interest. (d) Less tax. Housing of the Working Classes—Statistics. 201 Housing Statistics. The new buildings completed and opened between 1st April, 1910, and 31st March, 1911, comprise 408 cottages, providing accommodation for 2,884 persons. Up to 31st March, 1911, a total of 6,428 tenements in block dwellings, and 2,519 cottages, or a total of 8,947 lettings, containing 25,006 rooms; and 1,849 cubicles in lodging houses, affording accommodation altogether for 51,856 persons, had been provided and opened by the Council. The gross rent receivable for the year 1909-10 was £191,226 8s. 10d., and for the year 1910-11, £202,985 17s. Id., being an increase of £11.759 8s. 3d. Memoran. dum by the Housing Manager. The financial result of the year's working of all dwellings in occupation, after providing for interest and sinking fund charges on the capital expended, is a surplus of £3,514 15s. 7d., which, after adding interest on cash balances (£913 6s. 10d.,) gives a total net surplus of £4,428 2s. 5d., or 2.18 per cent. of £202,985 17s. Id., the gross rent receivable for the year. The interest and sinking fund charges amount to 49.37 per cent. of the gross rental. The sinking fund, which will redeem the capital expended on land and buildings within a period of 60 years, has been increased during the year by £'21,541 18s. 8d., and the total sum now set aside in this fund in respect of dwellings in occupation amounts to £166,637 15s. 9d. The expenditure for the management of the estates, including repairs, rates and taxes, water, lighting, etc., amounts to 39 09 per cent. of the gross rental. During the year the sum of £19,553 (9.63 per cent.) has been transferred to the repairs and renewals account, the unspent accumulations on which, with the interest earned during the year (£1,710 11s.), now amount to £59,037 11s. 8d. The loss of rent by empties (including the amounts lost at the opening of the new buildings —408 lettings) is equivalent to 8.89 per cent. of the gross rental. During the year 3,170 tenants left the dwellings. This is equivalent to 35 per cent. of the total number of tenements, as compared with 37.4 per cent in 1909-10. Of the 3,170 tenants who removed, 264 tenants, or 10.9 per cent. of the number, were given notice to quit by the Council, either for non-payment of rent, disorderly conduct, or some other cause. The remaining 2,906 tenants, or 89 per cent., gave notice to the Council and left to suit their own convenience. During the year, 5,394 applications for accommodation on the Council's estates (excluding lodging houses) were dealt with, and 718 transfers were effected. These transfers are sometimes to a different estate, owing to the tenant having changed his place of work, and sometimes to a larger or smaller tenement on the same estate, owing to the increase or decrease of the tenant's family. A number of tenants who removed from the dwellings were in arrear with their rent, and left without paying the amounts owing. Every effort has been made to recover these arrears on vacation, but the amount of £263 2s. 8d. or .13 per cent. (2s. 7d. per £100) of the gross rental has been included in the accounts as irrecoverable. During the year the Council did not rehouse any persons who had been displaced by the Council's improvement and clearance schemes. The total number of displaced persons rehoused to 31st March, 1911, is 1,756. The usual annual census of the Council's dwellings was taken in March, 1911, and showed that the rooms (excluding lodging houses), available for letting, were actually occupied by 30,976 persons, or an average of 1.24 persons per room. The birth rate for the year amounted to 28.6 per 1,000, and the death rate (exclusive of the three men's lodging houses) to 10.2 per 1,000. As in previous years, a careful examination of the census return was made with a view to the detection of cases of overcrowding. The maximum number of persons to be allowed in any tenement in the Council's dwellings has been fixed by the Committee at two persons per room, children up to the age of 5 being for this purpose reckoned as nil, and children between the ages of 5 and 10 as half an adult. This year the number of cases not complying with this standard was 50, or .56 per cent. of the total number of tenements. The overcrowding is usually found to be due to one or more children in the tenement having reached the age of 5 or 10 years, and so being counted in accordance with the Council's scale. This overcrowding is usually remedied by the removal of the family to a larger tenement in the dwellings. During the year the sum of £14,505 7s. 6d. (7.14 per cent. of the gross rental) has been spent in repairs to the buildings. These repairs include external painting at 15 blocks of dwellings and 631 cottages and cottage flats, whitening the soffits and cleaning or painting walls of 203 staircases, comb graining and varnishing the woodwork of 257 tenements, touching up, graining and varnishing 102 tenements, and cleansing repairs at 6,434 tenements. The whole of these repairs have been executed by direct labour employed in the housing department. During the year 9 small fires occurred in the dwellings, 8 being in tenements in block dwellings and 1 in a lodging house. The damage was in every case slight, and the total cost of reinstatement, amounting to £12 0s. 5d., was covered by the Council's insurance fund. 5716 o APPENDICES. ii iii APPEN DIX 1 TABLE SHOWING PROCEEDING OF LONDON SANITARY AUTHORITIES UNDER THE FACIORY AND WORKSHOP ACT, 1901. Premises, Particulars, Class, &o. City of London- Battersea. Bermondsey. Bethnal Green. Camberwell. Chelsea. Deptford. Finsbury. Fulham; Greenwich. Hackney. Hammersmit Hampstead Holborn. Islington. Kensingtoa. Lambeth. Lewisham. Paddington. Poplar. St. Marylebor St. Pancras. Shoreditch. South wark. Stepney. Stoke I Newington. Wandsworth. City of Westminster, Woolwich. 1 Inspections. 801 78 107 429 117 10 145 195 58 15 109 440 149 99 35 725 111 75 Factories (including factory laundries) 4,780 702 107 363 359 3 159 1,056 105 61 44 1,287 763 680 1,870 2,942 772 1,554 2,622 1,146 1,372 816 3,182 1,550 5,353 202 3,346 3,780 196 Workshops (including workshop , laundries) 5,802 1,947 131 4,904 2,545 953 439 1,911 520 150 2,176 817 1,010 2,444 2,324 73a 164 410 134a 1,220 2,305 321 712 2,656 88a 17a 1,828 1,470 102 Workplaces (other than outworkers premises) 1,026 996 93a 760 845 —a 200 413a 153 111a —a 2,905 1,851 3,231 4,623 3,132a 946 2,109 2,951a 2,424 3,692 1,246 4,334 4,355 5,540a 254a 5,899 5,361 373 Total (Inspections) 11,608 3,645 331a 6,027 3,749 956a 798 3,380a 778 322a 2,220a 2. Defects Found. Nuisances under the Public Health Acts. 112 23 62 490 165 157 139 12 496 152 100 248 726 937 7 184 941 42 Want of cleanliness 922 89 51 428 46 11 253 208 40 62 145 2 10 16 19 38 5 — — 2 16 5 1 26 92 — 5 223 10 Want of ventilation 72 3 1 16 2 — 3 14 — 2 24 — 14 2 26 10 9 8 1 4 4 2 — 9 39 1 44 2 Overcrowding 26 1 3 3 5 11 3 8 1 — 14 18 — — 113 12 — — — — 19 3 — 14 12 — 17 1 Want of drainage of floors — 4 2 — 4 — — 3 — — 8 137 45 146 449 86 160 43 6 207 98 15 23 995 267 42 387 643 28 Other nuisances 1,491 196 78 690 41 11 149 559 5 23 112 4 2 1 31 9 — 1 3 — 6 6 8 19 18 3 16 34 9 Sanitary accommodation Insufficient 40 6 11 15 2 — 3 17 3 — 4 25 5 71 502 68 322 67 26 3 34 10 55 34 138 15 110 513 Unsuitable 2,736 62 9 102 28 — 63 285 4 12 94 — — 12 8 5 1 1 2 1 28 6 8 7 31 6 76 3 Not separate for sexes 86 — 6 4 — 3 — 9 2 -— 7 Offences under the Factory & Workshop Act. Illegal occupation of underground bakehouse (s. 101) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 98 8 — 14 — 20 — 26 33 _ 71 11 — — Breach of special sanitary requirements for bakehouses (ss. 97-100) — 25 2 — — 14 — - 5 10 - — — — — — — — — — 27 1 — — — — — — — Other offences (excluding offencos relating to outwork) - — - - - - - 80 - - - 396 99 318 1,638 407 654 279 50 713b 410 181 343 1,830 1,605 67 720 2,491 95 Total (defects found) 5,373 386 163 1,258 128 50 474 1,183 60 109 408 3. Homework. 56 142 130 368 122 37 68 144 130 132 34 98 150 258 52 132 658 56 Received twice in the year from employers Number of Lists 1,455 81 90 188 165 79 74 250 22 26 404 70 124 131 538 123 8 — — 100 168 18 79 __ 83 — — Outworkers. correspondin g thereto Contractors 2,899 65 12 — 80 232 18 37 2 18 — 38 92 258 637 3,262 616 682 201 656 2,685 1,750 120 1,525 1,294 3,925 339 376 8,859 770 Workmen 14,107 411 878 3,394 1,857 544 510 4,774 50 200 4,642 8 16 6 150 11 13 16 10 12 - 10 14 17 24 - 4 13 6 Received once in the year from employers Number of Lists 85 5 5 10 16 5 2 37 10 — 55 4 8 — — 1 — — — — — 37 11 — Outworkers. corresponding thereto Contractors 55 2 — — — 2 — 41 5 — — 16 25 23 519 31 48 42 20 71 — 50 193 98 172 ____ 10 93 20 Workmen 431 6 16 28 90 3 4 356 14 — 256 292 40 315 3,336 333 946 186 281 1,825 873 877 2,971 1,158 8,004 70 422 510 38 Number of addresses of outworkers received from other Councils 255 358 830 3,261 1,612 139 629 936 233 277 3,235 114 355 469 1,532 588 421 96 431 1,430 1,464 143 1,452 791 1,826 340 253 4,269 102 Number of addresses of outworkers forwarded to other Councils 17,083 209 334 1,640 676 571 310 4,989 27 70 2,408 - - - - - - - - - - - - - - 46 - - - Prosecutions Failing to keep lists or permit inspection thereof — — — — — — — — — — — - - - - 2 - - - - - - - - - - - - - Failing to send lists . — — — — — — — — — — 1 Outioorkers' Premises. 267 80 175 946 169 735 332 305 1,773 329 23 2,040 599 3,762 346 488 974 266 Number of inspections of outworkers premises 303 954 1,492 6,218 1,263 138 258 604 261 297 1.256 21 - - 76 3 - 15 - - - - 102 631 - 36 263 16 Outwork in unwhole some premises (s. 108) . i Instances 52 108 41 — — 1 5 25 — 21 - 70 3 15 — - 102 631 - 36 306 16 s i Notices served — 55 108 19 — — 1 5 25 — - - - - - - - - - ( Prosecutions.. — — — —r- — — — — — — - - 17 4 8 12 4 28 76 - 14 103 - Outwork in infecte premises (ss. 109, 110 Instances 2 3 5 T— — — - - - - - - - - - - - - - - - - - - d Orders made (s. 110) - - - - - - - - - - - - - - - - - - >) Prosecutions (ss, 109,110 — — — — — — — — — 4. Workshops. Workshops on the Register at the end of 1910. 60 35 30 242 95 214 94 61 93 78 133 71 107 175 24 136 86 58 Bakehouses (c) 21 80 90 90 1 'it', 33 69 60 70 60 112 198 7 9 114 169 168 63 109 19 43 74 26 50 26 95 153 48 19 Laundries 1 2,114 55 40) 65 24 9 22 56 21 94 533d 426 1,092 1,315 1,322 642d 444 895 390 2.482d 1,642 1,147 2,375d 3,251 1,418 2,889 140e Other workshops 465 653) 1,491 d 618 186 1,948( 351 177a 945 Total (number of workshops on the Register) 2,135 600 783 1,963 1,722a 675 264 2,030f 477 258 1,151 791 d 468 1,131 1,671 1,586 l,024<f 601 1,065 502 2,603<i 1,849 1,244 2,532d 3,452 219 1,707 3,022 217e 5. Other Matters. Matters notified to H.M. Inspector of Factories. - 25 22 127 54 35 21 49 33 20 - 3 7 83 12 59 105 2 Failure to affix abstract of the Factory and Workshop Act (s. 133) 128 64 25 17 8 10 52 3 93 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts but not under the Factory and Workshop Act (s. 5) ) Notified by H.M. Inspector 37 4 21 39 17 16 6 48 7 1 22 20 1 12 2 25 20 3 26 13 33 21 37 42 190 12 15 112 2 Reports (of action taken) sent to H.M. Inspector 37 - 21 39 6 16 6 48 7 1 20 20 1 12 2 21 20 3 25 13 24 21 10 16 146 - 15 112 - Other 7 — — — 3 30 45 — — — 6 12 - - 1 - - - 1 - - 1 3 44 1 - 12 - Underground Bakehouses (s. 101). Certificates granted during 1910 — — — — — — — — — — — - - - - - - - - - - - - - - - - - 1 In use at the end of 1910 22 31 33 27 66 28 25 36 49 17 50 33 22 21 98 76 72 20 54 29 78 160 42 40 49 19 46 71 16 I (d) Includes workplaces other than places where food is prepared. («) Includes workplaces, (o) Excluding inspections of restaurant kitchens, etc. (b) Includes defects in homeworkers' premises. (c) Including bakehouses not in use during the year. iv. Annual Report of the London County Council, 1910. Report of the Medical Officer of Health—Appendix 11- v. APPENDIX II. CASES OF HUMAN GLANDERS IN LONDON—1893-1911. Date (usually that of death). Initials and age. Employment and where employed. Institution where treated. Symptoms. Course of disease. How long it was recognised before death. Post mortem appearances. Whether bacillus mallei found. Evidence, if any, as to manner in which disease was contracted, and general remarks. 24.x.93 W.W., 46 Stables of L.R. Car Co.,Hammersmith West London Hospital Eruption on forehead, neck, arms and thighs. Illness only diagnosed two days before death Ulceration of nasal septum, larynx and trachea. Nodules in lungs. Pus in elbow joints. Intramuscular abscess Bitten in finger of right hand by a glandered horse. The post mortem showed a predominance of disease on right side of body. There had been a number of cases of glanders in the stables recently. 8.x.94 M.B.M., 43 Cab proprietor of Paddington v. "Times" of 8.x.94 Injury to thumb, followed by inflammation in armpit — Two of M.B.M.'s horses said to have died from glanders He was kicked on the thumb when attending to them. 18.vii.97 J.T.L, 35 Stables in New King's Road, Fulham Fulham Infirmary Headache, difficulty of breathing, swelling on forehead. Day before death glanders diagnosed Examination of pus from swelling on forehead made nature of disease apparent Had been in attendance on glandered horses. During July nine horses were condemned at the premises at which J.T.L. worked. 17.vi.98 T.B., 18 Costermonger, Bagley's-lane Fulham St. George's Hospital Abscess in head. Pustules on body. Fever. Nature of disease not recognised before death Diagnosis made on evidence found at the post mortem examination On May 9th two animals, which had been stabled with deceased's pony, were condemned as being glandered. The man's own pony showed no sign of disease. 6.viii.98 G.H., 32 Carman, Wandsworth St. Thomas' Hospital 111 three years. Breaking out on arms seven months. At close of illness pustules broke out over body Diagnosis only made after death. During life it was believed he had typhoid fever A horse in the stable at which he worked was condemned as being glandered on 6.viii.95. 21.iii.99 E.V.N., 25 Carman, Camden Town London Temperance Hospital Cold and congestion of lungs. Later a rash appeared Diagnosis only made after death In Norwich until February, attended a sick horse when there. No evidence of contact with glandered horses subsequent to arrival in London. 10.viii.00 W.M., 45 Cab proprietor, Fitzroy-mews 3uy's Hospital Swellings in arms and legs and high fever Subcutaneous swellings, furuncles, small abscess in forearm. Fluid in knee joint Glanders existed in W.M.'s stud of 54 horses at Fitzroymews at time of his death. Nine animals in all were killed. 11.x. 00 G.B., Carman, Rygatestreet, E. London Hospital At first supposed to have " influenza," and then to have typhoid fever Admitted to hospital with pyrexia and multiple abscesses. Death on third day. B. mallei found Pure growth of B. mallei obtained from pus from abscesses. Orchitis produced, by loopful of this growth, in guinea pig. See Cntlbl. fiir Bakt. Orig. Bd. xxxix. 1. Paper by Drs. Bulloch and Twort. (a)31.x.OO J.A., — Stable in Kensalroad At first supposed to have plague and then to have glanders The case proved to be one of scleroderma — 7.i.01 H.S., 25 Horsekeeper, Hackney Westminster Hospital Intramuscular abscesses in right arm and leg Typical cultures were obtained from the pus, and these inoculated into g.p.'s gave positive characteristic reactions The man was discharged well. The horses he had charge of were healthy. This is Case III. in Bernstein and Carling's paper (1909). 23.i.01 W.W.D., 38 Horsekeeper, Hammersmith Fulham Infirmary Pains and swellings in various parts of body. Diagnosed after death " chronic glanders " Lungs were saved for examination, but were too decomposed to be used No evidence of contact with glandered horses. 12.i.02 J.R. 47 Employed in stable at Norwood Croydon Infirmary Swelling on inside of leg and on head — The horse he had tended died on 23.xii.01 from glanders. 21.ii.02 G.C., Coachman Royal Chest Hospital Death was certified to be due to " pyaemia " 22.viii.02 R.N., 46 At coal merchants Bow Poplar Sick Asylum Admitted with " lumbago " 7th June discharged himself, re-admitted on 11th and died on 17 th August. Discharge from right nostril Lungs infiltrated. Lymphatic glands enlarged. Larynx and pharyns hsemorrhagic spots. B. mallei cul tivated No evidence that the horses he tended had glanders. 10.v.03 C.F., 34 Organ grinder, Pim lico St. George's Infirm ary " Influenza " and later sore on foreheac (three days before death) Nodules in lungs. Pus on surface o brain. Intramuscular abscesses Kept his organ in empty stable in mews. Several glandered horses removed from within a short distance and one from adjoining stable. 30.v.03 A.D., 31 Packer, Waltham stow London Hospital Chronic pyaemia, multiple abscesses .. Three other chronic cases are mentionec in Drs. Bulloch and Twort's paper as having been treated at London Hos pital between 1900 and 1903 A.F. had abscesses of thighs lasting foi months. F.R. (23) a carman, was il many months. Intramuscular ab scesses. Another carman sufferec similarly from chronic pyaemia B. mallei isolated from abscess. In oculation gave positive result, g.p. diet on third day The man was discharged well. See paper by Drs. Bulloch and Twort referred to above. In all three cases the bacillus mallei was isolated by Drs. Bulloch and Twort. 31.x.03 C.P., 55 Printer, Bethna Green Eastern Hospital.. Admitted as enteric fever. Intramus cular abscesses developed B. mallei was isolated ... No evidence of contact with glandered horses. See Vet. Record 2.ix.05. Paper by Dr. Goodall. 3.ii.04 H.B., 51 Tram conductor, Leytonstone London Hospital 111 three weeks, shivering and fever Pustules on arms, legs and forehead Erythematous rash. Death two days after admission Farcy nodules in skin. Acute glanders nodules diffused throughout the lungs B. mallei isolated See paper by Drs. Bulloch and Twort referred to above. No evidence of contact with glandered horses. 6.v.04 S.S., 30 Tram driver, Clapton Hackney Infirmary Intramuscular abscesses (thigh and chest wall) No nodules in lungs. No ulcerations oi trachea or of septum nasi No evidence of contact with glandered horses. Inquest verdict left nature of disease open to doubt. 25.viii.04 D.O'C., 28 Farrier, Shoreditch Shoreditch Infirmary Supposed to have septicaemia. Dr. Bryett suspected case was one of farcy B. mallei found Had been in contact with glandered horse seven or eight weeks prior to illness. 14.xi.04 H.A.L., 24 Horsekeeper, Great Ormond-yard : Westminster Hospital On 31.x.04 fell and bruised ribs. Two days later " alveolar abscess." Pustular eruption. Sores on mouth. Nasal discharge Diffuse browny dark purplish swelling oi face and neck. Pustular eruption. Multiple subcutaneous and intramuscular nodules. B. mallei found Stud of 130 horses was tested and 20 reacted to mallein and were slaughtered. This is Case I. in Bernstein and Carling's paper (1909). l.iii.05 W.H., 33 Ostler, Limehouse Eastern Hospital Thought to have enteric fever. Swelling knee joint and forearm B. mallei isolated ... ... Patient recovered. Last case of glanders reported from stables 15.iii.04. 16.v.05 G.C.N., 52 Horsekeeper, Fulham St. George's Hospital Believed to be pleurisy, then rheumatic fever, then septicaemia. Pustules developed. Glanders diagnosed day before death B. mallei found in pus Bitten by a horse on hand in January, '05. Stud was badly glandered. 3.vi.05 E.A.C., (femal 44 3) Wife of carman, Fulham St. George's Hospital Three weeks' pain in knee and side. Pyrexia. Indurated patches and vesicles on skin B. mallei isolated. No nodules in lungs " Passionately fond of horses." One of her husband's horses was glandered. She lived in mews. ll.viii.05 A. A., 45 Horsekeeper, Lambeth Westminster Hospital Seven weeks' headache, muscular pains. Two weeks' swellings in left leg and forearm Intramuscular abscesses. B. mallei found. Dark haemorrhagic firm areas in lungs No clear evidence of contact with glandered horses. This is Case II. in Bernstein and Carling's paper (1909). See also Lond. Vet. Record 19.viii.05. 19.viii.05 A.B., 22 Carman Westminster Hospital First seen May, 1904. Then ill nine months. Erosion of oral and nasa pharynx. Mercury and iodides prescribed Lower jaw extensively necrosed, centra] portion of tongue sloughed. B. mallei found. Lungs clear Mallein reaction obtained January, '05. Death in Lambeth Infirmary. This is Case V. in Bernstein and Carling's paper (1909). (a) Indicates a case in which glanders was mspected t ut in which this diagnosis was not confirmed. vi. Annual Report of the London County Council, 1910. Report of the Medical Ofjieer of Health-Appendix 11. vii. Date (usually that of death). Initials and age. Employment and where employed. Institution where treated. Symptoms. Course of disease. How long it was recognised before death. Post mortem appearances. Whether bacillus mallei found. Evidence, if any, as to manner in which disease was contracted, and general remarks. 30.viii.05 A.T., 21 Carman, Stepney.. London Hospital.. " Septic pneumonia." Pustule above knee cap B. mallei found Several cases of glanders in stud of horses among which A.T. worked. 8.viii.05 G.C., 4o Farrier, Camberwell St. Thomas' Hos pital Blood poisoning." Hemorrhagic spots on legs. Wound on right arm Ulceration of hard palate and lower lip B. mallei not isolated Glanders had been present in stud of horses at place where he was employed. —.iv.06 S.G, 38 Horsekeeper, Isling ton — " Pyaemia and delirium " P.M. tuberculosis of lungs. B. mallei not found A few weeks before illness began a horse "coughed over him" —.ii.07 —.J. - Horse 'bus driver.. Seamen's hospital Boils on neck November, '06. Swelling increased and spread to chest. Large ulcer formed B. mallei found No evidence of glanders in horses among which this man worked. This is Case VI. in Bernstein and Carling's paper (1909). l.iv.07 T.T., 57 Cabdriver, South wark Southwark Infirm- arv Admitted 28th March, died 1st April .. B. mallei found A horse with clinical glanders found among those tended by T.T. Also two " reactors." 13.viii.07 F.B., — Window cleaner Southwark tXLy Southwark Infirm ary " Pyemia." Effusion right knee joint Nodules on skin and in nose B. mallei found Deceased had lodged with a carman. No contact with glandered horses was, however, proved. 8.ix.07 C.A.B., 24 Greengrocer, Wands worth Bolingbroke Hospital B. mallei found. No nodules in lungs A glandered horse found in stable at rear of deceased's dwelling. 7.ii.08 E.J.S., 40 Horsedealer, South wark Guy's Hospital .. At first thought to have " influenza,' then pneumonia, then typhoid fever Pustular rash. Diagnosed day before death B. mallei found Purchased worn-out horses for shipment abroad. 22.viii.08 H.W.C., 32 Horsekeeper, Fins bury St. Bartholomew's Hospital Pain in shoulder. Sores and intra muscular abscesses developed. Diag B. mallei found 75 horses at stable premises concerned were tested. 11 reacted and were slaughtered. 14.ix.08 P.O., 28 Master carman Southwark Guy's Hospital .. nosis made two days before death Abscess in shoulder. " Blood poison ing " Ill at time of death of H. W.C. (v. above) Lesion found post mortem in larynx. Intramuscular abscesses. One horse which he had driven was found to be glandered. 16.ix.08 D.L., 29 Horsekeeper, St. Pancras St. Bartholomew's Hospital Entered hospital and disease at once ; diagnosed B. mallei found 75 horses tested. (See above.) 11 reacted and were slaughtered. Worked in same stable as H.W.C. 2.xi.08 R.S.C., - Wandsworth Guy's Hospital .. 111 six weeks "influenza" rheumatic fever," than " septicaemia " B. mallei found No evidence to show this man had been in any way associated with horses. 19.xi.08 H.S., 59 Formerly a coach man, Marylebone Marylebone Infirmary Three weeks diarrhoea and sore on right elbow. Pnatnln.r rn.oh foAD B. mallei it was believed was found after death Lived in rooms over an empty stable. No evidence of contact with glandered horses. (a)10.xii.08 E.R.. 29 This case was believ ed at one time to be a case of glanders, but it later became (female) clear that it was not an instance of that B. mallei found disease, v. Ann. Rep. 1908, of Dr. Parkes, Chelsea. 2.iii.09 C.E.D., 41 Horsekeeper, Dulwich St. Thomas' Hospital Fainting fit and sickness 10th February. On 27th swelling right knee, and on leg (ankle) and forpihpaH Extensive disease among horses in stud at premises where C.E.D. was employed. (a) 7.iv.09 h.p., 36 This case was notifi ed in error in Isling ton. (a)15.iv.09. A case of sus pected glanders sent to Eastern Hospital. Dr. Goodall diagnosed erythema multiforme. (a) 9.ix.09 H.D., Case notified in Pop lar. The malady proved to be Impetigo contagiosum. -.vii.09 J.P., — Carman, Kensington University College, Golden-square On 8.viii.08 to University College as outpatient with sore throat In June, 1909, to Golden-square Hospital. Case notified to Medical Officer of Health of Kensington in July, 1909. Death recorded in " Return," 10.x.09. On 5.xi.09 case exhibited at Laryng. Soc. v. Trans. Roy. Soc. of Med. Extensive ulceration tonsils and fauces. In December, '08, case was shown at Laryng. Soc.; then thought to be refractory syphilitic ulceration. B. mallei found This case resembled that of A.B. Case V. in Bernstein and Carling's paper, v. supra. A full account of the case is given by Messrs. Addison and Hett, " Lancet," 23.x.09. The man was believed to have been in contact with a glandered horse. 14 x 09 J.H. W., 29 Member of staff of inoculation department St. Mary's Hospital Case notified as glanders to Paddington 9.v.09. Illness contracted in 1906. Glanders diagnosed and vaccine treatment adopted Intramuscular abscesses. About a fortnight before death,infection generalised B. mallei found An obituary notice appeared in "British Medical Journal," 30.x.09. (a)10.xi.09 - ... Golf professional... St. Bartholomew's Hospital That of Carman (next but one supra) Case in which question arose as to a diagnosis of glanders. Man in St. Bartholomew's Hospital. B. mallei eould not be isolated, and a mallein — The patient had punched out ulcers on his fauces. It was held that the case was not one of glanders. (a)10.xi.09 -.G., ... Inspector of exported horses — reaction proved negative A suspicion of glanders was entertained because there was a history of being — The case was one of acute eczema following injury to left shin. (a)15.iii,10 C.M., 62 Stableman until November, 1909 Chelsea West London Hospital "sneezed" over by a horse Admitted to St. George's Workhouse 18.xii.09. Transferred to infirmary 3-ii. 10. Furuncular rash on face 28.ii. — Case treated in West London Hospital. Mallein reaction negative. The man had been taking iodide of potassium prior to appearance of rash. † Indicates a case in which glanders was suspected but in which this diagnosis was not confirmed. viii. APPENDIX III. SUMMARY OF DEFECTS IN CHILDREN AS FOUND BY SCHOOL DOCTORS. Vision. Cleanliness. Clothing. Nutrition. Teeth. Throat and Nose. Hearing and ears. Skin. Normal children. Other defects. Scheme A. (140 Schools). Defective Vision. Disease of eyes. 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 Adenoids. Tonsils. Disease of nose. Other defects. Deaf. Discharging. Other defects. Ringworm. Other disease. 1 2 3 4 5 6 7 8 9 10 l1 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 Boys' departments 3843 555 5177 10894 8960 2772 516 3504 10060 10929 3327 499 3661 9345 12094 3054 165 4773 11067 7242 3928 1309 1968 3019 398 187 1161 636 213 81 400 15478 3159 Girl?' departments 3904 601 6760 8811 8080 3252 543 5248 9373 10553 2073 199 4455 9183 11057 2596 155 5272 10768 6911 3435 1060 1834 3259 233 212 1078 649 78 59 438 15789 3214 Infants' departments 667 894 6555 11142 10376 3246 549 4507 10934 13487 2669 271 4255 11605 13075 2754 179 9184 10508 7007 3662 1507 2325 3208 371 170 997 830 81 142 533 18875 3203 Mixed departments 975 125 2144 3840 2693 850 146 886 4341 3667 691 88 1008 4011 3831 793 30 1362 3965 2812 1182 352 361 980 66 49 200 169 12 15 120 4155 486 Total (140 schools) 9389 2175 20636 34687 30109 10120 1754 14145 34708 38636 8760 1057 13379 34144 40057 9197 529 20591 36308 23972 12207 4228 6488 10466 1068 618 3436 2284 384 297 1491 54297 10062 Scheme B. (123 Schools). Boys' departments 1312 274 1738 4192 3851 1498 244 1187 3966 4825 1391 154 1303 3972 4893 1303 52 2333 4565 2677 1448 500 886 1332 182 136 352 263 70 44 230 5616 1003 Girls' departments 1228 230 1724 3460 2846 1473 240 1252 3438 4038 916 99 1214 3471 3919 1088 51 2232 3934 2125 1125 327 686 1278 71 40 301 290 61 27 180 3693 840 Infants' departments 28 44 112 175 144 33 10 95 132 190 48 9 39 156 205 64 10 150 171 90 42 21 96 106 12 15 29 44 1 2 29 499 102 Mixed departments 170 44 793 586 228 57 18 600 750 256 74 5 583 659 364 78 1 419 582 395 195 93 122 144 18 1 30 50 7 6 23 1227 102 Total (123 schools) 2738 592 4367 8416 7069 3061 512 3134 828( 9309 242E 267 3139 8258 9381 2533 114 5134 9252 5287 2810 941 1790 2860 283 192 712 647 136 79 462 11025 2047 Annual Report of the London County Council, 1910. Appendix III. ix SUMMARY OF DEFECTS IN CHILDREN AS FOUND BY SCHOOL DOCTORS—continued. Scheme C. (130 Schools). Vision. Cleanliness. Clothing. Nutrition. Teeth. Throat and nose. Hearing and ears. Skin. Normal children. Other defects.[\###] Defective vision. Disease of eyes. 1 2 3 4 5 1 2 3 4 0 1 2 3 4 0 1 o 3 4 5 Adenoids. Tonsils. Disease of nose. Other defects. Deaf. Discharging. Other defects. Ringworm. Other disease. 1 2 3 4 5 6 7 8 9 10 n la la 14 15 46 17 18 )9 20 21 22 2a 24 25 26 27 28 29 30 31 32 33 34 Boys' departments 1335 304 2384 4577 4003 907 122 1511 3966 5090 1314 112 1370 3864 5174 1536 49 2475 4498 3055 1404 561 920 1272 173 79 399 325 40 30 201 6037 1199 Girls' departments 1348 281 2522 3970 3330 1030 148 1668 4074 4414 782 62 1412 3833 4656 1066 33 2346 4557 2554 1153 390 723 1176 98 97 354 319 36 29 140 6541 1024 Inf ants'departments 215 334 693 1019 1221 360 73 419 1086 1417 392 52 396 1062 1413 464 31 1041 1164 704 313 144 522 642 104 28 126 195 17 11 142 2091 702 Mixed departments 162 50 610 692 539 106 16 398 800 663 99 3 269 803 770 113 8 283 829 574 223 54 103 189 18 18 36 41 9 7 24 1150 262 Total (130 schools) 3060 969 6209 10258 9093 2403 359 3996 9926 11584 2587 229 3447 9562 12013 3179 121 6145 11048 6887 3093 1149 2268 3279 393 222 915 880 102 77 507 15819 3187 Grand Total 393 schools 15187 3736 31212 53361 46271 15584 2625 |2127£ 52920 59529 13776 1553 19965 51964 61451 14909 764 31870 56609 36146 18110 6318 10546 16605 1744 1032 5063 3811 625 453 2460 81151 15296 x. Annual Report of the London County Council, 1910. APPENDIX IV. COMPARISON OF METHODS OF ADMINISTRATION OF MEDICAL INSPECTION. (i) All children in attendance at schools. Entrants, children aged 8-9, 12-13, and cases presented by teachers only. A 140 schools. B 123 schools. C 130 schools. (2) (3) (4) Number of departments 382 374 385 Number on rolls— Boys 37,584 44,405 44,438 Girls 34,878 43,009 44,364 Infants 36,346 44,927 43,241 Total 108,808 132,341 132,043 Number examined— Boys, Girls, Infants, 34,808 33,055 32,844 Children aged 12-13— Boys ... ... ... 5,835 5,009 Girls ... ... ... 4,876 5,431 Total ... ... ... 10,711 10,446 Children aged 8-9— Boys ... ... ... 6,551 6,436 Girls ... ... ... 5,081 5,146 Total ... ... ... 11,632 11,582 Entrants— Infants ("Inspected ... ... ... 5,108 11,806 \ Examined in detail ... ... ... 1,655 3,160 Total ... ... ... 6,763 14,966 Presented bv teachers— Boys 576 1,229 Girls 906 1,299 Infants 340 1,462 Total 1,822 3,990 Totals examined 100,707 30,928 40,984 Number of parents invited 91,768 23,112 25,187 Do. who attended 53,406 15,289 16,054 Percentage attending 58.2% 66% 63.7% Advice cards issued— Boys 13,167 4,348 4,552 Girls 12,226 3,743 4,152 Infants 8,049 883 1,834 Total 33,442 8,974 10,538 Percentage of those examined 33.2% 29% 25.7% Percentage of those examined in detail 33.2% 34.7% 36.1% Number of doctors' visits 4,782 1,224.5 1,353.25 Number examined at each visit 21 25.2 30.2 Hours given by doctors 10.385.25 3,135 3,143.5 Do. nurses 12.588.25 3,898.8 4,056.0 Do. teachers 10.793.75 3,223.2 3,504 Average time per child— Doctor b min., 11 sec. 6 min., o sec. 4 min., od sec. Nurse 7 min., 29 sec. 7 min., 30 sec. 5 min., 56 sec. Teacher 6 min., 25 sec. 6 min., 15 sec. 5 min., 7 sec. Time spent on each child by doctor, nurse and teacher 20 min., 5 sec. 19 -rain., 50 sec. 15 min., 39 sec. Appendix V. xi. APPENDIX V. FORM M.O. 190. Defect. Number of children examined. Boys. Girls. Infants. Urgent Cases. Rbmarks. (State age of urgent cases.) 8—9 12-13 8—9 12—13 Boys. Girls. Boys. Girls. Infants. Cleanliness 1. Good 2. Average 3. Bad Clothing 1. Good 2. Average 3. Bad Nutrition 1. Good 2. Average 3. Bad Teeth 1. Good 2. Average 3. Bad Vision— Defeotive vision and squint Disease of the eyes Throat and Nose— Adenoids Tonsils Disease of nose Other defects Hearing and Ears- Deaf Discharging Other defects Speach — Stammering and stuttering Other defects Heart Valvular lesion Other defects Limes— Phthisis Other defects Skin- Ringworm Other defects Glands Rickets Deformities Nervous complaints Ansemia Tuberculosis other than chest Sundries Normal children xii Annual Report of the London County Council, 1910. APPENDIX VI. GENERAL REPORTS ON 356 SCHOOL BUILDINGS WHERE MEDICAL INSPECTION WAS CARRIED OUT IN THE YEAR 1910. Departments. Sanitation. Lighting. Heating. Ventilation. Furniture. Artificial. Natural. (1) Good. (2) Fair. (3) Bad. (4) Good (5) Fair. (6) Bad. (7) Good. (8) Fair. (9) Bad. (10) Good, (11) Fair. (12) Bad. (13) Good. (14) Fair. (15) Bad. (16) Good. (17) Fair. (18) Bad. (19) 308 Boys' departments 278 21 9 286 16 6 241 61 6 269 38 1 257 48 3 265 41 2 310 Girls „ 277 24 9 291 15 4 235 74 1 266 43 1 255 53 2 264 44 2 340 Infants „ 298 33 9 315 20 5 258 76 6 302 34 4 284 53 3 287 51 2 61 Mixed „ 53 7 1 60 1 — 51 10 — 53 7 1 53 8 — 52 9 — 1,019 906 85 28 952 52 15 785 221 13 890 122 7 849 162 8 868 145 6 Appendix VII. xiii APPENDIX VII. NUMBER OF CANDIDATES EXAMINED FOR THE PERMANENT SERVICE AND THE CONDITIONS FOUND. • Status. No. Examined. No. of Examinations. Fit. Vaccination. Referred Back. Withdrawn prior to ex ami nation or not j et reported. Not vaccinated. No marks. Want of cleanliness. Teeth. Vision. Heart. Vaccination. Sundry. For one defect. For two or more defects. Total. Rejected. i 2 3 4 5 8 7 8 9 10 11 12 13 14 15 16 17 Head and assistant teachers and instructors m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. M. f. m. f. m. f. m. f. m. f. 245 484 327a 607a 227a 479a 2 1 — 1 — 3 75 80 29 54 1 1 2 1 4 5 87 110 12 17 99 127 ... 27 15 Nurses, matrons, etc. — 11 — 14 — 7 ... ... — 0 - 2 ... ... ... — 3 — 2 — 5 — 1 (vision and hearing) — 3 Schoolkeepers, caretakers, etc. 44 — 48 — 37 — ... ... 6 — 1 — ... ... 2 — 9 — 9 — 1 (heart 6 — Total 289 495 375a 621a 264 a 486b 2 1 — 1 — 3 81 85 30 56 1 1 2 1 6 5 96 113 12 19 108 132 1 1 33 18 (a) In the case of 9 males and 10 females the figures for the first examination were included in the report for the 12 months ended 31st December, 1900. xiv. Annual Report of the London County Council, 1910. APPENDIX VIII NUMBER OF COUNTY SCHOLARSHIP CANDIDATES EXAMINED AND THE CONDITIONS FOUND. Scholarships. Number examined. Number of examinations. Fit. Vaccination. Referred back. Rejected. Withdrawn before re-examination or not yet reported. Not vaccinated. No marks. Want of cleanliness. Throat. Teeth. Vision. Heart. Sundry. For one defect. For two or more defects. Total. 1 2 3 4 5 6 7 8 9 10 l1 12 13 14 15 18 19 M. f. m. f. M. f. M. f. M. f. m. f. M. F M. f. M. f m. f. M. f. M. f. M. f. M. f. m. f. M. f. Junior County 864 835 1,219 1,328 857 797 108 116 30 34 26 250 27 50 218 258 127 85 1 2 27 30 289 319 66 (5 for 3) 165 (26 for 3) 355 48) 4 34 3 4 Supplementary Junior County 136 140 196 228 133 137 10 8 ... 1 ... 29 5 16 43 52 20 22 ... ... 5 7 45 49 14 34 (7 for 3 and 1 for 4) 59 83 ••. 1 3 2 Intermediate County 102 95 152 112 102 95 1 ... ... 1 1 2 ... ... 32 9 21 6 ... ... 3 ... 39 15 9 1 48 16 ... ... ... ... Senior County 43 19 52 22 42 19 ... ... ... ... ... ... ... ... 4 1 6 2 ... .... 1 ... 9 3 1 ... 10 3 ... ... 1 ... Totals 1,145 1,089 1,619 1,690 1,134 1,048 119 124 30 36 27 281 32 66 297 320 174 115 1 2 36 37 382 386 90 (5 for 3) 200 (33 for 3 and 1 for 4) 472 586 4 35 7 6 Appendix IX. xv. APPENDIX IX. NUMBER OF TRADE SCHOLARSHIP CANDIDATES EXAMINED AND THE CONDITIONS FOUND. Designation of scholarship. Number examined. Number of examinations. Fit. Vaccination. Referred hack. Rejected Withdrawn prior to re-examination or not yet reported. Not vaccinated. No marks. Want of cleanliness. Throat. Teeth. Vision. Heart. Sundry. For one defect. For two or more defects. Total. 1 2 3 4 5 6 7 8 9 10 l1 12 13 14 15 16 17 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Artificers, Boy 15 ... 15 ... 10 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 ... ... Beaufoy Institute 21 ... 31 ... 18 ... 1 ... 1 ... 2 ... ... ... 9 ... 4 ... ... ... ... ... 9 ... 3 ... 12 ... 2 ... 1 ... Borough Polytechnic 20 ... 28 ... 18 ... 1 ... l ... 1 ... ... ... 5 ... 4 ... ... ... ... ... 8 ... 1 ... 9 ... 1 ... 1 ... Book production 10 ... 17 ... 9 ... l ... .... ... ... ... 1 ... 6 2 ... ... ... ... ... 3 ... 3 ... 6 ... 1 ... ... ... Building and allied trades 25 ... 37 ... 24 ... l ... ... ... 1 ... 1 ... 8 ... 2 ... ... ... 1 ... 10 ... 1 (for 3) ... 11 ... ... ... 1 ... Cookery 8 ... 8 ... 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... Corset-making ... 9 ... 13 ... 9 ... 1 ... ... ... 1 ... 1 ... 3 ... ... ... ... ... ... ... 3 ... 1 ... 4 ... ... ... ... Dressmaking trade ... 66 ... 96 ... 65 ... 2 ... 1 ... 11 ... ... ... 19 ... 6 ... ... ... ... ... 24 ... 6 ... 30 ... ... 1 Engineering 40 ... 59 ... 39 ... 4 ... 7 ... 7 ... ... ... 14 ... 4 ... ... ... 1 ... 13 ... 6 (1 for 3) ... 19 ... ... ... 1 ... Furniture and cabinet making 20 ... 28 ... 18 ... 1 ... 1 ... ... ... 1 ... 8 ... 1 ... ... ... 1 ... 7 ... 2 ... 9 ... ... ... 2 ... Laundry work ... ... 9 ... 11 ... 8 ... 1 ... 2 ... 5 ... ... ... 4 ... ... ... ... ... ... ... 5 ... 2 ... 7 ... 1 ... ... Mercantile marine 7 ... 7 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... Millinery ... 21 ... 34 ... 20 ... 3 ... 1 ... 3 ... ... ... 6 ... 3 ... ... ... 2 ... 12 ... 1 ... 13 ... ... ... 1 Photography ... 12 ... 21 ... 11 ... 1 ... ... ... 1 ... ... ... 6 ... 1 ... 1 ... 1 ... 6 ... 2 ... 8 ... 1 ... ... Ee ady - made clothing, designing and making of ... 17 ... 23 ... 17 ... 5 ... ... ... 3 ... ... ... 2 ... 1 ... ... ... ... ... 4 ... 1 ... 5 ... ... ... ... Shoreditch Technical Institute 4 ... 4 ... 3 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... 1 ... Silversmithing 6 ... 8 ... 6 ... ... ... ... ... ... • .. ... ... 2 ... ... ... ... ... ... ... 2 ... ... 2 ... ... ... ... ... Tailoring, ladies' ... 28 ... 48 ... 28 ... 1 ... ... ... 8 ... 1 ... 13 ... 5 ... ... ... 3 ... 11 ... (1 for 3) 9 20 . . . ... ... ... Upholstery ... 31 ... 45 ... 30 ... 5 ... ... ... 10 ... 1 ... 6 ... 6 ... ... 3 ... 6 ... (1for 4) 9 ... 15 1 Waistcoat making ... 6 ... 11 ... 6 ... 1 ... ... ... 2 ... ... ... 2 ... 1 ... ... ... ... ... 3 ... 1 ... 4 ... ... ... ... Woodcarving 6 ... 6 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... Totals 182 199 248 302 160 194 9 20 10 4 11 44 3 3 53 61 17 23 ... 1 3 9 53 74 16 (2 for 3) 32 (1 for 4} 0 for 3) 69 106 15 2 7 3 xvi. Annual Report of the London County Council, 1910. APPENDIX X. NUMBER OF SPECIAL SCHOLARSHIP CANDIDATES EXAMINED AND THE CONDITIONS FOUND. Designation of scholarship. Number examined. Number of examinations. Fit. Vaccination. Referred back. Rejected. Withdrawn prior to re-examination or not yet reported. Not vacciuated. No marks. Want of cleanliness. Throat. Teeth. Vision. Heart. Sundry. For one defect. For two or more defects. Total, l 2 3 4 5 6 7 8 9 10 ll 12 13 14 16 18 17 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Art 24 13 34 18 24 13 ... ... ... ... ... ... ... ... 9 2 1 4 ... ... ... ... 10 4 ... 1 10 5 ... ... ... ... Blind 0 2 5 2 5 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cripple 11 6 11 6 11 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaf 2 5 2 2 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Domestic economy, Junr. ... 460 805 ... 413 ... 27 ... 10 ... 182 ... 38 ... 195 ... 64 ... 2 ... 32 ... 161 ... 158 (3 for 4) ... 319 ... 30 ... 18 George Green's Foundation 4 2 t 2 4 1 2 1 ... 1 2 ... 1 ... 1 ... ... ... ... ... 1 ... ... ... (30 for 3) 2 (1 for 3) 2 ... ... 1 ... ... Midwifery ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Science 10 ... 12 10 ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... 1 ... 1 ... 2 ... ... ... ... Trust Fund 8 3 16 4 8 3 ... ... ... ... ... 2 ... 4 1 2 ... ... ... 1 ... 5 1 2 ... 7 1 ... ... ... ... Totals 64 498 87 843 64 444 2 28 11 2 182 3 38 16 198 4 68 ... 2 2 32 16 166 5 (1 for 3) 159 (3 for 4) (30 for 3) 21 325 ... 36 ... 18 Appendix XI. xvii. • APPENDIX XI- NUMBER OF CANDIDATES EXAMINED FOR THE TEACHING. PROFESSION AND THE CONDITIONS FOUND. Awards. Number examined. Number of examinations. Fit. Vaccination. Referred back. Rejected. Withdrawn prior to re-examination or not yet reported. Not vaccinated. No. marks. Want of cleanliness. Throat. Teeth. Vision. Vaccination. Suudry. For one defect. For two or more defects. Total. 1 2 3 4 6 6 7 8 9 10 11 12 13 14 15 16 17 Bursars m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. M. f. m. f. m. f. m. f. m. f. m. f. m f. m. f. 65 353 86 501 64 341 3 10 ... ... 1 33 1 6 81 12 47 3 10 ... 7 18 118 2 29 (3 for 3) 20 147 1 8 ... 4 Domestic economy training ... 7 ... 9 ... 7 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 ... ... ... 2 ... ... ... ... Pupil teachers 63 207 76 271 62 201 1 5 ... ... 1 7 1 1 6 39 8 19 1 2 ... 11 10 45 3 (1 for 3) 16 (2 for 3) 13 61 ... 3 1 3 Pupil teachers, art 5 3 6 3 5 3 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... Pupil teachers, handicraft 10 ... 12 ... 9 ... ... ... ... ... ... ... ... ... 3 ... 1 ... ... ... ... ... 2 ... 1 ... 3 ... ... 1 ... Student teachers 145 454 179 552 145 444 1 10 ... 1 1 11 ... 5 21 42 12 30 ... 4 1 11 33 85 1 9 34 94 ... 7 ... 3 Training college students 277 744 356 926 251 721 7 11 ... 1 1 30 1 1 84 131 23 42 5 6 5 10 85 160 17 29 (2 for 2) 102 189 1 10 25 13 Totals 565 1,768 715 2,262 536 1,717 12 36 ... 2 4 81 2 8 121 294 56 139 9 22 6 39 149 410 24 (1 for 3) 83 (7 for 3, 173 493 2 28 27 23 xviii Annual Report of the London County Council, 1910. APPENDIX XII. TRAINING COLLEGES, PUPIL TEACHER CENTRES, SECONDARY AND TRADE SCHOOLS—DEFECTS NOTED ON MEDICAL EXAMINATION. Institutions. Number of Pupils. Defects. Boll. Returns analysed. Two or moie defective teeth Vision. Throat and Nose. Ears. Heart. Lungs. Anfemia. Nutrition. Cleanliness. Back. General physique. Defective Suitable glassed Unsuitable glasses. Strain. Hearing. Discharge. Round. Curvature. (1) (2) (3 (0 (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (1 9) Training Colleges. Avery-hill 305 100 2 1 18 2 1 - - - 1 - 5 1 1 3 - 1 Clapham 229 100 - - 18 - 5 - - 2 2 - 3 1 - 1 1 Fulham 179 87 11 4 15 1 - - - - - - 14 9 1 14 6 — Graystoke-place 146 89 6 - 14 6 2 - - - - - 19 2 - 10 1 — Islington 32 32 2 _ 9 2 - - - - - - 5 - - - 2 — London Day 157 100 6 5 19 - - 1 - - 3 - 10 - 1 10 2 Moorfields 167 100 12 9 15 2 — 2 — — 1 — 8 2 1 10 12 2 Pupil Teacher Centres. Mile End 155 131 7 19 13 4 — 1 — — — — 7 1 5 11 6 1 Woolwich 103 103 7 6 19 1 1 — — — 1 — 6 — 1 5 6 — Secondary School's. cermonusey 154 100 13 4 8 4 — 2 — — '2 — 11 7 4 24 8 — Brockley 138 100 5 4 1 - 1 - — — 2 — — - — — 2 — Chelsea 222 100 10 - 18 1 1 2 — — — — 5 — 2 8 2 — Clapham 505 100 9 3 20 1 1 — 1 1 — — 3 — 3 7 1 — Dalston 252 100 9 6 10 2 - 10 1 - 7 1 3 8 3 14 11 7 Eltham .. 181 97 6 1 12 1 1 5 1 1 3 - 3 2 2 6 4 - Forest-hill 123 100 2 2 18 2 1 2 — — 3 — 5 2 1 6 3 — Fulham 305 100 23 9 7 9 8 - - - - - 9 7 3 49 9 — George Green's 259 200 64 26 1 10 6 10 2 - 2 - 25 9 17 9 1 - Hackney 262 100 7 7 17 2 - 4 - - 1 - 3 5 31 12 13 8 Hackney Downs 452 150 32 3 11 5 — 7 — — 2 4 — 6 5 — — — Holloway 195 100 11 6 - 1 1 3 — — 3 — - 1 2 - 3 — Kentish Town 218 100 17 20 7 2 2 10 - - 2 - 12 8 5 19 16 8 Paddington 286 173 18 12 9 2 4 - 4 - 2 - 16 5 3 19 4 1 Peckham 218 100 18 3 3 6 6 4 2 - 1 - 20 9 - 13 4 - Putney 291 100 12 6 14 3 5 2 3 1 3 - 2 2 3 5 1 St. Marylebone Grammar School 108 100 20 3 8 3 — 1 1 — 1 2 1 2 5 2 3 — St. Pancras 116 100 13 9 15 - 1 10 - 1 - - 13 4 13 11 11 11 Stockwell 233 100 11 1 23 1 3 1 - - 1 - 3 3 1 8 2 1 Sydenham 148 100 6 6 16 2 3 2 2 1 — 1 9 1 1 6 1 1 Trade Schools. Beaufoy Institute 68 67 14 5 4 — 1 - - - - - 1 4 5 — — 1 Central School of Arts and Crafts 55 40 7 — 4 — — 1 1 — — — — — 3 — — — Himmersmith School of Arts and Crafts 167 95 3 2 28 2 4 1 1 — 2 — 1 - — 6 — — Norwood 30 '29 4 — 7 - - 2 — — 1 — 4 6 10 2 — Paddington 139 117 21 14 10 1 12 4 - - 8 5 2 14 10 Queen-square, Bloomsbury 158 100 16 6 11 3 2 3 — 1 2 — 11 2 2 20 8 School of Building 93 93 11 6 - 1 - 3 - 2 3 1 - - - - 1 1 School of Engineering 78 75 8 11 5 1 2 3 - - 2 - - - - - 2 - Shoreditch 238 196 45 6 7 7 - 5 5 3 4 — 6 5 17 4 5 5 Ann udi.c XIII. xi.f. APPENDIX XIII. RESULTS OF INQUIRIES INTO THE HISTORY OF 5,093 CHILDREN UNDER MEDICAL TREATMENT. Defect of No treatment obtained at time of revision. Stated to have been advised that no treatment needed. Treatment completed. Result satisfactory. Still under treatment. Treatment received, but symptoms recurred or not alleviated. Glasses fail to correct vision. Treatment received—no more can be done. Treatment incomplete, as children did not return. Still needed. Glasses prescribed but not yet obtained. Homo and other treatment not under medical supervision. Left or absent, but listory that treatment had been obtained. Left or absent—no history of treatment. Treatment still needed Treatment not nowneeded. Symptoms unrelieved, treatment still needed. Symptoms alleviated. Treatment no longer needed. Treatment still necessary. (1) Not commenced. Said to have been refused treatment Absent. History of no treatment. (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) Eyes and vision 494 16 39 36 19 18 592 117 23 39 8 33 120 14 2 89 167 Throat and nose 739 21 42 40 51 22 600 135 78 — 2 30 — — — 43 183 Ears 150 — 8 19 2 — 119 77 20 — 2 20 36 14 8 36 Teeth 516 3 12 8 — 137 22 11 — — 14 — — — 3 27 Skin 14 — 4 11 — — 44 14 1 — — 1 — 6 2 6 9 Miscellaneous affections 80 3 20 3 —• 63 130 4 — 9 — 3 4 4 62 3(a) Totals .. 1,993 37 99 138 83 40 1,555 495 137 39 12 107 120 59 22 153 487 (a) Died. xx Annual Report of the London County Council, 1910. APPENDIX XIV. HOUSING ACCOUNTS. Dr A.—HOUSING OF THE WORKING CLASSES ACT, 1890. Cr Expenditure. Income. I.—Revenue Account. PART I. PART I. Working Expenses and Dent Charges— £ 8. d. Income— £. s. d. Boundary-street Estate (Betlinal Green and Shoreditch)— Boundary-street Estate (Bethnal Green and Shoreditch)— Tenements (including laundry) £21,280 2 2 Tenements (including laundry) £22,581 18 - Automatic gas supply 2.619 18 11 Automatic gas supply 3,089 5 4 _ 23,900 1 1 25,671 6 4 Cable-street Dwellings (Stepney) 2,699 7 4 Cable-street Dwellings (Stepney) 2,911 — 6 Shelton-street Dwellings (Holborn) 1,440 15 1 .Shelton-street Dwellings (Holborn) 1,506 8 6 Millbank Estate (Westminster)—Proportion 5 291 11 10 Millbank Estate (Westminster)—Proportion 6,519 10 1 Churchway Dwellings (St. Pancras) 3,198 14 1 Churchway Dwellings (St. Pancras) 3,843 15 6 Hardy Cottages, Trafalgar-road (Greenwich) 841 10 - Hardy Cottages, Trafalgar-road (Greenwich) 761 4 10 Duke's-court Dwellings (Westminster)—Proportion 1,513 10 — Dukes-court Dwellings (Westminster)—Proportion 1,798 1 9 York-street (late Russell-court) Dwellings (Westminster)—Proportion 989 12 1 York-street (late Russell-cou rt) Dwellings (Westminster)—Proportion 1,122 3 9 Preston's-road Estate (Poplar)—Proportion 819 19 3 Preston's-road Estate (Poplar)—Proportion 551 19 3 St. Luke's Dwellings (Finsbury)— St.Luke's Dwellings(Finsbury) Wenlake Buildings 1,676 17 1 Wenlake Buildings 1,891 11 - Chadworth Buildings 2,876 10 3 Chadworth Buildings 3,073 3 - Clerkenwell and Holborn Dwellings— Clerkenwell and Holborn Dwellings— Mallory Buildings (Finsbury) 786 6 6 Mallory Buildings (Finsbury) 887 2 6 Nigel Buildings, etc. (Holborn) 5,582 19 6 Nigel Buildings, etc. (Holborn) 5,574 19 7 Webber-row Dwellings (Southwark) 4,038 7 5 Webber-row Dwellings (Southwark) 4,647 5 - Dwellings on sites compulsorily appropriated for rehousing, on the working of which a deficiency was anticipated owing to the character or situation of the site. Brook-street Dwellings (Stepney) 1,062 2 7 Brook-street Dwellings (Stepney) 890 14 - Goldsmith's-row Cottages (Shoreditch) 487 2 3 Goldsmith's-row Cottages (Shoreditch) 456 14 6 Hughes-fields Cottages (Greenwich) 2,103 9 8 Hughes-fields Cottages (Greenwich) 1,285 3 3 59,308 16 - 63,395 - 4 Surplus carried to Appropriation Account 4.505 - 7 Interest on cash balances 418 16 3 PART II. 63.813 16 7 PART II. 63,813 16 7 Working Expenses and Debt Charges- £ s. d. Income— £ s d Cranley Buildings, Brooke's-market (Holborn) 244 19 5 Cranley Buildings, Brooke's-market (Holborn) 281 7 - Borough-road Dwellings (Southwark) 1,791 8 4 Borough-road Dwellings (Southwark) 1,803 11 6 Cobham Buildings, Green-street and Pocock-street (Southwark) 1 040 9 10 Cobham Buildings, Green-street and Pocock-street (Southwark) 1,106 12 9 Ann-street Dwellings (Poplar) 113 14 6 Ann-street Dwellings (Poplar) 1,866 16 3 Sylva Cottages, Mill-lane (Deptford) 412 8 3 Sylva Cottages, Mill-lane (Deptford) 462 19 - 5,403 - 4 5,521 6 6 Surplus carried to Appropriation Account 163 2 11 Interest on cash balances 44 16 9 5,56 3 3 5,566 3 3 PART III.—(a)dwellins. PART III.—(a) Dwellings. v\ orkinc. Expenses and Deiit Charges— £ s. d. Income— £. s. d. Parker-street House (Holborn) 3,214 2 5 Parker-street House (Holborn) 3,191 19 7 Carrington House (Deptford) 5 713 4 4 Carrington House (Deptford) 4,308 6 10 Dufferin-street Dwellings (Finsbury) 592 9 - Dufferin-street Dwellings (Finsbury) 593 19 3 Green-street and Boyfield-(late GunOstreet Dwellings (Southwark). 1,623 11 10 Green-street and Boyfield-(late Gun-)street Dwellings (Southwark) 1,712 9 6 Millbank Estate (Westminster)—Proportion 818 18 5 Millbank Estato (W estminster) Proportion 976 4 7 Holmwood Buildings, 97, Southwark-street (Southwark) 366 3 7 Holmwood Buildings, 97, Southwark-street (Southwark) 347 19 6 Totterdown-fields Estate (Wandsworth) 21,168 9 4 Totterdown-fields Estate (Wandsworth) 21,733 6 9 Preston's-road Estate (Poplar)—Proportion 2,748 1 5 Preston's-road Estate (Poplar)—Proportion 2,123 14 5 Hughes-fields Dwellings (Deptford and Greenwich)—Proportion 1,127 9 9 Hughes-fields Dwellings (Deptford and Greenwich)—Proportion 765 3 6 White Hart-lane Estate (Tottenham) 9,00 9 4 White Hart-lane Estate (Tottenham) 8,112 10 — Wessex Buildings, Wedmore-street (Islington) 3,832 14 - Wessex Buildings, Wedmore-street (Islington) 3,869 6 - Norbury Estate (Croydon) 6.358 19 8 Norbury Estate (Croydon) 6,418 16 - Caledonian Estate (Islington) 4,773 10 - Caledonian Estate (Islington) 4,905 19 2 Briscoe Buildings (Lambeth) 2,434 3 11 Briscoe Buildings Lambeth) 2,386 13 3 Interest on cash balances 61,446 133 8 17 4 8 Deficiency carried to Appropriation Account 61,580 2,792 6 1 - - 64,372 7 - 64,372 7 — Housing of the Working Classes—Accounts. xxi Dr. HOUSING OF THE WORKING CLASSES ACT, 1890. Cr. Expenditure. Income. Revenue Account—continued. Part III.—(b) Estates in course of development. Part III.—(b) Estates in course of development. Expenses and Debt Charges— £ s. d. £ s. d. Income— Totterdown-fielda (Wandsworth) 712 8 1 White Hart-lane (Tottenham, Wood Green and Edmonton) 440 4 10 White Halt-lane (Tottenham, Wood Green and Edmonton) 3,666 4 8 Old Oak (Hammersmith) 203 — 2 Norbury (Croydon) 553 6 6 Old Oak (Hammersmith) 854 1 - 643 5 - Leas—Interest on overdrawn cash balances 183 7 3 5,786 - 3 459 17 9 Supervision 500 - - Deficiency carried to Appropriation Account (as below) 5,826 2 6 6,286 - 3 6,286 - 3 II.—Repairs and Renewals Fund. Actual exnenditure— £ s. d. Balance—1st April, 1910— £ s. d- Part I. £5.742 17 5 Part I. £19,665 12 9 Part II 499 2 2 Part II. 2,475 13 0 Part III 5,306 4 8 11 548 4 3 Part III. 13,751 6 5 35,892 13 - Brokerage and stamp duty on investment- Part I £3 19 3 Transfers from Revenue Account 14,125 4 9 Part III 7 4 1 Balance — 31st March, 1911 (of which £37.297 5s. 10d. is invested) carried 11 3 4 Dividends on investments and interest on cash balances— Part I. 613 13 8 to Balance Sheet- Part II. 90 16 8 Part I.—including £19,693 9s. Id. invested 20,699 13 9 Part III. 432 3 4 Part II.—Including £2.000 invested 2,698 8 4 1,136 13 8 Part III— inducluding £15.603 16s. 9d. invested 16,197 1 9 39,595 3 10 51,154 11 5 51,154 11 5 III.—Appropriation Account. Amounts brought from Revenue Account— Balance in hand—1st April, 1910— £ s. d. Deficiencv— £ s. d. Part I £883 11 2 Part III — Part II 539 13 5 Dwellings £2,792 1 — 1,423 4 7 Estates in course of development (as above) 5,826 9 6 Special County Account for contribution from Rates to meet 8,618 3 6 deficiencv for tho year 1910-11— Part III Less— Surplus—Part I £4,505 - 7 Dwellings 2,792 1 - Pa rt. II 163 9 11 Estates in course of development 5,826 2 6 4,668 3 6 3,950 - 8,618 3 6 Less —Transfer of surplus— part I 11 Part II 702 16 4 6,091 8 l 2,526 15 5 3,950 - - 3,950 - - xxii. The Annual Report of the London County Council, 1910. Dr. HOUSING OF THE WORKING CLASSES ACT, 1890.1 Cr. Expenditure. Income. IV.—Capital Account. PART I. PART I. Erection of Dwellings— £ s. d. Balance carried to Capital (Aggregate) Account (as below) £ s. d. Clerkenwell and Holborn Dwellings—Nigel (late Union) Buildings 239 13 8 370 12 10 St. Luke's Dwellings—Chadworth Buildings 18 8 0 Webber-row Dwellings 112 10 4 370 12 0 370 12 10 PART III. (a) Acquisition and Laying-out of Sites. PART III. £ s. d. White Hart-lane, Tottenham-Sir Samuel Montagu (Lord Swaythling) Gift Fund Account to meet expenditure during year on public garden £ s. d. £ s. d. White Hart-lane, Tottenham 4,108 14 9 33 5 6 Norbury, Croydon 1,485 9 - Old Oak Estate—Acquisition of Lands Fund Account to meet expenditure as contra 3,580 19 6 Old Oak, Hammersmith 3,580 19 6 Sale of Land, White Hart-lane Estate 2,555 — - 6,169 5 - Totterdown-fields, Wandsworth 3,412 17 8 Working Class Dwellings Account for value of sites appropriated for dwellings— 12,588 - 11 Totterdown-fields Estate, Wandsworth (as below) 5,465 16 1 Consolidated Loans Fund for proceeds of sales, contra 2,555 - - White Hartrlane Estate, Tottenham (as below) 3,708 — - Balance carried to Capital (Aggregate) Account (below) 2,787 - 2 Norbury Estate, Croydon (as below) 2,587 - - 11,760 16 1 17,930 1 1 17,930 1 1 (b) Working Class Dwelling.'. £ s. d £ s. 1. £ s. d. Totterdown-fields Estate, Wandsworth 31,151 14 2 Old Oak Estate — Acquisition of Lands Fund to meet' expenditure as contra 732 14 1 Add—Value of site appropriated for dwellings (as above) 5,465 16 1 White Hart-lane Estate, Tottenham 17,099 18 3 36,617 10 3 Balance carried to Capital (Aggregate) Account (as below) 38,895 - 11 Add—Value of site appropriated for dwellings (as above) 3,708 - - Norbury Estate, Croydon 28,874 9 10 20,807 18 3 Add—Value of site appropriated for dwellings (as above) 2,587 - - 31,46] 9 0 Old Oak Estate, Hammersmith 732 14 1 Briscoe-buildings, Brixton-hill, Lambeth 8 2 7 89,627 15 _ 89.627 15 V.—Capital (Aggregate) Account. Balance—1st April, 1910— £ s. d. £ s. 1. s. d. Part I 883,227 10 9 Balance -31st March, 1911,carried to Balance Sheet 2,136,075 13 1 Part II 80,011 6 7 Part III.— Estates in course of development 123,029 12 6 Dwellings 963,325 9 8 2,049,596 19 6 Expenditure in 1910-11— Part I.—(as above) 370 12 10 Part III.—Dwellings (as above) 88,895 - 11 89,265 13 9 Less -Part HI.—Estates in couise of development (above) 2,787 - 2 86,478 13 7 2,136,075 13 1 2,136,075 13 1 Housing of the Working Classes—Accounts.xxiii Dr. HOUSING OF THE WORKING CLASSES ACT, 1890. Cr. Expenditure. Income. VI.—Loan Account. Consolidated Stock (Moneys Raised). £ s. d. Balance—1st April, 1910— £ s. d. £ s. d. Stock cancelled during year—Cost 2,035 13 2 Moneys raised—Cash (8vo Accounts 1909-10, page 16) 2,049.596 19 6 Balance—31st March, 19li, carried to Balance Sheet 2,023,311 5 8 Less—Amount applied to cancelled(as below) 24,250 — 8 2025,346 18 10 2,025,346 18 10 2,025,346 18 10 VII.—Sinking Fund Account (Accumulating). (Transactions of the Consolidated Loans Fund in respect of Dwellings under the Housing Act, 1890.) Amount applied during year—Purchase and cancellation of stock (as above) £ s. d. Balance- 1st April, 1910— £ s. d. £ s. d. 2,035 13 2 Amounts provided in previous years for redemption (8vo Accounts 1909-10, page 10) 125,282 12 3 Balance—31st March, 1911, carried to Balance Sheet 118,147 16 9 Less—Amount applied in previous years—Purchase and can cellation of stock (as above) 24,250 _ 8 101,032 11 7 Amount provided during vear for redemption— Sinking Fund instalments provided out of Revenue in 1910-11 13,157 12 3 Tntprpst nn Arriimiilntinns nf Sinking- Fund 3,438 6 1 16,595 18 4 Proceeds of sales 2,555 120,183 9 11 120,183 9 11 VIII.—Norbury Brickfield. (This brickfield formed part of the estate at Norbury which was acquired by the Council in 1900-1 under Part III. of the Housing of the Warking Classes Act 1890. Brickmaking operations ceased in October, 1907, but bricks were not finally allocated to building works and the account closed until 31 st March, 1911.) (a) Deficiency Account. £ s. d. £ s. d. Balance—1st April, 1910 3,649 17 7 Balance transferred to Working Account (as below) 3,881 18 5 Interest on outlay—Year 1910-11 232 - 10 3,881 18 5 3,881 18 5 (b) Working Account (Final). £ s. d. £ s. d. £ s. d. £ s. d. Stock in hand, 1st April, 1910 5,771 17 2 Sale of bricks and ballast, etc. 1,144 11 10 Expenditure— Transfer from the Dwellings Capital Account (Norbury Estate)— Wages 151 6 4 Cost of bricks, etc., utilised for cottages on Norbury Estate (balance) 7,605 2 9 Cartage 87 1 1 Loss on bricks supplied to contractors for use on Totterdowr Fields Estate (balance) 1,204 19 _ Bates and taxes 10 10 10 248 18 3 9,954 13 7 Central office charges 51 19 9 Balance transferred from Deficiency Account (as above) 3,881 18 5 9,954 13 7 9,954 13 7 Dr.HOUSING OF THE WORKING CLASSES, ACT, 1890. Cr. Expenditure. Income. IX.—Sir Samuel Montagu (Lord Swaythling) Gift Fund. (Part III.) (a) Contribution Account. £ s. d. £ s d. £ s. d. Balance—31st March, 1911, carried to Balance Sheet 11,841 - 3 Balance—1st April, 1910 11,719 13 6 Note.—Of this amount £2.906 5s. -d. is invested in India Bills. Dividends on investment 91 11 10 Interest on uninvested portion 29 14 11 121 6 9 11,841 - 3 11,841 - 3 (b) Outlay Account. £ s. d. £ s. d. Balancb—1st April, 1910 7,553 19 9 Balance—31st March, 1911, carried to Balance Sheet 7,587 5 3 Expenditure in 1910-11 33 5 6 7,587 5 3 7,587 5 3 X.—Acquisition of Lands Fund. (Part III.) (a) Contribution Account. £ s. d. f. s d £ s. d Balance—31st March, 1911, carried to Balance Sheet 31,798 17 9 Balance—1st April, 1910 50,000 7 8 Note.—Of this amount £48,816 13s. 3d. is invested in India Bills. Dividends on investment 1,728 12 6 Interbst on uninvested portion 69 17 7 1,798 10 1 51,798 17 9 51,798 17 9 (b) Outlay Account. £ s. d. £ s. d. £ s d Expenditure in 1910-11 on Old Oak Estate- Acquisition and laying-out of sites 3,580 19 6 Balance—31st March, 1911, carried to Balance Sheet 4,313 13 7 Erection of dwellings 732 14 1 4,313 13 7 4,313 13 7 4,313 13 7 xxiv. Annual Report of the London County Council, 1910. Housing of the Workimj Classes—Accounts. xxv. Dr. HOUSING OF THE WORKING CLASSES ACT, 1890. Cr. XI.—Balance Sheet, 31st March, 1911. liabilities. assets and capital outlay. Loans raised and outstanding — £ s. d £ s. d. £ s. d. Consolidated Stock—Cash— Capital Outlay— Metropolitan— 239 ,315 1 3 Part I 883,598 3 7 2 ½ per cent Part II 80,014 6 7 London County— Part III.—Dwellings 1,052,220 10 7 2½ per cent 191 232 3 1 Estates in course of development 120,242 12 4 3 per cent 1,155 903 7 - 1 Less—Proceeds of sales (Part III.—Estates in course of development 2,136,075 12,642 13 - 1 - 3½ per cent 436 ,860 14 4 2,023 ,311 5 8 London County Bills (proportion) 86 .478 13 7 2,123,433 13 1 —(a)2,109,789 19 3 Sir Samuel Montagu (Lord Swaythling) Gift Fund—Outlay Account 7,587 4,313 5 13 3 7 Sundry Creditors 2,573 18 10 Acquisition of Lands Fund—Outlay Account 2,135,334 11 11 Special Accounts— Sinking Fund Assbts—Loans to Local Authorities and other investments 118,147 16 9 Sir Samuel Montagu ("Lord Swaythling) Gift Fund—Contribution Account (see outlay—contra) 11,841 - 3 Sundry Debtors 1,250 4 - Acquisition of Lands Fund (Part 111.)—Contribution Account (see outlay—contra) 51,798 17 9 Norbuky Estate—Ballast, etc 403 15 - 63,639 18 - Repairs and Renewals Fund — Investments— Part I 20,699 13 9 Part II 2,698 8 4 Repairs and Renewals Fund Investment Account £37,29 7 5 10 Part III 16,197 1 9 [Market value at 31st March, 1911, £35,049. 39,595 3 10 Sir Samuel ,montagu(lord Swaythling) gift Fund Investment a ccount- Appropriation Account (after taking into account net contributions from Rates amounting to £66,149 -s. 2d.) £3,000 India Bills at cost price 2,906 5 - Excess of Assets and Capital Outlay over Liabilities— Acquisition of Lands Fund (Part III.) Investment Account-- £50,000 India Bills at cost price 48,816 13 3 Stock cancelled—Cost 26,2Su 13 10 Sinking Fund balances £118,147 16 9 89,020 4 1 Less—Proceeds of sales, deducted from capital expenditure (contra) 12,642 - - 105,505 16 9 Cash in Hand— 105,505 10 7 Revenue Accounts 3,217 17 10 Special Accounts- Sir Samuel Montagu (Lord Swaythling) Gift Fund £1,347 10 - Less—Acquisition of Lands Fund (Part III.) 1,331 9 1 16 - 11 3,233 18 9 2,347,390 10 6 2,347,390 10 6 (a) Loans raised and outstanding £2,109,789 19 3 Leu—Sinking Fund balances 11 8.147 10 9 Net Debt 1,901,642 2 6 xxvi. Annual Report of the London County Council, 1910. Dr. B.—DWELLINGS UNDER IMPROVEMENT ACTS (a). Cr. Expenditure. Income. I.—Revenue Account. £ s. d. £ s. d. Working Expenses and Debt Charges— Income— Battersea-bridge Dwellings (Battersea) 1,105 12 8 Battersea-bridge Dwellings (Battersea) 1,145 15 6 Cotton-street Dwellings (Poplar) 1,042 14 - Cotton-street Dwellings (Poplar) 994 7 9 Durham Buildings, York-road (Battersea) 1,726 - 3 Durham Buildings. York-road (Battersea) 1,557 4 — Duke's-court Dwellings (Westminster)—Proportion 504 10 — Duke's-court Dwellings (Westminster)—Proportion 599 7 3 York-street (late Russell-court) Dwellings (Westminster)—Proportion 329 17 5 York-street (late Russell-court) Dwellings (Westminster)—Proportion 374 1 3 Herbrand-street Dwellings (Holborn) 2,327 1 7 Herbrand-street Dwellings (Holborn) 2,748 11 6 Bruce House, Kemble-street (Westminster) 6,692 1 5 Bruce House, Kemble-street (Westminster) 7,423 19 5 Bourne Estate (Holborn) 11,925 11 2 Bourne Estate (Holborn) 12,989 5 4 Millbank Estate (Westminster)—Proportion 9,177 11 10 Millbank Estate (Westminster)—Proportion 11,307 5 4 Swan-lane Dwellings (Bermondsey) 4,083 7 1 Swan-lane Dwellings (Bermondsey) 3,131 13 2 Valette Buildings (Hackney) 1,447 5 6 Valette Buildings (Hackney) 1,573 1 6 Hughes-fields Dwellings (Deptford and Greenwich)—Proportion 563 14 10 Hughes-fields Dwellings (Deptford and Greenwich)—Proportion 382 11 9 Bearcroft Buildings (Fulham) 584 10 11 Bearcroft Buildings (Fulham) 544 9 - Dwellings on sites compulsorily appropriated for rehousing, on the working of which a deficiency was anticipated owing to the character or situation of the site. Council Buildings (Poplar) 977 12 7 Council Buildings (Poplar) 705 19 6 Westview, Armitage and Collerston Cottages (Greenwich) 1,711 16 11 Westview, Armitage and Collerston Cottages (Greenwich) 1,280 - 9 Idenden Cottages (Greenwich) 1,083 - 5 Idenden Cottages (Greenwich) 1,085 - 6 Barnaby Buildings, Leroy-street (Bermondsey) 1,364 - 4 Barnaby Buildings, Leroy-street (Bermondsey) 1,287 13 9 Brightlingsea Buildings, Ropemaker's-fields (Stepney) 1,010 1 2 Brightlingsea Buildings, Ropemaker's-fields (Stepney) 802 12 9 Bekesbourne Buildings (Stepney) 1,262 3 8 Bekesbourne Buildings (Stepney) 1,203 19 - Darcy Buildings, London Fields (Hackney) 710 9 8 Darcy Buildings, London-fields (Hackney) 687 6 - Wan'dsworth-i oad Dwellings (Lambeth) 847 - 1 Wandsworth-road Dwellings (Lambeth) 887 15 6 50,475 16 9 52,712 - 6 Suhplus carried to Appropriation Account 2,551 19 11 Intrest on cash balances 315 16 2 53,027 16 8 53,027 16 8 II.—Repairs and Renewals Fund. £ 8. d. £ 8. d. Actual expenditure 4,650 12 6 Balance—1st April, 1910 18,097 6 2 Brokerage and stamp duty on investment... 5 18 5 Transfrrs from Revenue Account 5,427 15 3 Balance—31st March, 19ll (of which £18,702 14s. 2d. is invested) carried to Balance Sheet 19,442 7 10 Dividends on investments and interest on cash balances 573 17 4 24,098 18 9 24 098 18 9 III.—Appropriation Account. £ s. d. £ 8. d. General County Account for contribution to Rates 3,895 9 1 Balance—1st April, 1910 1,162 6 1 Amount brought from Revenue Account—Surplus 2,551 19 11 Tramways Account for contribution to meet one-third of deficiency on Hughes-fields (Deptford) Dwellings on 31st March. 1911, in respect of the rehousing of persons displaced by the Greenwich Generating Station 181 3 1 3,895 9 1 3,895 9 1 (a) For statutes under which these dwellings are erected, see page . Housing of the Working Classes—Accounts. xxvii. Dr. DWELLINGS UNDER IMPROVEMENT ACTS. Cr. Expenditure. Income. IV.—Capital Account. Erection of Dwellings— £ s. d. £ 8. d. Southampton-row improvements— Bourne Estate—proportion 47 19 _ Balance—31st March, 1911, carried to Capital (Aggregate) Account (see below) 387 15 6 St. John-street, Clerkenwell. improvement- Bourne Estate—proportion 11 10 3 Goswell-road widening— Bourne Estate—proportion 11 7 4 Central-street, St. Luke, widening— Bourne Estate—proportion 32 10 — Fulham Palace-road widening— Bearcroft-buildings 2 6 3 Holborn to Strand ImDrovement— Bourne Estate—proportion £281 14 6 Bruce House - 7 1 282 1 7 Rotherhithe Tunnel— Swan-lane Dwellings 1 1 387 15 6 387 15 6 V.—Capital (Aggregate) Account. £ s. d. Balance—31st March, 1911, carried to Balance sheet £ s. a. Balance—1st April, 1910 743,258 5 - 743,646 6 Expenditure in year 1910-11 (see above) 383 15 6 743,646 - 6 743,646 - 6 VI.—Loan Account. Consolidated. Slock (Moneys Raised). £ s. d. Balance—1st April, 1910— £ s. d. £ 8. d. Stock cancelled during year—Cost 579 12 11 Moneys raised—Cash (8vo Accounts, 1909-10, page 21) 743,2o8 5 — Balance—31st March, 1911, carried to Balance Sheet 736,127 13 9 Ltss—Amount applied to cancellation (as below) 6,550 18 4 736 707 g q o 736,707 6 8 736,707 6 8 VII.—Sinking Fund Account (Accumulating). Transactions of the Consolidated Loans Fund in respect of Dwellings under Improvement Acts. £ s. d. £ s. d. £ s. d. Amount applied during year—Purchase and cancellation of stock (as above) 579 12 11 Balance—1st April, 1910 - Balance—31st March, 1911, carried to Balance Sheet 40,051 12 5 Amounts provided in previous years ior redemption tovo accounts, 1909-10, page 18) 41,218 13 8 Less—Amount applied in previous years— Purchase and cancellntinrj of stock (as above) 6.550 18 4 34,667 15 4 Amount provided during year for redemption— _ _ Sinking Fund instalments provided out of Revenue in 1910-11 4,758 13 6 Interest on Accumulations of Sinking Fund 1,204 16 9 5,963 10 - 40,631 5 4 40,631 5 4 xxviii. Annual Report of the London County Council, 1910. Dr. DWELLINGS UNDER IMPROVEMENT ACTS. Cr. VIII.—Balance Sheet, 31st March, 1911. LIABILITIES. £ s. d. £ s. d ASSETS AND CAPITAL OUTLAY. £ s. d Loans raised and outstanding— Consolidated Stock—Cash— Capital Outlay, including £8,614 19s. 8d. for Drake Buildings, Hughes Fields (rehousing in connection with Tramways) 743,646 - 6 Metropolitan— 2£ per cent. London County— 61,838 16 2 Less—Proceeds of sales—Disposal of right of light (Bourne Estate) 1,000 - 2½ per cent 31,665 8 5 Sinking Fund Assets—Loans to Local Authorities and other investments 742,646 — 6 3½ per cent. 592,060 5 - 3½ per cent 50,563 4 2 40,051 12 5 London County Bills (proportion) 736,127 387 13 15 9 6 (a)736,515 9 3 Sundry Debtors 471 3 9 Sundry Creditors ) i ou,uiu 472 18 1 Repairs And Renewals fund Investment Account [Market value at 31st March, 1911, £17,999.] 18,702 14 2 Repairs and Renewals Fund 19,442 7 10 Cash in Hand 741 8 - Appropriation Account (after taking into account net contributions to Rates and from Tramways Account, amounting to £5,793 8s. 10d., Excess ok Assets and Capital Outlay over Liabilities— Stock cancelled- Cost 7, 130 11 3 Sinking Fund balances £40,051 12 5 Less—Proceeds of sales, deducted from Capital Expenditure (contra) 1,000 - - 39,051 12 5 46,182 3 8 802,612 18 10 802,612 18 10 (a) Loans raised and outstanding £736,515 9 3 Nett—Sinking Fund balances 40,051 1 2 5 NetDebt £696,463 16 10 Dr . C.—DWELLINGS UNDER THE HOUSING OF THE WORKING CLASSES ACT, 1890, AND IMPROVEMENT ACTS COMBINED. Cr. Expenditure. Income. I.—Revenue Account. (Apportionment calculated, on basis of accommodation.) Millbank Estate (Westminster)— £ s. d. £ s. d. Millbank Estate (Westminster)— £ s. d. £ s. d. Working expenses and debt charges 15,288 2 1 Income Less— Apportioned and transferred to the following accounts— 18,803 - - Less—Apportioned and transferred to the following accounts— Housing of the Working Classes Act, 1890—Part I. 5,291 11 10 Housing of the Working Classes Act, 1890—Part I 6,519 l0 1 Housing of the Working Classes Act, 1890—Part III. 818 18 5 Housing of the Working Classes Act, 1890—rart III 976 4 7 Dwellings under Improvement Acts 9,177 11 10 Dwellings under Improvement Acts 11,307 5 4 15,288 2 1 18,803 - - - - - - - Duke's-court Dwellings (Westminster)— Duke's-court Dwellings (Westminster)— Income 2,397 9 - Working expenses and debt charges 2,018 - — Less—Apportioned and transferred to the following accounts- Less-Apportioned and transferred to the following accounts 1 798 1 9 Housing of the Working Classes Act, 1890—Part I 1,513 10 _ Housing of the Working Classes Act, 1890—Part I 1 599 7 3 Dwellings under Improvement Acts 504 10 _ 9 018 _ _ Dwellings under Improvement Acts 2,397 9 _ Z,vJ10 - - - - York-street Dwellings (Westminster)— York-street Dwellings (Westminster)— 1,496 5 _ Workjing expenses and debt charges 1,319 9 6 Income Less—Apportioned and transferred to the following accounts— Less— Apportioned and transferred to the following accounts— Housing of the Working Classes Act, 1890—Part I 989 12 1 Housing of the Working Classes Act, 1890—Part I 1,122 3 9 Dwellings under Improvement Acts 329 17 5 Dwellings under Improvement Acts 374 1 3 l,496 5 _ 1,319 9 6 _ _ _ - - Preston's Road Estate (Polar)— Preston's-road Estate (Poplar)— Working expenses and debt charges 3,568 _ 8 Income 2,675 13 8 Less—Apportioned and transferred to the following accounts— Less—Apportioned and transferred to the following accounts— 551 19n 3 Housing of the Working Classes Act, 1890—Part I 819 19 3 Housing of the Working Classes Act, 1890—Part I 2,423 14 5 Housing of the Working Classes Act, 1890—Part III 2,748 1 5 Housing of the Working Classes act, 1890—Part III ° 2,675 13 8 3,568 - 8 - - - _ _ — Hughes-fields Dwellings (Deptford)— Hughes-fields Dwellings (Deptford)— Working expenses and debt charges 1,691 4 7 Income 1,147 15 3 Less— Apportioned and transferred to the following accounts— Less—Apportioned and transferred to the following accounts— Housing of the Working Classes Act, 1890—Part III. 1127 9 9 Housing of the Working Classes Act, 1890—Part III. 765 3 6 Dwellings under Improvement Acts 563 14 10 Dwellings under Improvement Acts 382 11 9 1,147 15 3 % 1,691 4 7 _ _ _ - - Housing of the Working Classes—Accounts. xxix. XXX. xxxi. xxx. Annual Report of the London County Council, 1910. Housing of the Working Classes—Accounts, xxxi D.—DETAILS OF REVENUE ACCOUNT. I.—Housing of the Working Classes Act, 1890. Dwellings. Income. Expenditure. Result of Year's Working, 1910-11. Surplus ( + ). Deficiency ( -). Gross Rental. Deductions. Net Rental. Maintenance and Management. Debt Charges, transferred to Consolidated Loans Fund. Total. (Columns 13 and 18.) Empties. Caretakers' Quarters, Amounts irrecoverable. Total. Supervision and Collection of Rent. Rates and Taxes. Lighting, Heating, Water and Insurance. Stores and Incidentals Transfer to Repairs and Renewals Fund. Total. Interest. Sinking Fund. Total. Land Buildings. Land. Buildings. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Part I. £ s. d. £ s. d. £ s. d. £ s d. £ s. d. £ s. d. £ s. d £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d £ s. d. Boundary-street (including laundry) 23,310 5 11 520 5 5 140 17 _ 67 5 6 728 7 11 22,581 18 _ 1,578 19 4 4,689 7 3 1,327 4 6 72 10 3 2,156 _ _ 9,824 1 4 1,788 13 5 7,457 13 10 405 4 7 1,804 9 _ 11,456 _ 10 21,280 2 9 +1,301 15 10 Do. Automatic Gas supply 3,089 5 4 _ 3,089 5 4 170 _ _ 2,025 19 10 — 13 6 161 _ _ 2,357 13 4 209 9 6 52 16 1 262 5 7 2,619 18 11 +469 6 5 Cable-street 2,963 5 _ 24 4 6 25 _ _ 3 _ _ 52 4 6 2,911 _ 6 133 9 4 648 13 5 106 _ 2 — 322 _ _ 1,210 2 11 106 2 7 1,091 4 7 25 14 9 266 2 6 1,489 4 5 2,699 7 4 + 211 13 2 Shelton-street 1,564 4 - 32 10 - 24 15 6 _ 10 _ 57 15 6 1,506 8 6 62 1 3 303 2 7 60 14 9 — 148 — — 573 18 7 144 1 6 545 - 2 36 11 4 141 3 6 866 16 6 1,440 15 1 + 65 13 5 Millbank (proportion) 6,582 5 3 29 13 4 30 5 5 2 16 5 62 15 2 6,519 10 1 317 13 5 1,212 3 3 210 7 - _ 14 7 622 7 6 2,363 5 9 315 12 5 2,099 14 11 62 15 5 450 3 4 2,928 6 1 5,291 11 10 + 1,227 18 3 churchway 3,905 4 _ 33 17 _ 27 7 6 _ 4 _ 61 8 6 3,843 15 6 199 2 _ 778 13 5 127 13 3 1 _ _ 355 _ _ 1,461 8 8 261 13 4 1,176 _ 5 53 3 4 246 8 4 1,737 5 5 3,198 14 1 +645 1 5 Hardy 878 12 6 98 _ _ 16 18 6 2 9 2 117 7 8 761 4 10 31 7 6 165 5 6 28 6 9 — 128 _ _ 352 19 9 30 12 1 375 _ 2 6 4 4 76 13 8 488 10 3 841 10 — 80 5 2 Duke's-court (proportion) 1,818 10 2 2 15 1 16 12 8 1 _ 8 20 8 5 1,798 1 9 87 6 10 322 17 7 55 4 9 — 192 15 _ 658 4 2 128 10 9 577 13 10 26 2 5 122 18 10 855 5 10 1,513 10 _ + 284 11 9 York-street (proportion) 1,142 12 11 2 12 10 16 12 8 1 3 8 20 9 2 1,122 3 9 53 15 2 198 3 6 35 17 6 — 104 6 — 392 1 2 95 6 11 399 5 5 19 13 1 83 5 6 597 10 11 989 12 1 + 132 11 8 Preston's-road(proportion) 823 18 4 258 19 _ 10 4 5 2 15 8 271 19 1 551 19 3 38 9 8 157 9 _ 24 11 6 — 12 5 105 16 6 326 19 1 44 15 9 367 — 7 8 19 2 72 3 8 493 _ 2 819 19 -268 _ _ St. Luke's— Wenlake 1,929 12 6 10 4 _ 24 15 6 _ 2 _ 35 1 6 1,894 11 _ 97 18 7 382 3 8 61 4 5 180 _ _ 721 6 8 164 15 10 633 5 10 31 15 7 125 13 2 955 10 5 1,676 17 1 + 217 13 11 Chadworth 3,410 13 - 295 6 6 22 3 6 20 _ _ 337 10 - 3,073 3 _ 149 15 5 576 8 5 93 4 4 — 275 _ _ 1,094 8 2 244 16 8 1,258 _ 2 50 16 11 228 8 4 1,782 2 1 2,876 10 3 + 196 12 9 Clerkenwell and Holborn— Mallory 912 12 6 2 1 _ 23 9 _ _ 25 10 _+ 887 2 6 37 _ _ 144 4 10 22 14 8 64 _ _ 267 19 6 57 4 1 379 4 11 10 5 11 71 12 1 518 7 _ 786 6 6 + 100 16 _ Nigel, etc 6,015 18 4 383 3 9 54 15 _ 3 _ _ 440 18 9 5,574 19 7 254 1 10 1,092 12 1 196 16 9 — 484 - — 2,027 10 8 513 16 — 2,491 7 11 92 9 7 457 15 4 3,555 8 10 5,582 19 6 — 7 19 11 Webber-row 4,911 10 _ 188 3 _ 61 5 6 14 16 6 264 5 _ 4,647 5 _ 245 9 6 1,083 17 6 146 13 10 _ 5 _ 434 _ _ 1.910 5 10 298 7 9 1,494 15 9 61 19 5 272 18 8 2,128 1 7 4,038 7 5 + 608 17 7 63,258 9 9 1,881 15 5 495 2 2 119 3 7 2,496 1 2 60.762 8 7 3,450 9 10 11,755 2 _ 4,522 14 _ 75 15 9 5,732 4 _ 25,542 5 7 4,194 10 1 20,554 18 _ 891 15 10 4,472 12 _ 30,113 15 11 55,656 1 6 + 5,106 7 1 Dwellings on sites compulsorily appropriated for rehousing, on the working of which a deficiency was anticipated owing to the character or situation of the site. brook-street 1,016 15 9 104 10 3 19 11 6 2 _ _ 126 1 9 890 14 _ 37 6 3 224 15 8 41 3 _ — 148 _ _ 451 4 11 52 5 3 442 14 8 12 4 5 103 13 4 610 17 8 1,062 2 7 — 171 8 7 Goldsmith's-row 484 15 9 8 19 9 19 11 6 _ 10 _ 28 1 3 456 14 6 19 _ _ 107 9 4 16 9 8 — 55 — — 197 19 _ 28 5 _ 201 5 7 7 1 11 52 10 9 289 3 3 487 2 3 — 30 7 9 Hughes-fields (cottages) 2,053 3 6 859 19 3 16 18 6 5 1 _ 768 8 9 1,285 3 3 53 _ _ 360 5 6 59 _ 4 — 232 _ _ 704 5 10 105 1 10 1,009 13 11 26 8 - 258 _ 1 1,399 3 10 2,103 9 8 — 818 6 5 3,555 3 6 859 19 3 56 1 6 6 11 _ 922 11 9 2,632 11 9 109 6 3 692 10 6 116 13 _ — 435 _ _ 1,353 9 9 185 12 1 1,653 14 2 45 14 4 414 4 2 2,299 4 9 3,652 14 6 — 1,020 2 9 Interest on cash balances — _ _ — _ _ _ — _ _ _ _ _ _ _ _ + 418 16 3 66,813 13 3 2,741 14 8 551 3 8 125 14 7 3,418 12 11 63,395 - 4 3,565 10 1 12,447 12 6 4,639 7 _ 75 15 9 6,167 4 _ 26,895 15 4 4,380 2 2 22.208 12 2 937 10 2 4,886 16 2 32,413 _ 8 59,308 16 _ + 4,505 _ 7 part II. Cranley 289 8 6 8 1 6 _ _ 8 1 6 281 7 20 12 10 57 5 4 9 8 7 30 _ _ 117 6 9 21 3 9 83 9 9 4 10 5 18 8 9 127 12 8 244 19 5 + 36 7 7 borough-road 1,869 6 _ 39 14 _ 26 _ 6 _ 65 14 6 1,803 11 6 96 16 3 436 8 _ 63 13 4 — 176 — — 772 17 7 153 — 5 683 1 2 32 3 11 150 5 3 1,018 10 9 1,791 8 4 + 12 3 2 Cobhain 1,131 10 _ 24 19 6 _ 2 3 24 17 _ 1,106 12 9 77 12 1 260 14 2 35 19 8 — 110 — — 484 5 11 64 5 5 398 1 4 12 19 2 80 8 _ 556 3 11 1,040 9 10 +66 2 11 Ann-street 2,135 5 6 245 _ _ 19 11 6 3 17 9 268 9 3 1,860 16 3 111 10 8 527 15 5 62 2 7 — 264 _ _ 965 8 8 69 3 4 712 10 6 14 1 1 152 10 11 948 5 10 1,913 14 6 — 46 18 3 Sylva 469 6 _ 6 _ _ _ _ 7 _ 6 7 _ 462 19 _ 19 2 6 104 2 7 14 5 6 — 51 — — 188 10 7 31 15 7 153 8 10 6 11 — 32 2 3 223 17 8 412 8 3 + 50 10 9 Interest on cash balances _ _ _ _ 373 9 6 _ _ _ _ — _ — _ — _ _ — _ + 44 16 9 5,894 16 _ 323 15 _ 45 12 _ 4 2 6 5,521 6 6 325 14 4 1,386 5 6 185 9 8 — 631 - - 2,528 9 6 339 8 ft 2,030 11 7 70 5 7 434 5 2 2,874 10 10 5.403 - 4 + 163 2 11 Part III. Dwellings. Parker-street House (b) 3,282 11 1 77 11 6 13 _ _ 90 11 6 3,191 19 7 862 6 6 389 8 4 496 11 _ 62 2 _ 445 _ _ 2,255 7 10 104 _ 11 663 15 _ 24 19 1 165 19 7 958 14 7 3,214 2 5 — 22 2 10 Carrington House (c) 7,665 3 4 3,277 12 6 78 _ _ 1 4 _ 3,356 16 6 4,308 6 10 1,424 3 6 705 16 8 704 15 3 88 13 2 646 — — 3,569 8 7 69 18 4 1,706 2 5 14 8 3 353 6 9 2,143 15 9 5,713 4 4 — 1,404 17 6 Dufferin-street 630 19 6 11 12 6 22 16 3 2 11 6 37 _ 3 593 19 3 59 7 8 135 15 4 24 15 3 — 145 _ _ 364 18 3 52 14 4 130 16 1 12 12 0 31 7 6 227 10 9 592 9 - + 1 10 3 Green-st. & Boylield-street 1,789 16 6 53 1 6 22 3 6 2 2 _ 77 7 _ 1,712 9 6 107 12 9 407 5 5 60 10 6 — 184 — — 759 8 8 109 _ 10 587 3 5 30 — 8 137 8 3 864 3 2 1,623 11 10 + 88 17 8 Millbank (proportion) 985 12 6 4 8 10 4 10 8 8 5 9 7 11 976 4 7 47 11 5 181 10 2 31 9 11 _ 2 2 93 3 11 353 17 7 63 18 7 316 2 8 12 14 3 72 5 4 465 _ 10 818 18 5 + 157 6 2 Holmwood 387 3 _ 20 18 6 18 5 _ _ 39 3 6 347 19 6 12 _ _ 98 14 4 14 4 5 60 _ _ 184 18 9 12 3 8 136 7 _ 2 15 1 29 9 1 181 4 10 366 3 7 — 18 4 1 Totterdown-flelds 24,562 8 3 (d)2,734 _ 9 50 _ _ 45 _ 9 2,829 1 6 21,733 6 9 918 9 _ 4,574 13 8 571 19 3 — 2,126 _ _ 8,191 1 11 2,106 12 2 8,733 16 9 416 15 5 1,720 3 1 12,977 7 5 21,168 9 4 + 564 17 5 Preston's-road (proportion) 3,170 1 8 996 6 6 39 6 7 10 14 2 1,046 7 3 2,123 14 5 148 1 8 605 16 1 94 11 2 2 7 7 407 3 6 1,258 - - 172 10 2 1,071 3 8 34 9 6 211 8 1 1,490 1 5 2,748 1 5 — 624 7 - Hughes-fields (dwellings) (proportion) 1,278 13 6 498 6 10 11 5 8 3 17 6 513 10 _ 765 3 6 43 4 6 221 9 3 43 14 3 — 146 13 4 455 1 4 27 3 5 535 17 5 5 7 11 103 19 8 672 8 5 1,127 9 9 — 362 6 3 White Hart-lane 10,949 13 6 (d) 2,786 8 _ 41 1 3 9 14 3 2,837 3 6 8,112 10 _ 530 4 _ 503 4 4 406 1 3 13 15 6 1,294 _ _ 2,747 10 1 1,205 9 8 4,567 5 1 225 10 5 854 14 1 6,852 19 3 9,600 9 4 — 1,487 19 4 Wessex 4,153 5 6 256 4 6 23 9 _ 4 6 _ 283 19 6 3,869 6 _ 212 _ _ 876 19 4 142 6 10 388 _ _ 1,619 6 2 361 17 1 1,482 9 5 73 11 7 295 9 9 2,213 7 10 3,832 14 _ + 36 12 _ Norbury 6,932 2 6 (d) 456 18 6 52 3 _ 4 5 _ 513 6 6 6,418 16 _ 315 8 8 1,192 16 _ 276 1 6 3 — — 626 — — 2,413 6 2 684 18 — 2,637 17 10 128 7 9 494 9 11 3,945 3 6 6,358 19 8 + 59 16 4 Caledonian 5,726 19 6 781 6 _ 29 19 6 9 14 9 821 _ 3 4,905 19 3 276 3 7 1,139 2 2 185 6 7 — 517 _ _ 2,117 12 4 462 12 10 1,756 7 6 98 15 2 338 2 2 2,655 17 8 4,773 10 _ + 132 9 3 Briscoe 2,527 12 3 113 8 6 27 7 6 _ 3 1 140 19 1 2,386 13 2 135 15 3 533 11 4 95 2 5 — 249 _ _ 1,013 9 _ 227 7 6 962 12 5 45 3 _ 185 2 _ 1,420 14 11 2,434 3 11 — 47 10 9 Interest on cash balances _ _ _ — _ _ _ _ _ — _ _ _ — _ _ — — + 133 17 8 Total for dwellings 74,042 2 7 12,068 4 11 433 7 11 94 1 5 12,595 14 3 61,446 8 4 5,092 8 6 11,566 2 5 3,147 14 7 170 _ 5 7,327 _ 9 27,303 6 8 5,660 7 6 25,287 16 8 1,125 10 11 4,995 5 3 37,069 _ 4 64,372 7 _ — 2,792 1 _ 140.7f><) 11 10 15,133 14 7 1,030 3 7 223 18 6 16,387 16 8 130,362 15 2 8,983 18 11 (/i)25,4 00 - 5 7,972 11 3 245 1ft 2 14,125 4 9 56,727 1 6 10,379 v 18 2 49,527 - 5 2,133 v 6 8 10,316 6 7 72,356 11 0 129,084 3 4 + 1,876 2 ft Part III. 0)59,906 18 7 12,449 13 3 Estates in course of development. Totterdown-flelds _ 4 1 6 _ 4 1 6 666 12 4 41 14 3 _ 708 6 7 712 8 1 — 712 8 1 White Hart-lane (e) 439 9 4 _ _ _ 15 6 _ 15 (e) 440 4 10 31 12 4 202 1 _ 233 3 4 2,917 8 9 — 515 2 7 3,432 1 4 3,666 4 8 — 3,225 19 10 0 Norbury (a) _ _ _ _ _ _ _ _ — _ — 536 4 10 — 17 1 8 553 6 6 553 6 6 — 553 6 6 Old Oak (/) 203. _ 2 _ _ _ _ (/) 203 - 2 _ 16 10 3 25 4 3 _ 41 14 6 678 6 _ — 134 _ 6 _ 812 6 6 854 1 _ — 651 _ 1 10 Supervision _ _ _ _ _ 500 _ _ _ — _ 500 _ _ — — _ — 500 _ _ — 500 _ _ Interest on cash balances _ _ _ — _ _ _ _ — — — — — — — 183 7 3 Total—Housing of the Working Classes Act, 1890 642 9 6 _ 15 6 _ 15 6 643 5 _- 500 _ _ 48 2 7 231 6 9 _ 779 9 4 4,798 11 11 — 707 19 - 5,506 10 11 6,286 _ 3 — 5,826 2 6 147,393 1 4 15,133 14 7 1,030 3 7 223 3 _ 16,387 l 2 131,006 _ 2 (q)9,483 18 11 25,448 3 _ 7,972 11 3 477 2 11 14,125 4 9 57,507 - 0 15,178 10 1 49,527 -_ 5 2,841 5 8 10,316 6 7 77,863 2 9 135,370 3 7 — 3,950 _ _ (k) £64,705 10 6 £13,157 12 3 II.—Dwellings under Improvement Acts. £ s. d. £ s. d. £ s. d. £ s. d £ S. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. Battersea bridge 1,235 16 _ 66 2 6 23 9 _ _ 9 _ 90 _ 6 1,145 15 6 47 8 — 256 — 9 42 — 1 — 134 — — 479 8 0 41 6 3 478 8 _ 8 7 11 98 1 8 626 3 10 1,105 12 8 + 40 2 10 Cotton-street 1,187 12 _ 170 _ 6 20 7 _ 2 6 9 193 4 3 994 7 9 57 6 7 286 18 4 34 16 11 — 148 _ _ 527 1 10 37 18 _ 388 7 2 8 4 _ 81 3 _ 515 12 2 1,042 14 _ — 48 6 3 Durham 1,702 8 6 126 9 6 18 5 _ _ 10 _ 145 4 6 1,557 4 _ 79 6 7 338 11 1 58 15 6 — 204 — _ 680 3 2 75 12 9 794 1 7 15 11 10 159 10 11 1,045 7 1 1,726 3 — 168 16 3 Duke's-court (proportion) 606 3 4 _ 18 5 5 10 10 _ 6 10 6 16 1 599 7 3 29 2 4 107 12 6 18 8 4 — 64 5 — 219 8 2 42 10 11 192 11 3 8 14 1 40 19 7 285 1 10 504 10 _ +94 17 3 Bruce House (I) 7,698 18 11 (m)174 6 _ 104 0 _ .9 Pi r> 274 19 6 7,423 19 5 1,997 2 2 835 - - 964 16 1 VI 10 - 601 - — 4,469 8 3 311 16 3 1,556 4 2 56 2 5 298 0 4 2,222 13 2 6,692 1 5 + 731 8 13,42? 18 11 310 1 1 5 4 651 7 1 2,51h 18 9 453 V 6 5 — — 1,100 — — 4,723 3 4 1,346 1 1 8 4,046 0 _ 271 17 8 936 s 0 7,201 7 () 2 Millbank (proportion) 11,416 o 3 51 1 52 9 1 4 17 11 108 16 1 1 11,307 5 4 550 19 3 2,102 6 11 364 16 5 1 6 3 1,079 8 7 4,098 6 5 547 8 1 3,641 4 1 108 17 5 780 5 5,078 15 5 9,177 11 0 + 2,129 3 a Swan-lane 4,Hi 6 6 959 3 _ 19 1 6 8 18 10 987 13 4 3,131 13 2 178 15 4 944 9 1 151 18 4 — 490 — — 1,765 9 166 17 9 1,762 1 0 28 16 9 359 8 3 2,318 4 7 4,083 7 4 — 951 4 Valette 1,680 5 6 82 15 23 9 1 107 4 1,573 1 6 78 5 9 337 12 4 54 3 2 157 _ _ 627 1 3 105 18 9 579 4 1 19 1 4 115 0 1 820 4 3 1,447 5 6 + 125 6 Hughes-fields (dwellings) (proportion 639 6 9 249 2 5 5 2 1 0 1 18 9 256 15 _ 382 11 9 21 12 2 110 14 8 21 17 2 — 73 6 8 227 0 8 13 11 8 267 8 9 2 14 - 51 9 9 336 4 2 563 14 0 — 181 3 1 Bearcroft 688 19 6 126 3 - 18 6 - - 1 6 144 10 6 544 9 - 22 - - 27 8 5 27 ~ 1 — 83 - - 159 8 ft 24 14 b 335 3 6 4 9 - 60 5 6 425 2 5 584 10 1 — 40 1 1 47,560 1 9 2,321 9 2 434 6 5 32 13 5 2,788 9 - 44,771 12 9 3,872 5 4 8,446 16 2 2,295 4 4 77 15 3 4,445 15 3 19,137 6 4 2,968 17 5 15,630 5 8 585 4 7 3,187 4 11 22,372 2 7 41,509 18 1 + 3,261 3 0 Dwellings on sites compulsorily appropriated for rehousing, on the working of which a deficiency was anticipated owing to the character or situation of the site. Council 79s 3 _ 92 16 7 6 93 3 6 705 19 6 48 10 1 194 14 - 28 3 9 — 105 - - 376 7 0 17 10 1 0 463 0 6 4 4 7 115 8 10 601 4 9 977 12 7 — 271 1 i,3i: 8 _ 32 10 - _ 7 2 .9 31 7 3 1,280 9 53 - - *5( 16 - 41 - 6 — 185 - - 529 6 6 32 8 1 1 912 6 9 7 4 2 230 7 1,182 5 1,711 16 1 — 431 6 ft Idenden 1,135 14 6 28 10 6 22 3 6 50 14 1,085 - 6 45 - - 209 — 5 32 14 3 — 129 - - 415 4 8 42 7 6 483 7 6 11 13 5 129 7 4 667 5 9 1,083 5 + 2 1 Barnaby 1,43: 6 6 120 10 6 20 7 - 2 5 3 143 12 9 1,287 13 9 69 8 10 342 V 10 49 14 6 — 148 - - 609 1 2 91 7 5 540 - 3 18 4 2 104 17 4 754 9 2 1,364 - 4 — 76 6 7 Brightlingsea 1,088 1 _ 264 1 6 19 1 6 1 15 3 285 8 3 802 12 9 37 _ 9 234 12 7 37 6 7 — 129 - - 437 9 1 31 15 7 447 3 6 6 7 1 86 15 1 572 1 3 1,010 1 © — 207 8 5 Bekesbourne 1,243 12 - 14 19 _ 22 3 6 2 10 6 39 13 - 1,203 19 - 63 9 ft 261 6 11 43 b — 120 - - 488 5 0 34 5 6 620 3 6 7 2 4 112 6 6 773 17 10 1,262 3 8 — 58 4 8 Darcy 74- — 34 2 6 22 3 6 _ — 57 1 — 687 6 — 28 — — 156 1 5 — - 284 ; 4 4 39 14 7 315 : 9 9 7 18 1 01 5 1 425 8 4 710 2 8 — 22 6 8 Wands worth-road 921 11 6 11 12 6 22 3 6 33 16 - 887 15 6 37 2 6 191 5 3 29 13 11 — 92 - - 350 1 8 61 8 4 363 1 9 9 11 2 72 7 2 496 18 5 847 - 1 + 40 15 5 8,675 3 6 599 2 6 129 2 6 6 10 9 734 15 9 7,940 7 9 381 11 8 1,840 4 5 288 15 10 — 982 - - 3,492 1 1 340 18 8 4,146 3 6 72 5 10 913 7 li 5,473 5 1 8,965 17 0 — 1,025 10 1 - Interest on cash balances •. .. — — — — — + 315 16 2 56,235 5 3 2,920 11 8 563 8 1 39 4 2 3,523 4 9 52,712 ~ 6 (n) 4,2 >3 17 - (0)10,2 87 - 7 2,584 2 77 16 3 5,427 15 3 22,630 8 3 3,309 16 1 19,776 19 2 657 10 5 4,101 2 10 27,845 8 ft 50,475 1ft 9 + 2,551 19 1 (p) £23,086 15 3 £4,758 13 3 (a) For Norbury Brickfield Account see page xxiii. (6) Including £17 12s. 7d. miscellaneous receipts for baths, storage of parcels, etc. I (c) Including £31 8s. lOd. as in note (6). (d) Including new cottages hrndcd over cn completion. (e) Including £10 fs. sale of tuif and £2 3s. 9d. interest on purchase money. (/) Including £44 15s. sale of turf, etc. (g) Local wages of caretakers, etc., £4,114 2s. -d., 1 central office, £5,369 16s. lid. (A) Before crediting £3,711 Is., inconr.e tax cn interest on capital outlay recovered (see note/). (j) Gross interest, £63,617 19s. 7(L, less tax, £3,711 Is., net £59,906 18s. 7d. (k) Gross interest, £68,713 16s. 8d., less tax, £4,008 6s.2d., net £64,705 10s. 6d. ' (I) Including £75 13s. 2d. miscellaneous receipts for baths, storage of parcels, etc. (m) Ixcluding £467 2s. 7d. relate cn weekly tickets (») Local wages of caretakers, etc., £2,295 5s. -d., central office £1,958 12s. -d. (o) Before crediting £1,430 3s. Id. income tax on interest on capital outlay teqovered, see note (p). (p) Gross interest, £24,516 18s. 4d., less tax, £1,430 3s. Id., net £23,086 15s. 3d. 5176 xxxii. xxxiii. xxxii. Annual Report of the London County Council, 1910. Homing of the Working Classes—Accounts. xxxiii. E.—PERCENTAGES ON GROSS RENTAL OF THE SEVERAL ITEMS OF INCOME AND EXPENDITURE IN RESPECT OF DWELLINGS IN THE DETAILED REVENUE ACCOUNT. Dwellings. 1 Income. Expenditure. Result of Year's Working (excluding interest on cash balances). Gross Rental. 2 Deductions. Maintenance and Management. Debt Charges., Total (cols. 13 and 18). 19 Empties. 3 Caretaker's Quarters. 4 Amounts irrecoverable. 5 Total. 6 Net Rental. 7 Supervision and Collection of Rent. 8 Rates and Taxes. (0) 9 Lighting, | Heating, Water and Insurance. 10 Stores and Incidentals. 11 Transfer to Repairs and Renewals Fund. 12 Total. 13 Interest, less tax Sinking fund. Total. 18 Surplus. 20 Deficiency. 21 Land. 14 Buildings. 15 Land. 16 Buildings. 17 L-Housing of the Work ing classes Act,,1890. Part I. £ % % % % % % % % % % % % % % % % % % % Boundary-street (including laundry) 23,310 2.23 .60 .29 3.12 96.88 6.77 20.12 5.69 .31 9.25 42.14 7.67 31.99 1.74 7.75 49.15 91.29 5.59 Do (automatic gas supply) 3,089 — — _ _ 100.00 5.51 _ 65.58 .02 5.21 76.32 _ 6.78 _ 1.71 8.49 84.81 15.19 — Cable-street 2,963 .82 .84 .10 1.76 98.24 4.50 21.89 3.58 _ 10.87 40.84 3.58 36.83 .87 8.98 50.26 91.10 7.14 — shelton-sstreet 1,564 2.08 1.58 .03 3.69 96.31 3.97 19.37 3.89 9.46 36.69 9.21 34.84 2.34 9.03 55.42 92.11 4.20 — Millbank 6,582 .45 .46 .04 .95 99.05 4.83 18.41 3.20 .01 9.45 35.90 4.80 31.90 .95 6.84 44.49 80.39 18.66 — Churchway 3,905 .87 .70 — 1.57 98.43 5.11 19.95 3.27 9.10 37.43 6.70 30.12 1.36 6.31 44.49 81.92 16.51 — Hardy 879 11.15 1.93 .28 13.36 86.64 3.57 18.81 3.22 14.57 40.17 3.48 42.68 .71 8.73 55.60 95.77 — 9.13 Duke's-court 1,819 .15 .91 .06 1.12 98.88 4.80 17.75 3.04 10.60 36.19 7.07 31.77 1.44 6.76 47.04 83.23 15.05 — york-street(late russell-court) 1,143 .23 1.46 .10 1.79 98.21 4.71 17.34 3.14 9.12 34.31 8.34 34.95 1.72 7.29 52.30 86.61 11.60 — Preston's-road 824 31.43 1.24 .34 33.01 66.99 4.67 19.11 2.98 .08 12.84 39.68 5.44 44.55 1.09 8.76 59.84 99.52 — 32.53 st. Luke's— Wenlake 1,930 .53 1.28 .01 1.82 98.18 5.07 19.81 3.17 9.33 37.38 8.54 32.82 1.65 6.51 49.52 86.90 11.23 chadworth 3,411 8.66 .65 .59 9.90 90.10 4.39 16.91 2.73 8.06 32.09 7.18 36.88 1.49 6.70 52.25 84.34 5.76 — Clerkenwell and Holborn— mallory 913 .22 2.57 — 2.79 97.21 4.05 15.81 2.49 7.01 29.36 6.27 41.56 1.13 7.84 56.80 86.16 11.05 Nigel,etc 6,016 6.37 .91 .05 7.33 92.67 4.22 18.16 3.27 8.05 33.70 8.54 41.41 1.54 7.61 59.10 92.80 — .13 Webber-row 4,911 3.83 1.25 .30 5.38 94.62 4.99 22.07 2.99 8.84 38.89 6.08 30.43 1.26 5.56 43.33 82.22 12.40 — book-street 1,017 10.28 1.92 .20 12.40 87.60 3.67 2211 4.05 14.55 44.38 5.14 43.54 1.20 10.20 60.08 104.46 16.86 Goldsinith's-row 485 1.85 4.04 5.79 94.21 3.92 22.17 8.40 11.34 40.83 5.83 41.52 1.46 10.84 59.65 100.48 — 6.27 Hughes-fields Cottages 2,054 36.35 .82 .25 37.42 62.58 2.58 17.54 2.88 — 11.30 34.30 5.12 49.17 1.28 12.56 68.13 102.43 — 39.85 Part II. Cranley 289 2.79 — — 2.79 97.21 7.13 19.79 3.26 10.36 40.54 7.33 28.84 1.56 6.37 44.10 84.64 12.57 — Brough-road 1,869 2.12 1.39 — 3.51 96.49 5.18 23.35 3.41 9.41 41.35 8.19 36.54 1.72 8.04 54.49 95.81 .65 — Cohbom 1,131 2.21 — .01 2.20 97.80 6.85 23.04 8.18 9.73 42.80 5.68 35.18 1.15 7.15 49.16 91.96 5.84 — Ann-street 2,135 11.47 .92 .18 12.57 87.43 5.22 24.72 2.91 12.36 45.21 3.24 33.37 .66 7.14 44.41 89.62 — 2.19 Sylva 469 1.28 .08 1.30 98.64 4.07 22.19 3.04 10.87 40.17 6.77 32.69 1.40 6.84 47.70 87.87 10.77 Part III. Parker-street House 8,283 2.36 .40 — 2.76 97.24 26 27 11-80 15-13 1.89 13.56 68.71 3.17 20.22 .76 5.06 29.21 97.92 — .68 Carrington House 7,665 42.85 1.02 .02 43.79 56.21 18.58 9.21 9.19 1.16 8.43 46.57 .91 22.26 .19 4.61 27.97 74.54 - 18.33 dufferin-street 631 1.84 3.62 .41 5.87 94.13 9.41 21.52 3.92 — 22.98 57.83 8.35 20.73 2.01 4.97 36.06 93.89 .24 — green-street and boyfield-(lategun) street 1,790 2.96 1.24 .12 4.32 65.68 6.02 22.75 3.38 — 10.28 42.43 6.09 32.81 1.68 7.70 48.28 90.71 4.97 — Millbank.. 986 .45 .46 .04 .95 99.05 4.83 18.41 3.20 .01 9.45 35.90 6.49 32.07 1.29 7.33 47.18 83.08 15.97 — Holmwood 387 5.41 4.71 — 10.12 89.88 3.10 25.50 3.67 3.15 35.22 .71 7.73 46.81 94.58 4.70 Totterdown-flelds 24,562 (a)l1.13 .21 .18 11.52 88.48 3.74 18.62 2.33 8.66 33.35 8.58 35.56 1.69 7.00 52.83 86.18 2.30 — Preston's-road 3,170 31.43 1.24 .34 33.01 66.99 4.67 19.11 2.93 .0 12.84 39.68 5.44 33.79 1.09 6.68 47.00 86.68 — 19.69 Hughes-fields Dwellings White Hart-lane . 1,279 10,950 38.98 (a)25.45 .88 .37 . 30 .09 40.16 25.91 59.84 74.09 3.38 4.84 17.32 4.59 3.42 3.71 .13 11.47 11.82 35.59 25.09 2.13 11.01 41.91 41.71 .42 2.06 8.13 7.81 52.59 62.59 88.18 87.68 — 28.34 13.59 Wesex 4,153 6.18 .56 .10 6.84 93.16 5.10 21.12 17.21 3.43 9.34 38.99 8.72 35.69 1.77 7.11 53.29 92.28 .88 — Norbury 6,932 (a)6.59 .76 .06 7.41 92.59 4.55 19.89 3.98 .04 9.03 34.81 9.88 38.06 1.85 7.13 56.92 91.73 .86 — Caledouian 5,727 13.64 .53 .17 14.34 85.66 4.82 21.11 3.24 — 9.03 36.98 8.08 30.67 1.72 5.90 46.37 83.35 2.31 Briscoe 2,528 4.49 1.08 .01 5.58 94.42 5.37 3.76 — 9.85 40.09 9.00 38.08 1.79 7.34 56.21 96.30 1.88 Total for Housing of the Working Classes Act, 1890 .. 146,751 10.32 .70 .15 11.17 88.83 6.12 17.31 5.43 .17 9.63 38.66 7.07 33.75 1.45 7.03 49.30 87.96 .87 — II.—Improvement Acts. Battersea-bridge 1,236 5.35 1.90 .04 7.29 92.71 3.84 20.72 3.40 10.84 38.80 3.34 38.71 .68 7.94 60.67 89.47 3.24 — Cotton-street 1,188 14.32 1.75 .20 16.27 83.73 4.83 24.16 2.93 12.46 44.38 3.19 32.70 .69 6.83 43.41 87.79 — 4.06 Durbham 1,703 7.43 1.07 .03 8.53 91.47 4.66 19.89 3.45 11.98 39.98 4.44 46.67 .92 9.37 61.40 101.38 9.91 Duke's-court 606 .15 .91 .06 1.12 98.88 4.80 17.75 3.04 10.60 36.19 7.07 31.77 1.44 6.76 47.04 83.23 15.65 York-street (late Russell-court) 381 .23 1.46 .10 1.79 98.21 4.71 17.34 3.14 9.12 34.31 8.34 34.95 1.72 7.29 52.30 86.61 11.60 — Herband-street 2,775 .12 .80 .04 .96 99.04 5.08 18.74 3.29 9.98 37.09 8.02 30.75 1.65 6.34 46.76 83.85 15.19 Bruce 7,699 (b)2.26 1.36 .05 3.57 96.43 25.94 10.84 12.53 7.81 58.05 4.05 20.21 .73 3.88 28.87 86.92 9.51 — Bourne 13,429 2.31 .85 .11 3.27 96.73 4.85 18.72 12.53 .93 8.19 35.18 10.03 34.60 2.02 6.98 53.63 88.81 7.92 — Millbank 11,416 .45 .46 .04 .95 99.05 4.83 18.41 3.20 .01 9.45 35.90 4.80 31.90 .95 6.84 44.49 80.39 18.66 — Swan-lane 4,119 23.28 .48 .22 23.98 76.02 4.34 22.93 3.69 — 11.89 42.85 4.05 42.79 .70 8.74 56.28 99.13 — 23.11 Valette 1,680 4.92 1.40 .06 6.38 93.62 4.67 20.09 3.22 — 9.34 37.32 6.31 34.50 1.14 6.87 48.82 86.14 7.48 — Hughes-fields Dwellings 639 38.98 .88 .30 40.16 59.84 3.38 17.32 3.42 — 11.47 35.59 2.13 41.91 .42 8.13 52.59 88.18 — 28.34 Bearcroft 689 18.31 2.66 .01 20.98 79.02 3.19 3.98 3.92 — 12.05 23.14 3.59 48.64 .65 8.82 61.70 84.84 — 5.82 Council 799 11.61 .05 11.66 88.34 6.07 24.36 3.53 — 13.14 47.10 2.19 58.00 .53 14.51 75.23 122.33 33.99 Wentview, Armitage and Collerston 1,311 2.48 .09 2.39 97.61 4.04 19.12 3.13 — 14.11 40.40 2.47 69.57 .55 17.54 90.13 130.53 — 32.92 ldenden 1,136 2.51 1.95 — 4.46 95.54 3.96 18.40 2.88 — 11.36 36.60 3.73 42.61 1.03 11.39 58.76 95.36 .18 — Barnaby 1,431 8.42 1.46 .16 10.04 89.96 4.85 23.93 3.47 — 10.34 42.59 6.38 37.73 1.27 7.33 52.71 95.30 — 5.34 Brightlingsea 1,088 24.27 1.80 .16 26.23 73.77 3.41 21.56 3.43 — 11.86 40.26 2.92 41.10 .58 7.97 52.57 92.83 19.06 Bekesbourne 1,244 1.20 1.79 .20 3.19 96.81 5.10 21.02 3.49 — 9.65 39.26 2.76 49.87 .57 9.03 62.23 101.49 — 4.68 darcy 744 4.53. 2.98 .10 7.66 92.34 3.76 20.97 3.58 9.94 38.25 5.34 42.45 1.06 8.30 57.15 95.40 — 3.06 Wanusworth-road 922 1.26 2.41 — 3.67 96.33 4.03 20.76 3.22 — 9.98 37.99 5.58 39.45 1.04 7.85 53.92 91.91 4.42 Total for Improvement Acts 56,235 5.19 1.00 .07 6.26 93.74 7.56 18.29 4.60 .14 9.65 40.24 5.89 35.17 1.17 7.29 49.52 89.76 3.98 — Total for dwellings 202,986 8.89 .79 .13 9.81 90.19 6.52 17.58 (c) 6.20 .16 9.63 39.09 (c) 6.75 34.14 1.38 7.10 49.37 88.46 (d)l.73 — (a) See note (d) on page xxxi. (b) Excluding 6.07 for rebate on weekly tickets. (d) Percentage on surplus of £3,514 15s. 9d., which excludes interest on cash balances amounting to £913 6s. l0d. (c) Before crediting Income tax on interest on capital outlay, the percentage on gross rental of this item being 2.53. 2 5176 xxxiv. xxxv. Annual Report of the London County Council, 1910. Housing of the Working Classes-Accounts. F.—SUMMARY OF FINANCIAL RESULTS. I.—Housing op the Working classes act. 1890. Dwellings. 1 Metropolitan Borough. 2 Accommodation (persons) (a) 3 Persons in occupation 31st March, 1911. 4 Date of opening. 5 Aggregate Balance on Revenue Account, 1st April, 1910. Surplus (+) Deficiency (—). 9 Result of Year's Working. Surplus (+ ) Deficiency (—) (page col. 20). 10 Aggregate Balance on Revenue Account, 31st March, 1911. Surplus (+) Deficiency (—). 11 Accumulations, of Sinking Fund to 31st March, 1911, (excluding proceeds of Sales). 12 Repairs and Renewals Fund. Land. 6 Buildings. 7 Total. 8 Unspent Accumulations on 1st April, 1910. 13 1910-11. Unspent Accumulations on 31st March, 1911. 17 Transfers from Revenue Account (page ,col. 12;. 14 Actual Expenditure. 15 Difference, being further amount set aside. 16 Part I. Bethnal Green and Shoreditch 5,380 4,420 1895-1900 £ s._d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. Boundary-street 62,010 _ - 275,526 6 - 337,536 6 - + 17,880 10 _ + 1,771 2 3 + 19,651 12 3 38,441 Cable-street Stepney 798 624 1896, 1901 3,660 _ _ 37,592 8 7 41,252 8 7 16,682 5 5 6.167 4 - 5,742 17 5 424 6 7 17,106 12 - Shelton-street Holborn 284 229 1896 5,100 _ 19,292 7 5 24,392 7 5 + 1,509 19 8 5,230 Millbank (proportion).. Westminster 1,536 1,020 1899-1902 11,906 70,390 13 1 82,297 5 1 + 175 + 65 5 ■+■ 241 3,559 Churchway St. Pancras 832 597 1901-2 8,550 - 39,126 14 47,676 14 + 6,069 14 10 + 1,227 18 + 11,820 + 6 714 13 5 3 6,252 Hardy Greenwich 306 233 1901 1,000 _ _ 12,298 9 _ 13,298 9 _ Duke's-court (proportion) Westminster 458 359 1902 4,20f _ _ 19,193 16 1 23,391: 16 1 York-street (proportion) 293 219 1903 6 14 + 284 11 9 f 2,435 1,502 Preston's-road (proportion) Poplar 269 137 1904 1,433 14 1 11.412 17 5 12,846 11 6 + 885 18 11 + 132 11 8 + 1,018 10 7 836 St. Luke's— Wrenlake Finsbury 490 367 1905 5,000 19,774 ,? 7 24,774 2 7 588 Chadworth Finsbury .. 720 566 1907 8,000 35,812 2 6 43,812 2 6 5 + 217 13 +- 1,305 ~ 960 Clerkenwell and Holborn— Mallory Finsbury 164 113 1906 1,620 11,479 o 3 13,09£ 2 3 + 196 12 9 + 484 1,195 Nigel,etc. Holborn 1,260 862 1908 14,550 71,210 It 11 85,760 13 u Webber-row Southwark 1,143 787 1906-7 9,750 - - 43,039 7 4 52,789 7 4 4- 2.167 Q 7 4- 2 775 18 Dwellings on sites compulsorily appropriated for rehousing, on the working of which a deficiency wasanticinat*dowin«tothe character or situation of the.it* Brook-street Stepney 308 245 1894, 1900, 1,800 15,314 0 17,114 _ 9 Goldsmith's-row Shoreditch 144 99 1895 1,000 8.128 8 11 Hughes-fields cottages Greenwich 666 353 1895 3,720 - - 35,756 1 1 39,476 1 1 — 487 — 8.549 8 4 7 — 30 — 81ft 7 fi 9 — 517 — 9.367 10 15 1 1,304 15 4 1ft ft Part II. Cranley Holborn 60 43 1897 750 _ _ 3,017 8 10 3,767 8 10 12,145 11 1 631 - - 499 2 2 131 17 10 2,277 8 11 Borough-road Southwark 400 292 1900 5,000 4 1 Cobham Southwark 279 221 1900 2,100 13,007 1 5 15,107 1 5 + 871 9 4 + 12 3 2 + 883 12 6 2,411 4 10 Ann-street Poplar 630 427 1901-2 2,260 _ 23,812 4 8 26,072 4 8 + 1,150 + 66 2 11 5 1,155 17 11 Sylva Deptford 144 103 1903 1,000 - - 5,053 7 7 6,053 7 7 + 444 16 + 50 18 10 9 — 850 + 495 6 9 1,655 331 12 2 Part III. Dwellings. Parker-street House Holborn 345 332 1893 3,750 \ 12,574 18 2 7,327 - 9 5,306 4 8 2,020 16 1 14,595 14 3 Carrington House Deptford 803 418 1903 2,200 7 7 57,136 17 7 479 - 2 — 22 2 10 + 456 1/ 4 4,524 V 6 Dufferin-street Finsbury 174 149 1892 1,900 _ _ 4,714 0 1 6,614 10 11 5 5 — 1,404 i; 6 10,581 2 11 i> Green-street and Boyfield-street Southwark 418 319 1897 3,860 18 4 + 1 Millbank (proportion) Westminster 230 153 1899-1902 2,411 14 5 10,540 5 3 12,951 19 8 1,770 13 9 + 88 17 8 + 1,859 11 5 3,049 1 1 Holmwood Southwark 72 42 1900 450 4,777 3 6 5,227 13 6 + 157 6 2 1,650 5 7 Totterdown-flelds Wandsworth 7,754 3,594 1903-10 74,664 1 2 4 38 Preston's-road (proportion) Poplar 1,035 527 1904 5,516 — 45 1^ + 564 17 5 + 518 19 i 10,355 1 5 Hughes-flelds-dwellings (proportion) Deptford and Greenwich 440 227 1904 855 6 8 16,374 2 9 17,229 19 5 — 4,780 1,249 V 10 3 — 624 — 362 7 6 3 — 5,404 1,611 14 16 3 3 1.837 722 2 19 8 2 White Hart-lane Tottenham 5,346 2,103 1904-10 40,133 _ _ 152,382 6 0 192,515 6 10 Wessex Islington 1,050 734 1904-5 11,818 13 2 9 1 57,879 1 3,521 norbury 2,623 — 1,358 + 36 12 — ■ 19 Caledonian-road Islington ., 1,384 955 1906 15,763 12 7 53,189 6 1 68,953 8 8 — 1,377 8 1 + 59 16 4 — 1,317 11 9 1,739 8 10 Briscoe Lambeth 718 333 1906 7,154 7 2 27,925 ? ? 35 079 19 l± 9 b Old Oak Total—Dwellings Hammersmith .. — — (b) 32 13 7 (b) 32 13 7 10 9 8 7 •• — 3,371 - 354.030 7 1 1,661,802 3 8 2,015,833 - 9 + 12,196 _ 7 + 1,278 11 10 + 13,474 12 5 120,455 12 1 Si,402 4 8 14,125 4 9 4 3 2,577 6 33,979 15 2 Intrest on cash balance * * • • •• •• — + 1,940 18 10 + 597 10 8 + 2,538 9 6 — Dwellings in course of erection— + 14,136 19 5 + 1,876 2 6 + 16,013 1 11 — - - - Part 1 Part III •• •• •• •• — — — z 6,613 5,601 17 17 1 3 6,613 5,601 17 17 1 3 — — — z — — — 12,215 14 4 — 12,215 14 4 Dividends (less expenses of investment) and interest (Repairs and Renewals Fund) 354,030 7 1 1,661,802 3 8 2,015,833 - 9 + 1,921 5 1 + 1,876 2 6 + 3,797 7 7 - 4,489 8 4 — — 1,125 10 4 1,125 0 4 5,615 8 8 part III. Estates in course of development d 120,242 12 4 — cd 120,242 12 4 64,120 5 3 — 5,826 2 6 69,946 7 9 11,335 18 6 474,272 9 5 1,661,802 3 8 2,136,075 13 1 — 62,199 - 2 — 3,950 - - — 66,149 - 2 131,791 10 7 35,892 1 3 _ 14,125 4 9 10,422 13 11 3,702 0 10 39,595 3 10 Add—Net contributions from rates to 31st March, 1911 66,149 - 2 II. Dwellings under 1 Improvement Acts. 286 211 1901 1 350 £ 15,704 s. 7 n. 8 £ 17,054 s. d. £ s. d. £ s. d. £ s. d. £ s. d. Cotton-street 360 232 12,768 1? 5 + 449 16 10 + 40 2 10 + 489 19 8 1,159 14 11 Durham Battersea 536 416 1904 2,380 _ _ 24,684 13 27,064 13 - — 417 1 8 — 48 6 3 — 465 7 11 1.040 6 1 Duke's-court (proportion) Westminster 152 120 1902 1,400 _ _ 6,397 18 9 7,797 18 9 7 3,301 3 0 York-street (late Russell-court) (proportion) Westminster 97 73 1903 1,000 - - 4,316 15 5 5,316 15 5 + 716 18 3 + 94 1/ 6 + 811 lb 6 500 15 5 Herbrand-street Holborn 680 531 1904 7,000 26,659 2 2 33,659 2 2 Bruce House Westminster 701 701 1906 8,830 _ _ 46,969 2 5 55,799 2 5 + 2,542 17 11 + 421 9 11 + 2,964 7 10 1,658 6 Bourne + 2,861 11 10 + 731 Iti + 3,593 9 10 Millbank (proportion) Westminster 2,664 1,769 1899-1902 20,650 10 2 122,083 15 11 142.734 6 1 + 5,857 1 3 + 1,063 14 2 + 6,920 15 5 9,374 2 10 Swan-lane Bermondsey 1,270 833 1902-4 5,000 55,870 5 60,870 5 - + 18,414 4 3 + 2,129 13 + 20,543 17 9 10,844 4 Valette Hackney 416 263 1905 3,000 18,172 11 1 21,172 11 1 8,044 \ Hughes-fields dwellings (proportion) Deptford and 220 113 1904 427 13 4 8,187 6 4 8,614 19 8 ■+■ 615 — 624 6 15 V 1 + 125 — 181 16 3 1 + 741 805 18 V 2 765 361 11 9 3 / 16.221 6 5,427 15 3 4,650 12 6 777 2 9 16,998 6 3 Bearcroft Fulham 220 117 1906 700 - - 9,562 19 - 10,262 19 - 9.71 11 Dwellings on sites compulsorily appropriated for rehousing, on the working of which a , . ... . , ,« . , .. ,. ... Council Poplar 240 130 1894 621 _ 16,420 7 _ 17,041 7 - Westview, etc. 464 333 1894 1,148 9 3 32,307 14 11 33,456 4 2 — 4,105 10 9 — 271 13 1 - 4,377 3 10 Idenden 400 263 1896 1,500 17,156 10 6 18,656 10 6 — 7,660 15 5 — 431 16 2 8,092 11 7 5,553 3 9 Barnaby Bermondsey 400 813 1904 2,875 _ _ 16,516 17 1 19,391 7 1 — 876 - 9 + 2 - 1 — 874 - 8 2,755 b l> Brightlingsea 340 1904 13,671 5 10 — 82 IV 1 — 76 6 7 " 159 a 8 833 19 6 Bekesbourne Stepney 380 250 1907 1,120 17,670 6 5 18,790 6 5 — 1,179 17 4 — 207 8 5 — 1,387 5 9 635 17 8 Darcy 190 132 1904 1,250 9,741 1?, 3 10,991 12 8 — 182 19 4 — 58 4 8 — 241 4 - 486 — Wands worth-road Lambeth 236 149 1905 1,560 " - 11,343 1 3 12,903 1 3 — 147 + 189 6 5 6 — 22 + 40 16 15 8 5 + 169 230 1/ 1 1 11 489 513 11 17 b 4 Total—Dwellings .. — 9,056 — 108,212 12 9 635,433 7 9 743,646 - 6 + + 6,179 959 14 1 9 11 + 2,236 + 315 3 16 9 2 + + 8,415 1,274 18 18 6 1 46,182 3 8 16,221 3 6 5,427 15 3 4,650 12 777 2 9 16,995 6 3 Interest on cash balances •• •• •• •• — — — Dwellings in course of erection •• - •• •• - - - + 7,138 3,897 16 7 8 9 f 2,551 19 11 + 9,690 3,897 16 7 7 9 — - Dividends (less expenses of investment) (Repairs and Renewals Fund) .. .. — — — + 3,241 8 11 + 2,551 19 11 + 5,793 8 10 1,876 2 8 — 567 18 11 567 18 11 2,4J4 1 7 108,212 12 9 635,433 7 9 743,646 - 6 + 3,241 8 11 + 2,551 19 11 + 5,793 8 10 46,182 3 8 18,0p7 6 2 5,427 15 3 4,082 13 7 1,345 1 8 1 19,412 7 10 Deduct—Net contributions to rates, after deducting contributions from Tramways Account, to 31st March, , _,, , . ' * ' 1911(page ) 5,793 a 10 — — ■ : =* - - (a) The accommodation Is arrived at generally by calculating two persfnstoa ic(m- The cfnfus taken in M&ub, 1£11. r hewed enaveiagof (e) After deducting expenditure of £3,580 19s. 6d. in 1910-11 met out of the Acquisition of Lands Fund. 1 21 persons per room. . . a™,,;.,;*;™ Af Tand* Fund n (6) After deducting expenditure of £732 14s. Id. in 1910-11 met out of the Acquisition of Lands iun«. (i) White Hart-lane, £34,837 lis. 101.; Norbury, £3,3*3 2s. 10d.; Old Oak,£31,991 17s. 8d. xxx vi. xxxvi. Annml Report of the London County Council, 1910. G.—DETAILS OF INVESTMENTS OF REPAIRS AND RENEWALS FUND Cost Price. Market Value, 31st March, 1911 (after deducting accrued interest). Name of Stock. Amount of Stock. Housing of the Working Classes Act, 1890. Dwellings (Improvement Acts). Total. Part I. Part II. Part III. Total. London County Consolidated— £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ £ 2½ percent. 24,570 14 9 12,693 9 1 1,000 _ _ 1,603 16 9 15,297 5 10 5,702 14 2 21,000 18,244 3 per cent. 12,246 9 8 1,000 — — 500 — _ 4,500 _ _ 6,000 _ _ 5,000 — — 11,0(10 10,808 New South Wales Government— 3½ percent. Inscribed (1918) 11,148 17 2 3,000 - - 500 - - 4,000 - - 7,500 - - 3,500 - - 11,000 10,954 Dominion of Canada- 3½ percent. (1930-50) 13,026 4 1 3,000 _ _ 5,500 8,500 _ _ .4,500 _ _ 13,000 13,042 19,693 9 1 2,000 - - 15,603 16 9 37,297 5 10 18,702 14 2 56,000 (a) 53,048 (a) Housing Act, 1890 £35,049 Improvement Acts 17,999 53,048 H.—CONTRIBUTIONS FROM AND TO RATES. Year Part I. Housing of the Working Classes Act, 1890. Dwellings (Improvement Acts). Total. Part II. Part III. Dwellings. Estates in course of development. I.—Contributions from the Rates. 1894-5-1909-10 (as per Accounts of 1909-10) £ 3,167 s. 17 d. 6 £ s. d. £ 27,717 s d. 9 £ 65,510 s. 13 d. 9 £ 5,097 s. 5 d. 4 £ 101,493 s. 5 d. 4 1910-11 - — 2,792 1 - 5,826 2 6 8,618 3 6 3,167 17 6 _ 30,509 9 9 71,336 16 3 5,097 5 4 110,111 8 10 II.-Contributions to the rates. 1894-5-1909-10 (as per Accounts of 1909-10) 26,561 10 9 2,000 - _ 2,821 16 _ (b)1,390 8 6 7,918 3 3 40,691 18 6 1910-11 Net contributions— From rates 5,388 11 9 702 16 4 3,895 9 1 9,986 17 2 31,950 2 6 2,702 16 4 2,821 16 _ (b) 1,390 8 6 11,813 12 4 50,678 15 8 27,687 13 9 69,946 7 9 To rates 28,782 5 - 2,702 16 4 6,716 7 — 59,432 13 2 III.—Contributions from Tramways Account. Proportion of deficiency on Hughes-fields (Deptford) Dwellings, Drake Buildings, allocated for rehousing persons displaced by the Generating Station. Greenwich - To 31st March, 1910 741 15 1 1910-11 181 3 1 922 18 2 Net contributions from Rates and Tramways Account— Housing of the Working Classes Act, 1890 66,149 - 2 Less—Dwellings under Improvement Acts 5,793 8 10 60,355 11 4 (b) In respect of Norbury Brickfield. xxxvii. Housing of the Working Classes—Accounts. xxxvii. APPENDIX XV. CAPITAL EXPENDITURE ON CLEARANCE SCHEMES UNDER THE HOUSING OF THE WORKING CLASSES ACT, 1890. Clearance Scheme. Date of Act sanctioning Scheme. Capital Expenditure to 31st March, 1911. Gross. Receipts applied to Capital Expenditure. Net. (a) Housing of the Working Classes Act, 1890. Part I. £ s. d. £ s. d. £ s. d. Whitechapel and Limehouse 1876 187,557 18 6 35.795 1 4 151,762 17 2 Holborn — 1,728 14 7 1,728 14 7 Goulston-street and Flower and Dean-street, Whitechapel 1877 371,607 5 5 87,635 15 7 283,971 9 10 Elizabeth-place, King-street and Mint-street, St. Georgethe-Martyr, Southwark ,, 66,785 10 8 14,342 5 9 52,443 4 11 Bedfordbury, St. Martin-in-the-Fields ,, 87,212 8 4 11,701 14 4 75,510 14 - Great Wild-street, St. Giles-in-the-Fields ,, 124,278 7 10 18,627 15 9 105,650 12 1 Pear Tree-court, Clerkenwell ,, 27,426 6 5 6,556 11 6 20,869 14 11 Whitecross-street, St. Luke ,, 391,302 19 2 76,360 5 3 314,942 13 11 High-street, Islington ,, 44,775 11 3 6,588 16 7 38,186 14 8 Old Pye-street, Westminster ,, 79,389 4 10 29,493 - 4 49,896 4 6 Bowman's-buildings, St. Marylebone 1878 52,348 6 6 15,889 15 6 36,458 11 _ Essex-road, Islington ,, 115,108 - - 17,209 6 2 97,898 13 10 Little Coram-street, Bloomsbury 1879 14,358 19 3 871 8 8 13,487 10 7 Wells-street, Poplar ,, 75,771 8 7 11,651 19 8 64,119 8 11 Great Peter-street, Westminster ,, 235 5 3 22 12 7 212 12 8 Tench-street, St. George-in-the East 1883 52,636 16 4 645 17 9 51,990 18 7 Brook-street, Limehouse ,, 23,794 14 11 3,988 2 6 19,806 12 5 Windmill-row, Lambeth ,, 13,212 5 8 3,433 12 11 9,778 12 9 Trafalgar-road, Greenwich ,, 20,700 4 - 3,023 12 8 17,676 11 4 Tabard-street, Newington 1885 18,629 13 7 10,400 7 8 8,229 5 11 Hughes-fields, Deptford ,, 91,978 3 5 8,083 5 10 83,894 17 7 Cable-street, Shadwell 1887 46,390 10 6 5,155 8 2 11,235 2 4 Shelton-street, St. Giles ,, 79,553 13 6 11,134 12 9 68,419 _ 9 Boundary-street, Bethnal Green 1891 353,430 3 9 74,442 7 10 278,987 15 11 Goldsmith's-row, Shoreditch ,, 4,885 7 10 1,090 17 6 3,794 10 4 Churchway, Somers Town, St. Pancras 1897 43,200 11 7 8,699 _ _ 34,501 11 7 Clare-market, Strand ,, 413,988 18 2 353,850 _ 2 60,138 18 - Aylesbury-place, Clerkenwell, and Union-buildings, Holborn 1900 194,100 15 - 18,948 4 6 175,152 10 6 Burford's-court, Tucker's-court and Favonia-street, Poplar ,, 16,829 7 3 5,530 10 - 11,298 17 3 Garden-row, Roby-street, Baltic-street and Honduras-street, St. Luke " 120,632 13 3 13,860 11 6 106,772 1 9 Webber-row and Wellington-place and King's Bench-walk, Southwark ,, 106,742 14 - 10,293 9 - 96,449 5 - Nightingale-street, St. Marylebone ,, 702 1 - 702 1 - — Providence-place, Poplar 1902 12,752 3 6 145 7 1 12,606 16 5 Tabard-street and Grotto-place, Southwark and Crosbyrow, Bermondsey — 82 19 6 82 19 6 General — 449 3 7 449 3 7 Total for Part I 3,254,579 6 11 866,173 17 10 (a)2,388,405 9 1 Part II. (i) Schemes carried out by the Council- Brooke's market, Holborn 1892 8,929 15 6 3,857 14 10 5,072 — 8 Mill-lane, Deptford 1894 23,341 1 11 14,174 16 4 9,166 5 7 Ann-street, Poplar ,, 11,089 10 5 6,735 2 - 4,354 8 5 Falcon-court, Borough 1898 50,951 6 10 15,798 10 1 35,152 16 9 (ii.) Contributions to schemes carried out by the Local Authorities— Green-street and Gun-street, Southwark 1893 1,568 14 10 — 1,568 14 10 Moira-place and Plumber's-place, Shoreditch 1894 27,500 - - — 27,500 - - Queen Catherine-court, Ratcliff 1895 2,787 2 8 — 2,787 2 8 London-terrace, St. George-in-the-East ,, 682 8 - — 682 8 - King John's-court, Limehouse 1899 6,429 - 8 — 6,429 — 8 Fulford-street and Braddon-street, Rotherhithe 1900 14,560 - - — 14,560 — — Brantome - place and Prospect-terrace, St. Pancras 1904 13,850 - - — 13,850 - - Norfolk-square, Islington ,, 3,986 19 8 3,986 19 8 Total for Part II 165,676 - 6 40,566 3 3 (a)125,109 17 3 Total for Parts I. and II 3,420,255 7 5 906,740 1 1 2,513,515 6 4 (a) Before deducting proceeds of sales carried to Consolideted Loans Fund. Note The receipts are derived from sales of land and rents, and include amounts transferred from the accounts of the dwellings for the housing values of the sites appropriated for that purpose. Under Part II. they include contributions from Local Authorities. xxxviii. xxxix. xxxviii. Annual Report of the London County Council, 1910. Housing of the Working Classes—Accounts. xxxix. APPE NDIX XVI. COMMERCIAL AND HOUSING VALUES OF SITES UTILISED FoR THE ERECTION OF WORKING CLASS DWELLINGS. Statement showing difference between the Commercial value and the housing value of sites (I.)Sold by the Metropolitan Board of Works to Dwellings Companies and others, with thf. obligation to erect dwellings for the working classes thereon, or (ii.) acquired or appropriated by the council for the erection of working class dwellings. (i.) Sites sold by the Metropolitan Board of Works to Dwellings Companies and others, with . (ii) Sites acquired or appropriated by the Council for the erection of working class the obligation to erect dwellings for the working classes thereon. dwellings. Clearance scheme or street improvement. Commercial value (estimated). Housing value. (Cash received from Dwellings Companies.) Difference charged to clearance scheme or improvement, (cost of writing down value of cleared site.) Dwellings Commercial value. (Estimated.) Housing value. (Estimated.) [Amounts charged to Dwellings Aocounts. Difference charged to clearance scheme or improvement (cost of writing down value of cleared site). Housing of the Working Classes Act, 1890. Housing of the Working Classes Act, 1890. Part I.—Clearance Schemes. £ £ £ Part I. £ £ £ Whitechapel and Limehouse 73,000 24,900 48,100 Boundary-street 131,670 62,010 69,660 Cable-street 8,500 3,660 4,840 Goulston-street and Flower and Dean-street, Whitechapel 80,000 32,106 47,894 Shelton-street 24,465 5,100 19,365 Elizabeth-place, King-street and ilint-street, St. George-theMartyr, Southwark 27,000 12,300 14,700 Millbank (a)16,202 11,907 4,295 Churchway 25,000 8,550 16,450 Bedfordbury, St. Martin-in-the-Fields 15,000 7,886 7 114 Great Wild-street, St. Giles-in-the-Fields 35,000 15,840 19,160 Hardy 4,000 1,000 3,000 Dukes-court York-street (late Russell-court) (a) 61,181 4,200 3,000 53,981 Pear Tree-court, Clerkenwell 12 000 5 925 6 075 Whitecross-street, St. Luke 105,000 36,882 68,118 Preston's-road 1,434 1,434 Nil. High-street, Islington 11,000 5,650 5,350 St. Luke's—Wenlake 25,900 5,000 20,900 Old Pye-street, Westminster 40,000 20,410 19,590 Do Chadworth 20 800 8 000 12,800 Bowman's-buildings, St. Marylebone 16,500 10,000 6,500 Clerkenwell and Holborn—Mallory 10,000 1,620 8,380 Essex-road, Islington 30,000 13,306 16,694 Do. Nigel, etc. 53,000 14,550 38,450 Wells-street, Poplar 12,000 5,000 7,000 Webber-row 28,500 9,750 18,750 Windmill-row, Lambeth 6,000 3.050 2,950 (b) Parker-street 14,035 3,750 10,285 Tabard-street, Newington 7.000 4,200 2,800 Brook-street 3 600 1 800 1 800 Hughes-fields, Deptford 2,600 1,460 1,140 Goldsmith's-row (a) 4,794 l,000 3,794 Hughes-fields 7,760 3,720 4,040 Total for Clearance schemes 472,100 198,915 273,185 Part II. Street Improvements. Cranley 1,500 750 750 Borough 8,146 5,000 3,146 Metropolitan Street Improvements Act, 1872— Bethnal Green-road 11 500 (a) 7 220 4,280 Cobham 6,466 2,100 4,366 Ann-street 2,850 2,260 590 Old-street to Oxford-street (Clerkenwell-road and Theobald'sroad) 38,400 10,360 27,540 Sylva 2,166 1,000 1,166 (c) Carrington House 3,834 2,200 1,634 Willow-walk (Great Eastern-street) 26,305 14,272 12,033 Metropolitan Board of Works (Various Powers) Act, 1876Appold-street (Sun-street) Shoreditch 2,100 1,250 850 465,803 163,361 302,442 Metropolitan Street Improvements Act, 1877— Camberwell and Peckham 1,500 600 900 (d) Dwellings under Improvement Acts. Charing Cross-road and Shaftesbury-avenue 77,000 (a) 33,715 43,285 Battersea-bridge 4,000 1,350 2,650 Gray's Inn-road (including Elm-street, Acts of 1884 and 1887) 22,730 14,335 8,395 Cotton-street 2,500 1,400 1,100 Durham 5,000 2,380 2,620 Jamaica-road and Union-road 10,700 5,300 5,400 Duke's-court York-street (late Russell-court) (a) 20,668 1,400 11,000 18,268 Kentish Town-road 2,500 2,300 200 Marshalsea-road (Southwark Bridge-road) 4,200 1,900 2,300 Herbrand-street 41,836 7000 34,836 Tooley-street 20,000 (a) 10,000 10,000 Bruce House 63,000 8,830 54,470 Metropolitan Street Improvments Act, 1883— Green-street, Bethnal Green 3,500 2,030 1,470 Bourne (a) 201,469 44,000 157,469 Millbank (a) 27,901 20,651 7,250 Swan-lane 6,850 5,000 1 850 Upper-street, Islington 2,500 950 1,550 Hampstead High-street 2,500 1,500 1,000 Valette 8,600 3,000 5,600 Metropolitan Board of Works (Various Powers) Act, 1885— Rosebery-avenue 30,000 24,775 5,225 Hughes-fields (a) 428 428 Nil. Bearcroft 2,229 700 1,529 Council 3,000 621 2,379 Westview, Armitage and Collerston 4,900 1,148 3,752 Total for Street Improvements 255,435 131,007 124,428 Idenden 4,400 1,500 2,900 Barnaby 6,100 2,875 3,225 Brightlingsea 4,100 1,000 3,100 Bekesbourne 2,350 1120 1,230 Darcy 2,350 1,250 1,100 Wandsworth-road (a) 4,596 1,560 3,036 Total 727,535 329,922 397,613 416,277 108,213 308,064 (a) Wholly or partly based on the capitalisation of annual ground rents. 882,080 271,574 610,506 (a) Actual cost of site purchased for re-housing purposes. (b) Erected as a lodging house under Part III., but provides accommodation in connection with Shelton-street Scheme. (c) Erected as a lodging house under Part III., but provides accommodation in connection with Mill-lane, Deptford, Scheme. (d) For statutes under which these dwellings are erected see page lvii. the Council's Valuer of the amount which would have been obtained in the open market at the time of the disposal of the re-housing site for the NOTE.—The figures in the column headed “Commercial value,” except in the few instances where actual cost is given, represent the estimate of 1 actually received from Dwellings Companies and others for the sites restricted to the erection of working class dwellings and in statement (ii) the site as cleared land free from all restrictions. The figures in the column headed." Housing value " represent in statement (i.) the sums | estimated housing value as determined by the Council on the advice of the Valuer, and charged to the capital accounts of the dwellings. xl APPENDIX XVII. HOUSING STATISTICS. A.—Number of Tenements Comprised in the Dwellings in Occupation on 31st March, 1910, together with Particulars of the Dwellings Opened between that date and 31st March, 1911. Dwellings. Metropolitan Borough. Date opened. Number of tenements of Total tenements. Total rooms. Cubicles. Number of persons provided for. Shops. Workshops. Stables Sheds. Cupboards 1 room. 2 rooms. 3 rooms 3 rooms with additional small bedroom. 4 rooms 5 rooms 6 rooms Total number of tenements, etc., in occupation on 31st March, 1910 Dwellings opened during the year 1st April, 1910, to 31st March, 1911— Totterdown Fields Estate— Church-lane .. .. (a)1 91 3,458 3,492 (b) 159 774 (c)462 3 8,539 23,565 1,846 48,971 102 97 12 192 17 Wandsworth June, 1910 Oct. & Nov. 1910 Apl., 1910 June & July, 1910 Mar. to Jan., 1911 10 10 50 100 Coteford-street 24 22 •• •• •• 46 149 298 •• •• •• •• •• Derinton-road •• •• 22 •• • • •• •• 22 66 •• 132 .. .. •• .. •• Lessingham-avenue •• •• •• •• 42 •• •• 42 168 •• 336 .. •• •• •• •• Okeburn-road •• •• •• 38 •• •• •• 38 133 •• 266 • • •• •• •• •• 46 60 42 10 158 566 1,132 Norbury Estate— Bavant-road Croydon June & } Aug., 1910 June, 1910 Oct., 1910 June, 1910 to Jan., 1911 •• •• 4 6 4 •• •• 14 •• •• 98 •• •• •• •• •• Newlands-road •• •• •• 10 1 •• •• 11 39 •• 78 .. •• .. .. Norton-gardens •• •• •• •• 4 •• •• 4 16 •• 32 •• •• •• •• •• Tylecroft-road * * * • 26 38 16 •• •• 80 275 550 * • • • • • 30 54 25 109 379 758 White Hart-lane Estate— Awlfield-avenue Tottenham Apl., 1910 July, 1910 to Jan., 1911 Feb., 1911 •• •• •• •• 16 •• •• 16 64 •• 128 •• •• •• •• • • Baliol-road . . . . 29 •• •• .. •• 29 87 •• 174 •• . . .. •• . . Benington-road . . •• . . •• 12 .. •• 12 48 •• 96 •• . . •• .. •• r Annual Report of the London County Council, 1910. xlii. B.—Accommodation Provided in all the Council's Dwellings open on 31st March, 1911. Dwellings. Metropolitan Borough. Date opened. Number of tenements of Total tenements Total rooms. Cubicles. Number of persons provided for. Shops. Workshops. Stables. Sheds. Cupboards 1 room. 2 rooms. 3 rooms. 3 rooms vith small1 additional bedroom. i rooms 5 rooms ) rooms Ann-street-dwellings— Adelaide-buildings Melbourne-buildings Sydney-buildings Poplar Sept., 1901 .. 25 15 .. .. .. .. 40 95 .. 190 Nov., 1902 .. 30 10 .. .. .. .. 40 90 .. 180 Dec., 1902.. .. 35 20 .. .. .. .. 55 130 .. 260 90 45 135 315 630 Barnaby-buildings Bermondsey Sept., 1904 .. 40 40 .. .. .. .. 80 200 .. 400 Battersea-bridge-buildings Battersea Oct., 1901 10 44 15 .. .. .. .. 69 143 .. 286 .. .. .. 12 Bearcroft-buildings Fulham Sept., 1906 .. 10 30 . . .. . . .. 40 110 .. 220 Bekesbourne buildings Stepney July, 1907 .. 45 20 .. 10 . . . . 75 190 .. 380 Borough-road-dwellings— Southwark Gardiner-buildings May, 1900 •• 8 .. .. .. •• • • 8 16 .. 32 Hunter-buildings May, 1900 .. 20 20 .. .. .. .. 40 100 .. 200 Murphy-buildings Oct., 1900 .. 24 12 .. .. .. .. 36 84 .. 168 .. .. .. .. .. 52 32 84 200 400 Boundary-street estate— Streatley-buildings Bethnal-green April, 1895 .. 32 24 .. .. .. .. 56 136 .. 272 .. 12 .. .. 4 Cleeve-buildings Shoreditch July, 1896 .. 7 12 .. 12 1 .. 32 103 .. 206 8 16 .. 8 Culham-buildings Bethnal-green Nov.1896 15 20 .. .. .. .. .. 35 55 .. 110 Sonning-buildings ,, Nov., 1896 .. 10 15 .. 15 .. .. 40 125 .. 250 Hurley-buildings ,, Jan., 1897 .. 5 5 .. .. .. .. 10 25 .. 50 Sandford-buildings ,, Jan., 1897 .. 5 5 .. .. .. .. 10 25 .. 50 Henley-buildings ,, March, 1897 .. 45 25 .. .. .. .. 70 165 .. 330 .. .. .. .. 5 Walton-buildings ,, March, 1897 .. 40 35 .. .. .. .. 75 185 .. 370 •• .. .. .. 6 Marlow-buildings ,, March, 1897 .. .. 12 .. 17 5 .. 34 129 .. 258 6 17 Shiplake-buildings ,, March, 1897 .. .. . . .. 25 .. 1 26 106 .. 212 4 Taplow-buildings ,, May, 1897 .. 25 25 .. .. .. .. 50 125 .. 250 Chertsey-buildings ,, July, 1897 .. 6 14 .. .. .. .. 20 54 .. 108 Sunbury-buildings ,, Aug., 1897 .. 50 25 .. 5 .. .. 80 195 .. 390 .. 32 .. .. 2 Iffley-buildings .. ,, March, 1898 .. 5 5 .. 5 .. .. 15 45 .. 90 .. Clifton-buildings ,, Jan., 1899 .. 27 36 .. 7 .. 2 72 202 .. 404 Molesey-buildings ,, March, 1899 .. .. 18 .. 2 . . 20 62 .. 124 Wargrave-buildings ,, May, 1899 .. 45 15 .. . . .. . . 60 135 .. 270 Cookham-buildings ,, July, 1899 .. 21 22 .. 10 1 .. 54 153 .. 306 Benson-buildings ,, April, 1900 .. 30 10 .. .. .. . . 40 90 .. 180 Hedsor-buildings ,, April, 1900 .. 50 35 .. .. .. .. 85 205 .. 410 Abingdon-buildings ,, May, 1900 .. 75 10 .. .. .. .. 85 180 .. 360 Laleham-buildings ,, May, 1900 .. 35 40 .. .. .. .. 75 190 .. 380 15 533 388 .. 98 7 3 1044 2690 .. 5380 18 77 .. 8 17 Bourne-estate— Holborn Denys-buildings Oct., 1902 .. 40 15 .. .. .. .. 55 125 .. 250 .. Frewell-b uildings jan.,1903 .. 40 15 .. .. .. .. 55 125 .. 250 . Scrope-buildings Jan., 1903 .. 50 5 .. .. .. .. 55 115 .. 230 Skipwith-buildings Feb., 1903 .. 40 15 .. .. .. .. 55 125 .. 250 Ledam-buildings March, 1903 .. 50 5 .. .. .. .. 55 115 .. 230 25 Shene-buildings May, 1903 .. 30 .. .. .. .. .. 30 60 .. 120 25 Redman-buildings Oct., 1904 11 31 58 .. 27 .. .. 127 355 .. 710 Rad cliff-buildings June, 1904 5 25 54 .. 21 .. .. 105 301 .. 602 23 .. .. 16 306 167 48 537 1321 2642 23 50 Union-buildings area— Holborn Buckridge-buildings Oct., 1908 .. 10 20 .. 10 .. .. 40 120 .. 240 Kirkeby-buildings Aug., 1908 . . 10 15 .. 20 .. .. 45 145 .. 290 Laney-buildings April, 1908 4 29 32 .. 5 1 .. 71 183 .. 366 15 .. 14 Nigel-buildings Dec., 1907 11 20 29 . . 11 .. .. 71 182 ,. 364 15 69 96 46 1 227 630 1260 15 Brightlingsea-buildings Stepney Sept., 1904 5 20 35 .. 5 .. .. 65 170 .. 340 Briscoe-buildings Lambeth Oct., 1906. .. 10 73 .. 30 .. .. 113 359 • • 718 Brook-street-dwellings— Stepney Beachcroft-buildings .. Sept., 1894 20 20 .. .. .. .. 40 100 .. 200 Cranford-cottages July, 1900 .. .. 18 . . .. .. . . 18 54 .. 108 20 38 58 154 398 Cable-street dwellings— Stepney Bewley-buildings March, 1896 .. 20 30 .. .. .. .. 50 130 .. 260 De'ilow-buildings March, 1896 .. 20 30 ..• .. .. .. 50 130 .. 260 Lowood-buildings May, 1901 (a)l 1 29 .. .. .. .. .. 40 (a) 69½ .. 139 Chancery-buildings May, 1901 (a)11 29 .. .. .. .. .. 40 (a)69½ .. 139 22 98 60 180 399 798 Caledonian-estate— Islington Burns-buildings July, 1906. .. .. 30 .. .. .. . . 30 90 .. 180 Scott-buildings July, 1906. .. .. 30 .. .. .. .. 30 90 .. 180 Wallace-buildings 1 Julv, 1906. .. 40 30 .. .. .. .. 70 170 .. 340 Knox-buildings July, 1906. .. 36 26 .. 4 .. .. 66 166 .. 332 Bruce-buildings Oct., 1906. 6 40 30 .. .. .. .. 76 176 .. 352 6 116 146 4 272 692 1384 Chadworth-buildings Finsbury 1 Anril. 1907 .. 58 68 .. 10 360 720 19 Churchway-dwellings— St. Pancras Wellesley-buildings March, 1901 .. 60 20 .. .. .. .. 80 180 .. 360 xliii- (a) One of the one-roomed tenements in each of these buildings contains a bed recess, and is reckoned as accommodating three persons. Annual Report of the London County Council, 1910. L i Housing of the Working Classes Statistics_ xliv. B.—Accommodation Provided in all the Council's Dwellings open on 31st March, 1911—(continued). Dwellings. Metropolitan Borough. Date opened. Number of tenements of Total tenements Total rooms. Cubicles. Number of persons provided for. Shops. Workshops. Stables Sheds. Cupboards. 1 room. 2 rooms. 3 rooms. 3 rooms with small additional bedroom. 4 rooms 5 rooms 6 rooms Cobham-buildings Southwark Poplar Oct., 1900 (a)l 39 20 .. .. .. .. 60 (a)139½ .. 279 Oot.ton-street-dwellings— Montreal-buildings Sept., 1901 .. 25 25 .. .. .. .. 50 125 .. 250 Toronto-buildings Sept., 1901 .. 5 15 .. .. .. .. 20 55 .. 110 30 40 70 180 360 Council-buildings, Poplar Poplar April, 1894 .. 30 20 .. .. .. .. 50 120 .. 240 Cranley-buildings Holborn Oct., 1897 .. 6 6 .. .. .. .. 12 30 .. 60 Darcv-buildings Hackney July, 1904 .. 25 15 .. .. .. .. 40 95 .. 190 Dufferin-street dwellings Finsbury April, 1892 29 23 4 .. .. .. .. 56 87 .. 174 .. .. 12 12 Duke's-court -dwellings— Fletcher-buildings Westminster April, 1902 .. 35 15 .. .. .. .. 50 115 .. 230 Beaumont-buildings May, 1902 10 15 5 .. 10 .. .. 40 95 .. 190 Sheridan-buildings Aug., 1902 .. 25 15 .. .. .. .. 40 95 .. 190 10 75 35 10 130 305 610 Durham-buildings Battersea July, 1904 .. 56 52 .. .. .. .. 108 268 .. 536 East Greenwich cottages— Collerston-cottages Greenwich May, 1894 .. 12 8 .. 4 .. .. 24 64 .. 128 Armitage-cottages June, 1894 .. 12 8 .. 16 .. .. 36 112 .. 224 Westview-cottages Aug., 1894 .. 6 4 .. 8 .. .. 18 56 .. 112 30 20 28 78 232 464 Goldsmith's-row-cottages Green-street and Boyfield- Shoreditch Southwark Sept., 1895 .. 8 12 .. 5 .. .. 25 72 .. 144 street (late Gun-street) dwellings— Albury-buildings June, 1897 6 24 6 .. .. .. .. 36 72 .. 144 Clandon-buildings June, 1897 6 18 6 .. .. .. .. 30 60 .. 120 Merrow-buildings Aug., 1897 .. 12 6 .. .. .. .. 18 42 .. 84 Ripley-buildings Aug., 1897 1 17 .. .. .. .. .. 18 35 .. 70 .. .. .. 8 13 71 18 102 209 418 8 Hardy-cottages Greenwich July, 1901 .. .. 51 .. .. .. .. 51 153 .. 306 Herbrand- street-dwellings— Coram-buildings Holborn Feb., 1904 .. 50 .. .. .. .. .. 50 100 .. 200 Dickens-buildings March, 1904 20 30 10 .. .. .. .. 60 110 .. 220 Thackeray-buildings March, 1904 .. 20 30 .. .. .. .. 50 130 .. 260 .. .. .. 28 20 100 40 160 340 680 28 Holmwood-buildings.. Southwark . .1 April, 1900 .. 12 4 .. .. .. 16 36.. 72 Hughes-fields-cottages Greenwich . Jan., 1895 • • 71 61 .. 2 .. 134 333 .. 666 Hughes-fields-dwellings— Drake-buildings Deptford Sept., 1904 .. 10 30 .. .. .. .. 40 110 .. 220 Raleigh-buildings Nov., 1904 .. 18 24 .. 8 .. .. 50 140 .. 280 Benbow-buildings Greenwich Oct., 1904 .. 10 20 .. .. .. .. 30 80 .. 160 38 74 8 120 330 660 ldenden-cottages Greenwich . Aug., 1896 .. .. .. .. 50 .. .. 50 200 .. 400 Mallory-buildings Finsbury July, 1906 1 15 17 .. .. .. .. 33 82 .. 164 5 Millbank estate— Hogarth-buildings Westminster May, 1899 .. 21 22 .. 10 1 .. 54 153 .. 306 Millais-buildings June, 1900 .. 15 10 .. .. .. .. 25 60 .. 120 Leighton-buildings July, 1900 .. 15 10 .. .. .. .. 25 60 120 Romney-buildings Nov., 1900 , . 35 25 . . , . ,. 60 145 290 Turner-buildings Dec., 1900 .. 43 39 .. 3 .. .. 85 215 .. 430 Ruskin-buildings March, 1901 .. 43 39 .. 3 .. .. 85 215 .. 430 Rossetti-buildings April, 1901 .. 35 25 .. .. .. .. 60 145 .. 290 Reynolds-buildings Oct., 1901 .. 39 40 .. .. .. .. 79 198 .. 396 .. .. .. 12 Mulready-buildings Dec., 1901 .. 20 25 .. .. .. 45 115 .. 230 Maclise-buildings Feb., 1902 .. 50 16 .. .. .. .. 66 148 .. 296 Landseer-buildings March, 1902 . . 20 25 .. .. .. .. 45 115 .. 230 Lawrence-buildings April, 1902 .. 50 16 .. .. .. .. 66 148 .. 296 Morland-build ings May, 1902 .. 30 30 .. .. .. .. 60 150 .. 300 .. .. .. 18 Wilkie-buildings July, 1902 .. 30 30 .. .. .. .. 60 150 .. 300 .. .. .. 18 Gainsborough-buildings Aug., 1902 2 38 40 .. .. .. .. 80 198 .. 396 .. .. .. 12 2 484 392 16 1 895 2215 4430 60 Norbury estate— Bavant-road Croydon May, 1906. .. .. 8 9 16 6 .. 39 149½ .. 299 Bulkeley-road Feb., 1908. .. .. .. 16 .. 20 36 156 .. 312 Newlands-road May, 1906 .. .. 30 16 5 8 59 206 .. 412 Northborough-road April, 1906 .. .. 26 .. 77 12 .. 115 446 .. 892 Norton-gardens Oct., 1910 .. .. .. .. 4 .. .. 4 16 .. 32 Palmers-road Feb., 1906 .. .. .. 6 8 2 .. 16 63 .. 126 Tylecroft-road June, 1910 .. .. 26 38 16 .. .. 80 275 .. 550 90 (b)85 126 48 349 1311½ 2623 Preston's-road estate— Poplar St. Lawrence-cottages March, 1904 .. .. 14 .. .. .. .. 14 42 .. 84 Ottawa-buildings March, 1904 .. 25 25 .. .. .. .. 50 125 .. 250 Baffin-buildings Ontario-buildings March, 1904 Aug., 1904 .. 20 25 5 25 .. .. .. .. 25 50 55 125 .. 110 250 Hudson-buildings July, 1904 .. 20 5 .. .. .. .. 25 55 .. 110 Winnipeg-buildings Sept., 1904 .. 25 25 .. .. .. .. 50 125 .. 250 Quebec-buildings Sept., 1904 .. 25 25 .. .. .. .. 50 125 .. 250 14.0 124 264 652 1304 xlv.' I Annual Report of the London County Council, 1910. Housing of the Workmg Classes-Statistics. (a) The one-roomed tenement at these buildings also contains a bed recess and is reckoned as accommodating three persons. (b) These cottages are reckoned as containing 3½ rooms, accommodating seven persons. xlvi. B.—Accommodation Provided in all the Council's Dwellings open on 31st March, 1911—(continued). Dwellings. Metropolitan Borough. Date opened. Number of tenements of Total tenements Total rooms. Cubicles. Number of persons provided for. Shops. Workshops. Stables Sheds. [ Cupboards. 1 room. 2 rooms. 3 rooms. 3 rooms with small additional bedroom. 4rooms 5 rooms 6rooms Russell-court dwellings— Stirling-buildings Westminster June, 1903 5 20 15 .. .. .. .. 40 90 .. 180 Siddons-buildings June, 1903 5 10 20 .. 5 .. 40 105 .. 210 10 80 35 5 80 195 390 Shelton-street-dwellings— Aldwych-buildings Holborn Aug., 1896 .. 30 .. .. .. .. .. 30 60 .. 120 .. 7 Cotterell-buildings Aug., 1896 .. .. .. .. 4 .. .. 4 16 .. 32 .. Lindsey-buildings Aug., 1896 1 5 .. .. .. .. .. 6 11 .. 22 •• 9 Powis-buildings Sept., 1896 .. 6 9 .. .. .. .. 15 39 .. 78 .. 4 Wimbledon-buildings Oct., 1896 2 4 2 .. .. .. .. 8 16 .. 32 8 45 11 4 63 142 284 20 Swan-lane-dwellings— Winchelsea-buildings Bermondsey Oct., 1902 .. 35 30 .. .. .. .. 65 160 .. 320 Rye-buildings April, 1903 .. 20 20 .. .. .. .. 40 100 .. 200 Sandwich-buildings May, 1903 .. 20 20 .. .. .. .. 40 100 200 Hythe-buildings May, 1904 .. 40 25 .. 5 70 175 350 Seaford-buildings Dec., 1904 .. 20 20 .. .. .. .. 40 100 .. 200 135 115 5 255 635 1270 Sylva-cottages Deptford Wandsworth March, 1903 .. .. 24 .. .. .. .. 24 72 .. 144 Totterdown-fields estate— Blakenham-road Aug., 1903 .. .. 26 .. 8 .. .. 34 110 .. 220 Church-lane May, 1905 .. .. .. .. .. 16 .. 16 80 .. 160 Coteford-street June, 1903 .. .. 117 70 .. .. .. 187 596 .. 1192 Cowick-road May, 1903 .. 47 181 .. .. .. .. 228 637 .. 1274 Derinton-road Aug., 1903 .. .. 159 64 67 23 .. 313 1084 .. 2168 Franciscan-road Jan., 1907 .. .. .. .. .. 41 .. 41 205 .. 410 4 Lessingham-avenue May, 1903 .. .. 18 .. 86 95 .. 199 873 .. 1746 Ruislip-street Mav, 1903 .. .. 29 .. 4 .. .. 33 103 .. 206 Okeburn-road Oct., 1909 .. .. .. 54 .. .. .. 54 189 .. 378 47 530 (b) 188 165 175 1105 3877 7754 4 Valette-buildings Hackney Lambeth May, 1905 .. 39 34 .. 7 .. .. 80 208 .. 416 Wandsworth-road-dwellings— Lennox-buildings May, 1905 3 17 20 .. .. .. .. 40 97 .. 194 Clere-cottages May, 1905 .. .. 7 .. .. .. .. 7 21 .. 42 8 17 27 47 118 286 Webber-row estate— Delarch-buildings Southwark Nov., 1906 .. 20 25 .. .. .. .. . 45 115 .. 230 Overy-buildings Nov., 1906 .. 20 25 .. .. .. .. 45 115 .. 230 Algar-buildings Dec., 1906. .. 20 25 .. .. .. .. 45 115 .. 230 Dauncy-buildings Jan., 1907. .. 20 25 .. .. .. .. 45 115 .. 230 Mawdley-buildings March, 190 7 3 13 10 .. 3 (c)5 .. 40 114 .. 223 10 8 93 116 3 (c)5 220 574 1143 10 Finsbury . Islington Tottenham March, 1905 25 46 .. 15 .. .. 86 248 .. 496 Wessex-buildings Oct., 1904 5 140 80 .. .. •• .. 225 525 .. 1050 White Hart-lane estate— Awlfield- avenue May, 1909. .. .. .. .. 16 11 .. 27 119 .. 238 Baliol-roed July, 1910 .. .. 29 .. .. .. .. 29 87 .. 174 Benington-road Feb., 1911 .. .. .. .. 12 .. .. 12 48 .. 96 Chesthunte -road Sept., 1904 .. .. 44 .. .. .. .. 44 132 .. 264 Cumberton-road April, 1910 .. .. 34 .. .. .. .. 34 102 .. 204 Kevelioc-road Apr., 1909. .. .. .. .. 18 22 .. 40 182 .. 364 Risley-avenue Sept., 1904 .. .. 4 .. 56 57 .. 117 521 .. 1042 Shobden-road March, 1907 .. .. .. .. 22 15 .. 37 163 .. 326 Siward-road Feb., 1907. .. .. 46 .. .. .. .. 46 138 .. 276 Spigurrel-Road Oct., 1906. .. .. 24 .. 16 4 .. 44 156 .. 312 . Teynton-terrace Aug., 1904 .. .. 11 .. 7 .. .. 18 61 .. 122 Tower-gardens-Road July, 1904 .. .. 14 .. 55 71 .. 140 617 .. 1234 Waltheof-avenue June, 1906 .. .. .. .. .. 37 .. 37 185 .. 370 Wateville-road Oct., 1904 .. .. 12 .. 9 18 .. 39 162 .. 324 218 211 235 664 2678 5346 Bruce House Westminster Deptford Holborn July, 1906. .. .. .. .. .. .. .. .. . . 701 701 2 Carrington-house Nov., 1903 .. .. .. .. .. •• .. .. .. 803 803 3 Parker-street-house Jan., 1893 .. •• •• .. .. .. .. .. .. 345 345 3 Totals (a)191 3,459 3,634 (b)273 915 (c) 472 3 8,947 25,006 1,849 51,856 102 97 1 2 192 17 xlvii. Note. In reckoning the number of rooms in the cottages on the Totterdown-fields, White Hart-lane and Norbury estates, kitchen sculleries have been omitted. (a) Three of these tenements also contain a bed recess, and each is reckoned as accommodating three persons. (b)These cottages are reckoned as containing 3½ rooms, accommodating seven persons. (c) Five tenements in Mawdley-buildings contain 1 small room, reckoned as accommodating one person only. Annual Report of the London County Council, 1910. Housing of the Working Classes—Statistics xlviii. C.—Rents Charged at the Council's Dwellings. Dwellings. Rent per week of tenements. Rent per night of cubicles. rent per week of workshops. Rent per week of 1 stables. Rent per week of sheds. Rent per week of cupboards. Gross rent per annum on 31st March, 1911. Borough. 1 room. 2 rooms. 3 rooms. 3 rooms with small additional bedroom. 4 rooms. j 5 rooms. 6 rooms. Ann-street-dwellings Poplar .. 5/- to 6/- 6/6 to 7/6 .. .. .. .. .. .. .. .. .. £ 2,129 s. 8 d. Barnaby-buildings Bermondsey .. 5/6 & 6/- 7/6 & 8/- .. .. .. .. .. .. .. .. .. 1,427 8 - Battersea -bridge-buildings Battersea 5/- 6/- to 7/6 8/- to 9/- .. .. .. .. .. .. .. 3d. .. 1,232 8 .- Bearcroft-buildings Fulham .. 5/9 to 7/- 8/6 to 9/6 . . .. .. .. .. .. .. .. .. 876 4 - Bekesbourne-buildings Stepney .. 5/- to 6/- 6/6 to 7/6 .. 8/- & 8/6 .. .. .. .. .. .. .. 1,240 4 - Borough-road-dwellings Southwark .. 6/6 to 8/- 9/6 & 10/- .. .. .. .. .. .. .. .. .. 1,864 4 - Boundary-street-estate Bethnal-green 3/- to 4/ 5/- to 8/- 7/-to 10/6 .. 9/- to 12/6 11/6 to 14/- 13/- .. 3/6 to 6/6 .. 6d. 3d. 22,962 9 - Bourne estate (including shops) Holborn 4/6 to 6/- 7/6 to 8/6 9/6 to 11/- .. ll/-to 13/- .. .. .. .. .. 3d. .. 13,396 - - Brightlingsea-buildings Stepney 3/6 & 4/- 5/- & 5/6 6/6 to 7/6 .. 8/- & 8/6 .. .. .. .. .. .. .. 1,084 4 - Briscoe-buildings.. Lambeth .. 6/6 & 7/- 7/6 to 8/6 .. 10/-toll/6 .. .. .. .. .. .. .. 2,520 14 - Brook-street-d wellings Stepney *..1 5/6 7/-to 8/- .. .. .. .. .. .. .. .. .. 1,014 - - Bruce-house (including shops) Westminster .. .. .. .. .. .. .. 6d„ 7d. and 1s. .. .. .. .. 7,698 18 11 Cable-street-dwellings Stepney 4/6 & 5/- 5/6 to 6/6 7/6 .. .. .. .. .. .. .. .. .. 2,955 4 - Caledonian-estate Islington 4/6 & 5/- 6/6 to 7/6 8/- to 9/6 .. 11/6 .. .. .. .. .. .. .. 5,569 4 - Carrington-house ing shops) Deptford .. .. .. .. .. .. .. 6d. and 1/- .. .. .. .. 7,665 3 4 Chadwocth-buildings (including shops) Finsbury .. 6/- to 7/- 8/- to 9/- .. 10/-to 11/- .. .. .. .. .. .. .. 3,393 10 — Churchway-dwellings St. Pancras 4/6 & 5/- 7/- to 8/- 9/6 to 10/6 .. 11/6 .. .. .. .. .. .. .. 3,893 10 - Cobham-buildings Southwark .. 6/- & 6/6 8/6 & 9/- .. .. .. .. .. .. .. .. .. 1,128 8 - Cotton-street-dwellings Poplar .. 5/6 7/- to 8/- .. .. .. .. .. .. .. .. .. 1,184 6 — Council-buildings, Poplar Poplar .. 5/- to 5/9 7/- & 7/6 .. .. .. .. .. .. .. .. .. 796 18 — Cranley-buildings Holborn .. 8/- 10/6 .. .. .. .. .. .. .. .. .. 288 12 — Darcy-buildings Hackney .. 6/- & 6/6 7/6 to 8/6 .. .. .. .. .. .. .. .. .. 742 6 — Dufferin-street-dwellings Finsbury 2/3 to 2/9 1 4/6 to 5/- 6/6 & 7/- .. .. .. .. .. .. 1/6 1/- .. 629 4 — Duke's-oourt-dwellings Westminster 4/- 6/6 8/6 .. 10/6 .. .. .. .. .. .. .. 2,418 - - Durham-buildings Battersea .. 4/6 to 6/- 6/- to 7 /- .. .. .. .. .. .. .. .. .. 1,697 16 - East Greenwich-cottages Greenwich .. 5/- 6/- & 6/6 .. 8/- & 8/6 .. .. .. .. .. .. .. 1,307 16 - Goldsmith's-row-cottages Shoreditch .. 5/6 7/6 to 8/6 .. 10/- ... .. .. .. .. .. 482 19 - Green-street and Boyfieldstreet (late Gun-street) dwellings Southwark 4/6 & 5/- 6/6 & 7/- 8/6 .. .. .. .. •• •• .. •• •• 1,784 18 - Hardy-cottages Greenwich .. .. 6/- to 7/- .. .. ..1.. .. .. .. .. .. .. £ 876 s. 4 d. Herbrand-street -dwellings Holborn 3/6 & 4/- 6/- & 6/6 8/- & 8/6 . . . . .. .. .. .. .. 3d. .. 2,767 4 - Holmwood-buildings Southwark .. 8/- & 9/- 11/6 .. .. .. .. .. .. ... .. .. 386 2 - Hughes-fields-cottages Greenwich .. 5/- & 5/6 6/- to 6/6 .. 7/- .. .. .. .. ... . . .. 2,044 8 - Idenden cottages Greenwich .. .. .. .. 8/6 & 9/- .. .. .. .. .. .. .. 1,131 - - Mallory-buildings Holborn 5/- 6/- to 7/- 8/6 to 9/6 .. .. .. .. .. .. .. .. .. 910 1 6 - Millbank-estate Westminster 4/6 & 5/- 6/- to 8/6 8/- to 10/6 .. 12/- to 13/- 12/6 .. . . .. .. 3d. 3d. 18,922 16 - Norbury-estate Croydon .. .. 7/- to 8/6 8/6 8/6 to 10/6 10/6 toll/6 .. .. .. .. .. .. 8,047 - - Parker-street-house (including shops) Holborn .. • • .. .. .. .. .. 6d. .. .. .. .. 3,282 11 1 Preston's-road-estate Poplar . . 4/6 &5/- 6/6 to 8/- . . . . . . .. .. .. .. . . .. 3,983 4 - Raleigh, Drake and Benbow-buildings (Hughesfields-dwellings) Greenwich and Deptford .. 5/- & 5/6 6/- & 6/6 .. 7/- & 7/6 .. .. .. .. .. .. .. 1,913 3 4 Russell-court-dwellings Westminster 4/6 6/6 8/6 .. 10/6 .. .. .. .. .. .. .. 1,519 6 - Shelton-street-dwellings Holborn 5/- 6/6 to 8/- 9/6 .. 11/- & 11/6 .. .. .. 4/6 to 6/- .. .. .. 1,554 16 - Swan-larie-dwellings Bermondsey .. 4/6 to 5/6 6/6 to 8/- .. 8/- to 9/- .. .. .. .. .. . . .. 4,108 - - Sylva-cottages Deptford .. .. 7/6 .. .. .. .. .. .. .. .. .. 468 - - Totterdown-fields-estate (including shops) Wandsworth .. 6/- & 6/6 3/6 to 9/- 9/-&10/- 9/- to 10/6 10/6 to 13/6 .. .. .. .. .. .. 25,754 1 4 - Union-buildings (including shops) Holborn 4/6 & 5/- 7/- to 8/- 9/- to 10/- .. 10/6toll/6 12/- .. .. .. .. 4d. .. 5,948 1 2 8 Valette-buildings Hackney .. 6/6 & 7/- 8/6 & 9/- .. 10/6 .. .. .. .. .. .. .. 1,675 1 4 - 'Wandsworth - road dwellings Lambeth 5/6 6/- & 6/6 8/- & 8/6 .. .. .. .. .. .. .. .. .. 919 2 - Webber-row estate (including shops) Southwark 5/- 5/6 to 7/6 8/- to 10/- .. 9/- 11/6 .. .. .. .. .. .. 4,911 4 _ Wenlake-buildings Finsbury .. 6/6 & 7/- 8/6 & 9/- .. 10/- & 10/6 .. .. .. .. .. .. .. 1,920 2 - Wessex-buildings Islington 4/- & 4/6 5/6 to 7/- 8/- to 9/- .. .. .. .. .. .. .. .. .. 4,141 16 - White Hart-lane estate Tottenham .. •• 6/6 to 8/- •• 8/3 to 9/3 9/3 to 13/- •• •• •• •• •• •• 15,770 - - Total £ 207,340 17 Annual Report of the London County Council, 1910. Housing of the Working Classes—Statistics. xlix. I. 1. Annual Report of the London County Council, 1910. D.—Accommodation Provided in the Council's Dwellings, and the Gross Rent per annum on 31st March, 1893, and each subsequent Year. Year. Tenements. Rooms. Cubicles. Persons provided for. Gross annual rent 1893 56 87 324 498 £ 3,577 s. 12 d. 1894 56 87 324 498 3,577 12 - 1895 358 871 324 2,066 8,119 11 8 1896 602 1,485 324 3,294 12,910 1 8 1897 984 2,603 324 5,530 22,020 9 8 1898 1,263 3,261 324 6,846 27,943 5 8 1899 1,355 3,525 324 7,374 30,062 5 8 1900 1,523 3,966 324 8,256 33,832 5 8 1901 2,346 5,936 324 12,196 51,241 17 8 1902 2,951 7,368 324 15,060 62,780 8 8 1903 3,881 9,552 324 19,428 81,087 19 8 1904 4,666 11,661 1,147 24,469 103,090 10 2 1905 5,929 15,098 1,147 31,343 ] 29,129 12 6 1906 6,326 16,352 1,147 33,853 136,315 7 6 1907 7,474 19,879 1,845 41,648 166,949 10 10 1908 7,880 21,085 1,845 44,060 177,487 14 7 1909 8,196 22,210 1,845 46,310 186,096 13 7 1910 8,539 (a) 23,578½ 1,846 49,003 194,019 15 - 1911 8,947 25,006 1,849 51,856 207,340 17 4 (a) Containing a number of small rooms reckoned as ½ rooms, each accommodating one person. E.—Number of Persons Rehoused by the Council after being Displaced by Improvement or Clearance Schemes. Dwellings. Metropolitan Borough. Number of displaced persons re-housed. Before 31st March, 1910. Duiing year 1910-11. Total. Ann-street-dwellings Poplar 25 25 Bekesbourne-buildings Stepuey 37 37 Boundary-street estate Bethnal-green 45 45 Borough-road-dwellings Southwark 50 50 Bourne estate Holborn 222 222 Brightlingsea-buildings Stepney 4 4 Brook-street-d wellings Stepney 9 9 Duke's-court-dwellings Westminster 516 516 Green-street and Boyfield-street (late Gunstreet) dwellings Southwark 13 Nil 13 Herbrand-street-dwellings Holborn 91 91 Millbank estate Westminster.. 174 174 Preston's-road-dwellings Poplar 8 8 Swan-lane-dwellings Bermondsey 186 186 Russell-court-dwellings Westminster 323 323 Webber-row estate Southwark 12 12 Wenlake-buildings Finsbury 41 41 Totals 1,756 1,756 Housing of the Working Classes—Statistics. F.—Number of Tenants who Vacated their Tenements during the Year 1910-1911 and Number of Tenants who were Transferred to other Tenements in the Council's Dwellings. Dwellings. Metropolitan Borough. Number of tenements Number of vacations, excluding transfers. Number of Transfers. Tenant's notice. Council's notice. Total. Percentage. Ann-street-dwellings Poplar 135 30 9 39 29 20 Barnaby-buildings Bermondsey 80 20 2 22 28 2 Battersea-bridge-buildings Battersea 69 17 3 20 29 2 Bearcroft-buildings Fulham 40 10 2 12 30 2 Bekesbourne-buildings Stepney 75 39 7 46 61 9 Borough-road-dwellings Southwark 84 16 2 18 21 8 Boundary-street-estate Bethnal-green 1,044 391 62 453 43 121 Bourne-estate Holborn 537 241 18 259 48 109 Brightlingsea-buildings Stepney 65 24 3 27 42 9 Briscoe-buildings Lambeth 113 84 4 88 78 22 Brook-street-dwellings Stepney 58 16 4 20 34 3 Cable-street-dwellings Stepney 180 49 5 54 30 11 Caledonian-estate Islington 272 146 11 157 58 38 Chadworth-buildings Finsbury 136 32 2 34 25 4 Churchway estate St. Pancras 180 43 4 47 26 21 Cobham-buildings Southwark 60 20 1 21 35 3 Cotton-street-dwellings Poplar 70 41 9 50 71 4 Council buildings, Poplar Poplar 50 17 5 22 44 3 Cranley-buildings Holborn 12 5 1 6 50 1 Darcy-buildings Hackney 40 11 1 12 30 Dufferin-street-dwellings Finsbury 56 22 3 25 45 9 Duke's-court dwellings Westminster 130 18 4 22 17 6 Durham-buildings Battersea 108 43 5 48 45 9 East Greenwich-cottages Greenwich 78 24 1 25 32 3 Goldsmith's-row-cottages Shoreditch 25 7 .. 7 28 1 Green-street and Boyfield-street dwellings Southwark 102 24 2 26 26 4 Hardy-cottages Greenwich 51 29 2 31 61 2 Herbrand-street-dwellings Holborn 160 22 2 24 15 14 Holmwood-buildings Southwark 16 6 .. 6 38 .. Hughes-fields-cottages Greenwich 134 61 11 72 54 12 Hughes-fields-dwellings Deptford 120 51 9 60 50 8 Idenden-cottages Greenwich 50 8 .. 8 16 1 Mallory-buildings Finsbury 33 4 1 5 15 .. Millbank-estate Westminster 895 189 11 200 22 62 (a)Norbury estate Croydon 349 103 1 104 30 13 Preston's-road estate Poplar 264 111 14 125 47 11 Russell-court-dwellings Westminster 80 11 1 12 15 8 Shelton-street-dwellings Holborn 63 3 .. 3 5 .. Swan-lane-dwellings Bermondsey 255 119 11 130 51 11 Sylva-cottages Deptford 24 5 . . 5 21 1 (n)Totterdown-fields-estate Wandsworth 1,105 401 19 420 38 101 Union-buildings Holborn 227 38 .. 38 17 12 Valette-buildings Hackney 80 24 1 25 31 3 Wandsworth-road-dwellings Lambeth 47 7 . . 1 15 2 Webber-row-estate Southwark 220 92 4 96 44 5 Wenlake-buildings Finsbury 86 14 .. 14 16 .. Wessex-buildings Islington 225 56 4 60 27 7 (a)White-Hart-lane estate Tottenham 664 162 3 165 25 21 Totals 8,947 2,906 264 3,170 35 718 (a) New buildings at these estates were opened during the year. lii. Annual Report of the London County Council, 1910. G-—Percentage of Total Outgoings for Maintenance on the Rent Receivable for the last Five Years. Dwellings. Metropolitan Borough. 1906-7. 1907-8. 1908-9. 1909 10 1910-11. Ann-street-dwellings Poplar 44 40 42 45 45 Barnaby-buildings Bermondsey 47 39 43 44 43 Battersea-bridge-buildings Battersea 38 37 39 40 39 Bearcroft-buildings Fulham (a)28 21 21 21 23 Bekesbourne-buildings Stepney .. (a) 37 39 39 39 Borough-road-dwellings Southwark 39 39 41 42 41 Boundary-street estate Bethnal-green 46 41 41 42 42 Bourne estate Holborn 35 34 35 35 35 Brightlingsea-buildings Stepney 42 38 40 41 40 Bruce house Westminster (a)54 54 55 54 58 Briscoe-buildings Lambeth (a)ll 27 34 41 40 Brook-street-dwellings Stepney 44 41 43 43 44 Cable-street-dwellings Stepney 43 42 42 41 41 Caledonian estate Islington (a)25 26 36 37 37 Carrington house Deptford 50 50 48 47 47 Churchway-dwellings St. Pancras 37 36 37 37 37 Clerkenwell Holborn-dwellings Mallory-buildings Holborn (a) 25 (a)25 (a)32 30 37 Union-buildings 34 32 Cobham-buildings Southwark 37 39 42 43 43 Cotton-street-dwellings Poplar 41 36 41 44 44 Council-buildings, Poplar Poplar 48 43 41 45 47 Cranley-buildings Holborn 39 38 39 40 41 Darcy-buildings Hackney 37 35 38 40 38 Dufferin-street-dwellings Finsbury 57 56 57 59 58 Duke's-court-dwellings Westminster 38 37 38 37 36 Durham-buildings Battersea 36 38 39 39 40 East Greenwich-cottages Greenwich 42 40 41 41 40 Goldsmith's-row-cottages Shoreditch 42 41 41 42 41 Green-street and Boyfield-street (late Gun-street) dwellings Southwaik 38 39 42 43 42 Hardy-cottages Greenwich 42 39 41 40 40 Herbrand-street-dwellings Holborn 37 36 37 37 37 Holmwood-buildings Southwark 43 42 45 49 48 Hughes-fields-cottages .. Greenwich 38 35 36 42 34 Hughes-fields-dwellings Deptford 41 38 38 39 3*6 Idenden-cottages Greenwich .. 38 36 37 38 37 Millbank estate Westmiuster.. 36 36 36 36 36 Norbury estate Croydon (fl)44 (-036 32 0)34 («)35 Parker-street house Holborn 68 69 68 67 69 Preston's-road-dwellings Poplar 43 37 38 41 40 Pussell-court dwellings Westmiuster.. 35 35 35 35 34 Shelton-street-dwellings Holborn 36 35 37 37 37 St. Luke'e-dwellings— Wenlake-buildings Finsbury | 38 0)34 34 j 38 37 Chadworth-buildings 32 32 Swan-lane-dwellings Bermondsey.. 38 36 41 43 43 Sylva-cottages Deptford 39 37 37 40 40 Totterdown-fields estate Wandsworth. . 31 (a 34 0)33 0)35 (a) 33 Valette-buildings ... Hackney 37 35 37 38 37 Wandsworth-road-dwellings Lambeth 38 37 38 39 38 Webber-row estate Southwark .. (<030 35 38 40 39 Wessex-buildings.. Islington 38 26 39 39 39 White Hart-lane estate Tottenham .. (<027 (a)28 0)27 (<024 0)25 (a) New buildings were opened during this year. liii. Housing of the Working Classes—Statistics. H.—Population of the Council's Dwellings According to the Census taken in March, 1911. Dwellings. Metropolitan Borough. Accommodation. Number of persons in occupation (including children). Number of children under 14 years of age in dwellings. Tenements. Rooms. Boys. Girls. Ann-street-dwellings Poplar 135 315 427 68 73 Barnaby-buildings Bermondsey 80 200 313 65 63 Battersea-bridge-buildings Battersea 69 143 211 44 43 Bearcroft-buildings Fulham 40 110 117 18 17 Bekesbourne-buildings Stepney 75 190 250 41 36 Borough-road-dwellings Southwark 84 200 292 54 47 Boundary-street estate Bethnal-green 1,044 2,690 4,420 838 814 Bourne estate Holborn 537 1,321 1,912 302 297 Brightlingsea-buildings Stepney 65 170 195 28 53 Briscoe-buildings Lambeth 113 359 333 51 53 Brook-street-dwellings Stepney 58 154 245 47 53 Bruce-house Westminster 701 701 701 .. .. Cable-street-dwellings Stepney 180 399 624 104 93 Caledonian estate Islington 272 692 955 174 173 Carrington-house Deptford 803 803 418 .. .. Chadworth-buildings Finsbury 136 360 566 104 89 Churchway-dwellings St. Pancras 180 416 597 76 96 Cobham-buildings Southwark 60 139½ 221 35 41 Cotton-street-dwellings Poplar 70 180 232 41 28 Council-buildings, Poplar Poplar 50 120 130 18 21 Cianby-buildings Holborn 12 30 43 14 5 Darcy-buildings Hackney 40 95 132 30 17 DuSerin-street dwellings Finsbury 56 87 149 22 16 Duke's-court-dwellings Westminster 130 305 479 80 56 Durham-buildings Battersea 108 268 416 85 85 East Greenwich-cottages Greenwich 78 232 333 77 67 Goldsmiths'-row-cottaees Shoreditch 25 72 99 12 14 Green-street and Boylield-street (late Gunstreet) dwellings Southwark 102 209 319 52 65 Hardy-cottages Greenwich 51 153 233 59 62 Herbrand-street-dwellings Holborn 160 340 531 95 86 Holmwood-buildings Southwark 16 36 42 3 7 Hughes-fields-cottages Greenwich 134 333 353 70 69 Hughes-fields-dwellings Deptford 120 330 340 91 54 Idenden-cottages Greenwich 50 200 263 59 50 Mallory-buildings Finsbury 33 82 113 11 18 Millbank estate Westminster 895 2,215 2,942 512 516 Norbury estate Croydon 349 1,311½ 1,169 223 214 Parker-street-house Holborn 345 345 332 .. .. Preston's-road estate Poplar 264 652 664 138 119 Russell court-dwellings Westminster 80 195 292 40 46 Shelton-street-dwellings Holborn 63 142 229 38 35 Swan-lane-dwellines Bermondsey 255 635 833 159 160 Sylva-cottages Deptford 24 72 103 23 20 Totterdown-fields estate Wandsworth 1,105 3,877 3,594 760 700 Union-buildings Holborn 227 630 862 132 141 Valette-buildings Hackney 80 208 263 37 32 Wandsworth-road-dwellings Lambeth 47 118 149 28 17 Webber-row estate Southwark 220 574 787 130 134 Wenlake-buildings Finsbury 86 248 367 48 38 Wessex-buildings Islington 225 525 734 120 129 White Hart-lane estate Tottenham 664 2,673 2,103 400 405 Totals 10,796 26,855 32,427 5,656 5,467 liv . Annual Report of the London County Council, 1910. K.—Particulars of Cases of Infectious Diseases Reported by Superintendents and Caretakers as having been Removed from the Council's Dwellings during the Year ended 31st March, 1911. Dwellings. Metropolitan Borough. Erysipelas. Measles. Scarlet Fever. Typhoid. Diphtheria. Chickenpox. Ann-street-dwellings Poplar ... 1 ... ... ... ... Barnaby-buildings Bermondsey ... ... 1 ... 2 2 Battersea-bridge-buildings Battersea ... 6 1 ... ... 1 Bearcroft-buildings Fulham ... ... ... ... ... ... Bekesbourne-buildings Stepney ... 4 ... ... ... ... Borough-road-dwellings Southwark ... ... ... ... 15 ... Boundary-street estate Bethnal-green ... 12 2 1 1 ... Bourne estate Holborn ... ... ... 2 2 . . . Brightlingsea-buildings Stepney 1 ... 1 ... ... ... Briscoe-buildings Lambeth ... 1 ... ... 2 ... Brook-street-dwellings Stepney ... 2 ... ... ... ... Cable-street-dwellings Stepney ... ... 1 ... 6 1 Caledonian estate Islington ... ... 2 ... 2 ... Chad worth-buildings Finsbury ... 1 3 ... ...1 ... Churchway-buildings St. Pancras ... 2 1 ... ... ... Cobham-buildings Southwark ... ... ... ... ... ... Cotton-street-dwellings Poplar 1 1 ... ... 1 ... Council-buildings Poplar ... ... ... ... ... ... Cranley-buildings Holborn ... ... ... ... ... . . . Darcy-buildings Hackney ... ... 2 ... ... ... Dufferin-street-dwellings Finsbury ... ... ... ... ... ... Duke's-court-dwellings Westminster ... 3 ... ... 1 1 Durham-buildings Battersea ... 7 21 ... 1 ... East Greenwich-cottages Greenwich ... 5 1 ... ... ... Goldsmith's-row-cottages Shoreditch ... 1 ... ... ... ... Green-street and Boyfield-street (late Gunstreet) dwellings Southwark ... ... ... ... 1 ... Hardy-cottages Greenwich ... ... ... ... 2 ... Herbrand-street-dwellings Holborn 1 10 5 ... 1 ... Holmwood-buildings Southwark ... 2 ... ... ... ... Hughes-fields-cottages Greenwich ... 3 2 ... 4 ... Hughes-fields-dwellings Deptford ... ... ... ... 3 ... Idenden-cottages Greenwich ... ... ... ... 2 ... Mallory-buildings Finsbury ... ... ... ... ... ... Millbank estate Westminster ... ... 7 ... 1 ... (a) Norbury estate Croydon ... ... 9 ... ... ... Preston's-road estate Poplar 1 3 1 ... ... ... Russell-court-dwellings Westminster ... ... 1 ... ... ... Shelion-street-dwellings Holborn ... ... 1 ... 1 2 Swan-lane-dwellings Bermondsey 1 ... 1 ... 1 ... Sylva-cottages Deptford ... ... ... ... ... ... (a)Totterdown-fields estate Wandsworth ... 2 2 ... 1 ... Union-buildings Holborn ... ... 1 2 3 ... Valette-buildings Hackney ... 1 2 ... ... ... Wandsworth-road-dwellings Lambeth ... 3 1 ... ... ... Webber-row estate Southwark ... 4 2 ... 1 ... Wenlake-buildings Finsbury ... 4 ... ... ... ... Wessex-buildings Islington ... ... 1 ... ... ... (a)White Hart-lane estate Tottenham ... ... 2 ... 2 ... Totals 5 78 74 5 57 7 (a) New buildings at, these estates were opened during the year. lv. Housing of the Working Classes—Statistics. L.—Particulars of Births and Deaths in the Council's Dwellings during the Year ended 31st March, 1911.(a) Dwellings. Borough. Births. Deaths. Total. Deaths occurring in the dwellings Deaths of residents occurring in institutions. Total. Ann-street-dwellings Poplar 13 1 2 3 Barnaby-buildings Bermondsey 12 .. 2 2 Battersa-bridge-building Battersea 10 2 1 3 Bearcroft-buildings Fulham 1 1 .. 1 Bekesbourne-buildings Stepney 7 2 .. 2 Borough-road-dwellings Southwark 8 2 1 3 Boundary-street estate Bethnal-green 136 24 26 50 Bourne estate Holborn 69 6 16 22 Brightlingsea-buildings Stepney 8 2 1 3 Briscoe-buildings Lambeth 6 . . . . .. Brook-stieet-dwellings Stepney 8 1 2 3 Bruce-house Westminster .. .. 31 31 Cable-street-dwellings Stepney 16 8 2 10 Caledonian estate Islington 29 13 5 18 Carrington house Deptford .. .. 16 16 Chadworth-buildings Finsbury 17 2 2 4 Churchway estate St. Pancras 24 3 3 6 Cobham-buildings Southwark 12 .. .. • • Cotton-street-dwellings Poplar 6 2 1 3 Council-buildings, Poplar Poplar 2 2 .. 2 Cranley-buildings Holborn 1 .. .. .. Darcy-buildings Hackney 3 .. .. .. Dufferin-street-dwellings Finsbury 5 2 3 5 Duke's-court-dwellings Westminster 11 6 3 9 Durham-buildings Battersea 10 6 .. 6 East Greenwich -cottages Greenwich 5 1 . . 1 Goldsmith's-row-cottages Shoreditch . . . . . . .. Green-street and Boyfield-street (late Gun-street) dwellings Southwark 15 1 2 3 Hardy-cottages Greenwich 9 2 2 4 Herbrand-street-dwellings Holborn 14 1 5 6 Holmwood-buildings Southwark 4 1 .. 1 Hughes-fields-cottages Greenwich .. .. 1 1 Hughes-fields-dwellings Deptford 11 4 2 6 Idenden-cottages Greenwich 3 2 1 3 Mallory-buildings Finsbury 1 1 .. 1 Millbank estate Westminster 62 21 13 34 Norbury estate Croydon 35 3 .. 3 Parker-street house Holborn .. 1 14 15 Preston's-road dwellings Poplar 27 7 4 11 Russell-court-dwellings Westminster 6 1 .. 1 Shelton-street-dwellings Holborn 4 1 .. 1 Swan-lane-dwellings Bermondsey 32 10 6 16 Sylva-cottages Deptford 4 .. .. .. Totterdown-fields estate Wandsworth 92 20 6 26 Union-buildings Holborn 19 7 4 11 Valette-buildings Hackney 10 4 .. 4 Wandsworth-road-dwellings Lambeth 2 2 .. 2 Webber-row estate Southwark 28 3 1 4 Wenlake-buildings Finsbury 4 1 2 3 Wessex-buildings Islington 22 6 1 7 White Hart-lane estate Tottenham 63 12 •• 12 Totals 886 197 181 378 (a) The particulars comprised in this table for estates within the county have been supplied by the Medical Officer of Health, and for estates outside the county by the registrars of the districts. 5176 s lvi. Annual Report of the London County Council, 1910. M.—Occupations of the Tenants. Nature of occupation. No. Nature of occupation. No. Nature of occupation. No. Agent on commission 58 Engineer 115 Packer 104 Artist and draughtsman 16 Engraver and enameller 23 Packing case maker 11 Attendant 125 Painter 120 Fireman 33 Pensioner 64 Baker 66 Fitter 98 Plasterer 11 Barber 30 Foreman and superintendent 82 Platelayer 1g Bargebuilder and ship worker 19 Furworker 16 Plumber 24 Barman 25 Gardener 21 Policeman and warder 337 Basketmaker and brushmaker 14 Gasworker 23 Polisher 40 Blacksmith and farrier 33 General dealer and hawker 51 Porter 370 Boilermaker 19 Glass worker 19 Postman 107 Bookbinder 48 Printer and printer's cutter 152 Bootmaker 102 Harness and saddle maker 10 Printer's reader 10 Boxmaker 15 Hat and cap maker 36 Brass finisher 31 Horsekeeper 41 Railway guard and signalman 32 Butcher 50 Housekeeper 44 Cabinetmaker 170 Inspector 40 Sawyer 12 Cabdi-iver 20 Instrument maker 47 Sailor 41 Card and paper cntter 12 Scavenger 17 Caretaker 41 Jeweller and silversmith 40 Soldier 10 Carman 182 Journalist and author 18 Shop assistant and salesman 246 Carpenter, 130 Labourer 581 stevedore 17 Cellarman 17 Lamplighter 14 stoker 48 Cigar and cigarette maker 123 Laundress 19 Storekeeper 34 Checker 24 Leather worker 42 Charwoman 150 Linesman 12 Tailor 167 Cleaner 98 Tailoress 43 Clergyman and churchworker 34 Machinist 42 Teacher 34 Clerk 455 Machine minder 10 Telegraphist 21 Clothmaker 22 Manager 16 Theatre worker 13 Coachman 24 Mechanic 73 Timekeeper 17 Coachbuilder 25 Mason and pavior 21 Tin worker and whitesmith 23 Collector 16 Messenger 55 Traveller and canvasser 90 Commi ssionaire 40 Metalworker 59 Turner and moulder 19 Compositor 110 Milkman 33 Umbrella and stick maker 16 Confectioner 15 Miscellaneous 215 Cook 131 Musician and artiste 58 Upholsterer 26 Cooper 10 Needlewoman 27 Costermonger 27 Decorator 39 Newsvendor 27 Waiter and steward 108 No occupation 246 Warehouseman 174 Domestic and hotel servant 98 Nurse 24 Watchmaker 12 Dressmaker 58 Watchman 38 Electrician 50 Omnibus and tram conductor 88 Widow 94 Omnibus, tram and motor driver 172 Wireman 15 Engine driver 40 Wood carver 13 lvii. Housing of the Working Classes—Statistics. APPENDIX XVIII. STATEMENT SHOWING STATUTES UNDER WHICH DWELLINGS UNDER IMPROVEMENT ACTS (xxxviii) WERE ERECTED. Dwellings. Act. Battersea-bridge-dwellings Bridges Acts of 1881 and 1884. Council-buildings Blackwall Tunnel Acts, 1887 and 1888. Westview,'Armitage and Collerston-cottages Idenden-cottages Cotton-street-dwellings Barnaby-buildings L.C.C. (General Powers) Act, 1897-Long-lane and Tabardstreet widening. Durham-buildings L.C.C. (General Powers) Act, 1898—York-road, Battersea, Improvement and L.C.C. (Tramways and Improvements) Act, 1901—Bed Lion-street to Tooting High-street Improvement. Duke's-court-dwellings L.C.C. (Improvements) Act, 1899—Holborn to Strand Improvement. York-street (late Russell-court) dwellings Herbrand-street-dwellings Bruce-house Bourne-estate L.C.C. (Improvements) Act, 1899—Holborn to Strand and Southampton-row Improvements—L.C.C. (Improvements) Act, 1900—St. John-street, Clerkenwell and Goswell-road Improvements and L.C.C. (General Powers) Act, 1901— Central-street, St. Luke, Improvement. Millbank-estate L.C.C. (Improvements) Act, 1899—Holborn to Strand Improvement and L.C.C. (Improvements) Act, 1900— Thames Embankment Extension and Westminster Improvements. Swan-lane-dwellings L.C.C. Thames Tunnel (Rotherhithe and Ratcliff) Act, 1900. Brightlingsea-buildings Bekesbourne-buildings Darcy-buildings L.C.C. Improvements Act, 1900—Mare-street (Hackney) Improvement. Valette-buildings Wandsworth-road-dwellings L.C.C. (Improvements) Act, 1900—Nine Elms-lane widening. Hughes-fields-dwellings L.C.C. (Tramways and Improvements) Act, 1902—Tramways —Greenwich generating station. Bearcroft-buildings L.C.C. (Tramways and Improvements) Act, 1902—Fulham Palace-road and High-street widening.